Kaplan Management of Care B – Flashcards
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Which of the following client statements about advanced directives MOST concerns the nurse on the medical surgical unit?
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"My living will is all made out and secure in my safe deposit box" Rationale: nurse needs to assess whether this is the only copy of the living will and whether client is the only one who has access to the safe deposit box; such storage is not advised, as it is unlikely to be available if client is incapacitated; it is advisable, but not required, that the client give copies of the living will to his/her physician and to chosen family members
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The nurse manager delegates a task to another staff member. Which of the following includes appropriate technique/s to use when delegating? SATA
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- The nurse manager maintains eye contact. Rationale: eye contact is important; state exactly what is being delegated and what the expected outcome is; convey recognition of the authority to perform what is expected - The nurse manager states what, how, and when a task should be performed. Rationale: Delegator should obtain feedback to ensure that staff understands the assignment; identify priorities, acknowledge monitoring activities required, specify any performance limitations, such as time limits, specify deadlines, specify report time lines and data expected, specify parameter deviations, including when immediate action must take place, and be clear about what my not be delegated.
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The client is admitted with a stroke. The nurse notes the client has difficulty swallowing and requires assistance with bathing, toiling, and feeding. The delegation is appropriate if the RN delegates the tasks of bathing and toiling to which staff member?
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The nursing assistive personnel Rationale: Assists with direct client care acitvities such as bathing, transferring, ambulating, feeding, toileting, obtaining vital signs, height and weight, intake and output, housekeeping, transporting stable clients, and stocking supplies; appropriate delegation
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The nurse cares for clients in the psychiatric emergency department. Which client will the nurse see first?
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A client receiving haloperidol experiencing an oculogyric crisis Rationale: yes are locked upward; acute dystonic reaction; notify health care provider for an order for an anticholinergic agent to correct this reaction
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The nurse recruiter for a hospital addresses senior nursing students attending an open house in the facility. The recruiter states an advantage of working at the institution is they have recently implemented a clinical ladder system. A student asks what that means. Which is the best response by the recruiter?
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"A clinical ladder allows the nurse to stay at the bedside and still progress in the profession." Rationale: Clinical ladders were developed to provide support and incentive for staff nurses to stay at the bedside, or at least in the client care role, and advance rather than have to leave direct client care for teaching or management positions to achieve such advancement; having clinical ladders also helps meet the needs of the large numbers of high-acuity level clients now commonly seen in hospitals; a clinical ladder can be seen as a reward system for clinical excellence, with different responsibilities and advantages (such as salaries and scheduling) for each progressive level
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Four clients in the ER are complaining of side effects from their medication. Which of the following clients should the nurse see first?
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A client receiving clozapine and experiencing flu like symptoms. Rationale: unstable client; may have agranulocytosis; clozapine is an antipsychotic pregnancy risk B
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The nurse is seeing patients in the pediatric clinic. Which of the following patients should the nurse see first?
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A 9-year-old who has used a weapon against his mother and caused physical harm to others. Rationale: unstable patient; at risk for harm to self and others
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The nurse reviews the client care given by another RN to a group of psychiatric clients. The nurse knows this is which type of review?
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Peer review Rationale: The evaluation of an individual's practice by colleagues who have similar education and experience; purpose is to provide the individual with feedback from staff members who best understand the job requirements.
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The nurse knowns that which of the following documents is backed by the force of law?
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Nurse practice acts Rationale: Nurse practice acts are a legal code and have the force of law fully behind them; they are specific statues, passed by the state legislature, which define and regulate nursing practice within each state; they are address licensure and entry to practice requirements, defined the scope of nursing practice, and establish a Board of Nursing for oversight and enforcement of the act.
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The nurse is seeing patients in the psychiatric clinic. Which of the following patients should the nurse see first?
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A 15-year-old male brought in by police because he threatened to jump off a bridge and has access to a gun. Rationale: using Maslow's hierarchy of needs theory to prioritize, physiological issues take priority over psychological issues; patient is at risk for self harm and must be seen first; observe for safety
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The medical nurse reviews charting principles with newly assigned LPNs/LVNs. Which of the following should the nurse indicate is charting that reflects subjective data?
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"Patient states, 'I have had pains in my stomach for three days now'." Rationale: Subjective data is information given by the client and reflects their feelings and perceptions as well as concerns; it is best charted in their own words.
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The nurse manager of the psychiatric day hospital is reviewing group therapy as part of the orientation of new nursing staff who are to develop and lead groups. The manager should identify which of the following group process stages as the one in which members are most likely to engage in arguments and power struggles?
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Storming. Rationale: also known as the conflict stage, it follows the forming stage; issues about control, authority, and power dominate, both between members and also in response to the leader; resistance and hostility are intense.
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An RN discusses delegation with a new nurse. Which of the following statements by the new nurse indicates an understanding of the meaning of delegation?
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Delegation occurs when an RN assigns a specific function or aspect of patient care to an LPN/LVN or UAP. Rationale: delegation is the reassignment of responsibility for the performance of a job from one person to another; responsibility for the task is transferred, but the accountability for the process or outcome of the task remains with the delegator.
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The nursing team caring for clients on the pediatric unit consists of one RN, two LPN/LVNs, and three nursing assistive personnel. Which client does the nurse assign to the nursing assistive personnel?
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A child who needs help socializing with other children. Rationale: Assists with direct client care activities such as bathing, transferring, feeding, toiling, obtaining vital signs, height and weight, intake and output, housekeeping, transporting stable clients and stocking supplies.
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The nurse is seeing clients in the medical surgical unit. Which client will the nurse see first?
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A client diagnosed with heart failure who received 800 mL of IV fluids in 2 hours. Rationale: assess for circulatory overload
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The nurse describes the new nursing vice president's style of leadership. The nurse states, "The vice president lets us do what we want." The nurse is describing which leadership style?
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Laissez-faire Rationale: lack of leadership and non-directive; many have difficulty with this type of leadership due to the lack of guidance.
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An RN receives the assignment for the day shift. Which client is appropriate for the nurse to delegate to an LPN/LVN with 30 years of experience?
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A client three days postoperative requiring a dressing change. Rationale: stable client with a predictable outcome.
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Student nurses discuss characteristics of good documentation. The student nurses identify which of the following adheres to the legal guidelines for appropriate documentation?
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A nurse documents changes to the patient's condition. Rationale: record patient's vital signs, symptoms, behaviors, complaints, and response to treatment; notify physician and the team
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The nursing team consists of an RN, two LPN/LVNs and two nursing assistive personnel. It is most appropriate for the nurse to care for which client?
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A client 24 hours after a laminectomy with spinal fusion having difficulty voiding. Rationale: most unstable client; requires skills of an RN.
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The parents of an adult child have just been informed that the client will die shortly. The parents do not want the nurse to discuss the situation with the client. The nurse states, "I will be truthful." The nurse's action is based on which ethical concept?
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Veracity Rationale: telling the truth; intentionally deceiving a client violates this principle.
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The community health maternity nurse planks visits for the day. Which client should the nurse see first?
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A newborn with pallor. Rationale: Assess for respiratory distress syndrome; expiratory grunting, retractions, decreased breath sounds, apnea, pallor, hypothermia and poor muscle tone.
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The new charge nurse is hired to manage the pediatric unit. The charge nurse states in a meeting, "I run my unit with a lot of control and make all decisions." The staff recognizes the new charge nurse is practicing which leadership style?
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Autocratic. Rationale: leader gives orders and makes decisions; an efficient way to run things; usually stifles creativity and decreases motivation; works best in times of crisis.
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A series of in services on team development are being held for nurse managers at a teaching hospital by the staff development department. The educator has just reviewed the concepts of group process roles and identified several of them by name. One of the managers asks, "Could you please explain what exactly is meant by the gatekeeper role?" Which of the following responses by the educator is best?
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"The gatekeeper ensures that everyone has an opportunity to speak." Rationale: The gatekeeper is a group maintenance role (vs. task role) which focuses on keeping communication channels open and thus regulating communication within the group this may be done by directly encouraging or facilitating the participation of others and/or by limiting time in order to regulate communication flow; this function has an impaction group acceptance of individual members.
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The nurse manager researches models of care delivery and decides to further explore primary nursing. The nurse manager identifies which model best describes primary nursing?
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One registered nurse is responsible for the client's total care throughout the client's hospitalization. Rationale: the RN is responsible for developing the plan of care and managing associate RNs and other staff who provide care to the client; this model of care increases professional job satisfaction for the nurse and increases client satisfaction; the disadvantage is that all RNs may no provide total care.
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After receiving the night shift's report, the nurse plans assignments for the day on the pediatric unit. Which client will the nurse see first?
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A client diagnosed with hemophilia repairing joint pain. Rationale: joint pain indicates bleeding; treatment includes factor VIII, RICE (bed rest, ice compression, and elevation)
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The nurse manager discusses substance abuse among nurses. the nurse knows which activity alerts the nurse manager to a potential problem with substance abuse among the staff?
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A staff member does not allow another nurse to sign when narcotics are wasted. Rationale: impaired nurse might forge another RN's signature and then consume the narcotic that was not wasted; will also see unprofessional conduct, frequent reports of pain by clients during the impaired nurse's care.
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The nurse in the emergency department (ED) informs a client, "The physician is very busy and will see you in thirty minutes." The client demands to see the Director of Nursing. Which of the actions by the nurse is most appropriate?
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Report the situation to the nurse's immediate supervisor. Rationale: Follows the chain of command; emphasis on vertical relationships; nurse reports to nurse manager, who then reports to director, nurse reports problems and concerns to the next person with authority.
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The student nurse discusses causes of malpractice suits with the instructor. The instructor intervenes if the student includes which occurrence as an example of malpractice?
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Failure to document within 30 minutes after a change in the client condition. Rationale: failure to report and failure to document can lead to malpractice suits; nurse required to document in a timely fashion but not required to document within 30 minutes.
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The nurse is dissatisfied about the standard of care on the oncology unit The nurse discusses this with other nurses and a local news station. Afterward, the nurse is asked to resign by the nurse manager. The nurse responds to the nurse manger, "You can't fire me because I am protected by the whistle-blower law." Which statement best describes why this nurse may be subject to being fired?
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The nurse may not be covered by the whistle-blower law. Rationale: Whistle-blower laws vary from state to state and according to the subject matter.
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The nurse enters the room of a client admitted for evaluation of a convulsive disorder. The family members present report the client just had a seizure. After determining vital signs are normal, there are no injuries, and placing the client in side-laying position, which action will the nurse take next?
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Interview the family about what they observed and accurately document their response using their own words. Rationale:
