Professional Nursing Concepts 3 > Leadership > Flashcards
Leadership Flashcards
What are the 5 rights of delegation?
- Right task
- Right circumstances
- Right person
- Right direction and communication
- Right supervision
When delegating to a UAP, what should the nurse make sure of first?
The task must be considered routine or this patient, not require substantial scientific knowledge or technical skills, be considered safe for this patient, and have predictable outcomes.
What should the nurse clearly communicate to the UAP when delegating?
- Specific tasks to be done for each patient
- When each task is to be done
- Expected outcomes for each task
- Who is available as a resource if needed
- When and in what format a task report will be completed.
What tasks may be delegated to a UAP?
- VS, I and O’s
- Transfers and ambulation
- Postmortem care
- Bathing and feeding
- Gastrostomy feedings in established systems
- Attending to safety
- Weighing
- Performing simple dressing changes
- Suctioning of chronic tracheostomy’s
- Performing basic life support
What tasks may not be delegated to a UAP?
- Assessments, interpreting data, nursing diagnosis
- Creating a care plan
- Evaluating care effectiveness
- Care of invasive lines
- Administering parenteral meds
- Inserting NG tubes
- Patient education
- Performing triage
- Giving telephone advice
What are the steps to the delegation process?
- Define the task
- Deciding on the delegate
- Describing the task
- Reaching an agreement
- Monitoring performance and providing feedback
What does a nurse do as a case manager?
- Organizes patient care by diagnosis-related groups
- Requirements
- Function of nursing case managers
Define autocratic leadership
Belief that individuals externally motivated, incapable of independent decision making
Define democratic leadership style
A leader as a catalyst facilitator
Define a laissez-faire leadership style
Hands-off approach
Presupposes group is internally motivated
Define a bureaucratic leadership style
Relies on organization’s rules, policies, and procedures
Define a situational leadership style
- Flexible in task, relationship behaviors
- Considers staff’s abilities
- Knows nature of task to be done
- Is sensitive to context in which task takes place
Define a charismatic leadership style
Charming personality evokes feelings of commitment in followers
Define transactional leadership style
Relationship with followers based on exchange for valued resource
Define transformational leadership style
Fosters creativity, risk taking, commitment, collaboration with clear and attainable goal
Define shared leadership
No one individual has knowledge or ability beyond other members
Define shared governance
Aims to distribute decision making among a group of people
Which of the following clients can be assigned to UAP?
- Client with stable pulmonary artery pressure after a mitral valve replacement
- Client on bed rest with bathroom privileges and negative troponin and CK-MB levels
- Client admitted with chest pain to rule out a myocardial infarction
- Client requiring discharge and wound care teaching after a coronary artery bypass surgery
The correct answer is:
The correct answer is: Client on bed rest with bathroom privileges and negative troponin and CK-MB levels
The client with negative troponin and CK-MG levels rule out an MI and can be safely cared for by the UAP.
The client with a pulmonary artery catheter requires close monitoring by a nurse
the client with chest pain requires close monitoring and interventions by a nurse
client teaching is performed by the nurse.
The staffing office notified the charge nurse that one of the nurses scheduled to work has called in sick. The available staff now includes one RN and two UAP for a team of eight clients. Which of the following clients should be reassigned to the RN?
- Client diagnosed with Addison disease 2 days
- Client with chronic renal failure who is to be discharged today
- Client admitted at 2000 yesterday with dehydration related to diarrhea
- Client admitted today at 1100 with hypokalemia and first-degree heart block
The correct answer is: Client admitted today at 1100 with hypokalemia and first-degree heart block
The client with hypokalemia combined with neck pain requires assessment and intervention by an RN.
The UAP can take care of the other clients with assistance from the RN as required.
A nurse is responsible for supervising staff on a unit that includes registered nurses (RNs), licensed practical nurses (LPNS) and unlicensed assistive personnel (UAP). Which statement is related to the supervision of staff as opposed to the delegation of tasks?
- Statement to another RN: “please start an IV on Mr. Smith in room 458.”
- Statement to an LPN: “Please give 8:00 am meds to the client in 322”
- State to a UAP: “Please answer the call light for the client in 321.”
- Statement to a health unit coordinator: “There are new orders on Mr. Jone’s chart that need to be entered”
The correct answer is: Statement to a health unit coordinator: “There are new orders on Mr. Jone’s chart that need to be entered.”
Supervision is the initial direction and periodic evaluation of a person performing an assigned task to ensure that he or she is meeting the standards of care. The RN is supervising the health unit coordinator to perform the task of completing orders.
Delegation includes understanding that the authorized person is acting in the place of the RN and carrying out tasks such as starting an IV answering a call light, or giving medications.
A nurse manager is evaluating a new nurse’s time-management skills. Which statement made by the new nurse may indicate potential concerns with time management?
- I am late in giving the antibiotic because I needed to assist with a dressing change
- I completed the physical assessment before checking for morning meds to be given
- I didn’t get out on time because I admitted a client who came 15 minutes before the end of my shift
- I would like to leave but I still need to document all the meds I gave today
the correct answer is: “I would like to leave but I still need to document all the medication I gave today.”
Adequate time-management skills will reduce anxiety for nurses. Documentation should be done as soon as possible, especially for medication administration.
With the constantly changing environment of client care, individual components of care may be delayed or nurses may not finish their assigned shift on time due to outside factors. This does not mean a nurse does not have good time-management skills.
A nurse is working with a certified nursing assistant (CNA) and a licensed practical nurse (LPN) in providing care to a group of clients. Which tasks should the nurse assign to the CNA and LPN?
- CNA to take and document vital signs on all client: LPN to complete the discharge paperwork to be reviewed with two clients
- CNA to empty and record urinary catheter bag drainage: LPN to administer oral and intramuscular meds
- CNA to perform simple dressing changes: LPN to assess and care for two non complex clients
- CNA to assist clients with hygiene: LPN to provide postmortem care and meet with a decreased client’s family
Remember you as the RN are ultimately responsible for your patient’s care. These are questions based on NCLEX and Scope of Practice. Assessments are normally completed by the RN, it is their responsibility and in their scope of practice. I know you all do assessments, that you have the knowledge to do the assessment, but remember as an RN you are ultimately responsible and should be doing the assessments.
With a question like this, you know that CNA’s can empty and record, and LPNS can give oral and IM medications. You know both answers are correct in that response, so that would be the correct response.
The correct answer is: CNA to empty and record urinary catheter bag drainage: LPN to administer oral and intramuscular medications
The scope of practice for a CNA includes measuring and recording intake and output and for the LPN to administer oral and intramuscular medications.
A CNA is able in some facilities to perform simple dressing change, but if the registered nurse (RN)changes it the RN would be able to assess the incision. An LPN should not be assessing clients.
A NA is able to assist with hygiene, but meeting with the family of a deceased client should be completed by the RN and not the LN.
A CNA is able to take and document vital signs, but the RN should be completing discharge paperwork to be reviewed with the clients. The discharge paperwork often includes a reviews of the care plan and addressing unmet needs of the client.
A registered nurse (RN) recognizes the need to provide further education regarding the scope of practice for an ancillary staff member when the staff member offers to take which action?
- Transport a 25 year old client diagnosed with schizophrenia to an off-site eye appointment
- Facilitate the smoking breaks earned by the various clients on the unit
- Provide visual observation every 15 mins for a client who expresses suicidal ideation
- Determine whether restraints may be removed from a client who was acting aggressively
Ancillary staff can mean anyone involved in the care of that patient, CNA’s, LPN’s, other RN’s, Social workers, student nurses, dietitians, etc..
The correct answer is: Determine whether restraints may be removed from a client who was acting aggressively
The scope of practice for ancillary staff does not include evaluation of client status/condition/behavior. Determining whether the removal of physical restraints is therapeutic is not within the scope of practice. The decision should be made by the RN caring for that patient (requires an assessment and evaluation) or the physician.
The other interventions may be assumed by ancillary staff as deemed appropriate by the RN.
A nurse is completing a home-care visit with an elderly client who is ready to be discharged from home-care services. This is the nurse’s last visit. Each time that the nurse attempts to leave, the client offers a new subject and attempts to delay the nurse’s departure. Which is the best action by the nurse?
- Set up an appointment for an additional home-care visit
- Plan to meet the client for coffee the following Sunday
- Be firm and clear about the termination of the relationship and solicit feedback from the client
- Abruptly feel the client that the session has ended and that the nurse must leave
The correct answer is: Be firm and clear about the termination of the relationship and solicit feedback from the client
Being firm and clear about the termination of the relationship maintains professional boundaries, while soliciting feedback helps the client maintain a positive attitude about the interaction.
Abruptly telling the client that the session has ended does not leave room for feedback from the client and may also leave the client with negative feelings about the interaction.The client may feel as though he or she did nor said something wrong to cause the nurse to leave abruptly
Setting up an additional home care visit only prolongs the termination phase and may allow the client to become manipulating.
Planning to meet the client for a social visit is inappropriate and may violate professional and ethical codes of conduct.
The nurse has received reports on four pediatric clients. Which client should the nurse assess first?
- 14 year old who had an appendectomy 12 hours ago and has a 2.5 cm (1in) circular area of bloody drainage on the dressing
- 6 year old who had closed reductions of a fractured left tibia 2 hours earlier and has swelling of the left goes
- 11 month old admitted 8 hours ago with dehydration whose vital signs are: T= 99.7, HR- 126, RR- 28
- 8 week old admitted 4 hours ago with substernal retractions and an oxygen saturation of 92%
The correct answer is: 8-week-old admitted 4 hours ago with substernal retractions and oxygen saturation of 92%
The 8-week old patient has substernal retractions which will affect oxygenation and has an O2 sat of 92% which is low for an 8 week old. This infant is in the beginning phases of respiratory distress. Using the strategy of ABC’s (airway, breathing 1st issue) with the age of patient being the second strategy being used.
ABC’s and Age
The 14-year-old with bloody drainage is not an abnormal finding
The 6-year-old with swelling of the left toes is not an unusual finding and will need to elevate the left leg
The 11-month-old has dehydration, vital signs, temp, and pulse are elevated but not priority patient
After a change of shift report, which client should the nurse assess first?
- 46 year old with carpal tunnel syndrome reporting wrist pain with movement
- 63 year old with osteoporosis who is anticipating discharge and needs instructions
- 26 year old with a femur fracture reporting that the cast is tight
- 54 year old with a left leg amputation reporting pain in the left foot
The correct answer is: 26 year old with a femur fracture reporting that the cast is tight
Acute vs Chronic and Maslows
26 year old with a tight cast is an acute situation and physiological on Maslows
46 year old with carpal tunnel, pain is expected to find with movement
63-year-old anticipating discharge is not an acute situation
54 year old with left leg amputation reporting pain in the left foot (Phantom pain)
After receiving the report, which client should the nurse assess first?
- 16 year old admitted 3 days ago for DKA whose insulin drip was discontinued 4 hours ago
- 34 year old 2 hours post op for a transsphenoidal hypophysectomy
- 61 year old admitted 3 days ago with an Addisonian crisis whose sodium is 131 mEq/L
- 56 year old admitted yesterday with a lower GI bleed whose hemoglobin is 7.9 mg/dL
The correct answer is: 34 year old 2 hours post-op for a transsphenoidal hypophysectomy
Time
The patient 2 hours post-op is the patient in the most critical/acute phase of the four patients.
16-year-old DKA patient admitted 3 days ago with insulin drip discontinued 4 hours ago not acute
56 year old admitted yesterday with GI Bleed with HGB 7.9: Hgb low, but not acute since admitted yesterday
61 year old admitted 3 days ago with sodium 131 mEq/L: Sodium low, but not acute
The nurse is working with unlicensed assistive personnel (UAP) in a long-term care facility. An elderly male client becomes incontinent. What would be the delegated role for the unlicensed staff member?
- Gather the supplies for an indwelling urinary catheter
- Apply a condom catheter
- Place the client in an adults sized diaper
- Stand the client at the bedside to use a urbano every two hours
The correct answer is: Stand the client at the beside to use a urinal every two hours
Self-care & Least Invasive
Standing the client at the bedside to use the urinal gives the patient the ability to help care for himself and is the least invasive of the options.
Inserting an indwelling urinary catheter is the most invasive
Applying a condom catheter is invasive, but not as invasive as an indwelling catheter
There is nothing in the question that indicates this is a chronic problem, diapering is invasive
The nurse is conducting a teaching session for a client with a new diagnosis of diabetes. At the beginning of the session, what is most important for the nurse to do?
- Make sure the client purpose and objectives of the teaching sessions
- Determine whether the client is comfortable or needs to go to the bathroom before teaching begins
- Introduce the client to the equipment that will be discussed during the teaching session
- Review with the client the importance of learning how to manage his or her diabetic condition
The correct answer is: Determine whether the client is comfortable or needs to go to the bathroom before teaching begins
Maslow
Determining if the patient is comfortable or needs to go to the bathroom identifies physical needs that the patient may need to address before they are able to listen to instructions and education.
Physiological must be dealt with before any of the other options.
A client presents to the emergency department reporting two days of severe abdominal pain, vomiting, and constipation. The health care provider suspects bowel obstruction. After obtaining the vital signs, what is the nurse’s next priority?
- Arrangements for surgery
- X-ray studies of the abdomen
- Insertion of a nasogastric tube
- Full abdominal assessment
The correct answer is: Full abdominal assessment
Nursing ProcessAssessment is the priority.
Arrangements for surgery, X-ray studies of the abdomen, and Insertion of an NG Tube will not be completed until a complete abdominal assessment is completed to determine what is going on with the patient.
A client with a prescription for an antipsychotic medication that may cause orthostatic hypotension is receiving discharge instructions from the nurse. Which of the following statements by the client would indicate an understanding of the instructions?
- I will lie down for a while after I take the med
- I will limit my alcohol intake to two drinks per day
- I will rise slowly and carefully
- I will stop the medication when I feel better
The correct answer is: “I will rise slowly and carefully.”
Safety
Rising slowly and carefully will assist in preventing falls.
The nurse is caring for a client experiencing a sudden onset of difficulty breathing. The pulse oximetry is reading 88% on room air. What would be the nurse’s first action?
- Raise the head of the bed
- Call for help
- Obtain nasal cannula tubing
- Assess the lung sounds
The correct answer is: Raise the head of the bed
Fast Vs Slow: Least Invasive
The patient’s pulse oximetry is 88% on room air. You want to do the intervention that will help raise the O2 Sat the quickest.
Raising the head of the bed will assist with lung expansion and breathing which may increase O2 Sats. It is also the least invasive
Calling for help will not do anything for your patient to improve his oxygenation
Obtaining nasal cannula tubing takes moments to obtain (slower) and the option does not say to apply oxygen, it just says to get the tubing.
Assessing the lung sounds will not assist with lung expansion and breathing, assessing the lung sounds will just verify lung sounds.
After experiencing agrand mal seizure, a college student tells the nurse, “I’m so embarrassed. How will I face my roommates again”
- Don’t worry. I think your roommates will understand about your illness
- Do your roommates know you have a history of grand mal seizures?
- Your illness seems to cause you feelings of embarrassment
- In time you will adjust to those feelings
The correct answer is: “Your illness seems to cause you feelings of embarrassment.”
Therapeutic Communication
Your illness seems to cause you feelings of embarrassment encourages the patient to be open and discuss feelings
Don’t worry understates the patient’s fears
Do your roommates know is a closed-ended question, either yes or no and does not allow for further discussion
In time you will adjust understates the patient’s fears.
The nurse is working with an experienced certified nursing assistant on a busy unit. Which of the following activities can be delegated to the assistant? Select all that apply.
- Taking a client’s vital signs
- Performing a blood glucose check
- Assessing a client after a chest X-ray
- Documenting and emptying a Foley catheter bag
- Documenting oral intake after the morning trays
- Evaluating a client’s response to pain medication
The correct answers are: Taking a client’s vital signs, Performing a blood glucose check, Documenting and emptying a Foley catheter bag, Documenting oral intake after the morning trays
Scope of practice
Understanding the scope of practice for the certified nursing assistant is required for delegation
Assessing is an RN scope of Practice
Evaluating is an RN scope of Practice
