MCI, Staffing

Question 1

Nurses and community officials are working together to ensure that churches and schools have needed supplies to provide shelter for large numbers of individuals in the event of a natural or manmade disaster. These activities represent which phase of a disaster continuum?

A. Preparedness
B. Relief response
C. Recovery
D. Crisis intervention

Answer 1

A. Preparedness

Rationale: Every disaster response begins as a local event known as the preparedness phase, which consists of planning, preparedness, prevention, and warning

Question 2

A terrorist incident has occurred, resulting in a possible exposure to smallpox. What term would be used to classify this incident?

A. Chemical
B. Biologic
C. Radiologic
D. Nuclear

Answer 2

B. Biologic

Rationale: The biologic category refers to diseases such as plague or smallpox. Chemical is associated with organic agents that spread through the air. Radiologic require the introduction of ionizing radiation particles. Nuclear is associated with nuclear weapons

Question 3

The Metropolitan Medical Response System (MMRS) is accurately described by which statement?

A. It is totally financed by the federal government national disaster fund
B. It consists of responders who have obtained specialized training and equipment to deal with mass casualty events
C. It has a storehouse of medications and antidotes to be used during response in times of national emergencies
D. It arranges for patient admissions to federal hospitals

Answer 3

B. It consists of responders who have obtained specialized training and equipment to deal with mass casualty events

Rationale: The MMRS responds to disaster with trained individuals who have expertise in this type of situation and who have the equipment required to be effective

Question 4

A community in the New Madrid fault zone experiences an earthquake resulting in injuries from propelled objects and abrasions for many victims. The local supply of antibiotics is quickly exhausted. Local authorities would contact which agency for access to the needed medication?

A. Commissioned Corps Readiness Force
B. Strategic National Stockpile
C. Department of Homeland Security
D. Young Men’s Christian Association (YMCA)

Answer 4

B. Strategic National Stockpile

Rationale: The Strategic National Stockpile provides antibiotics, antidotes, and medical and surgical items when local and state supplies have been exhausted

Question 5

What is the focus of care during the relief response phase of a disaster resulting from a “dirty bomb”?

A. Treatment for burns and poisoning is provided for victims
B. Emergency plans are coordinated between agencies
C. Reconstruction of destroyed facilities and homes begins
D. Food stores are collected for potential victims

Answer 5

A. Treatment for burns and poisoning is provided for victims

Rationale: During the relief response phase of a disaster, emergency responders aid victims and stabilize the scene; with a dirty bomb, radioactive material causes burns and poisoning

Question 6

A nurse learns of a mass casualty disaster following a known terrorist attack. On arriving at the scene, the nurse knows that care will be based on what fact regarding these situations?

A. The response of local hospitals will be dictated by the federal government
B. The same ground rules practiced in other settings and during smaller crises will be applicable
C. The least experienced nurses will be assigned to triage low-risk victims and victims who have no chance of survival
D. Multiple incident commanders ensure a quick, effective response

Answer 6

B. The same ground rules practiced in other settings and during smaller crises will be applicable

Rationale: The fundamentals of nursing applied to other settings and situations can be used in a disaster. None of the other options accurately describe how the needed care will be determined or delivered

Question 7

Nurses caring for the victims of a mass casualty incident based on what principle?

A. Common terminology to be used by hospitals and participating agencies
B. Nurses will take charge of communicating with the news media
C. Federal law enforcement will determine whether there is a credible threat of a terrorist attack
D. Triaging will give priority for care to those with the greatest chance of survival rather than those most critically ill

Answer 7

D. Triaging will give priority for care to those with the greatest chance of survival rather than those most critically ill

Rationale: Care is shifted from categorizing patients at low, intermediate, and critical risk to using resources to serve those with the greatest likelihood of survival

Question 8

During a community health fair, the disaster medical assistance team (DMAT) informs participants that every community must be ready to provide disaster care. A participant asks, “In a disaster, the local community cannot possibly be effective, so why not have a plan to call federal agencies immediately to provide relief?” How should the DMAT respond to this question?

A. “Unless known terrorist activities involving mass destruction occur, the federal government doesn’t become involved”
B. “The community is essentially the ‘first responder’ to any disaster”
C. “The preparedness phase of a disaster is the responsibility of the community, the relief response phase is assigned to state agencies, and the recovery phase is the responsibility of federal agencies”
D. “Unless local health care facilities are incapacitated, state and federal agencies will withhold assistance”

Answer 8

B. “The community is essentially the ‘first responder’ to any disaster”

Rationale: Each disaster begins locally, and each community responds first and receives assistance from state and federal agencies when local resources aren’t adequate for the situation

Question 9

A nurse who is conducting a staff in-service on the phases of a disaster continuum teaches participants that, during the impact/response stage, activities focus on what?

A. Community awareness in anticipation of a terrorist attack or natural disaster
B. Determining the effectiveness of the disaster medical assistance team (DMAT)
C. The use of an all-hazards approach
D. Initiating effective, appropriate response activities

Answer 9

D. Initiating effective, appropriate response activities

Rationale: Response activities during the relief response phase consist of immediate actions to save lives and meet basic human needs

Question 10

Following a terrorist attack, victims are exhibiting post traumatic stress syndrome, and care providers are exhibiting compassion fatigue. Which federal response system should be initiated to begin to address victim and provider psychosocial needs?

A. Strategic National Stockpile
B. Metropolitan Medical Response System (MMRS)
C. Commissioned Corps Readiness Force
D. National Disaster Medical System

Answer 10

B. Metropolitan Medical Response System (MMRS)

Rationale: The MMRS is concerned with deploying trained responders who can provide mental health care for victims and health care providers

Question 11

The crisis communication officer may first inform the public or health care facility of a disaster or an act of terrorism. What is the primary responsibility of this representative regarding information regarding the event?

A. To contain the facts to within the administration group
B. To facilitate the public to assist in obtaining the necessary emergency supplies
C. To provide understandable and straightforward facts about the event within the facility and possibly to the news media
D. To assure the public that information will be released as soon as it has been confirmed by state and federal agencies

Answer 11

C. To provide understandable and straightforward facts about the event within the facility and possibly to the news media

Rationale: The crisis communication officer is the first contact for patients, families, and employees within the facility or news media, so they may better understand the situation and know how to react and protect themselves

Question 12

The disaster medical assistance team works quickly to contain contaminants from a chemical plant explosion. Afterward, personnel undergo a special process to remove harmful chemicals from equipment and supplies. This removal process is refereed to by what term?

A. Containment
B. Decontamination
C. Triage
D. Scene assessment

Answer 12

B. Decontamination

Rationale: Decontamination is the physical process of removing harmful substances from personnel, equipment, and supplies. Containment is the limitation of an emergency situation within a well-defined area. Triage is the process of prioritizing which patients are to be treated first; first action in any disaster response. Scene assessment is the act of reviewing the location of an event to look for information that might help determine treatment options

Question 13

A group of local volunteers have completed an emergency response course and are able to assist with triage of injured citizens. They also participate in local health fairs to teach residents how to react during tornadoes. The responders are members of what organization?

A. Medical Reserve Corps (MRC)
B. Metropolitan Medical Response System (MMRS)
C. National Disaster Medical System (NDMS)
D. Commissioned Corps Readiness Force (CCRF)

Answer 13

A. Medical Reserve Corps (MRC)

Rationale: The MRC are local volunteers trained to respond to local emergencies. None of the other options are volunteers who work at the local level

Question 14

Troops from the United States participating in a peace mission in a foreign country were the victims of suicide bombers and many soldiers were evacuated back home to receive specialized medical care. The nation’s medical responses will be augmented by what organization?

A. The federally coordinated National Disaster Medical System
B. Local homeland communities where troops receive care
C. The Medical Reserve Corps, which organizes and utilizes public health, nursing, medical, and other volunteers
D. The National Incident Management System, which guides government, nongovernmental organizations, and the private sector to work seamlessly during disaster situations

Answer 14

A. The federally coordinated National Disaster Medical System

Rationale: The National Disaster Medical System supplements care for casualties evacuated back to the United States from overseas and federally declared disasters including national disasters, major transportation accidents, technological disaster, and acts of terrorism

Question 15

The Federal Bureau of Investigation (FBI) has determined from a reliable source that a bomb is in the possession of a known terrorist group and the likely target is a government building in the local community. What term is used to identify this situation?

A. All-hazards approach
B. Biologic event
C. Credible threat
D. Natural disaster

Answer 15

C. Credible threat

Rationale: A credible threat is a situation in which the FBI determines that a terrorist threat is probable and verifies the involvement of a weapon of mass destruction in the developing terrorist incident. All-hazards approach is a process approach for all sectors to prepare for any emergency or disaster that may occur. Biological events involve microorganisms or toxins from living organisms with infectious or non-infectious properties that produce lethal or serious effects in plants and animals. A natural disaster is one that is a result of nature (flood, earthquake, tornado, etc)

Question 16

The emergency response team responded to a terrorist attack where hundreds of people died following symptoms of chest tightness, palpations, seizures, and finally paralysis. A colorless odorless liquid known as Sarin (GB) was the agent, which is primarily inhaled with limited exposure through the skin. The concentration of Sarin hasn’t been measured. What level is the minimum level of PPE that would be needed?

A. A
B. B
C. C
D. D

Answer 16

B. B

Rationale: Level B requires a high level of respiratory protection, but less skin protection, providing a chemical splash-resistant suit with hood and self-contained breathing apparatus (SCBA). It providers maximum respiratory protection but less skin protection that level A equipment

Question 17

A state is devastated by a tornado killing many people, destroying communication systems, utility services, homes, and medical facilities. The state requests immediate assistance from the U.S. Congress and from surrounding states. The affected state should first contact what agency?

A. Emergency Management Assistance Compact (EMAC)
B. Institute of Medicine (IOM)
C. Red Cross
D. Strategic National Stockpile

Answer 17

A. Emergency Management Assistance Compact (EMAC)

Rationale: The EMAC is an organization authorized by the U.S. Congress through which a state impacted by a disaster can request and receive assistance from other member states quickly and efficiently

Question 18

A nurse is interested in learning the phases of the disaster continuum and realizes it has many similarities to the nursing process. To better understand the phases of a disaster, which is true when comparing the phases of the disaster continuum to the nursing process?

A. The preparedness phase of the disaster continuum is consistent with the assessment and planning steps of the nursing process
B. The recovery phase of the disaster continuum is consistent with the planning step of the nursing process
C. The recovery phase of the disaster continuum is consistent with the implementation step of the nursing process
D. The response relief phase of the disaster continuum is consistent with the evaluation step of the nursing process

Answer 18

A. The preparedness phase of the disaster continuum is consistent with the assessment and planning steps of the nursing process

Rationale: The preparedness phase requires assessing possible needs or the community and planning appropriate interventions and is consistent with the assessment and planning steps of the nursing process

Question 19

In the preparedness phase for disasters, the community plans for a possible terrorist attack using anthrax as the weapon of destruction. What treatments and/or preparations would be needed?

A. Vaccines and Level B PPE
B. Treatment for burns, decontamination, and Level A PPE
C. Social distance determination, decontamination for radioactive fallout
D. Identify and detect incendiary devices, treatment for burns and propellants

Answer 19

A. Vaccines and Level B PPE

Rationale: Anthrax is a biologic weapon and requires Level B protection since it is a known agent and can be carried in wind or surfaces. Timing of treatment is critical and vaccines are available

Question 20

Health care professionals have been activated to respond to a disaster, and the registered nurse who is coordinating the effort realizes that fact about the situation? SATA.

A. In the event of a mass casualty incident, care is prioritized to those who have the greatest chance of surviving
B. Communities should use their own resources first to attempt to stabilize and organize the response
C. State assistance occurs any time a disaster occurs, regardless of the community’s resources
D. The emergency operating plan developed by one central agency rather than individual facilities should be put into operation
E. Strict protocols regarding the use of resources must be followed

Answer 20

A. In the event of a mass casualty incident, care is prioritized to those who have the greatest chance of surviving
B. Communities should use their own resources first to attempt to stabilize and organize the response

Rationale: Care is shifted to doing the most good for the most people. Efforts begging at the local level

Question 21

When teaching community preparedness for a community group, the nurse explains that components of the National Disaster Medical System (NDMS) provide assistance in what form? SATA.

A. Making available a nationwide bomb disposal squad team for the rapid removal of explosive devices
B. Creating teams of healthcare providers who are experts and have specialized supplies and equipment
C. Facilitating patient evacuation from the disaster area to an unaffected area
D. Arranging for hospitalization in federal and volunteer non-federal acute care hospitals
E. Providing mental health care for the community, for victims, and or healthcare providers

Answer 21

B. Creating teams of healthcare providers who are experts and have specialized supplies and equipment
C. Facilitating patient evacuation from the disaster area to an unaffected area
D. Arranging for hospitalization in federal and volunteer non-federal acute care hospitals

Rationale: The NDMS provides specially trained teams of people along with equipment designed for disaster relief. The NDMS is responsible for removing patients from unsafe to safe areas. The NDMS coordinates efforts to evacuate victims to federal or non-federal volunteer hospitals that can care for disaster victims

Question 22

The emergency preparedness team that is used to describe the process of limiting the emergency within a well-defined area is _____________.

Answer 22

Containment

Rationale: Containment is correct because the focus is to prevent the agent that caused the disaster from spreading

Question 23

The term used during a pandemic disaster that refers to the attempt to contain germs by limiting socialization and personal interactions is ______________.

Answer 23

Social distancing

Rationale: The term social distancing refers to the attempt to keep people as far apart as possible to limit the possibility of spreading germs

Question 24

The task of completing and signing the initial assessment on a newly admitted patient who is about to undergo minimally invasive procedures on an outpatient basis can be delegated to whom?

A. The RN
B. The LVN
C. UAP
D. All levels of staff, because the information is about the past and cannot change

Answer 24

A. The RN

Rationale: Only the RN can perform and sign the admission assessment, although some components such as monitoring vital signs may be delegated

Question 25

An RN recently relocated to another region of the country and immediately assumed the role of charge nurse. When determining the appropriate person to whom to delegate, the RN bases decisions on what fact?

A. The role of the LVN is the same from state to state
B. The LVN can be taught to perform all the duties of an RN if approved by the employer and if additional on-the-job training is provided
C. Review of the state’s nurse practice act for LVNs is vital since it defines the role and scope of practice of the LVN
D. The Joint Commission has certified and established roles for the LVN

Answer 25

C. Review of the state’s nurse practice act for LVNs is vital since it defines the role and scope of practice of the LVN

Rationale: The scope of practice of the LVN varies significantly from state to state; RNs should know the LVN nurse practice act in the state in which they practice and should understand the legal scope of practice of the LVN

Question 26

Which task is most likely to be considered in a state’s practice act as appropriate to delegate to a LVN if the patient’s condition is stable and competence in the task has been established?

A. Administer an enema for an elective surgery patient
B. Administer an antiarrythmic medication IV while interpreting the patient’s rhythm on the cardiac monitor
C. Develop a plan of care for a stable patient admitted for observation after a head injury
D. Teach a patient how to instill eye drops for glaucoma

Answer 26

A. Administer an enema for an elective surgery patient

Rationale: The RN who is delegating must consider the following: 1. The delegate’s current workload and the complexity of the task, 2. Whether the staff member is familiar with the patient population and with the task to be performed, and 3. Whether the RN is able to provide the appropriate level of supervision. The delegation decision-making tree would also support delegation of this task

Question 27

A patient is admitted with hypotension, SOB, flushing, and hives. All levels of staff have been trained to assess vital signs. Given budget restrictions and proper delegation rules, to which care provider would the RN delegate the task of obtaining the initial blood pressure reading?

A. RN
B. LVN
C. UAP
D. Since all are trained, the task can be delegated to anyone

Answer 27

A. RN

Rationale: The patient’s condition isn’t stable, therefore, the skills of an RN are required

Question 28

A nurse is delegating to the newly hired nursing UAP the task of assisting with oral hygiene, knowing that this assignment “doesn’t require decisions based on the nursing process.” The nurse is correctly using which of the five rights of delegation?

A. Supervision
B. Communication
C. Person
D. Circumstance

Answer 28

D. Circumstance

Rationale: Right circumstance involves the delegation of tasks that don’t require independent nursing judgments

Question 29

A student nurse is concerned about delegation practices and wonders why hospitals employ UAP and LVNs. The student nurse refers to the National Council of State Boards of Nursing and learns that the role of these personnel is to focus o what?

A. Supplementing the staffing pattern when an RN is not available
B. Aiding the RN by performing appropriately delegated care tasks
C. Replacing the RN when the health care facility provides long-term care
D. Providing patient teaching, allowing more direct care to be provided by the RN

Answer 29

B. Aiding the RN by performing appropriately delegated care tasks

Rationale: The UAP and LVN can increase productivity of the RN by performing those tasks that fall within their scope of practice

Question 30

An RN delegates to the UAP the task of performing BP checks for a group of patients on a nursing unit. The UAP accepts the task and is responsible for what associated task?

A. Delegating the task to another UAP if he or she doesn’t have the time or skill to complete the task
B. Keeping the RN informed of any abnormal BP readings
C. Calling the physician when the patient’s vital signs aren’t within established parameters
D. Informing the dietary department to initiate a low-sodium diet for patients who are hypertensive

Answer 30

B. Keeping the RN informed of any abnormal BP readings

Rationale: After accepting the assignment, the UAP is responsible for completing the task and reporting any patient concerns to the RN. The remaining options are the responsibility of the RN

Question 31

Which task is appropriate for the RN to delegate to the UAP provided the delegate has had experience and training?

A. Evaluate the ability of a patient to swallow ice after a gastroscopy
B. Assist a patient who is postoperative hip replacement to ambulate with a walker for the first time
C. Change the disposable tracheotomy cannula for a new postoperative tracheotomy patient if secretions are thick and tenacious
D. Obtain a sterile urine sample from a patient with a Foley catheter that is connected to a closed drainage system

Answer 31

D. Obtain a sterile urine sample from a patient with a Foley catheter that is connected to a closed drainage system

Rationale: Obtaining a sterile urine sample from a patient with a Foley catheter that is connected to a closed drainage system is not an invasive procedure, and risk to the patient is minimal, making the task appropriate for delegation

Question 32

An LVN has transferred to a nursing unit and arrives for the first day. The RN checks with the LVN often throughout the shift to provide support and determine if assistance is needed. The RN is providing which level of supervision?

A. There is no supervision, because at times the LVN isn’t with the RN
B. Periodic inspection is being used. Because the LVN is licensed, the RN is relieved of the need to evaluate care
C. Continual supervision is being provided until the RN determines competency
D. Initial supervision is being provided because this is the LVN’s first day on the unit

Answer 32

C. Continual supervision is being provided until the RN determines competency

Rationale: This level of supervision is required when the working relationship is new, the task is complex, or the delegate is inexperienced or hasn’t demonstrated an acceptable level of competence

Question 33

An RN is counseled by the nurse manager regarding inappropriate delegation when the RN engages in what activity?

A. Instructing the nursing assistance to greet ambulatory surgery patients and show them to their rooms
B. When asking a novice nursing assistance to collect a sputum specimen, the RN states, “I will show you this time and you can show me the next time.”
C. Assigning the float LVN the task of completing a plan of care for a stable patient who was admitted for routine replacement of a feeding tube
D. Asking an LVN who has demonstrated competence to perform a dressing change before the patient is discharged home

Answer 33

C. Assigning the float LVN the task of completing a plan of care for a stable patient who was admitted for routine replacement of a feeding tube

Rationale: Only an RN can initiate and complete a new plan of care; this doesn’t fall within the scope of practice of the LVN. The RN has violated one of the five rights of delegation

Question 34

An RN delegates to an experienced LVN the task of administering oral medications to a group of patients. The RN then observes the LVN recording a patient’s medication administration just before entering the patient’s room. What is the RN’s initial intervention?

A. Checking the patient’s drug packages to ensure that the correct drugs were given
B. Stopping the LVN immediately and nonjudgmentally discuss the possible consequences of this action
C. Contact the nurse manager and ask that the LVN’s license be suspended
D. Call the pharmacy and ask for replacement medications for the patients

Answer 34

B. Stopping the LVN immediately and nonjudgmentally discuss the possible consequences of this action

Rationale: The LVN has the competency but violated one of the rights of medication administration and is practicing unsafe care. The RN’s initial responsibility requires that he or she intervene and identify concerns with the LVN

Question 35

Which statement related to delegation is correct?

A. The practice of UAP is defined in the nurse practice act
B. Nursing practice can be delegated only when the LVN and UAP have received adequate training
C. Supervision is not required when routine tasks are delegated to a competent individual
D. The RN must be knowledgeable about the laws and regulations that govern nursing practice, as well as those that have no clearly defined parameters, such as for UAP

Answer 35

D. The RN must be knowledgeable about the laws and regulations that govern nursing practice, as well as those that have no clearly defined parameters, such as for UAP

Rationale: Accountability remains with the RN, and he or she is responsible for knowing what tasks can be delegated ad what is defined as nursing practice

Question 36

During orientation, an RN learns that LVNs in the facility receive additional training to perform some tasks such as hanging continuously infusing IV fluids that have no additives. It is important for the RN to understand that what is the basis for this practice?

A. The health care facility can override the state practice act by having all LVNs and UAP participle in on-site training
B. LVNs are license, and accountability for their own practice rests with each LVN
C. The RN can determine what tasks are legally delegate to the LVNs on his care team
D. The nurse practice act and state regulations related to delegation override the organization’s policies

Answer 36

D. The nurse practice act and state regulations related to delegation override the organization’s policies

Rationale: The state’s nurse practice act is the deciding factor regarding what can legally be delegated

Question 37

A nurse moves from California to Arkansas and due to having 20 years or experience as a registered nurse is immediately placed in charge of the telemetry unit. The staffing consists of LPNs and two UAP. The RN is unsure of the scope of practice of the LPNs and reviews the nurse practice act for Arkansas, which lacks clarity on some tasks. What should the RN do to best acquire the necessary information?

A. Query the state nursing association to determine their stance on the role of LPNs
B. Ask the LPNs on the unit to list what tasks they routinely performed
C. Contact the state board of nursing to determine legal scope of practice for LPNs
D. Refer to California’s nurse practice act because the scope of LVNs is consistent across the U.S.

Answer 37

C. Contact the state board of nursing to determine legal scope of practice for LPNs

Rationale: If the nurse practice act lacks clarity, the state board of nursing can provide guidance

Question 38

An RN makes the following assignments at the beginning of the shift. Which assignment would be considered high-risk delegation?

A. A novice RN is assigned a patient with DM requiring mixing of regular and NPH insulin
B. An LPN is assigned an older adult with PNA and who requires dressing changes on a foot wound
C. A UAP is assigned the task of assisting a patient with late stages of Huntington’s disease to ambulate
D. A float RN from the oncology unit is assigned a patient with a WBC count of 4000 mm

Answer 38

C. A UAP is assigned the task of assisting a patient with late stages of Huntington’s disease to ambulate

Rationale: Risk of falling is great in later stages of Huntington’s disease due to chorea movements; this makes it inappropriate to delegate ambulation to the UAP

Question 39

The RN instructs the LPN to “Give an enema to the discharged patient in room 327 who is reporting being constipated. Then be sure to document on the medication administration record when given.” Which of the five rights was missing in the situation? The right of:

A. Direction and communication
B. Task
C. Person
D. Circumstances

Answer 39

A. Directions and communication

Rationale: The directions weren’t clear. The RN didn’t specify which type of enema to give and what outcome to expect. And the RN gave no instructions related to reporting back

Question 40

Which situation would be appropriate for the supervisory level of initial direction and/or periodic inspection?

A. Experienced RNs work together to provide care for a group of patients newly diagnosed with meningitis
B. The RN assigns the LPN tasks within her scope of practice and checks back during the shift to ensure the tasks are completed correctly
C. A new graduate nurse is assigned care to a male patient with a hematocrit of 11 g of hemoglobin per deciliter and is receiving a blood transfusion. The charge nurse checks on the patient status every 15 to 30 minutes and asks the graduate to explain “next steps”
D. No supervision is necessary since both are RNs

Answer 40

B. The RN assigns the LPN tasks within her scope of practice and checks back during the shift to ensure the tasks are completed correctly

Question 41

When determining the scope of practice for LVN and UAP, which statement accurately describes the common policies which exist in most state practice acts?

A. The RN is held accountable for the decision to delegate, but responsibility rests only with the delegatee
B. The RN may only delegates tasks that aren’t in the scope of practice of the LPN if the delegatee is certain they are competent to perform the task
C. Since the LPN is licensed, they practice professional nursing
D. To determine what tasks can be safely delegated, the RN must first assess the patient

Answer 41

D. To determine what tasks can be safely delegated, the RN must first assess the patient

Rationale: The stability of the patient must be determined prior to delegation. Even routine tasks such as taking vital signs that are often delegated may need to be performed by the RN when the patient’s condition is critical

Question 42

A nurse is concerned about the risk of delegating tasks to licensed practical nurses and UAP. What is the best way for the nurse to determine competency of an inexperienced delegatee?

A. Personally observe the delegatee perform the assigned task
B. Ask the delegatee how many times he has performed the task
C. Question the patient to confirm that the care provided was satisfactory
D. Ask other nurses if they feel the delegatee is competent

Answer 42

A. Personally observe the delegatee perform the assigned task

Rationale: The best way for the nurse to determine the competency of LPNs or UAPs is to observe them perform the task

Question 43

Care delivery using the team-based approach is used on a telemetry nursing unit. The team consists of one RN, two LPNs, and one UAP. Staff have been charged to improve quality of care while ensuring cost containment. Which assignments would meet both criteria?

A. The RN administers all medications to all patients
B. The LPN performs sterile dressings and IV turning changes on all central lines
C. The experienced UAP places telemetry electrodes and attaches to cardiac monitor
D. The RN administers an enema to a stable patient who has an order “administer fleet enema PRN when no bowel movement in 2 days”

Answer 43

C. The experienced UAP places telemetry electrodes and attaches to cardiac monitor

Rationale: the UAP, when properly trained, can place patients on telemetry. This meets quality and cost containment goals because the LPN and RN have higher salaries

Question 44

Which statement made by an RN regarding delegation indicates the need for additional teaching? SATA

A. UAP can assess vital signs during the first 5 minutes for a patient who is receiving a blood transfusion because a reaction now is unlikely
B. An LVN can administer a PPD if there is no history of a positive PPD
C. When dopamine is ordered continuously, the LVN can administer dopamine at a low dose for increasing renal perfusion
D. UAPs can transfer a patient who is being discharged home from the wheelchair to the bed if they have received training and demonstrated competency
E. Responsibility can be delegated to the UAP, but the delegator retains accountability

Answer 44

A. UAP can assess vital signs during the first 5 minutes for a patient who is receiving a blood transfusion because a reaction now is unlikely
B. An LVN can administer a PPD if there is no history of a positive PPD
C. When dopamine is ordered continuously, the LVN can administer dopamine at a low dose for increasing renal perfusion

Rationale: The statement ―UAPs can assess vital signs during the first 5 minutes for a patient who is receiving a blood transfusion because a reaction at this time is unlikely‖ indicates the need for further teaching because the patient is at highest risk of a reaction during the first few minutes of a blood transfusion; thus, the assessment skills of an RN are required. The statement ―an LPN/LVN can administer a PPD (tuberculin skin test) if there is no history of a positive PPD‖ indicates the need for further teaching because administration of intradermal medication requires the skill of an RN. Dopamine is a vasoactive drug that can have a profound effect on a patient‘s blood pressure and cardiac output; administration requires the assessment and evaluation skills of an RN.

Question 45

When considering the feasibility of an all-RN staff, a nursing administrator determines what fact concerning the RN‘s role? SATA

a. They are generally costlier and less efficient than LPNs.
b. They are usually more reactive than proactive to patient care errors.
c. They have a positive effect on patient outcomes when managing patient care.
d. They are effective overseers of patients‘ overall health condition.
e. Their training makes them effective care delegators.

Answer 45

c. They have a positive effect on patient outcomes when managing patient care.
d. They are effective overseers of patients‘ overall health condition.
e. Their training makes them effective care delegators.

Rationale: RNs are effective at coordinating care that results in improved patient outcomes. RNs are valuable monitors of a patient‘s health status—a practice that results in improved patient outcomes and effective delegation of care.

Question 46

Which functions can be delegated only to another RN with appropriate experience and training? SATA

a. Assessment of skin integrity on third day of hospitalization
b. Evaluation of patient teaching related to turn, cough, and deep breathing exercises
c. Nursing judgment related to withholding medication based on vital signs
d. RNs do not delegate to other RNs, they delegate only to licensed practical nurses or unlicensed assistive personnel
e. Formulation of nursing diagnosis ―potential for fall

Answer 46

a. Assessment of skin integrity on third day of hospitalization
b. Evaluation of patient teaching related to turn, cough, and deep breathing exercises
c. Nursing judgment related to withholding medication based on vital signs
e. Formulation of nursing diagnosis ―”potential for fall”

Rationale: Activities like assessing skin integrity—which include the core of the nursing process and require specialized knowledge, judgment, and/or skill—can be delegated only to another RN. Activities like evaluating patient teaching—which include the core of the nursing process and require specialized knowledge, judgment, and/or skill—can be delegated only to another RN. Activities like deciding to withhold medication based on vital signs—which include the core of the nursing process and require specialized knowledge, judgment, and/or skill—can be delegated only to another RN. Activities like formulating a nursing diagnosis—which include the core of the nursing process and require specialized knowledge, judgment, and/or skill—can be delegated only to another RN.

Question 47

How do accrediting agencies such as The Joint Commission address staffing?
a. Imposing maximum staffing levels
b. Requiring a specific staff mix
c. Stipulating nurse-patient ratios
d. Confirming delivery of satisfactory care

Answer 47

d. Confirming delivery of satisfactory care

Rationale: Accrediting agencies do not address minimum staffing levels; however, they do look for evidence that patients receive adequate care, and this can occur only with adequate staffing.

Question 48

What is customer satisfaction primarily based upon?
a. Access to modern, up-to-date facilities
b. Availability of an extensive menu selection
c. Personal interactions with employees
d. Having to undergo fewer invasive procedures

Answer 48

c. Personal interactions with employees

Rationale: Interactions between employees and patients/families affect clinical outcomes, functional status, and even physiologic measures of health

Question 49

Nurses on a unit provide personal hygiene, administer medications, educate the patient and family about treatments, and provide emotional support. These nurses provide patient care based on which nursing delivery system?

a. Total patient care
b. Partnership nursing
c. Team nursing
d. Functional nursing

Answer 49

a. Total patient care

Rationale: In total patient care nurses provide all aspects of patient care. This isn’t true of the other options

Question 50

A hospital converts to a system of care delivery in which RNs, LPNs, and unlicensed assistive personnel (UAP) are responsible for implementing a specific task, such as medication administration or personal hygiene, for the entire nursing unit. What term is used to describe this type of delivery system?

a. Total patient care
b. Functional nursing
c. Team nursing
d. Primary nursing

Answer 50

b. Functional nursing

Rationale: In functional nursing members of the team are assigned specific tasks such as assessment or medication administration. This is not true for the other options.

Question 51

What title identifies a nurse who is responsible for following the patient from admission through discharge or resolution of illness while working with a broad range of health care providers?

a. Nurse manager
b. Case manager
c. Coordinator of patient-centered care delivery
d. Team leader in team nursing care delivery

Answer 51

b. Case manager

Rationale: The case manager, in collaboration with an interdisciplinary team, oversees the use of health care services by clients throughout a course of illness.

Question 52

A patient is admitted with coronary artery disease and is scheduled for coronary artery bypass grafting (CABG). According to the clinical pathway the patient should be extubated and discharged from critical care the day after surgery. During surgery the patient‘s oxygen saturation decreased drastically because of chronic tobacco abuse. Subsequently, the patient remained on the ventilator an additional 2 days postoperatively. According to the clinical practice guideline for CABG, this situation results in what type of event?

a. Patient outcome
b. Variance
c. Care goal
d. Nursing standard

Answer 52

b. Variance

Rationale: A variance is a deviation from the planned path

Question 53

A patient is admitted with pneumonia. The case manager refers to a plan of care that specifically identifies dates when supplemental oxygen should be discontinued, positive-pressure ventilation with bronchodilators should be changed to self-administered inhalers, and antibiotics should be changed from intravenous to oral treatment, on the basis of assessment findings. This plan of care is referred to by what term?

a. Patient classification system
b. Clinical pathway
c. Patient-centered plan of care
d. Diagnosis-related group (DRG)

Answer 53

b. Clinical pathway

Rationale: A clinical pathway is a plan that specifies the timing and sequencing of major patient care activities and interventions by the interdisciplinary team for a particular diagnosis, procedure, or health condition.

Question 54

The nurse manager determines that four RNs, five LPN/LVNs, and two unlicensed assistive personnel (UAP) are required per shift to meet the needs of the patient population on the unit, according to acuity and census. The nurse manager is concerned with what related process?

a. Assignments
b. Staffing
c. Output
d. Productivity

Answer 54

b. Staffing

Rationale: Staffing is the activity of determining that an adequate number and mix of health care team members are available to provide safe, high-quality patient care.

Question 55

A nurse manager is mentoring a novice nurse manager in determining staffing needs. The mentor explains that the acuity level of the patient is determining by implementing what process?

a. “Assessing patient satisfaction with nursing care.”
b. “Quantifying the amount and intensity of care required.”
c. “Examining the skill mix and educational preparation of the staff.”
d. “Determining the number of hospital days required by the patients.”

Answer 55

b. “Quantifying the amount and intensity of care required.”

Rationale: Patient acuity is measured by determining the amount and intensity of care required

Question 56

The nurse manager is planning staffing levels and realizes that the first step is to focus on what activity?

a. Knowing the intensity of care needed by patients according to physical and psychosocial factors
b. Examining the educational level of the staff
c. Assessing the skill level of caregivers
d. Reviewing the budget to determine the financial consequences of past staffing
patterns

Answer 56

a. Knowing the intensity of care needed by patients according to physical and psychosocial factors

Rationale: The nurse manager must determine the number and mix of health care providers according to the wide range of care requirements of individual patients.

Question 57

A hospital is concerned with nurse retention and realizes that job satisfaction is a major influence. To best enhance employee satisfaction related to staffing, what intervention should
the management team implement?

a. Begin negotiating for additional agency nurses.
b. Propose hiring more part-time employees.
c. Adopt the concept of participatory staff involvement.
d. Regularly use “float” nurses to cover vacancies.

Answer 57

c. Adopt the concept of participatory staff involvement.

Rationale: Staffing methods that include staff participation and enhance staff autonomy have been demonstrated to play a major part in ensuring employee satisfaction.

Question 58

A patient is admitted for a hysterectomy, and the RN develops and implements the plan of care but also delegates to the LPN/LVN the responsibility of administering oral medications. While off duty, this RN receives a call requesting a change in the plan of care because the patient has developed deep vein thrombosis. The nurse who originally planned the care is practicing which type of nursing care delivery?

a. Modular
b. Primary
c. Team
d. Functional

Answer 58

b. Primary

Rationale: The primary nurse assumes 24-hour responsibility for planning, directing, and evaluating the patient‘s care from admission through discharge but may delegate or provide primary care during the shift when present.

Question 59

When deciding which staffing option to use on a nursing unit that will open soon, the manager recognizes what basic fact related to this issue?

a. Continuity of care is enhanced and errors are reduced when nurses provide care over longer shifts and consecutive workdays, such as 12-hour shifts on three consecutive days per week.
b. The use of part-time nurses provides the variability needed to meet diverse patient needs.
c. Satisfaction of the staff equates to satisfaction of patients.
d. Nurses provide the same level of care, regardless of the work environment.

Answer 59

c. Satisfaction of the staff equates to satisfaction of patients.

Rationale: High nurse satisfaction is generally equated with high patient satisfaction and positive patient outcomes.

Question 60

A task force is considering factors that contribute to high-quality safe staffing. Which statement reflects an understanding of the American Nurses Association‘s (ANA) recommendations?

a. Because patient needs remain constant on a daily shift, staffing needs at the beginning of the shift should be sufficient to provide safe, high-quality care.
b. Staffing should allow time for the RN to apply the nursing process so decisions result in high-quality, safe patient outcomes.
c. Patient acuity levels affect staffing by increasing the need for unlicensed personnel to provide routine basic care rather than increasing RNs in staff mix.
d. RN staffing is not cost-effective; thus, is it important for staffing models to limit the number of RNs assigned per shift.

Answer 60

b. Staffing should allow time for the RN to apply the nursing process so decisions
result in high-quality, safe patient outcomes.

Rationale: The ANA recommends that nurses have time to exercise professional judgment; that would include the achievement of outcomes

Question 61

A nursing unit comparing team nursing to the partnership model would find what statement to be true?

a. With the partnership model, an RN does not have to be part of the mix.
b. Leadership abilities of the RN are a major determinant of effectiveness of care for both models.
c. The RN teaches the LPN/LVN or unlicensed assistive personnel (UAP) how to apply the nursing process in team nursing.
d. With team nursing the RN cares for the patient while the team members work with the family or significant others.

Answer 61

b. Leadership abilities of the RN are a major determinant of effectiveness of care for both models.

Rationale: The RN leads regardless of whether partnership model or team nursing is practiced.

Question 62

When a nurse uses a criteria such as “high risk for falls,” “infection protocols,” and “special communication needs” to determine the mix and number of staff needed on a telemetry unit, what is the nurse is using?

a. A patient classification system
b. Diagnostic-related groups
c. Case management
d. Clinical pathways

Answer 62

a. A patient classification system

Rationale: Patient classification systems group patients according to care needs to determine safe staffing levels.

Question 63

A nurse makes patient care assignments as follows: RN1 has rooms 200-210; RN2 has rooms 211-221; RN3 has rooms 222-232. The two unlicensed assistive personnel have half the rooms, with one assigned to 200-215 and the second to 216-232. What term is used to identify the care delivery model being used?

a. Team
b. Primary
c. Partnership
d. Modular

Answer 63

d. Modular

Rationale: Modular (or geographic) assignments are based on a geographic location in the nursing unit.

Question 64

A patient has decided to stop hemodialysis because his renal failure progresses and he wishes to spend more time with family. Palliative care will continue, and the approach will be discussed with the patient and family as needed and at change of shift. The care delivery model in this situation is referred to by what term?

a. Partnership
b. Patient-centered
c. Case management
d. Total patient care

Answer 64

b. Patient-centered

Rationale: Patient-centered care models entail the health care team partnering with the patient and family to ensure that patients‘ wants, needs, and preferences are the priority while allowing the patient and family to participate in decisions and educational needs.

Question 65

A nurse plans care knowing when specific recovery milestones are expected. The nurse is providing care via what delivery model?

a. Patient classification systems
b. Clinical pathways
c. Functional nursing
d. Case management

Answer 65

b. Clinical pathways

Rationale: Clinical pathways plans patient care activities and interprofessional interventions and desired patient outcomes within a specified time period for a particular diagnosis or health condition.

Question 66

An orthopedic unit is considering different types of care delivery models and staff have an opportunity to ask questions about how the models differ. The nurse manager provides an overview and uses the above visual to demonstrate which model of care delivery?

a. Team
b. Partnership
c. Primary
d. Functional

Answer 66

d. Functional

Rationale: Functional care delivery models assign tasks to each provider. In the above visual, the LPN is responsible for oral medication administration, the unlicensed assistive personnel provide hygiene, and the RN is assigned to task that require the nursing process.

Question 67

While participating in a task force to proactively plan for nursing care delivery over the next 20 years, a nurse learns that dramatic changes will occur because of what factor? SATA

a. The increases in the number of minimally invasive procedures being performed for disease treatment
b. Care provided for patients over an extended period in acute care settings
c. The reduction in the number of nurses and other health care professionals who are available to provide care
d. The widespread illiteracy and decreased self-efficacy of the aging patient population
e. The need to focus on social and environmental influences, educational level, and individual characteristics and values of the patient
f. The devaluing of nursing as a means of improving patient outcomes

Answer 67

a. The increases in the number of minimally invasive procedures being performed for disease treatment
c. The reduction in the number of nurses and other health care professionals who are available to provide care
e. The need to focus on social and environmental influences, educational level, and individual characteristics and values of the patient

Rationale: Invasive surgical procedures are being replaced by laparoscopic procedures. The demand for nurses and other health care professionals cannot keep pace with the increased need for health care required by the growing older population. Care will focus on the unique lifestyles and values of a diverse population.

Question 68

Which factors would be considered in the first steps in developing an effective patient classification system? SATA

a. Planned procedures
b. Ethnic diversity of patients
c. Clinical competency of staff
d. Educational level of nurses
e. Age of patients

Answer 68

a. Planned procedures
b. Ethnic diversity of patients
e. Age of patients

Rationale: The first step in developing a patient classification system is to understand the intensity of care needs, which requires identifying specific patient characteristics and care requirements.

Question 69

A nurse responsible for staffing a medical-surgical unit must consider what factors? SATA

a. The patient census
b. Physical layout of the unit
c. Complexity of care required
d. Educational level of all staff
e. Task preferences of the nurses

Answer 69

a. The patient census
b. Physical layout of the unit
c. Complexity of care required
d. Educational level of all staff

Rationale: The primary considerations for staffing a specific nursing unit are the number of patients; the level of intensity of care required by those patients (commonly referred to as patient acuity); contextual issues, such as architecture, geography of the environment, and available technology; level of preparation and experience of the staff members providing the care; and the quality of the nurses‘ work life.