HESI LEADERSHIP MANAGEMENT PROCTORED EXAM NURSING RNSG 2221 QUESTIONS AND ANSWERS

HESI LEADERSHIP MANAGEMENT PROCTORED EXAM NURSING RNSG 2221 QUESTIONS AND ANSWERS VERSION 1 A nurse is preparing a client who speaks limited English for surgery. Which of the following is the most appropriate nursing action in obtaining informed consent from this client? d. Seek the assistance of a nurse on the floor who is fluent in the client's language. Select one: a. Do nothing as this is the provider's primary concern. b. The nurse should explain the procedures using pictures and hand gestures. c. Have the nurse respond to the client's concerns so the provider can prepare for surgery. d. Seek the assistance of a nurse on the floor who is fluent in the client's language. The nurse is responsible for ensuring that the client understands the information provided regarding the procedure. A nurse is performing initial teaching with a client who will be receiving electroconvulsive therapy (ECT). Which statement by the client indicates a need for further teaching? a. "My Dilantin dose will be increased several days before the procedure." Select one: a. "My Dilantin dose will be increased several days before the procedure." b. "Before the procedure, I will have an EKG to assess for heart irregularities." c. "I will need to continue taking my regular blood pressure medication." d. "I will stop taking my lithium for 2 weeks prior to my procedure." Because the therapeutic action of ECT is to induce seizures, any medications that affect the client's seizure threshold must be decreased or discontinued several days before the procedure. Any cardiac conditions, such as dysrhythmias, should be monitored and treated before the procedure A daughter of a client with a terminal illness pulls a nurse to the side and says, "Although my mother's living will states she is not to be resuscitated, the family wants everything done to save her if she has a cardiac arrest." How should the nurse respond? Select one: a. "The living will documents your mother's wishes and must be followed." b. "I will contact the provider to make him aware of your request." c. "If your mother has a cardiac arrest, we will begin resuscitation if you wish." d. "Since the living will is a legal document a lawyer will have to make the changes." a. "The living will documents your mother's wishes and must be followed." A living will is a document that expresses the client's wishes regarding medical treatment in the event the client becomes incapacitated and is facing end-of-life issues. The client's wishes should be followed by the health care provider. A provider informs the wife of a comatose client with terminal cancer that she will need to sign the consent for insertion of a gastrostomy feeding tube. The nurse knows this is against the client's wishes. What is the appropriate action by the nurse? Select one: a. Inform the wife she cannot sign the consent b. Prepare the consent for the wife to sign. c. Ask the provider for an order for a NG tube instead. d. Consult the hospital's ethics committee. d. Consult the hospital's ethics committee. If the nurse believes the provider's actions are directly against the client's wishes, the nurse should contact the hospital's ethics committee. These committees are typically multidisciplinary and are organized to consciously and reflectively consider significant and often difficult issues related to client care. Any nurse can consult the hospital's ethics committee when deemed necessary. Unless the client has designed another person as his health care power of attorney, the wife, as immediate next of kin, can legally sign the consent for the procedure if she wishes. A client is seeking treatment for stress related to unexpected loss of employment and is engaging in the stress management technique of cognitive reframing. Which of the following statements would indicate to the nurse that the client understands this stress management technique? Select one: a. "I have excellent job skills; I just need to find a new employer." b. "When I do my daily yoga exercises, I feel so much better." c. "Once I decided what was most important to me, things got easier." d. "I can visualize the perfect interview and being offered a new job." a. "I have excellent job skills; I just need to find a new employer." Cognitive reframing is a simple and effective technique for reducing stress by looking at things in a more positive light in order to experience them as less stressful. Cognitive reframing for this client would involve building confidence in job skills and searching for a new job. A nurse is preparing a client with terminal illness for discharge to a nursing home when he states: "I don't want to go to a nursing home to die. I would rather die at home." What would be the most appropriate action by the nurse? Select one: a. Contact the client's case manager. b. Continue to make the discharge arrangements. c. Assess the client's reasons for feeling this way. d. Inform the provider of the client's decision. a. Contact the client's case manager. Contact the client's case manager would be the most appropriate action by the nurse. The case manger would be able to determine if the client's wishes could be carried out. A client is hospitalized for multiple rib fractures following a motor vehicle accident (MVA). The results of an arterial blood gas (ABG's) are; pH 7.30, pCO2 48, HCO3 26 and pO2 91 on 2 L/min of oxygen per nasal cannula. Which of the following interventions has the highest priority? a. Assist the client to deep breathe, splinting with a pillow. The client is experiencing Select one: a. Assist the client to deep breathe, splinting with a pillow. b. Increase the client's O2 delivery to 4 L/min. c. Administer an anti-anxiety agent to calm the client. d. Notify the health care provider of the abnormal ABG's. respiratory acidosis from hypoventilation caused by painful respirations due to fractured ribs. Splinting the chest wall with a pillow will decrease pain associated with deep breathing. Deeper breaths will allow for better gas exchange, which will correct the acidosis. The nurse is caring for a client admitted with diverticulitis. The client reports severe abdominal pain and assessment reveals that the client's abdomen is rigid and tender. The client's vital signs are: T: 101.8 F (38C); HR: 120; B/P: 100/50. Urine output was less than 300 ml during the previous eight hours. The client states the pain is "worse than before". What is the priority nursing intervention for this client? Select one: a. Encourage the client to increase fluids b. Administer the prescribed scheduled antibiotic c. Notify the client's health care provider d. Administer bisacodyl suppository as needed c. Notify the client's health care provider The client is febrile, tachycardic and hypotensive with verbalization of increased worsening abdominal pain. These are signs of possible rupture of the diverticulum, pelvic abscess, or bowel obstruction and the provider needs to be notified. The nurse is caring for four clients receiving chemotherapy. Which of the following clients should the nurse see first? Select one: a. A client with cervical cancer and a hemoglobin level of 8.2 mg/dL b. A client with breast cancer and a sodium level of 115 mEq/L c. A client with ovarian cancer with a white blood cell count of 4,500 cells/mcL d. A client with endometrial cancer and a potassium level of 5.0 mEq/L b. A client with breast cancer and a sodium level of 115 mEq/L A sodium level less than 120 mEq/L is considered a medical emergency and needs immediate assessment and treatment. At 0715 the nurse is assigned to care for the following four clients. Which of the following clients should the nurse plan to see first? Select one: a. A client who will be transferred to a skilled care b. A client with diabetes mellitus type I waiting for a breakfast tray at 0745. The diabetic client waiting for facility at 0930. b. A client with diabetes mellitus type I waiting for a breakfast tray at 0745. c. A client scheduled for a bronchoscopy at the bedside at 0900. d. A client with pneumonia scheduled for a portable chest x-ray at 0730. breakfast should be assessed first. Prior to breakfast the client's blood glucose needs to be drawn and if insulin coverage is required it is administered before breakfast. Once the client begins to eat and digest food they will be at risk for increasing blood glucose levels without their insulin coverage. A nurse is caring for a client who has been committed to an acute Mental Health facility with an involuntary emergency commitment order. What should the nurse include when orienting the client to the facility? Select one: a. The client can leave the facility at any time if they sign a medical release form. b. Length of stay at the facility will be determined by the courts. c. Family will not be able to visit until their provider grants the visitation privileges. d. The client has the right to refuse treatment, unless he has been judged to be incompetent. d. The client has the right to refuse treatment, unless he has been judged to be incompetent. Clients admitted under involuntary commitment are still considered competent and have the right to refuse treatment, unless they have gone through a legal competency hearing and have been judged incompetent. The client who has been judged incompetent has a temporary or permanent guardian, usually a family member if possible, appointed by the court. The guardian can sign informed consent for the client. The guardian is expected to consider what the client would want if they were still competent. This type of commitment is usually imposed by primary care providers, mental health providers, or police officers based on the client's need for psychiatric treatment, the risks of harm to self or other, or the inability to provide self- care. The following clients have been assessed in the emergency department. Which of the following clients requires immediate attention? Select one: a. An 81 year-old client with a history of heart failure and new onset pneumonia with a respiratory rate of 32 and a temp of 101 F (38). b. A 6 year-old client with an open tibial fracture that occurred two hours ago after being hit by a car. c. A 19 year-old client who is vomiting and complaining of new onset right lower quadrant pain with rebound tenderness. d. A 48 year-old male complaining of chest pain, cardiac monitor showing sinus tachycardia with occasional PVC's. d. A 48 year-old male complaining of chest pain, cardiac monitor showing sinus tachycardia with occasional PVC's. While all of these clients require nursing care, the 48 year-old male with c/o chest pain and a cardiac rhythm of sinus tachycardia with occasional PVC's needs immediate attention! Chest pain is an indication of myocardial ischemia and this client has other factors that put him at risk for sudden death: gender, age and PVC's. PVC's are not normal in a 48 year old. PVC's occur when the myocardium is irritated, usually from hypoxia but also from electrolyte imbalance, usually involving K+. This client is young and as a result has not had sufficient time to develop adequate collateral circulation. A nurse is caring for four laboring clients. Each of the clients is requesting an epidural. Which of the following clients should receive her epidural first? Select one: a. Mulitipara with contractions occurring every 3 minutes, lasting 45 seconds. The cervical os is dilated 5 cms. b. Primipara with contractions occurring every 10-15 minutes, lasting 15 seconds. The cervical os is dilated 3 cms. c. Primipara with contractions occurring every 2 a. Mulitipara with contractions occurring every 3 minutes, lasting 45 seconds. The cervical os is dilated 5 cms. An epidural is indicated in the active phase of labor. Active labor is defined as: cervical dilation of 4-7 cms, contractions occurring every 3-5 minutes and lasting 30-60 seconds. minutes, lasting 90 seconds. The cervical os is dilated 10 cms. d. Mulitipara with contractions occurring every 2 minutes, lasting 130 seconds. The cervical os is dilated 8 cms. transition phase of labor and is approaching second stage: cervical dilation of 8-10 cms, contractions every 2-3 minutes and lasting 45-90 seconds. Many clients in this phase of labor become exhausted. An epidural during this phase could prolong delivery as the epidural may interfere with the client's ability to push. A nurse is preparing a client who speaks limited English for surgery. Which of the following is the most appropriate nursing action in obtaining informed consent from this client? Select one: a. Seek the assistance of a nurse on the floor who is fluent in the client's language. b. The nurse should explain the procedures using pictures and hand gestures. c. Have the nurse respond to the client's concerns so the provider can prepare for surgery. d. Do nothing as this is the provider's primary concern. a. Seek the assistance of a nurse on the floor who is fluent in the client's language. The nurse is responsible for ensuring that the client understands the information provided regarding the procedure. A nurse is caring for a client recently diagnosed Hepatitis C. He asks the nurse to promise him his wife will find not out about his diagnosis. What is the best response by the nurse? Select one: a. "I can't promise you because your provider may inform her anyway." b. "Your wife has the right to know about your condition because she may be at increased risk." c. "I'll place a note in your chart concerning your request for your wife not to be informed." d. "Your medical information is considered confidential to be shared only if you agree." d. "Your medical information is considered confidential to be shared only if you agree." The client must give consent for health care information, including laboratory results, diagnosis, and prognosis, to be shared with anyone that is not involved in the client's care. This includes sharing the information with family members. Even though the wife may be at an increased risk for Hepatitis C, she cannot be informed without the client's consent. A nurse is using silence to communicate with a client. Which of the following describes a therapeutic purpose of silence? Select one: a. Conveys the nurse's understanding of the client and assists with clarification. b. Encourages the client to discuss central issues and keeps communication goal-oriented. c. Allows the client time to gain insights and slows the pace of the interaction. d. Communicates the nurse's interest and concern for the well-being of the client. c. Allows the client time to gain insights and slows the pace of the interaction. Silence gives the client time to think and gain insights, slows the pace of the interaction, and encourages the client to initiate conversation, while conveying the nurse's support, understanding, and acceptance. A client is admitted to the hospital for suspected infective endocarditis. The client is reporting chills, fatigue, myalgia and dyspnea upon exertion. When assessing the client the nurse notes a heart murmur and a temperature of 102.3 F (38.2 C). Which of the following orders should the nurse implement first? Select one: a. Order the EKG b. Administer acetaminophen 325 mg by mouth c. Obtain the blood cultures from three sites d. Administer IV Penicillin G, 2 million units c. Obtain the blood cultures from three sites Obtaining blood cultures is the priority intervention. Cultures must be drawn prior to initiation of antibiotics so sensitivity results are not influenced. Obtaining specimens from three sites increases the reliability of the results. Clients at risk for endocarditis should be treated with prophylactic antibiotics prior to dental procedures; respiratory and GI diagnostic procedures; GU and Cardiac surgeries. Administering an antipyretic medication should follow the administration of antibiotics. Temperatures may be as high as 102-104 degrees F. in clients with infective endocarditis. Antipyretics are a priority for this client, but it is a lower priority than blood cultures and antibiotic administration. Clients at risk for endocarditis should be treated with prophylactic antibiotics prior to dental procedures; respiratory and GI diagnostic procedures; GU and Cardiac surgeries. A nurse has accepted a new position and is attending the general nursing orientation. Which of the following topics will most likely NOT be included in the orientation? Select one: a. Rules of conduct b. Fire safety c. Health promotion d. Accident prevention a. Rules of conduct Orientation activities are more specific for the position, whereas general employee orientation provides the employees with general information about the organization. Rules of conduct are employee indoctrination content and are not part of the nurse's orientation schedule The staff development department can provide the new employee with more inforamtion about aspects of concern such as health promotion. An elderly client is three days post-operative an anterior and posterior colporrhaphy. Which of the following assessments has the highest priority in this client's care? Select one: a. Abdomen firm and tender to palpation above the symphysis pubis. b. Oral temperature 100.8 F (38.2 C). c. Breath sounds decreased with fine crackles audible at bilateral bases. d. Apical pulse 90 and slightly irregular. a. Abdomen firm and tender to palpation above the symphysis pubis. An assessment of an abdomen being firm and tender to palpation above the symphysis pubis has the most immediate implications for this post-op client. Urinary retention is possible complication of colporrhaphy and a firm and tender abdomen above the symphysis pubis is an indication of urine retention. The priority intervention for acute urinary retention is catheterization. A community based nurse receives a client referral. Which of the following actions should be performed first? Select one: a. Encourage the client to contact appropriate agencies. b. Obtain information about community resources accessible to the client. c. Collaborate with the health care team and the referring agency to assess client needs. d. Educate the client about the community resources that are available c. Collaborate with the health care team and the referring agency to assess client needs. The nurses who receive the referrals need to work collaboratively with the health care team and the referring agency or persons. Continuous coordinated care among all health care providers involved in a client's care is essential to avoid duplication of effort by the various personnel caring for the client. Understanding client needs is the first step in the referral process. The nurse manager observes a nurse placing several packages of suction catheters in her pocket to use as the nurse provides treatments to several clients with tracheostomies. Which of the following recommendations should the nurse manager make? Select one: a. Leave suction catheters in the supply room until needed b. Store suction catheters in a dedicated space at client's bedside c. Carry catheters in pocket but note how many catheters are used for each client d. Place suction catheters in a treatment tray rather than in a pocket b. Store suction catheters in a dedicated space at client's bedside Storing suction catheters in a dedicated space at client's bedside is the best choice. While the cost of supplies must be considered, clients with new tracheostomies for example require frequent suctioning and the client may be placed in jeopardy if the necessary equipment is not readily available. Resource allocation is a responsibility of the unit manager as well as every practicing nurse. Providing cost-effective client care should be balanced with quality care. A nurse is charting the morning assessments on the computer when a client calls for assistance from his room. What actions should the nurse take next? Select one: a. Complete the charting before assisting the client. b. Log off of the computer before responding. c. Take the computer to the client's door while assisting him. d. Have an assistive personnel stay with the computer. b. Log off of the computer before responding. The nurse should always log off the computer when leaving the terminal to protect her user name as well as to protect client information. A nurse is managing the nursing staff on a medical- surgical unit. When evaluating client care, which of the following statements represents correct implementation of the five rights of delegation by the nursing staff? Select one: a. A licensed practical nurse creates the nursing care plan for a client experiencing post-operative pain 2 days after an appendectomy. b. A licensed practical nurse delegates to the assistive personnel to teach the client about ambulating with a walker before discharge. c. An RN asks the assistive personnel to record the intake and output of a client who is admitted to the unit with heart failure. d. An RN asks the licensed practical nurse to administer total parenteral nutrition to a client who had minor surgery 2 days ago. c. An RN asks the assistive personnel to record the intake and output of a client who is admitted to the unit with heart failure. A nurse is triaging clients after a tornado disaster. A 22-year-old client being triaged has asymmetrical chest movement, shortness of breath and absent lung sounds on the left side. What category of triage should the nurse place this client at? Select one: a. Nonurgent Class III b. Emergent Class I c. Expectant Class IV d. Urgent Class II b. Emergent Class I This client has manifestations of a pneumothorax and needs immediate treatment with a chest tube to re-expand lung. c. Expectant Class IV Which of the following situations demonstrate a violation of the ethical principle veracity? Select one: a. A nurse tells a client that she will be back at 9am but doesn't return until 11am. b. A nurse tells a client that a medication will relieve pain when she knows that it will not. c. A nurse attempts an IV insertion at a site where no vein is seen or felt. d. A nurse does not allow a client to refuse a treatment. b. A nurse tells a client that a medication will relieve pain when she knows that it will not. Veracity - the nurse's duty to tell the truth. HESI LEADERSHIP MANAGEMENT PROCTORED EXAM VERSION 1 Leadership and Management Alternate Item Format Quiz urse is planning discharge rventions designed to promote and ntain independence and maintain lth for a child with a spinal cord injury I). Which of the following interventions appropriate? ect all that apply. ect one or more: ncouraging annual flu vaccinations iscussing sexuality issues ssessing food choices romoting an exercise program valuating bowel training a. Encouraging annual flu vaccinations c. Assessing food choices. d. Promoting an exercise program e. Evaluating bowel training An SCI client should take measures to prevent illnesses such as receiving the flu or pneumonia vaccination. The nurse should promote a high fiber diet with increased fluid intake to assist with bowel and bladder training. At discharge an appropriate intervention would be to evaluate food choices made by the client. The nurse should make certain that structured exercise is provided through physical or occupational therapy to promote strength and endurance. Effective bowel training that allows the client to be continent of stool with foster in dependence in the SCI client. ording to the American Hospital ociation's Patient Care Partnership, nurse understands that client rights in health care setting include which of following? Select all that apply. ect one or more: lient involvement in the plan of care ssistance with childcare ngements elp with billing and filing insurance ms rrangements for home follow-up visits reparation for discharge a. Client involvement in the plan of care c. Help with billing and filing insurance claims e. Preparation for discharge The Patient Care Partnership identifies high quality of care, protection of client privacy, involvement in care, help when leaving the hospital, and help with billing claims as client rights during a hospital stay. urse is delegating client care. Which of following leadership functions are ociated with delegation? Select all that ly. ect one or more: unction as a resource person in egating tasks to subordinates. ommunicate insistently when egating tasks. se delegation as a time management tegy. dentify situations appropriate for egation. a. Function as a resource person in delegating tasks to subordinates. c. Use delegation as a time management strategy. d. Identify situations appropriate for delegation. Functioning as a role model, supporter, and resource person in delegating tasks to subordinates are leadership functions that are associated with delegation. Assisting followers to use delegation as a time management strategy and team- building tool is considered an effective leadership function. Assisting followers in identifying situations appropriate for delegation is considered an effective leadership function. e. Display indifference to how a cultural phenomenon affects transcultural delegation. harge nurse is managing a conflict ween co-workers. Which of the a. Pursue alternative dispute resolutions when conflict cannot be resolved. owing are effective management ctions for conflict resolution? Select all t apply. ect one or more: ursue alternative dispute resolutions en conflict cannot be resolved. btain needed unit resources through ctive negotiation strategies. uppress the need for closure and ow-up to negotiation. reate a work environment that imizes the conditions for conflict. void facilitating conflict resolution olving subordinates. b. Obtain needed unit resources through effective negotiation strategies. d. Create a work environment that minimizes the conditions for conflict. Pursuing alternative dispute resolutions when conflict cannot be resolved by using traditional conflict management strategies is a critical leadership skill for conflict resolution. Obtaining needed unit resources through effective negotiation strategies is a critical leadership skill for conflict resolution. Creating a work environment that minimizes the conditions for conflict is a critical leadership skill for conflict resolution. urse is supervising a graduate nurse. nurse evaluates the client care the duate nurse provides by doing which he following? Select all that apply. ect one or more: valuates the nurse's goals. rovides feedback to the nurse. einforces client education. ntervenes if necessary. etermines if client outcomes were t. b. Provides feedback to the nurse. d. Intervenes if necessary. e. Determines if client outcomes were met. The supervising nurse will provide feedback to the graduate nurse when necessary and appropriate. The supervising nurse will intervene as necessary if unsafe clinical practices are identified. The supervising nurse will determine if client outcomes were met. urse has received an inappropriate ignment. Which of the following ons should the nurse take? Select all t apply. ect one or more: ring the inappropriate assignment to attention of the charge nurse. a. Bring the inappropriate assignment to the attention of the charge nurse. c. File an unsafe staffing complaint with the appropriate personnel. The nurse should bring the inappropriate efuse the assignment and report to nurse manager. ile an unsafe staffing complaint with appropriate personnel. ccept the assignment and complete ks as comfortable. elegate care of the assigned client(s) nother nurse. assignment to the attention of the scheduling/charge nurse and negotiate a new assignment at the beginning of their shift. An unsafe staffing complaint should be filed with the appropriate personnel if there is no satisfactory resolution of the assignment after reporting it to the charge nurse. staff members have called in sick on medical-surgical unit and no itional help is available. The aining team members consist of an an LPN and unlicensed assistive sonnel (UAP). Which of the following uld be considered by the nurse when king client assignments? Select all that ly: ect one or more: ssess and verify the competency of health care team. dentify what tasks are appropriate to egate for each specific client. ssess the health status and plexity of care required by the client. ontinually provide supervision, either ctly or indirectly, to the team. valuate client needs to determine if igned nurse can meet plan of care comes. a. Assess and verify the competency of the health care team. b. Identify what tasks are appropriate to delegate for each specific client. c. Assess the health status and complexity of care required by the client. Using the five rights of delegation to decide and assign client care formalizes the use of professional judgment and critical thinking skills. Assessing and verifying the competency of the health care team considers the right person being assigned a client that is within their scope of practice. Using the five rights of delegation to decide and assign client care formalizes the use of a professional judgment and critical thinking skills. Identify what tasks are appropriate to delegate for each specific client is realizing the right task for the team member. Using the five rights of delegation to decide and assign client care formalizes the use of professional judgment and critical thinking skills. Assessing the health status and complexity of care required by the client considers the right circumstance for the team member to deliver effective care. urse is working in the Emergency artment (ED). In which order should following clients be triaged? 0-year-old male reporting shortness of ath. 8-year-old male with a possible tured tibia. 4-year-old female with a swollen and ised ankle. 0-year-old female with high fever and ductive cough. ect one: , 4, 3, 1 , 4, 2, 3 , 2, 4, 1 , 4, 3, 1 b. 1, 4, 2, 3 Rationales: 1. Shortness of breath is considered an emergent triage category and implies that a condition exists that poses an immediate threat to life or limb. This client would be seen first. 4. High fever and productive cough would raise suspicion of pneumonia. New onset of pneumonia is considered an urgent triage category. This implies that the client should be treated quickly, as long as respiratory failure does not appear imminent. 2. A possible fractured tibia is considered an urgent triage category. This implies that the client should be treated quickly. 3. A swollen and bruised ankle is considered non-urgent. The client can generally wait for several hours without a significant risk of clinical deterioration. urse is caring for a client experiencing anaphylactic reaction. List the owing interventions to be taken by the se in order beginning with highest rity. dminister epinephrine IVP each the client to carry an EpiPen at imes egin an intravenous infusion with % sodium chloride stablish a patent airway. dminister diphenhydramine IVP ect one: , 3, 1, 5, 2 , 3, 2, 4, 1 , 2, 5, 4, 1 , 4, 5, 1, 3 a. 4, 3, 1, 5, 2 - Airway is always the highest priority if there is the possibility of a compromised airway. - An intravenous line will be necessary to administer emergency drugs. - Epinephrine is the drug of choice for the treatment of anaphylaxis. The medication is administered every 10 to 15 minutes until the reaction has subsided. Epinephrine is given for its vasoconstrictive action. - Benadryl (Diphenhydramine) blocks histamine release and reduces capillary permeability. - Teaching is important to prevent or treat further reactions, but this will be done after the crisis period is over. HESI LEADERSHIP Proctored Exam VERSION 2 1. A nurse manager is preparing to institute a new system for scheduling staff. Several nurses have verbalized their concern over the possible changes that will occur. Which of the following is an appropriate method to facilitate the adoption of the new scheduling system? A. Identify nurses who accept the change to help influence other staff nurses B. Provide a brief overview of the new scheduling system immediately before it implementation C. Introduce the new scheduling system by describing how it will save the institution money D. Offer to reassign staff who do not support the change to another unit 2. A client who is febrile is admitted to the hospital for treatment of pneumonia. In accordance with the care pathway, antibiotic therapy is prescribed. Which of the following situations requires the nurse to complete a variance report with regard to the care pathway? A. Antibiotic therapy was initiated 2 hr after implementation of the care pathway B. A blood culture was obtained after antibiotic therapy has been initiated C. The route of antibiotic therapy on the care pathway was changed from IV to PO D. An allergy to penicillin required an alternative antibiotic to be prescribed. 3. A nurse should recognize that an incident report is required when A. A client refuses to attend physical therapy B. A visitor pinches his finger in the client‟s bed frame C. A client throws a box of tissues at a nurse D. A nurse gives a med 30 min late 5. Client satisfactory surveys from a med-surg unit indicate the pain is not being adequately relieved during the first 12 hr post-opt. The unit manager decides to identify post-opt pain as a quality indicator. Which of the following data sources will be helpful in determine the reason why clients are not receiving adequate pain management after surgery? A. Prospective chart audit B. Retrospective chart audit C. Postoperative care policy D. Pain assessment policy 6. A nurse precepting a newly licenced nurse who is caring for a client who is confused and has an IV infusion. The newly licensed nurse has placed the client in wrist restraints to prevent dislodging the IV catheter. Which of the following questions should the precepting nurse ask? A. “Did you secure the restraints to the side rails of the bed?” B. “Are you able to insert two fingers between the restraint and the client‟s skin?” C. “Did you tie the restraints using double knot?” D. “Are you removing the client‟s restraints every 4 hr?” 7. A nurse is caring for an older adult client who has stage III pressure ulcer. The nurse request a consultation with the wound care specialist. Which of the following actions by the nurse is appropriate when working with a consultant? A. Arrange the consultation for time when the nurse is caring for the client is able to be present for consultation B. Provide the consultant with subjective opinions and beliefs about the client‟s wound care C. Request the consultation after several wound care treatment tried D. Arrange for the wound care nurse specialist to see the client daily to provide the recommended treatment 8. A client is admitted wit TB and placed in a negative pressure room. Which of the following actions is appropriate? A. Notify the local health department of the admission B. Place a sign on the client‟s door with the diagnosis C. Ensure that admitting staff undergo PPD skin tests D. Determine who had contact with the client in the last 48 hr 9. A nurse is caring for a client who is unconscious and whose partner is health care proxy. The partner has spoken with the provider and wishes to discontinue the client‟s feeding tube. The provider states the nurse, “I will not discontinue the client‟s treatment. His partner has no right to make decisions regarding the client‟s care. “Which of the following responses by the nurse is appropriate? A. You should consider speaking with the facility‟s ethics committee before making your decision B. You have the right to make decision, even if the partner is the client‟s health care proxy C. The client has designated his partner as health care proxy in his advance directives D. We‟ll need to have the nursing supervisor review the client‟s advance directives 10. A nurse is caring for a client who has increased intracranial pressure and is receiving IV corticosteroids. Which of the following info is most important for the nurse to report at shift change? A. Gasglow Coma scale score B. Most recent blood glucose reading C. Lab test scheduled for next shift D. Reddened area on the coccyx 11. A nurse is assigned the following four clients for the current shift. Which of the following clients should the nurse assess first? A. A client who has a hip fracture and is in Buck‟s traction B. A client who has aspiration pneumonia and a respiratory rate of 28/min C. A client who has diabetes mellitus stage 2 pressure ulcer on his foot D. A client who has a C diff infection and needs a stool specimen collected 12. A nurse is caring for a client who fell and is reporting pain in the left hip with external rotation of the left leg. The nurse has been unable to reach the provider despite several attempts over the past 30 min. Which of the following actions should the nurse take? A. Notify the nursing supervisor about the issues B. Contact the client‟s physical therapist C. Apply a warm compress to the hip D. Reposition the client for comfort 13. The mother of a client with breast cancer states, it‟s been hard for her, especially after losing her hair. And it has been difficult to pay for all the treatments. Which of the following actions is appropriate client advocacy? A. The nurse investigates potential resources to help the client purchase wig B. The nurse explains to the mother that most clients with cancer lose their hair C. The nurse informs the next shift nurse regarding the mother‟s concerns. D. The nurse suggests counseling for the client‟s body image issues 14. Which of the following items must be discarded in a biohazard waste receptacle? A. A urinary catheter drainage bag from a client who is post-opt B. A bed sheet from a client with bacterial pneumonia C. A perineal pad from a client who is 24-hr post-vaginal delivery D. An empty IV bag removed from a client who has HIV 15. A nurse tells the unit manager, “I am tired of all the changes on the unit. If things don‟t get better, I‟m going to quit. “Which of the following responses appropriate? A. “So you are upset about all the changes on the Unit” B. “I think you have a right to be upset, I am tired of the changes too” C. “Just stick with it a little longer. Things will get better soon D. “ You should file complaints with hospital administrator 16. According to the HIPAA regulations, which of the following is a violation of client confidentiality? A. Telephone the pharmacy with a prescription for the spouse to pick up B. Providing a copy of the record to the transporting paramedic C. Reporting a client‟s disposition to the referring provider D. Informing housekeeping staff that the client is in dialysis unit 17. A Nurse preceptor is evaluating a newly licensed nurse‟s competency in assisting with a sterile procedure. Which of the following actions indicates the nurse is maintaining sterile technique? (Select all that apply.) A. Open the sterile pack by first unfolding the flap farthest from her body B. Rests the cap of a solution container upside down on the sterile field field C. Removes the outside packaging of a sterile instrument before dropping into the sterile D. Holds a bottle of a sterile solution 15 cm (6 inches) above the sterile field E. Places sterile items within 1.25 cm (0.5 inch) border around the edge of the sterile field 18. A nurse is providing care for 4 post-opt clients. The nurse should first assess the client A. Whose pulse has been steadily increasing during the past shift B. Who is reporting a pain level of 8 on a scale of 0 to 10. C. Whose urine output averaged 32 ml/hr for the past 24 hr D. Who is reporting nausea after the prescribed antiemetic was administered 19. A nurse is preparing to transcribe a client‟s med prescription in the medical record. Which of the following should the nurse recognize as containing the essential components of a medication order? A. NPH insulin 10 Units before and at bedtime B. Haloperidol (Hadol) 1mg per mouth C. Multivit every morning by mouth D. Aspirin 650 mg by mouth every 4hr 20. A nurse is assisting with orientation of a newly licensed nurse. The newly licensed nurse is having trouble focusing and has difficulty completing care for his assigned clients. Which of the following interventions is appropriate? A. Recommend that he takes time to plan at the beginning of shift B. Advise him to complete less time-consuming tasks first C. Ask other staff members to take over some of his staffs D. Offer to provide care for his clients while he takes a break 21. A nurse in an urgent care clinic is admitting a client who has been exposed to a liquid chemical in an industrial setting, which of the following actions should the nurse take first? A. Remove the client‟s clothing B. Irrigate the exposed area with water C. Report the incident to OSHA Don personal protective equipment. 22. A facility provides annual staff education regarding ethical practice. A charge nurse recognizes a need for further education when which of the following behaviors is observed? A. A nurse refuses to actively participate during an elective abortion procedure scheduled for her client. B. A nurse gives prescribed opioids to a client who has a terminal illness and respirations of 8/min C. A nurse explains to a client‟s family that a DNR order includes withholding comfort measures D. A nurse informs a confused client who wants to go home that he is going to stay at the facility until he is better 23. A nurse is an ambulatory care setting is orienting a newly licensed nurse who is preparing to return a call to a client. The nurse should explain that which of the following is an objective of tele health? A. Assessing client needs B. Providing med reconciliation C. Establishing communication between providers D. Developing client treatment protocols 24. Which of the following put a hospital at the highest risk of infringement of client record confidentiality? A. A nurse clusters documentation of care for multiple clients? B. A provider and nurse access client info using one access code C. Paper-based charts are stored at the nurse‟s station D. A nurse performs electronic documentation outside a client‟s room 25. Which of the following observations requires a charge nurse to intervene and demonstrate safe handling techniques? A. A nurse cleans up blood spill with a 1:10 bleach solution B. A nurse uses googles to perform tracheostomy suctioning C. A nurse disconnects an indwelling urinary catheter from the drainage bag to collect a specimen D. A nurse places a mask on a client with TB before transport to the radiology department 26. Which of the following should lead a nurse to suspect abuse that must be reported? A. A school-age child has several bruises on her lower legs. B. A toddler cries whenever his parents enters the hospitals room. C. An Adolescent admitted to the emergency won‟t speak to his parents D. A preschool child who was previously toilet trained now requires diapers in the hospital 27. A parish nurse is making referral to a community meal delivery program for a member of the congregation. This is an example of which of the following functions of the parish nurse? A. Liaison B. Pastoral care provider C. Health educator D. Personal Health counselor 28. A nurse performing triage during a mass casualty incident should recognize that which of the following clients should be transported to the hospital first? A. A client who reports substernal chest pain radiating to the neck ????? B. A client who has an open fracture of the femur C. A client who has a 4-inch laceration on the forearm D. A client who has a penetrating head injury and fixed dilated pupils 29. 29. 30. A nurse manager overhears a provider and a staff nurse talking about a client‟s diagnosis in the cafeteria. Which of the following actions should the nurse take first? A. Provide a staff in-service about client confidentiality B. Report the incident to the nursing supervisor C. Remind them that the client info is confidential ???????? D. Fill out an incident report regarding the situation 31. A client has a substance use disorder is admitted to the mental health Unit and reports that he has been depressed lately. When preparing for discharge the next day, the client states: “It‟s Ok. Soon everything will be just fine.” Which of the following is the nurse‟s primary first action? A. Ask the client if he has considered hurting himself B. Provide the client with info about Alcoholics Anonymous C. Encourage the client to participate in physical activities D. Reinforce the need to follow up with the discharge referral 32. A nurse is caring for a client who reports acute pain but refuses IM medication. The nurse distracts the client and quickly administer the injection. This illustrate which of the following? A. False imprisonment B. Battery C. Assault D. Libel 33. A nurse manager smells alcohol on the breath of a nurse who is starting a shift. Which of the following actions should the nurse manager take first? A. Report the situation to the director of nursing B. Have a blood alcohol level drawn from the nurse C. Document a factual description of the situation D. Remove the nurse from the unit 34. A nurse observes a paper bag at the bedside of a client. This finding suggest that the client is receiving treatment for which of the respiratory disorders A. Asthma B. Hyperventilation C. Stidor D. Atelectasis 35. A nurse is preparing the discharge a client back to a long-term care facility after he was admitted to an acute care facility 2 days ago for pneumonia. Which of the following information should the nurse include in the verbal transfer report? A. Lab results within the expected reference range B. List of regularly prescribed meds C. Date of last bowel movement D. Level of consciousness 36. A nurse who is precepting a newly licensed nurse is discussing the client assignment for the shift. Which of the following actions should the nurse preceptor take first to demonstrate appropriate time management? A. Review the client‟s new lab values B. Document assessment data C. Complete required tasks D. Determine client care goals 37. A nurse manager is reviewing isolation guidelines with a newly licensed nurse. Which of the following statements by the newly licensed indicates understanding of isolation guidelines? A. I will instruct visitors to wear a mask when visiting a client who is on contact precaution B. I will place a client who has compromised immunity in a negative- pressure airflow room C. I will wear N-95respirator mask when caring for a client who is on droplet precaution D. I will have a client who is on airborne precautions wear a mask when out of her room 38. A charge nurse is delegating tasks to the staff on the unit. Which of the following tasks is appropriate to delegate to a licensed practical nurse? A. Changing the dressing on a postoperative wound B. Referring a client to social services for assistance with transportation C. Instructing a client who is obese about a low-fat diet D. Providing the first oral feeding to a client following a stroke 39. A case manager working in a rehabilitation unit is discharging to home a client who a spinal cord injury level C-7. Which of the following is the priority action creating the discharge plan? A. Select strategies for cost-effective home care B. Identify the client‟s ability to perform activities of daily living C. Provide educational handouts related to care requirements. D. Recommend community resources available to assist with client care. 40. A nurse is preparing to complete morning assessments on several assigned clients. Which of the following clients should the nurse plan to assess first? A. A client who has a nasogastric tube to intermittent suction and reports nausea B. A client who has an early morning blood glucose of 220 mg/dl C. A client who had a bladder scan that indicated 250 ml of urine in the bladder D. A client who is 3 days post-opt & whose dressing has serosanguinous drainage 41. A nurse is making shift assignments in a hospital. Which of the following tasks is appropriate to assign to a licensed practical nurse? A. Plan break times for assistive personnel. B. Pick up the meal trays after lunch. C. Administer a nasogastric tube feeding. D. Determine adequacy of ventilator settings 42. An RN is planning client assignments for a licensed practical nurse (LPN) and three assistive personnel. The RN should assign the LPN to the client who requires A. Recording of daily intake and output B. Assistance with meals C. A complete bed bath D. Frequent dressing changes 43.43. 44. A nurse is caring for 4 clients. Which of the following tasks can be delegated to an assistive personnel? A. Assessing a client who just returned from hemodialysis B. Reviewing dietary instructions for a client with kidney stones C. Obtaining a stool sample from a client with renal failure D. Monitoring a client with a fluid restriction 45. A charge nurse is making rounds observes that an assistive personnel (AP) has applied wrist restraints to a client who is agitated and does not have a prescription for restraints. Which of the following actions should the nurse take first? A. Inform the unit manager of the incident B. Remove the restraints from the client‟s wrists. C. Speak with the AP about the incident D. Review the chart for non-restraint alternatives for agitation. 46. A client is brought to the emergency department (ED) following a motor-vehicle creash. Drug use is suspected in the crash, and a voided urine specimen is ordered. The client repeatedly refuses to provide the specimen. Which of the following is the appropriate action by the nurse? A. Document the client‟s refusal in the chart B. Tell the client that a catheter will be inserted C. Obtain a provider‟s prescription for a blood alcohol level. D. Assess the client for urinary retention. 47. Nurses on an impatient care unit are working to help reduce unit costs. Which of the following is appropriate to include in the cost-containment plan? A. Use clean gloves rather than sterile gloves for colostomy care. B. Wait to dispose of sharps containers until they are completely full. C. Return unused supplies from the bedside to the unit‟s supply stock. D. Store opened bottles of normal saline in a refrigerator for up to 48 hr. 48. An older adult client is awaiting surgery for a fractured right hip. The nurse should recognize that which of the following can be delegated to an assistive personnel? A. Turning the client B. Recording the client‟s vital signs C. Determining the client‟s pain level D. Checking the pulses of the client‟s right foot. 49. To resolve a conflict between staff members regarding potential changes in policy, a nurse manager decides to implement the changes she prefers regardless of the feelings of those who oppose those changes. Which of the following conflict-resolution strategies in the nurse manager using? A. Compromising B. Collaborating C. Cooperating D. Competing 50. A charge nurse on an obstetrical unit is preparing the shift assignment. Which of the following clients should be assigned to an RN who has floated from a med-surg unit? A. A client who has gestational diabetes and is receiving biweekly nonstress tests B. A primigravida client who is 1 day post-opt following a cesarean section and has a PCA pump C. A multigravida client who has preemclampsia and is receiving mistoprostol (Cytotec) for induction of labor. D. A client who is at 32 weeks of gestation and has premature rupture of membranes. 51. A nurse working on a med-surg unit is managing the care of 4 clients. The nurse should schedule an interdisciplinary conference for which of the following clients? A. A client who is at risk for pressure ulcers and has an albumin of 4.2 g/dl B. A client who has type 1 DM and uses insulin pump C. A client who has orthostatic hypotension and is receiving IV fluids. D. A client who is receiving heparin and has an aPTT of 34 seconds 52. A charge nurse is assessing staff knowledge about safety procedures regarding needlestick injuries. Which of the following statements by a nurse indicates appropriate understanding of these safety procedures? A. Prophylatic treatment should be initiated after a needlestick during preparation of an injection B. I should stop the bleeding as soon as possible following a needlestick injury C. An incident report should be completed if a client receives a stick from her own used needle D. The needle should be recapped to prevent injury during transport to the biohazard container. 53. A nurse on a medical surg Unit is caring for a group of clients with the assistance of a licensed practical nurse (LPN) and an assistive personnel. Which of the following taks should the nurse assign to the LPN A. Obtaining a urine specimen from an older adult client B. Providing postmortem care for a client who has just died C. Accompanying a client who just had a wound debridement to physical therapy D. Reinforcing dietary teaching with a client who has heart disease 54. A nurse enters the room of a client who is unconscious and finds that the client‟s son is reading her electronic medical records from a monitor located at the bedside. Which of the following actions should the nurse take first? A. Recommend the son meet with the provider to get info about his mother‟s condition B. Complete an incident report regarding the breach of the client‟s confidentiality C. Log out of the computer so that the client‟s son is unable to view his mother‟s info D. Report the possible violation of client confidentiality to the nurse manager 55. A home health nurse is assessing the home environment of a client who is on continuous oxygen therapy. Which of the following findings requires the nurse to intervene? A. The oxygen machine has a grounded plug ????????? B. The family keeps a spare oxygen tank in the room C. The window of the client‟s room are open D. The client is covered with a woolen blanket Rationale: Oxygen therapy safety precaution: Avoid materials that generate static electricity, such as woolen blankets and synthetic fabrics. Advise clients and caregivers to wear cotton fabrics and use cotton blankets. 56. A nurse is teaching a client how to use a finger stick glucometer at home. Which of the following instruction should the nurse include? A. Elevate the arm for 1 min before taking the blood sample B. Cap the lancet prior to putting it in in the trash C. Obtain the blood sample from the finger pads. D. Warm the hands prior to piercing the skin 57. A nurse in the emergency department is preparing to care for a client who arrived via ambulance. The client is disoriented and has a cardiac arrhythmia. Which of the following actions should the nurse take? A. Contact the client‟s next of kin to obtain consent for treatment. B. Proceed with treatment without obtaining written consent C. Have the client sign a consent for treatment. D. Notify risk management before initiating treatment. 58. A client has a new permanent pacemaker inserted. Which of the following home care instructions should the nurse include? A. The client should avoid using microwave oven to heat food ???????? B. Regular programming evaluations can be conducted by telephones C. The client should avoid using remote control devices to prevent dysrhythmias D. Suctioning could cause the unit to have an electrical shock. 59. While auditing the medical records of clients currently on an oncology unit, the nurse manager finds that 6 of the 15 records lack documentation regarding advance directives. Which of the following is the priority action for the nurse to take? staff. A. Reinforce the potential consequences of not having this info on record to the nursing B. Ask the nurses who are caring for clients without this info in the medical record to obtain it. C. Meet with nursing staff to review the policy regarding advance directives. D. Remind nurses to obtain this info during the admission process. 60. A client is admitted with COPD. Which of the following findings should the nurse report to the provider? A. Oxygen saturation 89% on room air. B. WBC‟s count 9,000/mm C. Report of dyspnea on exertion D. Bilateral crackles on auscultation of lungs. 61. A charge nurse notices 2 staff nurses are not taking meal breaks during 8-hr shifts. Which of the following actions should the nurse take first? A. Provide coverage for the nurse‟s breaks. B. Determine the reasons the nurses are not taking scheduled breaks. C. Discuss tie management strategies with the nurses. D. Review facility policies for taking scheduled breaks. 62. A nurse is caring for a client who has anorexia nervosa. Which of the following interdisciplinary team members should be consulted in regard to this client‟s care? (Select all that apply.) A. Occupational therapist B. Nutritional therapist C. Physical therapist D. Mental Health counselor E. Case manager 63. A nurse manger is reviewing guidelines for informed consent with the nursing staff. Which of the following statements by a staff nurse indicates that the teaching was effective? A. Guardian consent is required for an emancipated minor B. Consent can be given by a durable power of attorney. C. A family member can answer any questions the client has about the procedure. D. The nurse can answer any questions the client has about the procedure 64. A nurse on a medical-surg unit is caring for 4 clients. This nurse should recognize that which of the following clients is the highest priority? A. A client who is newly diagnosed with pancreatic cancer and is scheduled to begin IV chemotherapy. B. A client who has peripheral vascular disease and has absent pedal pulse in right foot. C. A client who is post-opt following a laminectomy 12 hr ago and is unable to void. D. A client who has methicillin-resistant Staphylococcus Aureus (MRSA) and has an axillary temp of 38 degree C ( 101 F) 65. A client scheduled for a tubal ligation procedure starts to cry as she wheeled into the surgical suite. Which of the following nursing statements is an appropriate nursing response? A. It‟s not too late to cancel the surgery if you want to B. This won‟t take long and it will be over before you know it. C. Why did you make the decision to have this procedure D. You shouldn‟t be worried because the procedure is very safe 66. A nurse working in the emergency department is assessing several clients. Which of the following clients is the highest priority? A. A client who has a raised red skin rash on his arms, neck, and face B. A client who reports right-sided flank pain and is diaphoretic C. A client who reports shortness of breath and left neck and shoulder pain D. A client who has active bleeding from a puncture wound of the left groin 67. A nurse is working on a quality improvement team that is assessing an increase in client falls at the facility. After problem identification, which of the following actions should the nurse plan tot ake first of the quality improvement process? A. Review current literature regarding client falls. B. Implement a fall prevention plan C. Notify staff of the increased fall rates D. Identify clients who are at risk for falls 68. A nurse is evaluating a newly licensed nurse who is administering a vitamin K (Aquamephytoin) injection to a newborn. Which of the following actions by the newly licensed nurse indicates understanding of the teaching? (Select all that apply.) A. Selects the dorsogluteal site to administer the injection B. Cleans the injection site with alcohol C. Applies gentle pressure at the site after injection D. Aspirate the syringe for blood return after needle insertion E. Inserts the needle at a 45 degree angle. 69. A nurse enters a client‟s room and observes a fire in a trash can. Identitfy, the sequence of actions the nurse should take. ( Move all the actions into the box on the right, placing them in the selected order performance.) 1. Remove the client from the area 2. Activate the fire alarm system 3. Confine the fire by closing doors and windows 4. Extinguish the fire if possible 70. Which of the following actions taken by a nurse constitutes battery? A. Failing to put up side rails on a confused client‟s bed B. Telling a client who refused his oral medication that he will be given an injection C. Inserting a feeding tube against the wishes of a client who refuses to eat D. Threatening to apply wrist restraints to control a client who is agitated Leadership & Management Chapter 1 Questions VERSION 3 1. A nurse enters the room of a client and finds the client lying on the floor. Which of the following actions should the nurse take first? A) Call the provider. B) Ask a staff member for assistance getting the client back in bed. C) Inspect the client for injuries. D) Instruct the client to ask for help if they need to get out of bed. 2. An RN on a medical-surgical unit is making assignments at the beginning of the shift. Which of the following tasks should the nurse delegate to the PN? A) Obtain vital signs for a client who is 2 hr post procedure following a cardiac catheterization. B) Administer a unit of packed red blood cells (RBCs) to a client who has cancer. C) Instruct a client who is scheduled for discharge in the performance of wound care. D) Develop a plan of care for a newly admitted client who has pneumonia. 3. A PN ending their shift reports to the RN that a newly hired AP has not calculated the intake and output for several clients. Which of the following actions should the RN take? A) Complete an incident report. B) Delegate this task to the PN. C) Ask the AP if they need assistance. D) Notify the nurse manager. 4. A nurse manager is developing an orientation plan for newly licensed nurses. Which of the following information should the manager include in the plan? (Select all that apply.) A) Skill proficiency B) Assignment to a preceptor C) Budgetary principles D) Computerized charting E) Socialization Into Unit Culture F) Facility policies and procedures 5. A nurse manager is providing information about the audit process to members of the nursing team. Which of the following information should the nurse manager include? (Select all that apply.) A) A structure audit evaluates the setting and resources available to provide care. B) An outcome audit evaluates the results of the nursing care provided C) A root cause analysis is indicated when a sentinel event occurs. D) Retrospective audits are conducted while the client is receiving care. E) After data collection is completed, it is compared to a benchmark. 6. A nurse is participating in a quality improvement study of a procedure frequently performed on the unit. Which of the following information will provide data regarding the efficacy of the procedure? A) Frequency with which procedure is performed B) Client satisfaction with performance of procedure C) Incidence of complications related to procedure D) Accurate documentation of how procedure was performed 7. A nur