Nursing Test 2

The Laissez-Faire Style

- AKA permissive, nondirective or passive - allows members to determine their own goals and methods to achieve (doesn't help) - little planning, minimal decision-making and a lack of involvement - Only time this is acceptable is when group members have the same level of education & they known the same tasks as the leader. - If asked for input the only thing they'll say is that the group is doing it wrong. - If faced with difficult decision they will avoid in the hopes that the problem resolves itself.

Consequences of Authoritarian Leadership

- People often harbor hostile feelings that they are fearful to express, use passive aggressive techniques to even out playing field, and feel oppressed and unable to use their full potential as a worker.

Management

- aimed toward influencing employees to be as productive as was humanly possible.

Key Leadership Qualities (Read each one in book)

1) Critical Thinker 2) Problem Solver 3) Integrity 4) Active Listener 5) Skillful Communicator 6) Courage 7) Initiative 8) Energy 9) Optimism 10) Perseverance 11) Well-Roundedness 12) Coping Skills 13) Self Knowledge

Key Leadership Behaviors (read about each one in book)

1) establish trust and cooperation among individuals 2)Acknowledge good work and success 3)Show respect for individuals 4) Provide a sense of direction 5) promote higher levels of performance 6)Resolve Conflicts successfully 7) Foster cooperation 8) reinforce goals 9) Develop staff strengths 10) Motivating Personnel

TWO KEY TASKS of MANAGERS

Budget Preparation & Planning for Staff Coverage

Development of Conflict Resolution Skills

Build on existing skills. Avoid personal attacks. Listen actively. Ignore trivia. Set the stage. Establish trust.

What is the trait theory?

Focuses only on the traits of the individual and does not take into account how the person acts in specific situations.

Extreme bottom-up vertical violence can sometimes manifest itself as: A) using passive-aggressive ways to decrease productivity. B) an environment that remains in a constant state of fear. C) an employee "going postal" and causing physical injury. D) decreased communication.

C) an employee "going postal" and causing physical injury.

10. True or False Management and leadership are the same thing.

False

What are the four Nursing Models?

Functional Nurse, Team Nurse, Primary Care Nurse, and Modular Nurse.

When are authoritarian leaders most effective?

In situations requiring immediate action or those that are life threatening. When productivity is the highest concern.

Modular Nursing (client-focused care)

Nurses are paired with less-trained caregivers. Generally involves cross-training of personnel.

Team Nursing Model

Team members functioning together to achieve clients goals. (Team leader, Team member)

The Need for Good Communication

The nursing profession recognizes communication as one of the cornerstones of its practice. Nurses must be able to communicate with clients, family members, physicians, peers, and associates in an effective and constructive manner to achieve their goals of high-quality care. Good communication is essential for good leadership and management.

Learn the skills

The purpose of all negotiation is to achieve a goal or objective. It is a skill that nurse managers must learn. All nurses should familiarize themselves with the skills.

6. The nurse knows that a catheter oblation will correct which of the following health problems. a. An irregular heart beat b. A low urine output c. An electrolyte imbalance d. An enlarged prostate

a. An irregular heart beat

10. Select all that apply: What are important tasks for the RN to carry out prior to delegating a task to ancillary personnel? a. asses the patient b. know the knowledge level of the ancillary personnel c. check the list of tasks to see if it is appropriate for this person d. know the position description e. educate the assistive personnel in specific tasks f. check the status of the RNs malpractice insurance

a. asses the patient b. know the knowledge level of the ancillary personnel d. know the position description e. educate the assistive personnel in specific tasks

7. Identify the quality that a good follower would least likely display. a. Criticizes the leader b. Think outside the box c. Is always compliant and obedient d. Questions the leader

c. Is always compliant and obedient

5. Which skill would a good leader least likely have? a. Good listener b. Problem solver c. Quick decision maker d. Maintain convictions in the face of adversity

c. Quick decision maker

1. Which of the following is an accurate statement about the person who is authorized to receive a delegated task? a. They do not have to be qualified to perform the task by the state practice act. b. The authorization does not hold any legal status. c. The task must fall under the RN's scope of practice. d. The task must fall under the physician's scope of practice.

c. The task must fall under the RN's scope of practice.

8. What is a list of tasks that certain health-care personnel can perform that is produced by the health-care facility known as? a. policy and procedures b. special delegation tasks c. indirect delegation d. consensus delegation

c. indirect delegation

Consequences of Laissez-Faire Style

can leave people feeling lost and frustrated back of the lack of direction by the leader.

Lost in the Middle Leader (mediocre)

tries to balance between the minimal tasks required to meet goals of the organization and the needs of his or her subordinates.

A client with cellulitis is to receive linezolid 600 mg IV over 2 hours. Based on the medication label (600 mg/ 300 mL), the nurse will set the infusion pump for __________ mL/hr.

• 150 mL/hr •The label indicates 600 mg of medication in 300 mL. To infuse 300 mL in 2 hours, the nurse will need to give 150 mL/hr.

A client admitted to the emergency department reports new-onset itching of the trunk and groin. The nurse notes multiple reddened wheals on the chest, back, and groin. Which question should the nurse ask *next*? •"Do you have a family history of eczema?" •"Have you been using sunscreen regularly?" •"How do you usually manage stress?" •"Are you taking any new medications?"

•"Are you taking any new medications?" •Wheals are frequently associated with allergic reactions, so asking about exposure to new medications is the most appropriate question for this client. The other questions would be useful in assessing the skin health history but do not directly relate to the client's symptoms.

At the beginning of the shift, an unlicensed assistive personnel (UAP) tells the nurse, "I have several clients today who have wound infections. I will do my best, but if I put on a gown and gloves every time I go into their rooms, I will never get all the care done!" Which response by the nurse is *best*? •"I know you are busy, but please try to comply with the standard infection control measures because these clients have serious infections." •"Let's look at the client assignments for today and make changes so that you can give the needed care and maintain good infection control." •"If you are unable to follow infection control standards, perhaps you need a review class in correct use of personal protective equipment." •"Tell me what you think are the most important times to use personal protective equipment to prevent infections from spreading."

•"Let's look at the client assignments for today and make changes so that you can give the needed care and maintain good infection control." •Seeking the UAP's input into changes is respectful and helps with team dynamics. This response also most directly addresses the UAP's concern about difficulties with time management. Asking the UAP to try to comply suggests that noncompliance with needed infection control actions is an option. The suggestion that the UAP will have to attend a class is disrespectful because it sounds like a threat, and there is no indication that the UAP needs more training on infection control. Asking the UAP to clarify when personal protective equipment is needed may lead to useful discussion about infection control but should be done when more time is available for discussion.

The nurse takes the health history of a client who has been admitted to the same-day surgery unit for elective facial dermabrasion. Which information is *most* important to convey to the plastic surgeon? •The client does not routinely use sunscreen •The client has a family history of melanoma •The client has not eaten anything for 8 hours •The client takes 325 mg of aspirin daily

•The client takes 325 mg of aspirin daily •Because aspirin affects platelet aggregation, the client is at increased risk for postprocedure bleeding, and the surgeon may need to reschedule the procedure. The other information is also pertinent but will not affect the scheduling of the procedure.

Why are interpersonal bonds important in establishing an environment of civility? A) It provides individuals with a feeling that they have a duty to each other B) Individuals are less likely to demonstrate incivility to others they know well C) A close family atmosphere always enhances civility D) People are more likely to overlook individuals imperfections

A) It provides individuals with a feeling that they have a duty to each other

What is the most serious consequence of bullying and intimidation in the workplace? A) Client safety is jeopardized. B) Nurses quit after a short time, which increases the nursing shortage even more. C) The morale of the workplace becomes very negative. D) Hospital costs increase and reduce the ability to purchase necessary equipment.

A) Client safety is jeopardized.

Identify the characteristic that would commonly be found in an individual recognized as a "violator/tormentor"? A) Self-absorption and negative attitudes B) High self-esteem and rigid behavior C) Positive attitudes and codependence D) High energy levels and manipulative behavior

A) Self-absorption and negative attitudes

Select all of the elements that are commonly a result of workplace lateral violence. A) A toxic work environment B) Increased self-esteem C) Workplace physical violence D) Psychological pain E) Positive emotions F) Anxiety

A, C, D, F

The caring-civility link is best exemplified by which of the following? A) Helping in disasters in foreign countries B) Conducting scholarly research into overcoming health-care disparities C) Accepting criticisms from physicians even though unjustified D) Making nursing assignments based on clients' needs and nurses' skills

B) Conducting scholarly research into overcoming health-care disparities

What is an example of horizontal violence? A) A student talking back to an instructor in the classroom B) Posting false and derogatory information on FaceBook about a fellow student C) Faculty assigning additional homework when students fall asleep during class D) Keying the car of faculty who are unreasonable and unfair

B) Posting false and derogatory information on FaceBook about a fellow student

What is the first step in defusing the spiral of incivility? A) Reflecting on the problem B) Developing a plan to resolve the problem C) Active listening to a fellow worker's accounts of incivility D) Reporting the incident to a superior

C) Active listening to a fellow worker's accounts of incivility

Identify the primary role of civility in the nursing profession. A) It allows nurses to practice without fear of retaliation. B) Unit morale is maintained at a high level, increasing productivity. C) Civility is simply an expectation of professional behavior. D) Civility in the profession enables nurses to make caring the focal point of their practice.

D) Civility in the profession enables nurses to make caring the focal point of their practice.

What has been identified as a key element to effective education of nursing students A) A feeling of personal safety in the classroom setting B) Low stress levels produced by decreased work assignments C) Permitting students to use cell phones during classes D) High-quality interpersonal relationships between students and teachers

D) High-quality interpersonal relationships between students and teachers

Which element increases the likelihood of incivility? A) Using a problem-solving approach B) Using assertive communication C) Internalizing workplace issues D) Increased levels of stress

D) Increased levels of stress

What action would contribute most in preventing experienced nurses from "eating their young"? A) Punishing experienced nurses with extra shifts for displaying incivility to new graduates B) Keeping new graduate nurses segregated as much as possible from hostile experienced nurses until they gain more on-the-job experience C) Providing in-service training sessions for experienced nurses on civility D) Teaching new nurses to be more assertive and to express their opinions without fear

D) Teaching new nurses to be more assertive and to express their opinions without fear

Followership (can't be a leader w/o followers)

FOLLOWERS: sometimes will question & criticize their leader. Have the right to decide which leader they wish to follow and when they will follow. They hold a powerful impact on leaders success. INDIVIDUALS VS GROUPS: - When individuals look at the leader they bring all their experiences with past leaders into the evaluation and base their perception on how well the current leader measure up to the "good" leader they experienced in the past. - A group brings a collection of past experiences and knowledge when considering leader's abilities. They share beliefs with one another.

The nurse obtains this information about a 60-year-old client who has a shingles infection. Which finding is of *most* concern? •The client has had symptoms for about 2 days •The client has severe burning-type discomfort •The client has not had the herpes zoster vaccination •The client's spouse is currently receiving cancer chemotherapy

•The client's spouse is currently receiving cancer chemotherapy •Because exposure to clients with shingles may cause herpes zoster infection (including systemic infection) in individuals who are immune suppressed, teaching about how to prevent transmission and possible evaluation and treatment of the client's spouse is needed. Antiviral treatment is most effective when started within 72 hours of symptom development. The client will need analgesics to treat the pain associated with shingles and may receive vaccination, but the biggest concern is possible infection of the client's spouse.

Factors That Affect Communication

Change Fear of the unknown Anger Positive or negative expression Group dynamics Unwritten rules Competition Peer evaluation Working environment Coping with difficult behavior Stress A destructive circle

Conflict Resolution

Conflict on the job A common situation that causes conflict is when nurses feel overworked or overwhelmed by their assignments. "Why isn't anyone helping me?"

Which of the following statements is most accurate about individuals who bully other people? A) They obtain their reward when the bullied individual stands up to them. B) They have low self-esteem and poor self-image. C) They use bullying as a form of entertainment. D) Their targets usually are strong-willed and confident, and they use bullying as a way to "bring them down a peg or two."

B) They have low self-esteem and poor self-image

Democratic Style of Leadership (supportive, participative, transformational)

- If trying to achieve a goal, planning, goal setting, to implementing and taking credit for the success of the project are shared by all group members. - BASED ON FOUR BELIEFS: 1. Every group member needs to participate 2. freedom of expression is allowed in order to maximize creativity 3. group members accept responsibility for themselves and for the welfare of the whole group. 4. group members must respect one another as unique and valuable contributors. - can be time consuming especially when group members are disagreeing strongly. - TRUST, COLLABORATION, CONFIDENCE and AUTONOMY

What are the leadership traits?

- SMART & SKILLFUL - Self motivated - Great Communicator - Confident and assertive - Creative - Persistence - Stress tolerance - Risk taker - Ability to accept criticism

Authoritarian Style of Leadership (controlling, directive, autocratic)

- These leaders provide direction by giving orders that the group is expected to carry out w/o question. - Final decision rests with the leader, input from group MAY be considered. - If they evaluate group members and think there is a better way of doing something they'll make on the spot changes.

Benevolent leader (another type of authoritarian leader)

- attempts to include the feelings and concerns of the group but at the end they are the ones who make the final decision.

Key behaviors of nurse managers

- understand job description, responsibilities, and level of authority. - organize - motivate others - delegate - personnel development - maintain external relationships - manage finances & preparation of budgets - establish goals/outcomes - analyze and solve problems

High Relationship-Low Task Leader

- well liked because they are interested in every group members feelings and provides acceptance but they allow group to make own decisions without regard to the task at hand and ultimately may not achieve the goals the group was organized for in the first place.

Select all of the actions that the Nursing Organizations Alliance recommends help build a positive workplace environment and overcome incivility. A) Developing an action plan to immediately stop lateral violence and bullying B) Training leaders competent in cooperation and communication C) Sharing decision-making with all those it will affect D) Developing professional standards including the development and acquisition of an appropriate set of values and an ethical framework in the work environment E) Continuously developing employee skills and clinical knowledge F) Recognizing and rewarding employees' contributions

B, C, E, F

Select all of the elements that may make a person a target for bullying. A) Being highly self-confident B) Having a different sexual orientation C) Possessing physical defects D) Defending himself or herself against bullies E) Unintentionally displaying an attitude of timidity F) Being ostracized from the group

B, C, E, F

What is the underlying principle upon which all definitions of civility are built? A) Good manners B) The Civil Rights Act of 1974 C) Recognizing the importance of all human beings D) The fight against injustice and oppression

C) Recognizing the importance of all human beings

How does transformational leadership aid in reversing incivility in the work or school environment? A) Nurse leaders learn how to develop plans to deal with incivility when it occurs. B) It acts as a lens through which leaders can reflect and change inequalities. C) It creates a more open channel of communication from workers to leaders. D) It maintains the status quo so that the environment is more predictable, thereby reducing workers' stress levels.

B) It acts as a lens through which leaders can reflect and change inequalities.

Which of the following statements is most accurate about lateral violence? A) It is a new phenomenon for the nursing profession. B) Oppression theory notes that marginalization is a key contributing factor to lateral violence. C) It has not been connected by research to the production of physical symptoms. D) The concept of inappropriate use of coercive power becomes a key element in lateral violence.

B) Oppression theory notes that marginalization is a key contributing factor to lateral violence.

Identify the item that is not a manifestation of covert lateral violence. A) Making faces behind someone's back B) Whining C) Threatening body language D) Fabrication

C) Threatening body language

All of the following are methods faculty can use to overcome academic incivility, except: A) become a catalyst and a change agent in one's own nursing program. B) make civility and cooperation a key element in the vision, mission statement, and outcomes of the program. C) revise the curriculum so that shared values, collegiality, and collaboration are threads that guide students and faculty in the learning process. D) develop and post a list of uncivil behaviors that nursing faculty display.

D) develop and post a list of uncivil behaviors that nursing faculty display.

Assertive communication

Direct Accurately expresses the person's feelings, beliefs, ideas, and opinions Respects self and others Encourages trust and teamwork Encourages others to express their opinions in an open and respectful atmosphere

Keys to successful negotiation include

Do some research. Clearly identify the objectives and goals. Avoid taking criticism personally. Avoid making personal attacks. Negotiate in good faith. Respect the other side's goals and objectives. Pre-plan the elements of the negotiation. Attend workshops or seminars on negotiation and bargaining.

Understanding Communication

Encoding and decoding Communication is interactive sharing of information. It requires a sender, a message, and a receiver. The receiver has the responsibility to listen to, process, and understand (encode) the information and then respond to the sender by giving feedback (decoding). Factors that interfere with the encoding process Sender factors Unclear speech Monotone voice Poor sentence structure Inappropriate use of terminology or jargon Lack of knowledge about the topic.Factors that interfere with the encoding process (cont'd) Receiver factors Lack of attention Prejudice and bias Preoccupation with another problem Physical factors such as pain, drowsiness, or impairment of the senses.Verbal communication: both the written and spoken word, constituting only about 7% of the communicated message. Nonverbal communication: makes up 58% of communication and includes body language, facial expressions, gestures, physical appearance, touch, and spatial territory (personal space). Paraverbal communication: makes up 35% of communication and includes vocal cues (tone, pauses), volume, and speed of speech. When the verbal, nonverbal, and paraverbal messages are congruent (relay the same information), then the message is more easily encoded and clearly understood.

Conflict resolution strategies

Strategy 1: Ignore the conflict Strategy 2: Confront the conflict Strategy 3: Postpone the conflict

Communication Styles

Submissive Aggressive-hostile

Management Theories

TIME-MOTION THEORY: increased productivity but decreased employee satisfaction. (planning, organizing, commanding, coordination, and controlling the work on any employee). With this approach providing money will increase employee productivity. HUMAN INTERACTION THEORY define management as the ability to provoke from employees their commitment, loyalty, creativity, productivity, and continuous improvement. They provide counseling, boost motivation, understanding human behavior, using and using leadership skills.

1. In which setting would the Laissez-Faire style of leadership work best? a. A busy intensive care unit b. A organization involved in long term nursing research c. A nursing home staffed mostly by ancillary health care workers d. An ambulance service staffed by paramedics

b. A organization involved in long term nursing research

4. Select all that apply. Select the key behaviors of successful leaders and managers. a. Chooses one person in the work group to rely on b. Acknowledges good work and success c. Provides individuals with more difficult challenges d. Resolves conflicts before they get out of control e. Keeps good records of all the mistakes individuals in the group make f. Maintains a highly competitive environment

b. Acknowledges good work and success c. Provides individuals with more difficult challenges d. Resolves conflicts before they get out of control

6. Select all that apply: What are positive aspects of delegation? a. It relieves the RN from responsibility for a number of nursing tasks. b. It allows more care to be given to more patients. c. It leaves accountability and decision making with ancillary personnel. d. It motives ancillary personnel to seek more education. e. Frees the RN from lower level time consuming tasks. f. Allows the RN more time to plan for care.

b. It allows more care to be given to more patients. d. It motives ancillary personnel to seek more education. e. Frees the RN from lower level time consuming tasks. f. Allows the RN more time to plan for care.

2. In which situation is the RN responsible only for supervising ancillary personnel to make sure the tasks are carried out safely? a. When they are LPNs b. When an official body has a predesignated a list of tasks that non-nursing personnel may undertake in the care of clients. c. RNs are always responsible for the full supervision of tasks conducted by ancillary personnel. d. Legally, the authority or power to delegate is restricted to professionals who are licensed and governed by a statutory practice act.

b. When an official body has a predesignated a list of tasks that non-nursing personnel may undertake in the care of clients.

High Task - Low Relationship Leader

leader does all the planning with little regard to the input or feelings of the group, gives orders, and expects them to be carried out w/o questions.

Both Extremes (low-relationship-low task orientation)

leader is uninvolved, no planning, little concern for the group members feelings and accomplishes little.

9. Fill in the blanks: Unlike the development of leadership theory, which primarily focused on the leader, the early study of _______________ was aimed toward influencing employees to be as ______________ as was humanly possible.

management, productive

Reasons nurses are uncomfortable with conflict

Fear of retaliation Fear of ridicule Fear of alienation of others Mistaken belief that they are unable to handle the conflict situation Feeling like they do not have the right to speak up Past negative experiences with conflict situations Family background and experiences Lack of education and skills on conflict resolution

Conflicting powers

In formal contract negotiation, there is an obvious power control conflict. Each side is reluctant to give up power or relinquish any control of key factors such as money or rights. The employees' group tries to gain some power from management and improve benefits for its members.

Rules for assertive communication

It takes practice. It requires a willingness to take risks. It requires a willingness to make mistakes and try again. It requires an understanding that not every outcome sought will be obtained. It requires strong self-esteem. Constant re-examination of outcomes helps assess progress. Goals for assertiveness growth need to be established beforehand. Others should be allowed to make mistakes.

Relationship-Task Orientation Leader

Leader can be oriented more toward establishing relationships or achieving assigned tasks and resolving problems, often dictated by the work setting.

Problems with Democratic Style of Leadership

Leaders feel as if they have no control over group.

Negotiation

The process of give and take between individuals or groups with the goal of reaching an agreement acceptable to both sides. A specialized two-way communication skill in which individuals or groups with differing needs or ideas settle on a middle ground result that may not completely please either party. Negotiations may be formal or informal, hostile or friendly. Bargaining A special type of negotiation that is used when money-related issues are being discussed. Collective bargaining A formal type of negotiation. Used by groups of workers represented by a union or a negotiating body to solve workplace issues. Salaries, health-care benefits, safe work environment, hiring practices

5. True or False: When nurses delegate nursing tasks, they are delegating nursing.

True

9. True or False: Clients who are relatively stable and not likely to experience drastic changes in health-care status are the most suitable for delegation.

True

Mediation or arbitration

Used when the sides are unable to reach a resolution to their differences. Mediation is a form of alternative dispute resolution. The appointed mediator works with both sides to reach an agreement. The agreement is non-binding and either side can reject the settlement.

Arbitration

Usually the last step before the dispute is taken to court for litigation Can be either non-binding or binding Both parties must agree ahead of time to comply with whatever decision is reached by the arbitrator.

8. How can leaders better understand their effectiveness by using information from their followers? a. How do the followers view themselves in the organizational structure? b. Followers believe they have little power over decisions that are made? c. How do the followers view the mistakes the leader makes? d. How submissive are the followers to the leader?

a. How do the followers view themselves in the organizational structure?

2. A nurse is using the benevolent leader approach on her unit. Identify the feelings that the staff often develop in response to the benevolent leader approach. a. The nurse leader is condescending and patronizing b. The nurse leader is poor at her job c. The staff will only follow those directions they feel are positive for their work d. The staff will be passive-aggressive in their responses to the nurse leader

a. The nurse leader is condescending and patronizing

7. Most state practice acts do not give delegation authority to which group of health care providers? a. dependent practitioners b. independent practitioners c. RNs with associate degrees d. when the person who is assigned a task also has a license and the tasks fall under that person's scope of practice

a. dependent practitioners

Dictator leadership (dictatorial authoritarian)

no regard for the feelings and needs of the group members. achieving goal is only thing that matters and they will use any means (including harsh critcism) to do so.

Primary Care Nursing Model

provides and is responsible for all of the client's nursing needs. Nurses are designated either as the primary nurse responsible for clients care or as the associate nurse who assists in carrying out the care. These nurses are SELF-DIRECTED and concerned with consistency of care.

Consequences of authoritarian leadership?

suppresses creativity of the group, reduce motivation levels, may cause passive aggressive behavior,

3. Fill in the blanks: When they accept a delegated _____, assistive personnel accept the _______________ attached to it.

task, responsibility

Functional Nursing Model

assigned to specific TASKS rather than specific clients (ex: medication nurse: administers meds and does documentation regarding med administration) Charge nurse, medical nurse and treatment nurse

3. A High Task - Low Relationship style of leadership is similar to what other style of leadership? a. Laissez-Faire b. Democratic c. Low Task - High Relationship d. Authoritarian

d. Authoritarian

4. When a nurse delegates tasks, the outcomes of tasks should be: a. Related to the patient's nursing diagnosis. b. In line with hospital policies. c. Unknown to the assistive personnel because the RN is responsible for outcomes. d. Clear and predictable.

d. Clear and predictable.

A 22-year-old woman who has been taking isotretinoin to treat severe cystic acne makes all these statements while being seen for a follow-up examination. Which statement is of *most* concern? •"My husband and I are thinking of starting a family soon." •"I don't think there has been much improvement in my skin." •"Sometimes I get nauseated after taking the medication." •"I have been experiencing a lot of muscle aches and pains."

•"My husband and I are thinking of starting a family soon." •Because isotretinoin is associated with a high incidence of birth defects, it is important that the client stop using the medication at least 1 month before attempting to become pregnant. Nausea and muscle aches are possible adverse effects of isotretinoin that would require further assessment but are not as urgent as discussing the fetal risks associated with this medication. The client's concern about whether treatment is effective should be addressed, but this is a lower priority intervention.

The nurse is planning hospital discharge teaching for four clients. For which client is it *most* important to instruct about the need to use sunscreen? •A 32-year-old client with pneumonia who has a new prescription for doxycycline •A fair-skinned 55-year-old client with psoriasis who works outside for 8 hours daily •A dark-skinned 62-year-old client who has had keloids injected with hydrocortisone •A 78-year-old client with a red, pruritic rash caused by an allergic reaction to penicillin

•A 32-year-old client with pneumonia who has a new prescription for doxycycline •Systemic use of tetracyclines such as doxycycline is associated with severe photosensitivity reactions to ultraviolet (UV) light. All individuals should be taught about the potential risks of overexposure to sunlight or other UV light, but the client taking doxycycline is at the most immediate risk for severe adverse effects.

Which client is *best* for the nurse manager on the burn unit to assign to an RN who has floated from the oncology unit? •A 23-year-old client who has just been admitted with burns over 30% of the body after a warehouse fire •A 36-year-old client who requires discharge teaching about nutrition and wound care after having skin grafts •A 45-year-old client with infected partial-thickness back and chest burns who has a dressing change scheduled •A 57-year-old client with full-thickness burns on both arms who needs assistance in positioning hand splints

•A 45-year-old client with infected partial-thickness back and chest burns who has a dressing change scheduled •A nurse from the oncology unit would be familiar with dressing changes and sterile technique. The charge RN in the burn unit would work closely with the float RN to provide partners to assist in providing care and to answer any questions. Admission assessment and development of the initial care plan, discharge teaching, and splint positioning in burn clients all require expertise in caring for clients with burns. These clients should be assigned to RNs who regularly work on the burn unit.

The nurse has just received the change-of-shift report in the burn unit. Which client requires the *most* immediate assessment or intervention? •A 22-year-old client admitted 4 days previously with facial burns due to a house fire who has been crying since recent visitors left •A 34-year-old client who returned from skin-graft surgery 3 hours ago and is reporting level 8 pain (on a scale of 0 to 10) •A 45-year-old client with partial-thickness leg burns who has a temperature of 102.6°F (39.2°C) and a blood pressure of 98/46 mm Hg •A 57-year-old client who was admitted with electrical burns 24 hours ago and has a blood potassium level of 5.1 mEq/L (5.1 mmol/L)

•A 45-year-old client with partial-thickness leg burns who has a temperature of 102.6°F (39.2°C) and a blood pressure of 98/46 mm Hg •This client's vital signs indicate that the life-threatening complications of sepsis and septic shock may be developing. The other clients also need rapid assessment or nursing interventions, but their symptoms do not indicate that they need care as urgently as the febrile and hypotensive client.

The charge nurse on a medical-surgical unit is working with a newly graduated RN who has been on orientation to the unit for 3 weeks. Which client is *best* to assign to the new graduate? •A 34-year-old client who was just admitted to the unit with periorbital cellulitis •A 40-year-old client who needs discharge instructions after having skin grafts to the thigh •A 67-year-old client who requires a dressing change after hydrotherapy for a pressure ulcer •A 78-year-old client who needs teaching before a punch biopsy of a facial lesion

•A 67-year-old client who requires a dressing change after hydrotherapy for a pressure ulcer •A new graduate would be familiar with the procedure for a sterile dressing change, especially after working for 3 weeks on the unit. Clients whose care requires more complex skills such as admission assessments, preprocedure teaching, and discharge teaching should be assigned to more experienced RN staff members.

The nurse is performing a sterile dressing change for a client with infected deep partial-thickness burns of the chest and abdomen. List the steps in the order in which each should be accomplished. •Apply silver sulfadiazine ointment •Obtain specimens for aerobic and anaerobic wound cultures •Administer morphine sulfate 10 mg IV •Debride the wound of eschar using gauze sponges •Cover the wound with a sterile guaze dressing

•Administer morphine sulfate 10 mg IV •Debride the wound of eschar using gauze sponges •Obtain specimens for aerobic and anaerobic wound cultures •Apply silver sulfadiazine ointment •Cover the wound with a sterile guaze dressing •Pain medication should be administered before changing the dressing because changing dressings for partial-thickness burns is painful, especially if the dressing change involves removal of eschar. The wound should be débrided before obtaining wound specimens for culture to avoid including bacteria that are skin contaminants rather than causes of the wound infection. Culture specimens should be obtained before the application of antibacterial creams. The antibacterial cream should then be applied to the area after débridement to gain the maximum effect. Finally, the wound should be covered with a sterile dressing.

The home health nurse is caring for a client with a fungal infection of the toenails who has a new prescription for oral itraconazole. Which client information is *most* important to discuss with the health care provider (HCP) before administration of the itraconazole? •The client's toenails are thick and yellow •The client is embarrassed by the infection •The client is also taking simvastatin daily •The client is allergic to iodine and shellfish

•The client is also taking simvastatin daily •The "azole" antifungal medications inhibit drug-metabolizing enzymes (when used orally or intravenously) and can lead to toxic levels of many other medications, including some commonly prescribed statins. Thick and yellow toenails are typical with fungal infections in this area, and clients may be embarrassed by the appearance of the nails, but antifungal treatment will improve the appearance of the nails. The client's iodine allergy will be reported to the HCP but will not impact on use of itraconazole.

After reviewing the medical record (physical assessment: vesicular lesions throughout mouth and lips, reports level 9/10 oral pain; nutritional assessment: taking only a few bites of each meal, 2 lb/1 kg weight loss in past 3 days; social and emotional assessment: states "I feel like a monster with all these herpes sores all over my mouth, refuses to see visitors") for a client who has an oral herpes simplex infection after being treated with chemotherapy, which intervention has the highest priority? •Offer reassurance that herpes can be treated with antiviral medication •Administer prescribed analgesics before meals •Offer the client frequent small meals and snacks •Encourage the client to maintain contact with some family members

•Administer prescribed analgesics before meals •The highest priority problems for this client are pain and inadequate nutrition. Administration of analgesics is the most important action because the client's acute oral pain will need to be controlled to increase the ability to eat and to improve nutrition. The client's concern about appearance and refusal to see visitors are also concerns but are not as high priority as the need for pain control and improved nutrition.

After the nurse performs a skin assessment on a 70-year-old new resident in a long-term care facility, which finding is of *most* concern? •Numerous striae are noted across the abdomen and buttocks •All the toenails are thickened and yellow •Silver scaling is present on the elbows and knees •An irregular border is seen on a black mole on the scalp

•An irregular border is seen on a black mole on the scalp •Irregular borders and a black or variegated color are characteristics associated with malignant skin lesions. Striae and toenail thickening or yellowing are common in older adults. Silver scaling is associated with chronic conditions such as psoriasis and eczema, which may need treatment but are not as urgent a concern as the appearance of the mole.

The charge nurse in a long-term care facility that employs RNs, LPNs/LVNs, and unlicensed assistive personnel (UAP) as staff members is planning the care for an 80-year-old client who has candidiasis in the skinfolds of the abdomen and groin. Which intervention is *best* to assign to an LPN/LVN? •Applying nystatin powder to the area three times daily •Cleaning the skinfolds every 8 hours and drying thoroughly •Evaluating the need for further antifungal treatment at least weekly Assessing for ongoing risk factors for skin breakdown and infection

•Applying nystatin powder to the area three times daily •Medication administration is included in LPN/LVN education and scope of practice. Bathing and cleaning clients require the least education and would be better delegated to a UAP. Assessment and evaluation of outcomes of care are more complex skills best performed by RNs.

Which of these actions will the nurse take *first* for a client who has arrived in the emergency department with sudden-onset urticaria and intense itching? •Ask the client about any new medications •Administer the prescribed cetirizine •Apply topical corticosteroid cream •Auscultate the client's breath sounds

•Auscultate the client's breath sounds •Because urticaria can be associated with anaphylaxis, assessment for clinical manifestations of anaphylaxis (e.g., respiratory distress, wheezes, or hypotension) should be done immediately. The other actions are also appropriate, but therapy will change if an anaphylactic reaction is occurring.

Which assessment finding calls for the *most* immediate action by the nurse? •Bluish color around the lips and earlobes •Yellow color of the skin and sclera •Bilateral erythema of the face and neck •Dark brown spotting on the chest and back

•Bluish color around the lips and earlobes •A blue color or cyanosis may indicate that the client has significant problems with circulation or ventilation. Further assessment of respiratory and circulatory status is needed immediately to determine if actions such as administration of oxygen or medications are appropriate. The other data may also indicate health problems in major body systems, but potential respiratory or circulatory abnormalities are the priority.

In which order will the nurse take these actions which are needed for a client seen in the family medicine clinic and diagnosed with impetigo? •Obtain specimen for culture •Apply topical antibiotic ointment •Give the client a hand hygiene handout •Clean off the crust from the lesion •Apply a sterile dressing to the wound

•Clean off the crust from the lesion •Obtain specimen for culture •Apply topical antibiotic ointment •Apply a sterile dressing to the wound •Give the client a hand hygiene handout •Culture of the wound will be needed before any antibiotic therapy, but the crust should be removed before wound culture to obtain a specimen that is not contaminated by normal skin bacteria. Application of topical antibiotic will be most effective with the crust removed and should be followed by covering the wound with a sterile dressing. The nurse will provide written teaching materials when the client is not distracted by the culture and dressing activities.

The charge nurse in a long-term care (LTC) facility that employs RNs, LPNs/LVNs, and unlicensed assistive personnel (UAP) is planning care for a resident with a stage III sacral pressure ulcer. Which nursing intervention is *best* to assign to an LPN/LVN? •Choosing the type of dressing to be used on the ulcer •Using the Braden scale to assess for pressure ulcer risk factors •Assisting the client in changing position at frequent intervals •Cleaning and changing the dressing on the ulcer every morning

•Cleaning and changing the dressing on the ulcer every morning •LPN/LVN education and scope of practice includes sterile and nonsterile wound care. LPNs/LVNs do function as wound care nurses in some LTC facilities, but the choice of dressing type and assessment for risk factors are more complex skills that are appropriate to the RN level of practice. Assisting the client to change position is a task included in UAP education and would be more appropriate to delegate to the UAP.

The nurse has just received a change-of-shift report for the burn unit. Which client should be assessed *first*? •Client with deep partial-thickness burns on both legs who reports severe and continuous leg pain •Client who has just arrived from the emergency department with facial burns sustained in a house fire •Client who has just been transferred from the postanesthesia care unit after having skin grafts applied to the anterior chest •Client admitted 3 weeks ago with full-thickness leg and buttock burns who has been waiting for 3 hours to receive discharge teaching

•Client who has just arrived from the emergency department with facial burns sustained in a house fire •Facial burns are frequently associated with airway inflammation and swelling, so this client requires the most immediate assessment. The other clients also require rapid assessment or interventions but not as urgently as the client with facial burns.

The charge nurse is supervising a newly hired RN. Which action by the new RN requires the *most* immediate action by the charge nurse? •Obtaining an anaerobic culture specimen from a superficial burn wound •Giving doxycycline with a glass of milk to a client with cellulitis •Discussing the use of herpes zoster vaccine with a 25-year-old client •Teaching a newly admitted burn client about the use of pressure garments

•Giving doxycycline with a glass of milk to a client with cellulitis •Dairy products inhibit the absorption of doxycycline, so this action would decrease the effectiveness of the antibiotic. The other activities are not appropriate but would not cause as much potential harm as the administration of doxycycline with milk. Anaerobic bacteria would not be likely to grow in a superficial wound. The herpes zoster vaccine is recommended for clients who are 60 years or older. Pressure garments may be used after graft wounds heal and during the rehabilitation period after a burn injury, but this should be discussed when the client is ready for rehabilitation, not when the client is admitted.

Which personal protective equipment will the nurse need when planning a dressing change for a client with a methicillin-resistant Staphylococcus aureus-infected skin wound? *Select all that apply.* •Gown •Gloves •Goggles •Surgical mask •Booties

•Gown •Gloves •Contact precautions include gown and gloves when doing dressing changes for a client with an infected wound. Booties are not needed for contact precautions. Goggles and a surgical mask may be needed if splashes or sprays are anticipated (e.g., with wound irrigation).

The nurse is caring for a client who has just had a squamous cell carcinoma removed from the face. Which action can be assigned to an experienced LPN/LVN? •Teaching the client about risk factors for squamous cell carcinoma •Showing the client how to care for the surgical site at home •Monitoring the surgical site for swelling, bleeding, or pain •Discussing the reasons for avoiding aspirin use for 1 week after surgery

•Monitoring the surgical site for swelling, bleeding, or pain •An LPN/LVN who is experienced in working with postoperative clients will know how to monitor for pain, bleeding, or swelling and will notify the supervising RN. Client teaching requires more education and a broader scope of practice and is appropriate for RN staff members.

The home health nurse is caring for a 72-year-old client who has a stage II pressure ulcer, with risk factors of poor nutrition, bladder incontinence, and immobility. Which nursing action should be delegated to the unlicensed assistive personnel (UAP)? •Telling the client and family to apply the skin barrier cream in a smooth, even layer •Completing a diet assessment and suggesting changes in diet to improve the client's nutrition •Reminding the family to help the client to the commode every 2 hours during the day •Evaluating the client for improvement in documented areas of skin breakdown or damage

•Reminding the family to help the client to the commode every 2 hours during the day •Although it is not appropriate for UAPs to plan or implement initial client or family teaching, reinforcement of previous teaching is an important function of UAPs (who are likely to be in the home on a daily basis). Teaching about medication use, nutritional assessment and planning, and evaluation for improvement are included in the RN scope of practice.

A client who has extensive blister injuries to the back and both legs caused by exposure to toxic chemicals at work is transferred to the emergency department. Which prescribed intervention will the nurse implement *first*? •Infuse lactated Ringer's solution at 250 mL/hr •Rinse the back and legs with 4 L of sterile normal saline •Obtain blood for a complete blood count and electrolyte levels •Document the percentage of total body surface area burned

•Rinse the back and legs with 4 L of sterile normal saline •With chemical injuries, it is important to remove the chemical from contact with the skin to prevent ongoing damage. The other actions also should be accomplished rapidly; however, rinsing the chemical off is the priority for this client.

A client is scheduled for patch testing to determine allergies to several substances. Which action associated with this test should the nurse delegate to unlicensed assistive personnel (UAP) working in the allergy clinic? •Explaining the purpose of the testing to the client •Examining the patch area for evidence of a reaction •Scheduling a follow-up appointment for the client in 2 days •Monitoring the client for anaphylactic reactions to the testing

•Scheduling a follow-up appointment for the client in 2 days •Scheduling a follow-up appointment for the client is within the legal scope of practice and training for the UAP role. Client teaching, assessment for positive skin reactions to the test, and monitoring for serious allergic reactions are appropriate to the education and practice role of licensed nursing staff.

Which finding by the clinic nurse about a client who has been taking adalimumab to treat psoriasis is *most* indicative of a need for a change in therapy? •Temperature 100.9°F (38.3°C) •Patches of scaly skin on chest •Erythema on sun-exposed areas of skin •Client report of worsening depression

•Temperature 100.9°F (38.3°C) •Biologic immunomodulating agents such as adalimumab (which are frequently used in autoimmune disorders) increase infection risk and should be discontinued in clients with manifestations of infection. Scaly patches, erythema after sun exposure, and depression need further investigation and may require changes in therapy, but the highest concern is risk for worsening infection if the medication is continued.

After the nurse has performed a skin assessment on a recently admitted 19-year-old client, which finding is the *highest* priority to report to the health care provider? •Mole 2 mm in diameter on the chest •Tenting of the skin on the forearms •Patches of vitiligo around both eyes •Scattered brown macules on the face

•Tenting of the skin on the forearms •Tenting of the skin on younger clients may indicate dehydration and the need for oral or IV fluid administration. The other data will be recorded but do not require any rapid interventions.

The health care provider (HCP) prescribes permethrin application for all family members of a client who has scabies. Which client information will be *most* important for the nurse to discuss with the HCP before client teaching about the medication? •The client has a newborn infant •Burrows are noted on the wrists •The client and family are homeless •Family members are asymptomatic

•The client has a newborn infant •Although all family members (symptomatic or not) should be treated for scabies, permethrin is contraindicated in clients who are younger than 2 months of age because of concerns that the medication may be absorbed systemically. Burrows on the wrist are commonly seen with scabies. The client's homelessness may affect teaching about how to launder clothes and linens but will not impact on use of permethrin for treating the scabies infestation.

When the nurse is evaluating a client who has been taking prednisone 30 mg/day to treat contact dermatitis, which finding is *most* important to report to the health care provider? •The glucose level is 136 mg/dL (7.6 mmol/L) •The client states, "I am eating all the time." •The client reports frequent epigastric pain •The blood pressure is 148/84 mm Hg

•The client reports frequent epigastric pain •Epigastric pain may indicate that the client is developing peptic ulcers, which require collaborative interventions such as the use of antacids, histamine2 receptor blockers, or proton pump inhibitors. The elevation in blood glucose level, increased appetite, and slight elevation in blood pressure may be related to prednisone use but are not clinically significant when steroids are used for limited periods and do not require treatment.

Which actions will the nurse use when treating a client with a venous ulcer on the right lower leg? *Select all that apply.* •Position the right leg lower than the heart •Use compression wraps consistently •Administer analgesics before wound care •Maintain a dry wound environment •Encourage right ankle flexion exercises •Clean wound with a nonirritating solution

•Use compression wraps consistently •Administer analgesics before wound care •Encourage right ankle flexion exercises •Clean wound with a nonirritating solution •Current guidelines for promotion of venous ulcer healing suggest use of compression, appropriate analgesia, use of exercises to improve venous return, and wound cleansing with a non-irritating solution such as normal saline. The extremity should be elevated to promote venous return and decrease swelling. A moist environment encourages wound healing.