leadership prepu
A staff nurse is talking with a clinical nurse leader and asks, "What exactly do you do?" Which statement by the clinical nurse leader wouid be appropriate? "I'm an administrator involved with client care." "My position is one of management." "I collaborate with health care teams to promote client care." "I'm an advanced practice nurse with a specific specialty area."
Correct response: "I collaborate with health care teams to promote client care." Explanation: A clinical nurse leader is a master's-prepared nurse who has earned the certified CNL credential and works collaboratively with the health care team to facilitate, coordinate, and oversee care provided to clients. This role is not considered an administrative or management role, but rather one of leadership in all health care settings. Clinical nurse specialists are advanced practice nurses with specialist education in a defined area of practice.
A nurse leader is working with a client with hypertension who needs to learn about a low-sodium diet. The nurse recognizes that the client is in the unfreezing stage of Lewin's Change theory with which client statement? "I don't see a problem with what I normally eat." "I am developing a daily meal plan for a low-sodium diet." "I have selected my daily menu with low-sodium foods." "I understand why I need to eat a low-sodium diet."
Correct response: "I understand why I need to eat a low-sodium diet." Explanation: Lewin's Change theory involves three phases, which include unfreezing, moving, and freezing. With the unfreezing stage, the person recognizes the need for change. The client who understands why a low-sodium diet is needed with hypertension recognizes that this is a necessary change for the client's health status. If the client does not recognize a problem that needs to be changed, as in the client who wants to continue with a normal diet, the person is not ready for change. The person who is planning a meal is in the moving phase, which is the initiation of change after planning. The person who has already made the change with the daily menu is in the refreezing stage, where change has been effectively made.
When a novice psychiatric nurse shares with the nurse manager that talking about sexual abuse with clients is very uncomfortable, which would be the most effective response from the nurse manager? "What specifically makes you uncomfortable?" "I can take that client off of your assignment this shift." "It would be great if you could attend an in-service on therapeutic communication." "Have you ever been sexually abused?"
Correct response: "What specifically makes you uncomfortable?" Explanation: It is important for the novice nurse to identify what it is about discussing sexual abuse that is anxiety producing so that those issues can be addressed and resolved. Asking this question will assist the novice nurse in engaging in self reflection that can lead to a greater awareness of self and thus enhance the ability to be therapeutic. Suggesting the nurse have such abuse victims released from the nurse's care ignores the problem and minimizes the nurse's therapeutic effectiveness. Arranging for training is appropriate only if it is discovered that the problem relates to a lack of skills related to the nurse's therapeutic communication techniques. While prior sexual abuse may be the cause of the nurse's discomfort, it is not appropriate for the nurse manager to initiate this discussion in that manner.
A staffing agency is assigning a licensed practical/vocational nurse (LPN/VN) to cover a shift on a pediatric unit. Because the unit manager is unfamiliar with the nurse's skill level, what assignment is best for the LPN/VN? 8-year-old child admitted that morning with suspected meningitis 9-year-old child receiving subcutaneous insulin for diabetes mellitus 10-year-old child who had a tonsillectomy that morning 9-year-old child with Legg-Calve'-Perthes disease
Correct response: 9-year-old child receiving subcutaneous insulin for diabetes mellitus Explanation: The unit manager should assign the LPN/VN to the child with diabetes mellitus. Because the client is receiving subcutaneous insulin rather than IV insulin, the diabetes is likely stable. Meningitis is an acute condition with the potential to progress into respiratory depression and seizures; this child will require frequent nursing assessments. The child who had a tonsillectomy remains at risk for hemorrhage during the first 24 hours following surgery. Legg-Calve'-Perthes disease is associated with impaired circulation to the femoral capital epiphysis; the child with this condition requires aggressive monitoring.
The nurse participates in a quality assurance program and reviewing evaluation data from the previous year. Which should the nurse recognize as an example of outcome evaluation? A 4% increase in the number of baccalaureate-prepared nurses employed in the facility Bed occupancy rates of 97% in the critical care areas and 92% in the non-critical care areas A 2% reduction in the number of repeat admissions for clients who underwent hip replacement surgery A rate of 98% of clients admitted to the hospital who had a nursing history completed within 24 hours after admission
Correct response: A 2% reduction in the number of repeat admissions for clients who underwent hip replacement surgery Explanation: Quality assurance programs focus on three types of evaluation: structure, process, and outcome. Outcome evaluation focuses on measurable changes in the health status of clients, such as a 2% reduction in the number of repeat admissions for clients who underwent hip replacement surgery. Structure evaluation focuses on the environment in which care is provided, such as the number of baccalaureate-prepared nurses employed in the facility and bed occupancy rates. Process evaluation focuses on the nature and sequence of activities carried out by nursing implementing the nursing process, such as a rate of 98% of clients admitted to the hospital who had a nursing history completed within 24 hours after admission.
Which situations should a supervisor consider in making assignments for nurses in the neonatal unit? A pregnant nurse shouldn't care for a neonate whose mother was positive for human immunodeficiency virus (HIV). A nurse with young children shouldn't care for a neonate whose mother has gonorrhea. A nurse with young children shouldn't care for a neonate with erythema toxicum. A pregnant nurse shouldn't care for a neonate with cytomegalovirus (CMV).
Correct response: A pregnant nurse shouldn't care for a neonate with cytomegalovirus (CMV). Explanation: CMV exposure can affect the fetus; women who are pregnant should avoid contact with CMV-positive clients. HIV is transmitted via blood and body fluids; all staff should take contact precautions. When a mother has gonorrhea, a nurse should administer eye prophylaxis to the neonate to prevent neonatal ophthalmic infection. It isn't a concern for staff. Erythema toxicum is a common rash in infancy; communicability isn't a concern.
Two nurse managers working on different units in a hospital are planning for a major change to occur on both units. One nurse manager reports to the other having identified a key power player on the unit. Which description most applies to a key power player in this context? A regular employee who is a natural leader Someone in whom the nurse manager can confide Someone who spreads untrue rumors An employee who will resist the change
Correct response: A regular employee who is a natural leader Explanation: People who are "natural leaders" because of their demonstrated ability to influence others are "key power players," whose support is essential to effecting change. The other choices do not describe persons who necessarily have power.
The nursing instructor is evaluating assessment techniques of several student nurses while performing assessments of pediatric clients. Which assessment techniques will require further instruction? Select all that apply. A student organizes assessment equipment by laying all items, such as blood pressure cuff, stethoscope, and otoscope, on the bedside table A student asks the child if he would like a blanket since the exam room is cool A student nurse allows the child to play with toys during the physical examination A student nurse awakens a sleeping infant in order to adequately assess the heart and lungs A student allows a parent to hold the infant during the assessment
Correct response: A student organizes assessment equipment by laying all items, such as blood pressure cuff, stethoscope, and otoscope, on the bedside table A student nurse awakens a sleeping infant in order to adequately assess the heart and lungs Explanation: Young children may be frightened by seeing a large amount of equipment, so the student should take out one piece of equipment at a time. If the infant is asleep, auscultate the heart, lungs, and abdomen first while the baby is quiet.
A nurse is caring for a client with a fresh postoperative wound following a femoral-popliteal revascularization procedure. The nurse fails to routinely assess the pedal pulses on the affected leg, and missed the warning sign that the blood vessel was becoming occluded. The nurse manager is made aware of the complication and the nurse's failure to assess the client properly. What action should be taken by the nurse manager? Review the nurse's malpractice insurance policy. Address the nurse's omissions as negligent behavior. Ask the nurse whether the client refused the assessments. Reprimand the nurse for being forgetful.
Correct response: Address the nurse's omissions as negligent behavior. Explanation: Negligence refers to careless acts on the part of an individual who is not exercising reasonable or prudent judgment. It also refers to the failure to do something that a reasonable person (another nurse) would do.
A nurse caring for a group of clients on the neurological floor is working with a nursing assistant and a licensed practical nurse (LPN). Their client care assignment consists of a client with new-onset seizure activity, a client with Alzheimer's disease, and a client who experienced a stroke. While administering medications, the registered nurse receives a call from the intensive care unit (ICU), saying a client who underwent a craniotomy 24 hours ago must be transferred to make room for a new admission. The ancillary staff is providing morning care and assisting clients with breakfast. How should the nurse direct the staff to facilitate a timely transfer? 1. Tell the ICU they have to wait to transfer the client because everyone is too busy to accept the client. 2. Ask the nursing assistant to finish providing care to the clients and the LPN to administer the remaining medications so the registered nurse can accept the client from the ICU. 3. Administer the medications quickly and ask the nursing assistant and LPN to finish providing care for the clients. 4. Notify the supervisor that the client care assignment is unsafe with the addition of the new client, and insist the supervisor assist with the assignment.
Correct response: Ask the nursing assistant to finish providing care to the clients and the LPN to administer the remaining medications so the registered nurse can accept the client from the ICU. Explanation: The registered nurse should use the ancillary staff to help effectively manage the group of clients. While the registered nurse accepts the client from the ICU, the nursing assistant can provide care for the clients, and the LPN can administer the remaining medications. Telling the ICU to wait or notifying the supervisor that they must assist are incorrect options because the nurse should assess the situation and use the ancillary staff appropriately. The nurse has adequate staff to safely provide care for this group of clients. The nurse shouldn't administer medications quickly because haste is an unsafe practice that could lead to a medication error. Instead of rushing, the nurse should delegate the responsibility to the LPN.
A nurse is in charge of a large group of employees on a busy surgical floor. Today's care must be completed early due to a special event involving most of the employees. Which management style would work best in this situation? Authoritarian Coercive Democratic Laissez-faire
Correct response: Authoritarian Explanation: With authoritarian, or autocratic, leadership, the leader determines, dictates, and directs the activities of the group, with no input from the followers on decisions. It is particularly effective when decisions for a large group need to be made quickly and efficiently, as in this scenario. Coercion--involving forcing actions upon the staff--is not a recognized leadership style and, in any case, would not be an advisable approach as it would likely trigger resistance in the group and be counterproductive. Democratic leadership is appropriate when the task, or decision at hand, is not one that requires urgent action, when subordinates can be expected to make meaningful contributions, and when their input can be taken into account. Laissez-faire management provides little or no direction; coworkers develop their own goals, make their own decisions, and take responsibility for their own management.
A client is received into the emergency department after getting shot in the chest. The client is hemorrhaging profusely and is in hypovolemic shock. The nurse calls a code blue. What type of leadership style will be most effective during the management of the code? Autocratic leadership Laissez-faire leadership Democratic leadership Transactional leadership
Correct response: Autocratic leadership Explanation: Autocratic leadership will be most effective in this scenario. Autocratic leadership involves the leader assuming control over the decision and activities of the group. During code blue, a leader is needed to direct the actions needed and make quick decisions to positively affect the client. Laissez-faire leadership would ultimately lead to the demise of the client. Democratic leadership could possibly delay the client receiving life-sustaining measures and would be less effective than autocratic leadership. Transactional leadership would involve a reward system which would be unethical in this situation.
A nurse manager is trying to resolve a conflict between the day and night shifts. The nurse manager wants to convince the involved persons to set aside their differences, determine a priority common goal having to do with improved client care, and accept mutual responsibility for achieving this goal. The nurse manager is using which type of conflict resolution? Avoiding Collaborating Competing Compromising
Correct response: Collaborating Explanation: Collaborating has all parties set aside previously determined goals, determine a priority common goal, and accept mutual responsibility for achieving this goal. This requires mutual respect, honest communication, and shared decision making. Avoidance, as a method of conflict resolution, involves looking the other way and doing nothing to resolve the conflict. Competing has one side winning at the expense of the other. Compromising means that each side gives up something of equal value.
The nurse manager for the psychiatric unit sees that there are major conflicts between the day and night shift staff. The nurse manager suggests that each shift put aside their differences for a time and determine a common major goal. Which conflict resolution style does the nurse manager display? Avoiding Competing Collaborating Smoothing
Correct response: Collaborating Explanation: With the collaborating approach to conflict resolution, there is a joint effort to resolve the conflict with a win-win solution. All parties set aside previously determined goals, determine a priority common goal, and accept mutual responsibility for achieving this goal. With avoiding there is awareness of the conflict situation, but the parties involved decide to either ignore the conflict or avoid or postpone its resolution. Competing is an approach that results in a win for one party at the expense of the other. Smoothing is an effort to complement the other party and focus on agreement rather than disagreement, thus reducing the emotion in the conflict. The original conflict is rarely resolved with this technique.
The nurse manager in a critical care unit actively listens to the staff and engages the staff to offer decisions regarding problem solving and implementing these decisions. What type of managerial mindset does this manager exhibit? 1. Collaborative mindset 2. Reflective mindset 3. Analytical mindset 4. Action mindset
Correct response: Collaborative mindset Explanation: The collaborative mindset involves listening more than talking, and allowing people to take initiative and control their own work. The reflective mindset allows managers to mentally digest experiences and reflect on them in a different way. The analytical mindset encourages introspection so that one can recognize biases and see things in a unique new way. The action mindset mobilizes energy to change while being sensitive about the capabilities of the team and the direction that is needed.
The nurse has recently been promoted to nurse manager on a pediatric unit and has decided to accept input from staff regarding changes they would like to see on the unit. Which type of leadership style is the nurse embodying? Quantum Autocratic Democratic Laissez-faire
Correct response: Democratic Explanation: Democratic leadership style involves sharing the decision making process and activities with others who have an interest. Autocratic leadership style involves assuming control over the decisions and activities of the group. Laissez-faire leadership style involves the leader relinquishing power or control to the group. Quantum leadership style involves seeing an organization and members as interconnected and collaborative. This style involves change as continually unfolding, and frequently incorporates technology.
Which is the nurse's priority question to consider prior to delegating a task to an unlicensed assistive personnel (UAP)? Does this task fall within the scope of a UAP? What is the client's condition? How can I supervise the completion of this task? How can I explain the task to the UAP?
Correct response: Does this task fall within the scope of a UAP? Explanation: All of these questions are important, but the priority is whether the task falls within the scope of a UAP. If the answer is no, the rest of the questions are not necessary.
The nurse working with the hospital's infection control team is attempting to decrease the transmission of healthcare-associated pathogens. Which intervention will be most effective? Incentivizing health care workers to utilize hand hygiene Revising the facility's infection control protocols Encouraging visitors to adhere to isolation precautions Limiting visitors to family members over the age of 18
Correct response: Incentivizing health care workers to utilize hand hygiene Explanation: Most healthcare-associated pathogens are transmitted via the contaminated hands of health care workers. Therefore, the most effective strategies for decreasing transmission are those that educate or encourage health care workers to utilize effective hand hygiene. Revising the agency's infection control protocols is not nursing centered. Encouraging visitors to adhere to isolation precautions is important but does not affect the immediate surroundings and personal space that can cause a contaminated work environment. Limiting visitors to family members over the age of 18 is not client-centered care and will not decrease transmission of pathogens.
A nurse manager notes an increase in the frequency of client falls during the last month. To promote a positive working environment, how would the nurse manager most effectively deal with this problem? Reprimand the nursing personnel responsible for the clients when the falls occurred. Investigate the circumstances that contributed to client falls. Institute a new policy on the prevention of client falls on the unit. Determine if client falls have increased on other units in the hospital.
Correct response: Investigate the circumstances that contributed to client falls. Explanation: The most effective method to address the increased frequency of client falls (and to promote a positive working environment) would be to determine the circumstances that contributed to the clients' falls. Attempting to identify and reprimand individual nurses does not lead to an atmosphere of openness and honesty in determining the causes. Instituting a new policy to prevent falls is premature before identifying why the falls are occurring. It may be relevant later to determine if other units are having the same problem, but it is not necessary at this time.
Which indicates that the nurse, acting as a leader for a group of recovering clients with alcohol abuse, is addressing the responsibility of maintaining the group's process? Keeping the group on task by restating goals Deciding how often the group will meet Selecting individuals for membership in the group Determining that the group's format will be closed
Correct response: Keeping the group on task by restating goals Explanation: In a therapy group, the nurse-therapist has both task and maintenance role functions. Group task functions are concerned with the practical issues of leading a group, whereas groupmaintenance functions focus on less-tangible group processes. Keeping the group focused on its goals is "maintenance" in its nature. Deciding how often the group will meet, selecting individuals for membership in the group, and determining the group's format are considered tasks rather than maintenance items.
Which style of leadership is rarely used in a hospital setting because of the difficulty of task achievement by independent nurses? Democratic Autocratic Laissez-faire Transformational
Correct response: Laissez-faire Explanation: In laissez-faire leadership, also called nondirective leadership, the leader relinquishes power to the group, such that an outsider could not identify the leader in the group. Autocratic leadership, also called directive leadership or authoritarian leadership, involves the leader assuming control over the decisions and activities of the group. Transformational is often described as charismatic; transformational leaders are unique in their ability to inspire and motivate others. Democratic leadership, also called participative leadership, is characterized by a sense of equality among the leader and other participants.
Two nurses have requested that the nurse manager allow them to plan in-service education with creative, new education techniques. Which leadership style would be best for the nurse manager to use to get the new project completed? Autocratic Laissez-faire Democratic Authoritarian
Correct response: Laissez-faire Explanation: Laissez-faire leadership would work best in this situation, as it alone would allow the nurses the autonomy and creative environment they need to complete the project. The autocratic, democratic, and authoritarian leadership styles may stifle the creativity the nurses require to complete the project. Laissez-faire leadership style involves the leader relinquishing power or control to the group. Autocratic, or authoritarian, leadership style involves assuming control over the decisions and activities of the group. Democratic leadership style involves sharing the decision-making process and activities with others who have an interest.
The charge nurse on the orthopedic unit believes in giving the staff as much power as possible. The nurses are allowed, among other things, to create their own work schedules, provide dates and times for unit meetings, and create the agendas, to which the charge nurse contributes. The charge nurse's style of leadership can be described as which? Democratic Laissez-faire Autocratic Transformational
Correct response: Laissez-faire Explanation: With laissez-faire leadership, the leader relinquishes power to the group. Autocratic leadership involves the leader assuming complete control. Democratic leadership displays a sense of equality among the leader and other participants. Transformational leaders create intellectually stimulating practice environments and challenge themselves and others to grow personally and professionally and to learn.
A student nurse is scheduled to observe a surgical procedure. The nurse provides the student nurse with education on the dress policy and provides all attire needed to enter a restricted surgical zone. Which observation by the nurse requires immediate intervention? Hair is pulled back and covered by a cap. Scrub top and drawstring are tucked into pants. Shoe covers are used. Mask is placed over nose and extends to bottom lip.
Correct response: Mask is placed over nose and extends to bottom lip. Explanation: The mask should fit tightly, covering the nose and mouth. The mask should extend down past the chin. The mask may not effectively cover the mouth if extended only to the bottom lip. The hair, scrub top, drawstring, and shoe covering are all appropriate and do not require intervention.
A primary unit nurse tells the nurse-manager that a registered nurse hired 6 weeks ago needs an additional week of orientation to function effectively on the staff. Which action is most appropriate for the nurse-manager to take? Explain to the primary nurse that a 6-week orientation is standard. Meet with the new nurse and the primary nurse and help set up an additional week of orientation. Meet with the new nurse and question the new nurse about deficits in performance. Schedule a staff meeting to find out if there are deficiencies or flaws in the orientation process.
Correct response: Meet with the new nurse and the primary nurse and help set up an additional week of orientation. Explanation: The nurse-manager is responsible for adequate orientation of new staff. A need for additional orientation does not mean that a nurse is not competent or that there are deficits in performance. Although a 6-week orientation may be standard, orientation periods should be individualized to meet the needs of the staff as well as provide the best client outcomes. Periodically reviewing and revising the orientation process is a good idea. However, in this case, the most appropriate course of action is to help the new nurse complete the orientation as efficiently as possible.
What best describes the nurse's role in disaster preparedness? Administration of all of the medications Counseling the victims and families Multiple roles, including triage and the distribution of resources Performance of all of the skills such as IV insertion and wound care
Correct response: Multiple roles, including triage and the distribution of resources Explanation: Nurses will perform multiple roles when assisting with a disaster, including triage, procedures, counseling, and distribution of resources.
The nurse is assigned a client who had an uneventful colon resection 2 days ago and requires a dressing change. To which nursing team member should the nurse avoid delegating the dressing change? Registered nurse Nursing assistant A senior nursing student present for clinical Licensed practical nurse
Correct response: Nursing assistant Explanation: The nurse should avoid delegating the dressing change to the nursing assistant. The dressing change would be within the scope of practice of the registered nurse, licensed practical nurse, and the senior nursing student.
The nurse is coordinating care for a client with continuous pulse oximetry who requires pharyngeal suctioning. To which staff member should the nurse avoid delegating the task of suctioning? Registered nurse Nursing assistant who is a nursing student A senior nursing student present for clinical Licensed practical nurse
Correct response: Nursing assistant who is a nursing student Explanation: The nurse should avoid delegating this client to the nursing assistant who is a nursing student. Suctioning and the associated evaluation of the client would be within the scope of practice of the registered nurse, licensed practical nurse, and the senior nursing student present for clinical.
A nurse is caring for a client with pneumonia. Which task is most appropriate for the nurse to delegate to an experienced unlicensed assistive personnel (UAP)? Assessing for shortness of breath Instructing the client about the need to alternate activity with rest Obtaining vital signs every 4 hours Administering nebulizer treatments as needed
Correct response: Obtaining vital signs every 4 hours Explanation: Having the UAP obtain vital signs every 4 hours is most appropriate, as it is within the UAP's scope of practice to perform this task. Assessment, teaching, and administration of medication are not in the current scope of practice for UAPs.
The nursing instructor is teaching a group of nursing students about the various responsibilities of the labor and delivery medical team. The instructor determines the session is successful when the students correctly choose which function as the primary role of the LPN/LVN members of the team? Provide direct independent care to the client Assist the providers in the delivery room Provide care under the supervision of an RN Observatory to assist the RN
Correct response: Provide care under the supervision of an RN Explanation: The LPN may provide care within the appropriate scope of practice under the direct supervision of an RN. The RN is responsible for providing direct independent care of the client. Both LPN/LVNs and RNs assist health care providers in the delivery room. The LPN/LVNs provide more than just observatory functions for the RN.
A client in an acute care facility is assigned a case manager to oversee and coordinate care. What important function does a case manager have? Provide early, thorough discharge planning. Make sure the client is administered medications. Provide care to the client who is terminally ill and has less than 6 months to live. Make home visits to see that the client is taken care of after discharge.
Correct response: Provide early, thorough discharge planning. Explanation: An important function of case managers is to provide early, thorough discharge planning. The case manager is not responsible for the administration of medications. Hospice care provides care to the client who is terminally ill. The case manager oversees the care of the clients while they are hospitalized. Referrals to community agencies and home healthcare will be made for home visits.
A nurse-manager is preparing for annual staff performance evaluations. Which action is mostappropriate for the nurse-manager to include? Conduct performance evaluations in a group setting so input from peers may be used. Provide feedback on strengths as well as areas for improvement while formulating a plan to improve. Provide written documentation of areas for improvement and establishing goals. Ask primary nurses to conduct performance evaluations to help them achieve professional growth.
Correct response: Provide feedback on strengths as well as areas for improvement while formulating a plan to improve. Explanation: An effective performance evaluation recognizes strengths, identifies areas for improvement, and clarifies performance expectations. Recognizing strengths increases employee morale, so limiting the evaluation to areas of improvement and goals may leave an employee feeling defeated. The nurse-manager should conduct performance evaluations privately, not in front of others. The nurse-manager should document in writing all components of a performance evaluation. Although input from staff members can be useful in preparing performance evaluations, asking other nurses to conduct performance evaluations is inappropriate. The nurse-manager is responsible for the performance of the staff.
A nurse is caring for a client with acute renal failure and hypernatremia. In this case, which action can be delegated to the nursing assistant? Provide oral care every 2-3 hours. Monitor for signs and symptoms of dehydration. Teach the client about increased fluid intake. Assess the client's weight daily for trends.
Correct response: Provide oral care every 2-3 hours. Explanation: Providing oral care for the client every 2-3 hours is within the scope of practice of a nursing assistant. The other actions should be completed by the registered nurse.
The nurse manager of a medical-surgical unit is planning to make changes, becasue the unt is understaffed. What is the first action the manager takes to plan the change for the unit? Recognize the symptoms that indicate a change is needed and collect data Determine and analyze solutions to the problem Plan to make the change Evaluate the interventions made to correct the issue
Correct response: Recognize the symptoms that indicate a change is needed and collect data Explanation: The first step in planned change is recognizing symptoms that indicate a change is needed and collect supporting data. Determining and analyzing solutions to the problem comes after recognizing the symptoms. Planning and evaluation are the end results of the planned change.
A registered nurse is caring for a group of clients on a psychiatric unit. Which task can the nurse delegate to the licensed practical/vocational nurse? Redressing lacerations on the wrists of a client who attempted suicide. Preforming a suicide assessment on a client recently admitted with depression. Educating a client on the newly prescribed escitalopram and zolpidem. Assessing a client who is withdrawing from alcohol and methamphetamine.
Correct response: Redressing lacerations on the wrists of a client who attempted suicide. Explanation: A licensed practical/vocational nurse (LPN/LVN) can take care of stable clients with expected outcomes. LPN/LVNs can differentiate between normal and abnormal findings. A dressing change is an appropriate task to delegate to the LPN/LVN. A registered nurse (RN) must complete any task that requires nursing judgment. Providing education and assessing requires an RN.
A nurse manager must provide care to the unit's clients and employees under the constraints of the resources. This involves maintaining the financial constraints of the division. What term best describes this scenario? Management Allocation Resource management Financial management
Correct response: Resource management Explanation: In modern health care organizations, managers usually are responsible for accomplishing the work of the unit within the constraints of available resources. This process is called resource management. Allocation is the assignment of available resources to various uses. Management is the process of dealing with or controlling things or people. Financial management is the process of dealing with or controlling money.
A nurse working in a physician's office uses the managerial function known as "organizing." What is involved in this function? Resources Problems Workforce Evaluation
Correct response: Resources Explanation: The organizing function of the nurse manager involves acquiring, managing, and mobilizing resources to meet both clinical and financial objectives. The planning function of the nurse manager involves identifying problems and developing goals, objectives, and related strategies to meet the demands of the clinical arena. The directing function of the nurse manager involves leading others in achieving goals within the constraints of the current fiscal and workforce shortage scenarios, a demanding task for managers and staff alike. The staffing function of the nurse manager involves hiring, orienting, and scheduling to facilitate team building, as well as staff development. The controlling function of the nurse manager involves implementing mechanisms for ongoing evaluation, particularly in areas of clinical quality and financial accountability.
A nurse manager best demonstrates effective leadership characteristic by which action? Being very structured and rigid with the unit flow Knowing all information about the unit processes Indicating an interest in becoming a role model Sharing a vision for the unit and enlisting support
Correct response: Sharing a vision for the unit and enlisting support Explanation: The nurse leader on a nursing unit should have a vision for the unit and be able to share this with the staff in order to enlist support and cooperation among the staff. The nurse leader should already be a role model, rather than just demonstrating interest. This would be related more to someone who was developing leadership qualities. The nurse leader should be flexible, not rigid, and does not have to know all information about the unit; rather, the nurse leader needs to know what resources are available among the staff and other leadership in helping reach expected goals and outcomes.
Which of these statements reflects the expected functioning at a hospital that has achieved Magnet status? Nursing administration is in control of all decision-making. Most client outcomes have improved but are not at target range. Staff nurses are developing innovative solutions to problems. There is a decreased rate of retention among the nursing staff.
Correct response: Staff nurses are developing innovative solutions to problems. Explanation: A hospital that has achieved Magnet status has recognition of quality client care that is provided by nursing staff who are professional and well-qualified. The staff nurses participate in self-governance and, therefore, work toward innovative solutions to problems. Having an increased turnover among staff nurses and a lack of quality client outcomes would not be characteristics of a Magnet hospital.
Which task would a nurse choose to delegate to a nursing assistant? Select all that apply. Planning bathing techniques Taking a client's vital signs Documenting a client's oral intake Performing a blood glucose check Assisting with IV insertion
Correct response: Taking a client's vital signs Documenting a client's oral intake Performing a blood glucose check Assisting with IV insertion Explanation: Registered nurses are responsible for all phases of the nursing process. These responsibilities include planning bathing techniques. A nurse may delegate tasks such as taking vital signs, documenting intake and output, assisting with IV insertion, and performing blood glucose checks if the nurse follows the five rights of delegation. The five rights of delegation include: right task (the task is within the delegate's scope of practice), right person (the person is competent to perform the task), right communication (the nurse gives the right directions to complete the task), right feedback (the nurse works collaboratively with the delegate), and right follow-up (the nurse follows-up on the task after it has been completed).
The registered nurse (RN) wants to delegate measuring a client's urinary output to an unlicensed assistive personnel (UAP). Which factors should the nurse consider before delegating the task? The complexity of the activity, age of the UAP, and predictability of the outcome Predictability of the UAP, the amount of time required for the task, and RN's skill level The stability of the patient's condition, potential for harm, and complexity of the activity The context of the other patient needs, the desired outcome, and autonomy of the patient
Correct response: The stability of the patient's condition, potential for harm, and complexity of the activity Explanation: RNs should consider the following when delegating tasks to UAPs: qualifications and capabilities of the UAP (not the age of the UAP or the RN's skill level), stability of the patient's condition (not the autonomy of the patient), complexity of the activity to be delegated (not the time required to complete the activitiy), potential for harm, predictability of the outcome (not the predictability of the UAP or the desired outcome), and overall context of other patient needs.
Which of these statements regarding a nurse manager role is accurate? The nurse manager's main role in the nursing unit is to manage the unit budget. To effectively manage the nursing unit, the nurse manager should also be a leader. A healthy work environment is not within the scope of the nurse manager's role. The nurse manager will decide on the financial targets for the nursing unit.
Correct response: To effectively manage the nursing unit, the nurse manager should also be a leader. Explanation: In order to be an effective nurse manager, the nurse manager must also be a leader. This is important with management of a healthy work environment, which is a responsibility of the nurse manager. This is done by helping ensure that interpersonal conflicts are resolved. The nurse manager is also accountable for client census, staffing, supplies, and budget, but is not responsible for setting financial targets for the budget; this is usually managed at the executive level.
The RN is working with hospital administrators to transform care at their facility. Which nursing competency will be critical for the nurse to utilize? Work effectively in interdisciplinary teams Correctly utilize and troubleshoot high-tech equipment Navigate the electronic medical records system Do things the way they have always been done
Correct response: Work effectively in interdisciplinary teams Explanation: The RN working with administrators to transform care will need to be able to work effectively as part of an interdisciplinary team. The nurse will need to work as a team member with members of the administration, as well as representatives from other health disciplines involved in the project. The ability to use and troubleshoot equipment and to navigate the electronic medical records are important to the nurse, but will not necessarily help when working with administration to transform care. Doing things the way they have always been done is a barrier to transformation of care.
A nurse-manager in the office of a group of surgeons has received complaints from discharged clients about inadequate instructions for performing home care. Knowing the importance of good, timely client education, the nurse-manager should take which steps? Inform the nurses who work in the facility that client education should be implemented as soon as the client is admitted to either the hospital or the outpatient surgical center. Review and revise the way client education is conducted in the surgeons' office. Because none of the clients suffered any serious damage, the nurse-manager can safely ignore their complaints. Work with the surgeons' staff and the nursing staff in the hospital and outpatient surgical center to evaluate current client education practices and make revisions as needed.
Correct response: Work with the surgeons' staff and the nursing staff in the hospital and outpatient surgical center to evaluate current client education practices and make revisions as needed. Explanation: Every nurse who provides client care should provide client education. Nurses must work together to establish the best methods of educating clients. The most appropriate response is to contact the facility's nurse-manager, not the nursing staff. Evaluating client education in only the surgeon's office doesn't consider the entire client education process and all of the staff providing it. Client education is an important nursing responsibility and every complaint deserves attention.
The charge nurse on the adolescent unit must decide which nurse should admit a new client. Based on the present client care assignments, who is the best candidate to admit the client? a nurse who was reassigned from another ward at the beginning of the shift a nurse whose patient with asthma has decreasing oxygen saturation levels a nurse caring for a client who is paralyzed and has no visiting family a nurse who is about to start a complicated wet-to-damp dressing change
Correct response: a nurse who was reassigned from another ward at the beginning of the shift Explanation: The nurse's work load would be low because she was reassigned to the ward at the beginning of the shift. The client with asthma requires constant monitoring by the nurse until the situation is resolved. Simple tasks and procedures are commonly more time-consuming when clients with paralysis are involved because these clients can't directly aid in their own care. Additional time must also be allotted for the nurse about to undertake a complicated procedure, such as a wet-to-damp dressing change.
After a nurse manager implements a solution to the problem of delays in obtaining supplies, the first task for the manager is to: 1. ask the staff members for other solutions. 2. plan to monitor the supply cabinets. 3. assess whether the desired results have occurred. 4. make an appointment with the chief nursing officer.
Correct response: assess whether the desired results have occurred. Explanation: The nurse manager must evaluate the results of the efforts to determine whether the desired results have occurred. The nurse manager should solicit input from staff members about potential solutions before, not after, implementing a solution. Monitoring the supply cabinets would be more appropriate if the problem were suspected drug diversion by staff but would be unnecessary for evaluating for improvement in delays for obtaininig supplies. Making an appointment with the chief nursing officer is not necessary and would not help the nurse manager evaluate the change in procedure related to obtaining supplies.
A student is choosing an educational path and desires a nursing degree with a track for community nursing and leadership and that allows for classes in liberal arts. The student would best be suited in which type of program? licensed practical nursing program certification in a nursing specialty diploma nursing program baccalaureate program
Correct response: baccalaureate program Explanation: The baccalaureate degree in nursing offers students a full college or university education, with a background in liberal arts. It is an intense program as it includes a focus on nursing leadership skills with additional requirements for clinical practice labs and clincial internships throughout its duration. Licensed practical nursing programs, certification in a nursing specialty, and diploma nursing programs are shorter length programs who curriculum is focused more on clinical nursing skills.
A nurse is performing a sterile dressing change on a client's abdominal incision. While establishing the sterile field, the nurse drops the forceps on the floor. The nurse is unable to continue with the dressing change because there are no extra supplies in the room, and no one is present to bring new forceps. The nurse failed to organize: equipment and personnel. environment and client. logistics and planning. skills and assistance.
Correct response: equipment and personnel. Explanation: A key component of the organizing interventions is to ensure adequate equipment (extra supplies) and sufficient personnel to assist with more complex tasks. Skills are first learned in nursing school but then validated with policies and procedures of the institution. Assistance is necessary to assist with the skill but is not the main issue in this scenario. Environment would be related to the lighting and space. Client issues would be the correct response if the client was cognitively aware and not confused. Logistics and planning may be related to other issues such as making sure all the elements such as personnel, client, environment, and assistance are all present.
The selection of a nursing care delivery system (NCDS) is critical to the success of client care in a nursing area. Which factor is essential to the evaluation of an NCDS? 1. determining how planned absences, such as vacation time, will be scheduled so that all staff are treated fairly 2. identifying who will be responsible for making client care decisions 3. deciding what type of dress code per nursing 4. department will be implemented 5. identifying salary ranges for various types of staff
Correct response: identifying who will be responsible for making client care decisions Explanation: Determining who has responsibility for making decisions regarding client care is an essential element of all client care delivery systems. Dress code, salary, and scheduling planned staff absences are important to any organizations but they are not actually determined by the NCDS.
Identifying the kind and amount of nursing services required is a possible solution for: inadequate staffing. clients who fail to communicate their needs. nurses who are bored. nurses frustrated with substandard care.
Correct response: inadequate staffing. Explanation: A possible solution for inadequate staffing is to identify the kind and amount of nursing services required. Using a team conference to develop a consistent plan of care is a possible solution for the client who fails to communicate needs. Educating the client to become an assertive health care consumer is a possible solution for the client who quietly accepts whatever care is delivered or not delivered. A possible solution for the nurse who is a candidate for burnout is to learn to give quality care during the designated work period. An initiative to focus on quality improvement is a possible solution to nurses frustrated with substandard care. Reviewing task assignments and work schedules is a possible solution to bored nurses.
A client is scheduled to undergo an exploratory laparoscopy. The registered nurse (RN) asks the licensed practical nurse (LPN) to prepare the client for surgery. The RN must confirm that the LPN has specialized training before delegating which task? weighing the client teaching the client coughing and deep breathing exercises teaching the client how to collect a urine specimen initiating I.V. therapy, as ordered
Correct response: initiating I.V. therapy, as ordered Explanation: The RN must confirm that the LPN has specialized I.V. training before asking the LPN to begin I.V. therapy for this client. Initiating I.V. therapy is beyond the usual scope of practice for an LPN. Weighing the client, teaching coughing and deep breathing exercises, and teaching the client how to collect a urine specimen are within the scope of LPN practice and don't require additional training.
A nurse is working with a student nurse who is caring for a client with an acute bleeding cerebral aneurysm. Which action by the student nurse requires further intervention? positioning the client to prevent airway obstruction keeping the client in one position to decrease bleeding administering I.V. fluid as ordered and monitoring the client for signs of fluid volume excess maintaining the client in a quiet environment
Correct response: keeping the client in one position to decrease bleeding Explanation: The student nurse shouldn't keep the client in one position.The student nurse should carefully reposition the client often (at least every hour). The client needs to be positioned so that a patent airway can be maintained. Fluid administration must be closely monitored to prevent complications such as increased intracranial pressure. The client must be maintained in a quiet environment to decrease the risk of rebleeding.
What was one barrier to the development of the nursing profession in the United States after the Civil War? lack of educational standards hospital-based schools of nursing lack of influence from nursing leaders independence of nursing orders
Correct response: lack of educational standards Explanation: A lack of educational standards was one barrier to the development of the nursing profession after the Civil War. Other barriers included a male dominance of health care and the pervading belief that women were dependent on men. The location of nursing schools, a lack of influence from nursing leaders, and independent nursing orders were not barriers to the development of the nursing profession after the Civil War.
A nurse manager reviews an employee's contribution to the nursing division annually. This process is: interpreting quality indicators. employee's job satisfaction survey. performance appraisal. reward and development survey.
Correct response: performance appraisal. Explanation: Performance appraisal is typically conducted annually. Each organization determines a reward structure to define and to acknowledge success. Interpreting quality indicators pertains to evaluation of general client care, not of an individual nurse. An employee's job satisfaction survey is a tool that allows the employee to give feedback on the employee's satisfaction with work, not a review of the employee's contribution conducted by the nurse manager.
A medical-surgical unit manager intends to have licensed practical nurses (LPNs) in the unit administer intravenous push (IVP) medications. What source would the manager contact to include this procedure in the LPNs' practice? American Nurses Association (ANA) state nurse practice act (NPA) facility policies and procedures committee National League of Nursing (NLN)
Correct response: state nurse practice act (NPA) Explanation: Each state has its own NPA, which determines what the nurse is allowed to do in each particular state, providing constraints within which nurses practice. The NPA delineates scope of practice. Therefore, the manager would contact the NPA in this scenario. The other sources are not appropriate given the context of the scenario.
The nursing supervisor is evaluating how many clients each of the department nurses has been assigned for the shift. This type of evaluation would be considered: process. outcome. goal. subjective. structure.
Correct response: structure. Explanation: Availability of equipment, layout of physical facilities, nurse-client ratios, administrative support, and maintenance of nursing staff competence are some areas of concern for structure evaluation. Process, outcome, goal, and subjective evaluation address those respective categories.
A nurse-manager on an oncology unit has been informed that she must determine which nursing care delivery system (NCDS)/nursing care delivery model (NCDM) is best for efficient client care, client satisfaction, and cost reduction. Knowing that two or three registered nurses, four licensed practical nurses, and five nursing assistants are generally on duty on each shift and that the clients can easily be grouped by geographic location and client care needs, the nurse-manager and her staff appropriately decide to implement which NCDS/NCDM? functional nursing case management team nursing primary nursing
Correct response: team nursing Explanation: Team nursing is efficient and less costly to implement than primary or case management systems. Because staff members know each other well, they can function effectively as a team. Although functional nursing is the most cost-effective, care is commonly fragmented and clients are less satisfied. Case management and primary nursing require more registered nurses than are available.
A nurse in charge on a unit with a client who is receiving postoperative care for a below the knee amputation is deciding which nurse to assign to this client. Which nurse would be most beneficial for the client? the nurse who has worked with the client before and after the amputation a nurse who is just returning to work from a one-week vacation a nurse who often has been assigned to the client 3 previous night shifts a nurse with previous experience working with clients who have amputations
Correct response: the nurse who has worked with the client before and after the amputation Explanation: In this case, the charge nurse's best option for nursing assignment to this client is to assign the nurse who has worked with the client before and after the amputation. At present the client's ability to relate to others may be impaired. Limiting the number of new contacts initially will promote familiarity and trust and decrease the client's feelings of being overwhelmed.