Quiz Review 205
When considering online communication etiquette, which nurse demonstrates a primary rule that should be adhered to by all? A. "My friend's wedding was lovely and anyone wanting to see pictures can view them on my website." B. "I'm not familiar with the details so I'm not going to get into the discuss of whose right or wrong." C. "My cousin's prom dress cost $3,000 and worth every penny her parents spent on it." D. "I got this information at the workshop I attended last month; I'm posting the power points for everyone to review."
A. "My friend's wedding was lovely and anyone wanting to see pictures can view them on my website." (Interactions online are guided by the same sense of decency that any other style of communication dictates. Certainly, don't fan the flame of conflict or anger. The other options are not respectful of privacy, or potentially copyright laws.)
Which task is most likely to be considered in a state's practice act as appropriate to delegate to a LPN/LVN if the patient's condition is stable and competence in the task has been established? A. Administer an enema for an elective surgery patient. B. Administer an antiarrhythmic medication IV while interpreting the patient's rhythm on the cardiac monitor. C. Develop a plan of care for a stable patient admitted for observation after a head injury. D. Teach a patient how to instill eye drops for glaucoma.
A. Administer an enema for an elective surgery patient. (The RN who is delegating must consider the following: (1) the delegate's current workload and the complexity of the task, (2) whether the staff member is familiar with the patient population and with the task to be performed, and (3) whether the RN is able to provide the appropriate level of supervision. The delegation decision-making tree would also support delegation of this task.)
An RN is consistently late to work, causing reassignment of patient care and the need for repeated shift reports. The nurse, who receives a warning for repeated tardiness, states, "My husband left me, I have no car, no family close by, and the bus is always late, which makes me late. The nurse manager doesn't care how hard I try to get here, and I am raising a child by myself." The nurse is using which type of logical fallacy? A. Appeal to emotion B. Appeal to tradition C. Hasty generalization D. Confusing cause and effect
A. Appeal to emotion (An appeal to emotion is an attempt to manipulate other people's emotions for the purpose of avoiding the real issue.)
Time is becoming crucial for the nurse to address issues related to sponsoring programs to include hearing aid costs as part of Medicare coverage. The nurse involved in grassroots political actions realizes that the least timely method of reaching elected officials would be via what route? A. Letter B. Telephone C. e-mail D. Facsimile (fax)
A. Letter (Sending letters is the least timely mode by which to communicate with elected officials; because of the anthrax decontamination process that is now in place, delivery of U.S. mail to Congress and to the White House may be delayed by as long as 3 months, making letters an inefficient means of communicating with policymakers.)
A group of nurses meet with a state representative to explain the importance of allowing registered nurses the right to sign death certificates for patients who were under their care. As constituents and nurses, they requested that the senator vote against the bill restricting this practice. These nurses are serving in what role? A. Lobbyists B. Policymakers C. Officials with regulatory power D. Advocates for the Patient Safety and Quality Improvement Act.
A. Lobbyists (Lobbyists hope to educate and convince policymakers to respond positively to a particular position on an issue or to follow a particular course of legislative or regulatory action.)
A nurse is concerned about the risk of delegating tasks to licensed practical nurses and unlicensed assistive personnel. What is the best way for the nurse to determine competency of an inexperienced delegatee? A. Personally observe the delegatee perform the assigned task. B. Ask the delegatee how many times he/she has performed the task. C. Question the patient to confirm that the care provided was satisfactory. D. Ask other nurses if they feel the delegatee is competent.
A. Personally observe the delegatee perform the assigned task. (The best way for the nurse to determine the competency of LPNs or UAPs is to observe them perform the task.)
A patient is admitted with hypotension, shortness of breath, flushing, and hives. All levels of staff have been trained to assess vital signs. Given budget restrictions and proper delegation rules, to which care provider would the RN delegate the task of obtaining the initial blood pressure reading? A. RN B. LPN/LVN C. Unlicensed assistive personnel (UAP) D. Since all are trained, the task can be delegated to anyone
A. RN (The patient's condition is not stable; therefore, the skills of an RN are required.)
If a nurse practicing in a mental health agency could only belong to one professional organization, what criteria could be used to select the organization with the biggest impact? A. The American Nurses Association has a strong voice representing the nation's entire RN population. B. Specialty organizations such as the American Psychiatric Nurses Association lobby for higher education requirements for nurses. C. State nursing associations have limited power because they can lobby only state representatives. D. Professional organizations such as The American Association for the History of Nursing (AAHN) record the history of mental health nursing.
A. The American Nurses Association has a strong voice representing the nation's entire RN population. (The American Nurses Association is the voice for all registered nurses.)
The task of completing and signing the initial assessment on a newly admitted patient who is about to undergo minimally invasive procedures on an outpatient basis can be delegated to whom? A. The registered nurse (RN) B. The licensed practical/vocational nurse (LPN/LVN) C. Unlicensed assistive personnel (UAP) D. All levels of staff, because the information is about the past and cannot change.
A. The registered nurse (RN) (Only the RN can perform and sign the admission assessment, although some components such as monitoring vital signs may be delegated.)
The RN instructs the LPN to "Give an enema to the discharged patient in room 327 who is reporting being constipated. Then be sure to document on the medication administration record when given." Which of the five rights was missing in this situation? The right of A. direction and communication. B. task. C. person. D. circumstances.
A. direction and communication. (The directions were not clear. The RN did not specify which type of enema to give and what outcome to expect. And the RN gave no instructions related to reporting back.)
Which statement made by an RN regarding delegation indicates the need for additional teaching? (Select all that apply.) A. Unlicensed assistive personnel (UAP) can assess vital signs during the first 5 minutes for a patient who is receiving a blood transfusion because a reaction now is unlikely. B. An LPN/LVN can administer a PPD (tuberculin skin test) if there is no history of a positive PPD. C. When dopamine is ordered continuously, the LPN/LVN can administer dopamine at a low dose for increasing renal perfusion. D. UAPs can transfer a patient who is being discharged home from the wheelchair to the bed if they have received training and demonstrated competency. E. Responsibility can be delegated to the UAP, but the delegator retains accountability.
ANS: A, B, C (The statement "UAPs can assess vital signs during the first 5 minutes for a patient who is receiving a blood transfusion because a reaction at this time is unlikely" indicates the need for further teaching because the patient is at highest risk of a reaction during the first few minutes of a blood transfusion; thus, the assessment skills of an RN are required. The statement "an LPN/LVN can administer a PPD (tuberculin skin test) if there is no history of a positive PPD" indicates the need for further teaching because administration of intradermal medication requires the skill of an RN. Dopamine is a vasoactive drug that can have a profound effect on a patient's blood pressure and cardiac output; administration requires the assessment and evaluation skills of an RN.)
Which functions can be delegated only to another RN with appropriate experience and training? (Select all that apply.) A. Assessment of skin integrity on third day of hospitalization B. Evaluation of patient teaching related to turn, cough, and deep breathing exercises C. Nursing judgment related to withholding medication based on vital signs D. RNs do not delegate to other RNs, they delegate only to licensed practical nurses or unlicensed assistive personnel. E. Formulation of nursing diagnosis "potential for fall"
ANS: A, B, C, E (Activities like assessing skin integrity—which include the core of the nursing process and require specialized knowledge, judgment, and/or skill—can be delegated only to another RN. Activities like evaluating patient teaching—which include the core of the nursing process and require specialized knowledge, judgment, and/or skill—can be delegated only to another RN. Activities like deciding to withhold medication based on vital signs—which include the core of the nursing process and require specialized knowledge, judgment, and/or skill—can be delegated only to another RN. Activities like formulating a nursing diagnosis—which include the core of the nursing process and require specialized knowledge, judgment, and/or skill—can be delegated only to another RN.)
A nurse is concerned about older persons living alone at home without telephone service to contact emergency services. The nurse is advised to take part in grassroots efforts to address the situation. The nurse would take what action to increase effectiveness of the effort? (Select all that apply.) A. Posting signs to support the county's political candidates whose platform support services for poor and underserved person such as older adults B. Visiting with local politicians running for office and ask specific questions such as, "Would you support providing free emergency telephone service for older adults living alone?" C. Limiting voting to only presidential elections in which a candidate promises to initiate health care reform related to Medicare for older adults D. Joining the American Nurses Association and constituent member association E. Contacting representatives from surrounding states to garner support for free medical alert systems for older adults
ANS: A, B, D (Working in local political campaigns is an effective grassroots effort. Visiting, e-mailing, calling, and faxing local politicians to support free emergency telephone service for older adults is a grassroots tactic. Joining ANA and state nursing associations supports these organizations' lobbying efforts and is thus a way for individual nurses to influence the issues that nursing associations support.)
A nurse is interested in learning more about health policy and how it might impact nursing practice. She is especially interested in The Patient Protection and Affordable Care Act (PPACA) and how it will travel through the three branches of the federal government. When researching the roles of the legislative branch of the federal government what does the nurse learns about this branch? (Select all that apply.) A. It determines which laws are constitutional, such as recently deciding the PPACA is constitutional because it is a form of taxation. B. It has the exclusive power to determine where federal dollars will be spent, such as supporting the PPACA. C. It consists of the Office of the President and 15 executive departments that supported the PPACA. D. It has the power to veto laws found constitutional by the Supreme Court and therefore could veto the PPACA. E. It can override a Presidential veto, making it possible to amend the PPACA even without approval of the President.
ANS: B, E (The legislative branch possesses the sole power to enact legislation, tax citizens, and allocate federal spending. The legislature can override a presidential vote.)
When considering the feasibility of an all-RN staff, a nursing administrator determines what fact concerning the RN's role? (Select all that apply.) A. They are generally costlier and less efficient than LPNs. B. They are usually more reactive than proactive to patient care errors. C. They have a positive effect on patient outcomes when managing patient care. D. They are effective overseers of patients' overall health condition. E. Their training makes them effective care delegators.
ANS: C, D, E (RNs are effective at coordinating care that results in improved patient outcomes. RNs are valuable monitors of a patient's health status—a practice that results in improved patient outcomes and effective delegation of care.)
The healthiest form of communication is the ________ style.
Assertive (Assertive communicators are honest and direct while valuing and respecting other individuals' views and seeking a win-win solution without the use of manipulation or game-playing.)
A patient's spouse was just diagnosed with lung cancer although there was no history of tobacco use. The spouse states, "I am so mad. How can you get cancer without smoking?" Which statement by the nurse represents empathy? A. "Research is identifying many risk factors for cancer besides smoking." B. "I understand how you could feel angry about the diagnosis." C. "He is still a good husband." D. "Why do you think he got cancer?"
B. "I understand how you could feel angry about the diagnosis." (Empathy is feeling what the other person is feeling and seeing the situation as they see it; entails believing that the other person's feelings are valid, legitimate, and justified. The nurse is placing herself in the wife's position and sharing her emotions.)
A concerned nursing student calls the office of an elected official to voice support for the bill to ban smoking in all public places. The secretary asks, "Are you a constituent?" What does the term constituent mean? A. A member of a professional organization who supports the organization's political issue B. A citizen who is registered and is eligible to vote for a representative C. An elected official who proposes legislation to be considered as a potential law D. A member of the House of Representatives who is seeking support for a particular bill
B. A citizen who is registered and is eligible to vote for a representative. (A constituent is a citizen who can vote for candidates in elections for representation at local, state, and federal government levels.)
During a health history interview, the nurse listens to a patient relating the precipitating events that led to the onset of chest pain. She focuses her attention on the patient, makes eye contact, and acknowledges what the patient has to say. The nurse is exhibiting what communication technique? A. Assertive communication B. Active listening C. Empathy D. Passive communication
B. Active listening (In active listening a number of techniques can be used by the receiver to enhance the ability to listen; these include (1) providing undivided attention, (2) giving feedback (rephrasing), (3) making eye contact, (4) noting nonverbal messages (body language), and (5) finishing listening before one begins to speak.)
A student nurse is concerned about delegation practices and wonders why hospitals employ unlicensed assistive personnel (UAP) and LPN/LVNs. The student nurse refers to the National Council of State Boards of Nursing and learns that the role of these personnel is to focus on what? A. Supplementing the staffing pattern when an RN is not available B. Aiding the RN by performing appropriately delegated care tasks C. Replacing the RN when the health care facility provides long-term care D. Providing patient teaching, allowing more direct care to be provided by the RN
B. Aiding the RN by performing appropriately delegated care tasks. (The UAP and LPN/LVN can increase productivity of the RN by performing those tasks that fall within their scope of practice.)
A nurse would like to obtain background information and learn the political platform of a candidate who is running for national office. The nurse should contact what organization? A. National Registry for Candidates B. American Nurses Association Nurses C. National League of Nurses D. National Council of State Boards of Nursing
B. American Nurses Association Nurses (Through legislative updates, American Nurses Association Nurses Action Center keeps members up-to-date about background information and the platforms of candidates who are running for national office and also provides updates about key bills as they move through the legislative process.)
A bill is pending in the state legislature that will mandate teaching health promotion related to smoking cessation. Which action by the nurse should have the greatest impact on passage of the bill? A. Explain the rationale for the bill to the school board. B. Contact the elected representative's office by telephone to request support for the bill. C. Support a health advocate to run for election as state representative. D. Tell all students about the bill.
B. Contact the elected representative's office by telephone to request support for the bill. (Telephone calls are an effective means of communicating your support for a bill, next to a face-to-face meeting; ask to speak to the staff person assigned to the bill or issue for which the call is being made. After introducing yourself, give a brief and simple message such as, "Please tell Senator/Representative [name] that I support [bill number].")
When the policy process is compared with the nursing process, identifying the issue is consistent with which step of the nursing process? A. Assessment B. Diagnosis C. Planning D. Implementation
B. Diagnosis (The diagnosis step in the nursing process is consistent with identification of the targeted issue in the political process. As politically active nurses soon discover, effective involvement in policy development and political activities requires efforts similar to those used in the nursing process. The policy process and the nursing process are systematic approaches that use the nursing process for decision making.)
What situation demonstrates a nurse engaging in active listening? A. While assessing the patient's vital signs, the nurse records the data and states, "You are improving, your vital signs are normal." B. Eye contact is maintained while focusing on the patient as the patient describes the current pain level and location. C. The nurse states, "I know how you feel, I recently lost my father and I am still hurting." D. The nurse has cultural values that are in opposition to the patient but shares that "I agree with your decision to use herbs rather than the prescribed medications."
B. Eye contact is maintained while focusing on the patient as the patient describes the current pain level and location. (This behavior demonstrates active listening. A number of techniques can be used by the receiver to enhance the ability to listen; these include (1) providing undivided attention, (2) giving feedback (rephrasing), (3) making eye contact, (4) noting nonverbal messages (body language), and (5) finishing listening before one begins to speak.)
Throughout the history of health care in our nation, one particular piece of federal legislation provided funds for hospital construction. As the number of hospitals rapidly increased, the need for nurses to staff hospitals also increased, and the shift from community-based nursing care to hospital-based nursing care began. What fundamental piece of legislation was the basis of this action? A. Sheppard-Towner Act B. Hill-Burton Act C. Veterans Bill D. Access to Health Care Bill
B. Hill-Burton Act (The Hill-Burton Act, also known as the Hospital Survey and Construction Act, was enacted in 1950. This act provided funding that resulted in a boom in the construction of hospitals across the country. As the number of hospitals increased rapidly, so did the need for nurses to staff the hospitals. Thus the nurse's role was shifted from community and public health settings to the acute care setting.)
The nurse caring for a patient states, "Your blood pressure is dangerously high. Are you taking antihypertensive medicine?" The patient states, "I can't afford my medicine. I have no insurance." The nurse states "I feel really sorry for that patient. I wish it wasn't against policy to give her money." The nurse wants to help and places a note on Facebook that any donations would be appreciated to help a waitress who works at the cafeteria next door to the hospital buy her medications. The nurse posts that "She was so sick last evening when she came to the ED. I can't believe they don't provide insurance. I can't give her money but you all can help." This nurse's action has what possible outcome? A. Showing empathy and if she lets the patient know the money is not from her, she is not violating any social media guidelines. B. Increasing the risk for HIPAA violations C. No legal risk since she has properly followed policy and protected the patient by not using her name. D. The nurse is demonstrating the logical fallacy of slippery slope.
B. Increasing the risk for HIPAA violations (The National Council State Board of Nursing's policy on social media prohibits posting of patient information on social media sites. This patient could be identified by knowing where she works and the fact that she was seen in the ED the day before.)
An RN delegates to the unlicensed assistive personnel (UAP) the task of performing blood pressure checks for a group of patients on a nursing unit. The UAP accepts the task and is responsible for what associated task? A. Delegating the task to another UAP if he or she does not have the time or skill to complete the task B. Keeping the RN informed of any abnormal blood pressure readings C. Calling the physician when the patient's vital signs are not within established parameters D. Informing the dietary department to initiate a low-sodium diet for patients who are hypertensive
B. Keeping the RN informed of any abnormal blood pressure readings. (After accepting the assignment, the UAP is responsible for completing the task and reporting any patient concerns to the RN. The remaining options are the responsibility of the RN.)
A new mother is experiencing pain after delivering an infant with Down syndrome. The staff nurse states, "I don't think she is really hurting. Let the next shift give the pain medication." The team leader notices the staff nurse looks agitated and anxious and asks about any concerns in providing care to this new mom. The staff nurse admits having a stillborn infant with Down syndrome. This is an example of which component of communication? A. Personal perception B. Past experiences C. Filtration D. Preconceived idea
B. Past experiences (With past experiences that include a variety of positive, neutral, and negative events, the influence that these experiences can and will have on communication may be positive, neutral, or negative. The importance of recognizing that any reaction from the receiver may be biased by previous experience cannot be overstated.)
Political action committees (PACs) are established for what purpose? A. Financially supporting candidates B. Persuading policymakers to support certain policies C. Lobbying legislators D. Recommending health care policy
B. Persuading policymakers to support certain policies (A PAC is an arm of an organization, association, or labor union that is formed to persuade a policymaker to support a certain policy or program or, more often, to ensure the election or reelection of policymakers who support the organization's goals.)
A male nurse hired to work in the emergency department is observed throwing a contaminated needle into the trash can. The team leader reprimands the nurse for not appropriately disposing of sharps. The nurse states, "You don't care that I threw the needle in the trash. You just want an all-female staff," putting the team leader in a defensive position. This communication technique is referred to by what term? A. Straw man B. Red herring C. Slippery sloped. D. Confusing cause and effect
B. Red herring (A red herring is the introduction of an irrelevant topic for diverting attention away from the real issue.)
In today's world of fast, effective communication, what is the most commonly used means of societal communication? A. Facial expression B. Spoken word C. Written messages D. Electronic messaging
B. Spoken word (Verbal communication, which involves talking and listening, is the most common form of interpersonal communication. An important clue to verbal communication is the tone or inflection with which words are spoken and the general attitude used when speaking.)
Members of a state's constituent member association meet at a local restaurant to plan a Nurse Walk to support the local food bank. When entering the restaurant, the nurses note the environmental inspection report shows deficiencies because food handlers were not wearing hairnets and rodents were spotted, resulting in a score of 60 out of 100. This certificate of inspection is health policy enforced at which level of government? A. Local B. State C. Federal D. International
B. State (Health policy at the state level is responsible for ensuring food safety in restaurants.)
An RN delegates to an experienced LPN/LVN the task of administering oral medications to a group of patients. The RN then observes the LPN/LVN recording a patient's medication administration just before entering the patient's room. What is the RN's initial intervention? A. Checking the patient's drug packages to ensure that the correct drugs were given. B. Stopping the LPN/LVN immediately and nonjudgmentally discuss the possible consequences of this action. C. Contact the nurse manager and ask that the LPN/LVN's license be suspended. D. Call the pharmacy and ask for replacement medications for the patients.
B. Stopping the LPN/LVN immediately and nonjudgmentally discuss the possible consequences of this action. (The LPN/LVN has the competency but violated one of the rights of medication administration and is practicing unsafe care. The RN's initial responsibility requires that he or she intervene and identify concerns with the LPN/LVN.)
Which situation would be appropriate for the supervisory level of initial direction and/or periodic inspection? A. Experienced RNs work together to provide care for a group of patients newly diagnosed with meningitis. B. The RN assigns the LPN tasks within her scope of practice and checks back during the shift to ensure the tasks are completed correctly. C. A new graduate nurse is assigned care to a male patient with a hematocrit of 11.0 g of hemoglobin per deciliter and is receiving a blood transfusion. The charge nurse checks on the patient status every 15 to 30 minutes and asks the graduate to explain "next steps." D. No supervision is necessary since both are registered nurses.
B. The RN assigns the LPN tasks within her scope of practice and checks back during the shift to ensure the tasks are completed correctly. (When a working relationship is established and competencies of the delegate established, the delegator may check in during intermittently during the shift.)
A nurse who was recently certified in chemotherapy administration fails to check the compatibility of phenytoin before injecting into a continuous infusion of D5W leading to occlusion of the line. Which statement by the nurse demonstrates a red herring? A. The nurse is upset and states, "I am sure I have injected this before without a problem" and the supervisor interprets this to mean the nurse often takes shortcuts. B. The nurse states, "You are just upset because I am certified in chemotherapy administration and you are not." C. "The nurse who started the IV didn't get a blood return but determined the IV was the patient's—that is the problem." D. "This drug always occludes the line because it is so viscous."
B. The nurse states, "You are just upset because I am certified in chemotherapy (The nurse diverts attention away from the issue of not checking compatibility to introduce an irrelevant topic of chemotherapy administration certification which is not related to this situation.)
Which nurse is demonstrating a common, productive conflict resolution style? A. The nurse who does not express feelings or ideas that conflict with those of the administration B. The nurse who states," If I cover for you this weekend will you cover for me the weekend before my vacation?" C. The nurse overheard saying, "There is no use fighting this; one solution is as good as another." D. The nurse who regularly insists they have the most insight into the problem being discussed.
B. The nurse who states," If I cover for you this weekend will you cover for me the weekend before my vacation?" (Compromise occurs when people give up something to get partial goal attainment; such as in the scenario presented. The other options demonstrate avoidance, accommodation, and force as a conflict resolution technique.)
It is important for nurses to know the functions of the branches of the federal government. At a local meeting of the state nurses' association, an officer reminds members that the branch that can originate major policy initiatives is the _____ branch. A. executive B. legislative C. judicial D. administrative
B. legislative (The legislative branch possesses the sole federal power to enact legislation; the legislative branch originates and promotes major policy initiatives and has the power to override a presidential veto.)
A teenage patient is using earphones to listen to hard rock music and is making gestures in rhythm to the music. The nurse assesses the amount of urine output in the Foley catheter and leaves the room. What communication technique is demonstrated in both situations? A. Blocking B. Filtration C. Empathy D. False assurance
B.Filtration (Filtration is the unconscious exclusion of extraneous stimuli in communication.)
An older adult is unable to reach the telephone and is found dead at home several hours later. The son of the deceased person arrives at the hospital and asks, "Can I just please stay and hold my dad's hand? He was so afraid of dying alone." Which response by the nurse shows empathy? A. "Of course, you can. I'll let you know when the funeral home is here to transport his body." B. "It must be very hard to know he died alone." C. "I'll close the door so you can spend time with your dad. I will check back in a few minutes." D. "I lost my dad last year. He died alone. He was a policeman. I am just like you. Let me stay here and console you."
C. "I'll close the door so you can spend time with your dad. I will check back in a few minutes." (Empathy is demonstrated by the ability to mentally place oneself in another person's situation to better understand the person and to share the emotions or feelings of the person.)
An RN makes the following assignments at the beginning of the shift. Which assignment would be considered high-risk delegation? A. A novice RN is assigned a patient with diabetes mellitus requiring mixing of regular and NPH insulin. B. An LPN is assigned an older adult with pneumonia and who requires dressing changes on a foot wound. C. An unlicensed assistive person (UAP) is assigned the task of assisting a patient with late stages of Huntington's disease to ambulate. D. A float RN from the oncology unit is assigned a patient with a white blood cell 3 count of 4000 mm3 .
C. An unlicensed assistive person (UAP) is assigned the task of assisting a patient with late stages of Huntington's disease to ambulate. (Risk of falling is great in later stages of Huntington's disease due to chorea movements; this makes it inappropriate to delegate ambulation to the UAP.)
An RN is counseled by the nurse manager regarding inappropriate delegation when the RN engages in what activity? A. Instructing the nursing assistant to greet ambulatory surgery patients and show them to their rooms B. When asking a novice nursing assistant to collect a sputum specimen, the RN states, "I will show you this time and you can show me the next time." C. Assigning the float LPN/LVN the task of completing a plan of care for a stable patient who was admitted for routine replacement of a feeding tube D. Asking an LPN/LVN who has demonstrated competence to perform a dressing change before the patient is discharged home
C. Assigning the float LPN/LVN the task of completing a plan of care for a stable patient who was admitted for routine replacement of a feeding tube (Only an RN can initiate and complete a new plan of care; this does not fall within the scope of practice of the LPN/LVN. The RN has violated one of the five rights of delegation.)
A nurse is listening to a patient's apical heart rate. The patient asks, "Is everything okay?" The nurse says nothing and shrugs her shoulders. The nurse is demonstrating what form of negative communication? A. Ad Hominem Abusive B. Filtration C. Blocking D. False assurance
C. Blocking (Blocking occurs when the nurse responds with noncommittal or generalized answers.)
A nurse moves from California to Arkansas and due to having 20 years of experience as a registered nurse is immediately placed in charge of the telemetry unit. The staffing consists of LPNs and two unlicensed assistive personnel. The RN is unsure of the scope of practice of the LPNs and reviews the nurse practice act for Arkansas, which lacks clarity on some tasks. What should the RN do to best acquire the necessary information? A. Query the state nursing association to determine their stance on the role of LPNs. B. Ask the LPNs on the unit to list what tasks they routinely performed. C. Contact the state board of nursing to determine legal scope of practice for LPNs. D. Refer to California's nurse practice act because the scope of LPNs/LVNs is consistent across the United States.
C. Contact the state board of nursing to determine legal scope of practice for LPNs. (If the nurse practice act lacks clarity, the state board of nursing can provide guidance.)
An LPN/LVN has transferred to a nursing unit and arrives for the first day. The RN checks with the LPN/LVN often throughout the shift to provide support and determine if assistance is needed. The RN is providing which level of supervision? A. There is no supervision because at times the LPN/LVN is not with the RN. B. Periodic inspection is being used. Because the LPN/LVN is licensed, the RN is relieved of the need to evaluate care. C. Continual supervision is being provided until the RN determines competency. D. Initial supervision is being provided because this is the LPN/LVN's first day on the unit.
C. Continual supervision is being provided until the RN determines competency. (This level of supervision is required when the working relationship is new, the task is complex, or the delegate is inexperienced or has not demonstrated an acceptable level of competence.)
A nurse is overhead saying, "I don't mind working during the election and holiday. My parents are divorced, money is tight, and honestly, I don't trust any politicians anyway. I plan to take a few weeks off next month." She works independently to research strategies to improve patient-centered care for the large number of immigrants that arrived in the area and then works with the team to share ideas. She recommends, "Let's think the suggestions over and come back together next week." This nurse's communication style is consistent with which generation? A. Baby Boomers B. Traditionalist C. Generation X D. Millenniums
C. Generation X (Generation X individuals grew up in when there was a high rate of divorces; they tend to be more cynical and value work-life balance and teamwork. Holidays are often associated with family gatherings which may have been absent in this generation's family; belief that ALL politicians are untrustworthy may be viewed as cynical. The need to take time to form suggestions to save time and come together to reach team decision are reflective of this generation.)
Soon, the largest segment of the population will be those over age 65 years. To advocate for this vulnerable population, a nurse was a strong supporter for the Medicare Modernization Act (Medicare Part D), which focuses on what? A. Providing vision care benefits to elderly persons who were diagnosed as legally blind B. Removing limits to access to mental health/substance abuse services which are the most commonly used service in this population C. Providing coverage for medications for Medicare enrollees that constituted a huge expense for the elderly D. Expanded the practice opportunities for advanced practice registered nurses (APRN) who provide the majority of care for this population
C. Providing coverage for medications for Medicare enrollees that constituted a huge expense for the elderly. (The Medicare Modernization Act provided medication benefits to Medicare recipients and encouraged policymakers to have oversight to ensure drug effectiveness.)
A nurse gives phenytoin intravenously with lactated Ringer's solution containing multivitamins. The drug precipitates and obstructs the only existing line. When the team leader informs the nurse that these drugs cannot be mixed, the nurse states, "You've disliked me since I refused to switch my vacation time last month." Which type of logical fallacy has influenced the nurse? A. Ad hominem abusive B. Appeal to common practice C. Red herring D. Appeal to tradition
C. Red herring (Red herring is the introduction of an irrelevant topic in order to divert attention away from the real issue.)
An RN recently relocated to another region of the country and immediately assumed the role of charge nurse. When determining the appropriate person to whom to delegate, the RN bases decisions on what fact? A. The role of the LPN/LVN is the same from state to state. B. The LPN/LVN can be taught to perform all the duties of an RN if approved by the employer and if additional on-the-job training is provided. C. Review of the state's nurse practice act for LPN/LVNs is vital since it defines the role and scope of practice of the LPN/LVN. D. The Joint Commission has certified and established roles for the LPN/LVN.
C. Review of the state's nurse practice act for LPN/LVNs is vital since it defines the role and scope of practice of the LPN/LVN. (The scope of practice of the LPN/LVN varies significantly from state to state; RNs should know the LPN/LVN nurse practice act in the state in which they practice and should understand the legal scope of practice of the LPN/LVN.)
A group of nurses are meeting to decide how to staff the upcoming holidays. Each of the four members freely expresses thoughts about fair staffing but is willing to listen to other thoughts and reconsider their first recommendations. The nurses are avoiding conflict and supporting professional communication through implementation of what communication technique? A. Empathy B. Positiveness C. Supportiveness D. Accommodation
C. Supportiveness (Supportive communication occurs when each person's opinion/position is valued and each participant has the freedom to express a position but is willing to change that opinion/position.)
A nurse wants to apply open communication to obtain a thorough history and to determine cognitive function. Which question represents the use of open communication? A. Is today Wednesday? B. Do you know what day it is? C. Tell me what day of the week today is. D. Do you know what the first day of the week is?
C. Tell me what day of the week today is. (The patient must be able to name the day of the week rather than use answer yes or no.)
Care delivery using the team-based approach is used on a telemetry nursing unit. The team consists of one registered nurse (RN), two licensed practical nurses (LPNs), and one unlicensed assistive personnel (UAP). Staff have been charged to improve quality of care while ensuring cost containment. Which assignments would meet both criteria? A. The RN administers all medications to all patients. B. The LPN performs sterile dressings and IV tubing changes on all central lines. C. The experienced UAP places telemetry electrodes and attaches to cardiac monitor. D. The RN administers an enema to a stable patient who has an order "administer fleet enema PRN when no bowel movement in 2 days."
C. The experienced UAP places telemetry electrodes and attaches to cardiac monitor. (The UAP, when properly trained, can place patients on telemetry. This meets quality and cost containment goals because the LPN and RN have higher salaries.)
A person who is covered by Medicaid moves from one state to another and asks the nurse at the health department why the benefits changed. What is the nurse's correct response? A. "Local government controls which benefits each county can provide to Medicaid recipients." B. "The federal government does not fund any part of Medicaid, so each state must find ways to pay for benefits." C. "Each state determines benefits on the basis of the present economy." D. "Medicaid is funded by both state and federal governments, but benefits vary from state to state."
D. "Medicaid is funded by both state and federal governments, but benefits vary from state to state." (Medicaid is a program that is funded through a combination of state and federal funds; thus, benefits vary from state to state.)
A nurse is preparing an exercise program as part of a health promotion program for older adults with osteoporosis. Which question would retrieve the most valuable information about health practices? A. "Do you exercise?" B. "Do you like to exercise?" C. "When do you exercise?" D. "What exercise practices do you participate in?"
D. "What exercise practices do you participate in?" ("What exercise practices do you participate in?" is an open-ended question or statement that requires more information than just yes or no. This type of question augments the gathering of enough facts to build a more complete picture of the circumstances.)
Which component of an e-mail shown below would be both effective and concise? A. Subject: A short concise subject line: Meeting. B. Body: I would like you to answer these questions before the next meeting: Where would you like to meet? Do you want all the staff to attend? Can we serve refreshments? What is one goal for our unit? C. Body: Dear Staff, As you know, each department must reduce staff by 2%. We will need to discuss how to inform unlicensed staff about the downsizing efforts of the hospital. D. Body: The next staff meeting is scheduled for Tuesday, January 19, at 5 PM in the first-floor auditorium. Please send items for the agenda. Sally Smith, MSN, RN, [email protected] or ext. 5582
D. Body: The next staff meeting is scheduled for Tuesday, January 19, at 5 PM in the first-floor auditorium. Please send items for the agenda. Sally Smith, MSN, RN, [email protected] or ext. 5582 (This provides a message that is concise and accurate with a clearly conveyed message for the reader and contact information from the sender, all of which are important components of effective e-mail communication.)
A nurse is delegating to the newly hired nursing unlicensed assistive personnel (UAP) the task of assisting with oral hygiene, knowing that this assignment "does not require decisions based on the nursing process." The nurse is correctly using which of the five rights of delegation? A. Supervision B. Communication C. Person D. Circumstance
D. Circumstance (Right circumstance involves the delegation of tasks that do not require independent nursing judgments.)
A nurse would like to advocate for increased protective services and reporting mechanisms for elder abuse and attends the "meet the candidate" session at the town hall meeting. This is an important time for the nurse to implement what action? A. Educating the public about the nurse's political platform B. Being spontaneous and not deliver a rehearsed speech C. Addressing the person as "candidate" rather than using a first name that implies a working relationship D. Learning what the key issues are in the candidate's platform.
D. Learning what the key issues are in the candidate's platform. (Town hall gatherings with nurses allow the candidate to talk about his or her platform to a group of interested voters and afford nurses an opportunity to understand the candidate's vision and to voice their opinions and concerns about health care issues.)
Which task is appropriate for the RN to delegate to the unlicensed assistive personnel (UAP) provided the delegate has had experience and training? A. Evaluate the ability of a patient to swallow ice after a gastroscopy. B. Assist a patient who is postoperative hip replacement to ambulate with a walker for the first time. C. Change the disposable tracheotomy cannula for a new postoperative tracheotomy patient if secretions are thick and tenacious. D. Obtain a sterile urine sample from a patient with a Foley catheter that is connected to a closed drainage system.
D. Obtain a sterile urine sample from a patient with a Foley catheter that is connected to a closed drainage system. (Obtaining a sterile urine sample from a patient with a Foley catheter that is connected to a closed drainage system is not an invasive procedure, and risk to the patient is minimal, making the task appropriate for delegation.)
A nurse is asked to "float" to another area where the patients require total care. The nurse smiles, picks up her stethoscope, and says, "I'll come back and eat lunch with everyone here." When she enters the elevator she hits the wall and mutters, "Always me. Don't I have any rights"? The nurse is demonstrating which communication style? A. Assertive B. Aggressive C. Passive D. Passive-aggressive
D. Passive-aggressive (Passive-aggressive communication is represented by incongruent actions—the nurse shows friendly gestures by smiling and demonstrating she wants to have lunch with the staff on the original unit; however, she shows her anger by hitting the wall and muttering.)
A licensed practical nurse (LPN) has been practicing for 25 years on a unit where a newly graduated RN with a bachelor's degree is hired. Before the RN arrives on the unit, the LPN is heard saying, "She'll try to tell everyone what to do because she makes more money. She'll sit at the desk and let us do all the work." This is an example of what communication associated process? A. Interpretation B. Context C. Precipitating event D. Preconceived idea
D. Preconceived idea (Preconceived ideas are conceptions, opinions, or thoughts that the receiver has developed before having an encounter. Such ideas can dramatically affect the receiver's acceptance and understanding of the message.)
Which statement related to delegation is correct? A. The practice of unlicensed assistive personnel (UAP) is defined in the nurse practice act. B. Nursing practice can be delegated only when the LPN/LVN and UAP have received adequate training. C. Supervision is not required when routine tasks are delegated to a competent individual. D. The RN must be knowledgeable about the laws and regulations that govern nursing practice, as well as those that have no clearly defined parameters, such as for UAP.
D. The RN must be knowledgeable about the laws and regulations that govern nursing practice, as well as those that have no clearly defined parameters, such as for UAP. (Accountability remains with the RN, and he or she is responsible for knowing what tasks can be delegated and what is defined as nursing practice.)
During orientation, an RN learns that LPN/LVNs in the facility receive additional training to perform some tasks such as hanging continuously infusing intravenous fluids that have no additives. It is important for the RN to understand that what is the basis for this practice? A. The health care facility can override the state practice act by having all LPN/LVNs and unlicensed assistive personnel (UAP) participate in on-site training. B. LPN/LVNs are licensed, and accountability for their own practice rests with each LPN/LVN. C. The RN can determine what tasks are legally delegable to the LPN/LVNs on his/her care team. D. The nurse practice act and state regulations related to delegation override the organization's policies.
D. The nurse practice act and state regulations related to delegation override the organization's policies. (The state's nurse practice act is the deciding factor regarding what can legally be delegated.)
When determining the scope of practice for licensed practical nurses (LPN) and unlicensed assistive personnel (UAP), which statement accurately describes the common policies which exist in most state practice acts? A. The RN is held accountable for the decision to delegate, but responsibility rests only with the delegatee. B. The RN may only delegate tasks that are not in the scope of practice of the LPN if the delegatee is certain they are competent to perform the task. C. Since the LPN is licensed, they practice professional nursing. D. To determine what tasks can be safely delegated, the RN must first assess the patient.
D. To determine what tasks can be safely delegated, the RN must first assess the patient. (The stability of the patient must be determined prior to delegation. Even routine tasks such as taking vital signs that are often delegated may need to be performed by the RN when the patient's condition is critical.)
Which statement accurately describes communication? A. The components of communication are mutually exclusive. B. Communication is linear. C. Communication involves only the sender and the receiver; everything else is superficial. D. When the receiver becomes the sender, the subcomponent of communication that is in use is feedback.
D. When the receiver becomes the sender, the subcomponent of communication that is in use is feedback. (Communication is a process that requires certain components, including a sender, a receiver, and a message. Effective communication is a dynamic process: With a response (feedback), the sender becomes the receiver, the receiver becomes the sender, and the message changes.)
A nurse who is interested in graduate school wants to learn about recently passed legislation regarding changes in Medicare reimbursement for care provided by clinical nurse specialists. The best source for information on changes in federal programs is the ________________.
Federal Register (The Federal Register is the best source of information about proposed rules and regulations for newly enacted legislation and about changes to existing rules for federal programs (www.fr.cos.com).)
Another name for an eligible voter is a _________.
constituent
The greatest barrier to access to health care for a poor Hispanic person living in downtown Chicago is lack of health ____________________.
insurance (Lack of health insurance is the greatest barrier to access to health care and it has a tremendous impact on an individual's health. Studies have consistently found that the uninsured receive less than adequate health care.)
