Test 2 Practice Questions Flashcards

1
Q

To reduce the incidence of falls in a skilled nursing unit, the nurse manager contacts the risk manager. Risk management is a process that attempts to identify potential
hazards and:
a. Compensate for previous injuries.
b. Eliminate these risks before anyone else is harmed.
c. Supersede the need for staff members to file incident reports.
d. Discipline staff members who have been involved in previous incident reports.

A

B: Eliminate these risks before anyone else is harmed.

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2
Q

A colleague asks you to give her your password access so that she can view her
partner’s healthcare record. This request violates the patient’s right to:
a. Privacy
b. Confidentiality.
c. Undue authorization of treatment.
d. Protection against slander.

A

A. Privacy

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3
Q

On your nursing unit, you employ LPNs, RNs, and advanced practice nurses.
You will need to be familiar with at least:
a. Two nursing practice acts.
b. Two nursing practice acts in most states.
c. At least one nursing practice act.
d. One nursing practice act and a medical act.

A

C. At least one nursing practice act
In all states, you will need to be familiar with at least one nursing practice act. In some states, there may be two nursing practice acts if RNs and LPNs/LVNs come under different licensing boards.

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4
Q

As a charge nurse, you counsel your RN staff member that he has satisfied his duty of care by notifying a child’s physician of his concerns about deterioration in the child’s status at 0330 hours. The physician does not come in. The child dies at 0630 hours. As the charge nurse, you could be held liable for:

a. Professional negligence.
b. Assault.
c. Avoidance.
d. Murder.

A

A. Professional negligence

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5
Q

Mr. M. complains to you that one of your staff asked him details about his sexual relationships and financial affairs. He says that these questions were probing and unnecessary to his care, but he felt that if he refused to answer, the nurse would be angry with him and would not provide him with good care. Mr. M.’s statements reflect concern with:

a. Privacy.
b. Confidentiality.
c. Veracity.
d. Informed consent.

A

A. Privacy

Privacy protection includes protection against unwarranted intrusion into the patient’s affairs.

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6
Q

To satisfy duty of care to a patient, a nurse manager is legally responsible for all
of the following except:
a. Notifying staff of changes to policies related to medication administration.
b. Scheduling and staffing to ensure safe care.
c. Delegating in accordance with practice acts.
d. Supervising the practice of the physician.

A

D: supervising the practice of the physician
Legally, the nurse manager is accountable to nursing practice standards, standards for nurse
administrators, and hospital policies and procedures.

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7
Q

While walking past a patient’s room, you overhear one of the RN staff telling a

patient that the patient has no right to refuse chemotherapy treatment because the family and the doctor think the treatment is the best option for the patient. This patient is 40 years of age and alert. When you meet later to discuss what you heard with the RN, it is important to:

a. Discuss how statute law enforces the right of the doctor, but not of families, to ensure that patients comply with recommended treatment plans.
b. Discuss that statute law provides for patient autonomy and refusal of treatment.
c. Remind the nurse to provide clearer explanations to aid in the patient’s comprehension of the treatment and compliance.
d. Acknowledge the nurse’s role in ensuring that she does not fail in her duty of care for the patient.

A

B: Discuss that statute law provides for patient autonomy and refusal of treatment.

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8
Q

With regard to nursing practice, nurse managers are held responsible for (select all that apply):

a. Practicing within legal guidelines established under state law and nurse practice acts
b. Ensuring that nursing staff under their supervision are currently licensed to practice.
c. Referring all errors in nursing judgment to state discipline boards.
d. Ensuring that physicians are properly licensed to provide care on patient care units.

A

A, B

Nurses are responsible for knowing and practicing under state law and nurse practice acts. Managers are responsible for monitoring staff practice and ensuring that staff hold current, valid

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9
Q

The risk manager informs the nurse manager of an orthopedic unit that her unit has had an increase in incident reports about patients falling during the 11­7 shift. The nurse manager knows that the best way to resolve the problem is to:

a. Use creativity.
b. Obtain support from the 7­3 shift.
c. Use institutional research.
d. Identify the problem.

A

D. Identify the problem

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10
Q

Several nurses on an adolescent psychiatric unit complain that the teens are becoming unmanageable on the 0700­1900 shift. To resolve this problem, the nurse manager decides that the staff should have a brainstorming session. The goal of brainstorming is to:

a. Evaluate problem solutions.
b. Critique the ideas of others.
c. Generate as many solutions as possible.
d. Identify only practical and realistic ideas.

A

C. Generate as many solutions as possible

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11
Q

During a fire drill, several psychiatric patients become agitated. The nurse manager quickly assigns a staff member to each patient. This autocratic decision style is most appropriate for:

a. Routine problems.
b. Crisis situations.
c. Managers who prefer a “telling” style.
d. Followers who cannot agree on a solution.

A

B: Crisis situations

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12
Q

After the nurses who work on an adolescent psychiatric unit have had a brainstorming session, they are ready to resolve the problem of teenagers who are unmanageable. To maximize group effectiveness in decision making and problem solving, the nurse manager has:

a. Prevented conflict.
b. Formed highly cohesive groups.
c. Used majority rule to arrive at decisions.
d. Encouraged equal participation among members.

A

D. Encouraged equal participation among members.

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13
Q

To solve a problem, the nurse manager understands that the most important problem­solving step is:

a. The implementation phase.
b. Identification of numerous solutions.
c. Accurate identification of the problem.
d. Evaluation of the effectiveness of problem resolution.

A

C. Accurate identification of the problem.

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14
Q

The nurse on the 7­-7 shift is assigning a component of care to an unlicensed nursing personnel (UNP) employee. The night nurse should remain:

a. Accountable.
b. Responsible.
c. Authoritative and liable.
d. Responsible and task­oriented.

A

A. Accountable

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15
Q

The unit manager is working in a large metropolitan facility and is told that two UNPs are to be assigned to work with her. Delegation begins with:

a. Acknowledging the arrival of the second UNP on the unit.
b. Providing clear directions to both UNPs.
c. Matching tasks with qualified persons.
d. Receiving reports from the prior shift.

A

c. Matching tasks with qualified persons

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16
Q

The day shift nurse asks an LPN/LVN to complete a component of care for a client. The day shift nurse is engaging in what function?

a. Delegating
b. Assigning
c. Sharing
d. Authorizing

A

B. Assigning
Delegation refers to transfer of responsibility for work; the day shift nurse retains accountability for the outcomes of patient care.

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17
Q

With delegation, responsibility and accountability remain with the:

a. Physician.
b. Professional who delegates.
c. Individual who receives the delegation.
d. Individual who previously performed the task.

A

B. Professional who delegates

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18
Q

An RN colleague, who is a long­standing and collaborative member of your team, is performing a complex and novel dressing for the first time for the patient to whom she has been assigned. Which of the following would be the most appropriate communication with her?

a. “How do you usually do this kind of dressing?”
b. “The dressing needs to be done today and tomorrow with the supplies on this cart.”
c. “Here is what you need for the dressing, and I will show you what needs to be done”
d. “I know you know what you are doing. Let me know if you have any problems.”

A

C. “Here is what you need for the dressing, and I will show you what needs to be done”

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19
Q

Leslie, a UNP, transfers a patient while using improper technique. The patient is injured, and as a result, a suit is launched in which both Sarah (the delegator) and Leslie (the delegatee) are named. Sarah is named in the suit because she:

a. Retains accountability for the care of the patient.
b. Worked the same shift as Leslie.
c. Has passive accountability for delegation.
d. Retains accountability for the outcomes of care for the patient.

A

D. Retains accountability for the outcomes of care for the patient.

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20
Q

An example of a care activity that would likely not be delegated by an RN to a UNP is (select all that apply):

a. Teaching self­catheterization to a patient with paraplegia who has limited English.
b. Basic care for a patient with a head injury who is rapidly deteriorating.
c. One­to­one observation with a suicidal patient.
d. Assessment of patients being admitted through the Emergency Department.
e. Basic hygienic care for a patient who is post MI and stable.

A

A, B, D

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21
Q

The nurse manager is aware that conflict is occurring on her unit; however, she is focused on preparing for a state health department visit, so she ignores the problem. A factor that can increase stress and escalate conflict is:

a. The use of avoidance.
b. An enhanced nursing workforce.
c. Accepting that some conflict is normal.
d. Managing the effects of fatigue and error.

A

A. The use of avoidance

Avoidance as a conflict­management style prolongs conflict and has a tendency to escalate conflict.

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22
Q

A nursing instructor is teaching a class on conflict and conflict resolution. She relates to the class that conflict in an organization is important, and that an optimal level of conflict will generate:

a. Creativity, a problem­solving atmosphere, a weak team spirit, and motivation of its workers
b. Creativity, a staid atmosphere, a weak team spirit, and motivation of its workers.
c. Creativity, a problem­solving atmosphere, a strong team spirit, and motivation for its workers
d. A bureaucratic atmosphere, a strong team spirit, and motivation for its workers.

A

C. Creativity, a problem­solving atmosphere, a strong team spirit, and motivation for its workers.

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23
Q

Factors that influence the ease with which conflict is resolved include all except
which of the following?
a. Level of interdependence of the parties
b. Interprofessional collaboration.
c. Expression of one’s own needs and ideas.
d. Avoidance of the issue or concern.

A

D. Avoidance of the issue or concern.

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24
Q

In trying to achieve MagnetTM status, the chief nursing officer establishes a shared governance model to help nurses experience job satisfaction. However, some nurses who have enjoyed working with less autonomy resist this change and begin to criticize and make rude comments about managers who embrace this model, as well as colleagues who support it. The comments are largely ignored because those who are making them are well established nurses who are often vocal about their displeasure with the organization. Organizational conflict is arising from which of the following?

a. Staffing practices
b. Increased participation in decision making
c. Allocation of resources
d. Tolerance of incivility

A

D. Tolerance of incivility

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25
Q

The education consultant for the hospital is presenting a workshop titled “Documentation: A Manager’s Responsibility.” Which of the following points would she not include in her PowerPoint presentation? Documentation:

a. Cannot be left to memory. A notation must be placed in the personnel file.
b. Should avoid discussion of the problem.
c. Should include what was done about the problem when it occurred.
d. Needs to include date, time, and place.

A

B. Should avoid discussion of the problem

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26
Q

During coffee and other breaks, Rosalie, the new RN, is shut out of conversations with the other staff. When she approaches other staff on the unit to ask questions, they turn and walk off in the other direction. The behavior of the staff is characteristic of:

a. Dislike.
b. Lack of trust in Rosalie’s abilities.
c. Horizontal violence.
d. Cultural incompetence.

A

C. Horizontal violence

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27
Q

The ability to transfer selected nursing activities in a given situation to a competent individual is known as:

a. Supervision.
b. Accountability.
c. Responsibility.
d. Legal authority

A

D. Legal Authority
Legal authority is the ability to transfer selected nursing activities in a given situation to a competent individual. Responsibility is the reliability, dependability, and obligation to accomplish work.

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28
Q

A nurse manager understands that the typical first step in handling an employee with a disciplinary problem is to do what?
A. Provide a verbal reprimand.
B. Provide a written reprimand.
C. Provide reminder of employment standards.
D. Provide a day off without pay.

A

C. Provide reminder of employment standards.

29
Q
The nurse on the 11-7 shift is assigning a component of care to an unlicensed nursing personnel (UNP) employee. The night nurse will remain what?
A. Accountable and responsible.
B. Accountable and liable.
C. Authoritative and liable. 
D. Responsible and task-oriented.
A

A. Accountable and responsible

30
Q

The nurse understands that certain factors need to be considered before delegating tasks to others. These factors include which of the following?
A. Complexity of the task and the age of the delegate.
B. Potential for benefit and the complexity of the task.
C. Potential for benefit and the number of staff.
D. Complexity of the task and the potential for harm

A

D. Complexity of the task and the potential for harm

31
Q

Which one of the following organizations published the Code of Ethics for Nurses that provides provisions for eliminating discriminatory practices against patients and nurses?
A. National League for Nurses
B. American Nurses Association
C. National Council of State Boards of Nursing
D. Sigma Theta Tau International Nursing Honor Society

A

B. American Nurses Association

32
Q

A hospital in a large metropolitan area hopes to obtain magnet status. The following are characteristics of the nursing service in this hospital. Select the areas that must be addressed in order to become a magnet hospital. (Select all that apply.)
A. The hospital has a nurse vacancy rate of 20%.
B. The chief nursing officer holds a MSN, with a specialty in nursing administration.
C. 50% of the nurse managers hold a BSN.
D. Transforming Care at the Bedside has been implemented in all units.
E. Cost reduction at the hospital has resulted in a 50% decrease in the number of staff in the Education Department.

A

A, C, E

33
Q

A new graduate nurse is preparing to insert an intravenous catheter in a client. While she has done this twice in nursing school, she would feel more confident if she could review the procedure again before insertion. Which of the following sources should the nurse use to obtain this information and the standard at which it should be performed?
A. Internet
B. Institutional policy and procedure manual
C. Nursing skills textbook
D. Nurse Practice Act

A

B. Institutional policy and procedure manual

34
Q

Kari, a head nurse on the dialysis unit, has been informed during budget planning meetings that budget cuts are likely. She discusses this at the next unit meeting and tells staff members that unless they do their jobs well, their positions may be terminated, and there will be no replacement. Kari is enacting which management style?

a. Transformational
b. Transactional
c. Trusting
d. Truthful

A

B. Transactional leaders tend to rely on position and power, and they tend to reward and punish according to performance and conformity with expectations.

35
Q

Knowing when to have the entire team participate in the decision making process or when to have only the team leader make the decisions depends on the situation and the desired outcomes. The autocratic process is used in which of the following situations?

a. The task and the outcome are relatively simple and defined
b. It is unlikely that the group will reach a consensus.
c. A decision has to be discussed thoroughly.
d. A number of options need to be considered.

A

a. The task and the outcome are relatively simple and defined

36
Q

To prepare for the orientation of newly hired nurses, the nurse manager plans a presentation outlining the concept of healthcare networks. Healthcare networks are:

a. Units that provide only primary care services.
b. Owned by the institutions.
c. A feature of all public institutions.
d. Units that serve large populations.

A

D. Units that serve large populations

Healthcare networks are interconnected units. Their aim is serving large regional populations.

37
Q

A facility that provides care for patients whose average length of stay is less than 30 days and to patients whose average length of stay is longer than 30 days, and who require inpatient and ambulatory care for addictions, through a spectrum of wellness and illness services and providers, would be considered:

a. A healthcare network.
b. A tertiary care institution.
c. Rehabilitative.
d. Long-term care.

A

a. A healthcare network.
Healthcare networks embrace and provide wellness and illness services, including

primary, secondary and tertiary care, through a network of providers

38
Q

A hospital is working toward becoming a Magnet hospital. The chief nursing officer is aware that professional nursing departments of the future will:

a. Not be directed by nurses.
b. Be virtual organizations.
c. Be designed to maintain nursing standards of practice.
d. Be entitled to have client care departments.

A

c. Be designed to maintain nursing standards of practice.

39
Q

The chief nursing officer and the dean of the School of Nursing believe that by establishing rules and regulations and controlling the environment, this partnership will:

a. Promote professional medical authority, autonomy, and responsibility.
b. Need a degree of flexibility to engender success.
c. Be essential for self-governance.
d. Provide for the establishment of medical committees.

A

b. Need a degree of flexibility to engender success.

40
Q

A clinic nurse as observed another nurse deviating from agency policy in performing wound care. The best approach for the clinic nurse to take is to:

a. stay out of it
b. inform the nursing supervisor
c. fill out a notification form (incident report)
d. assess the risk to the client and the agency before proceeding

A

d. assess the risk to the client and the agency before proceeding

41
Q

Actions of Manager for Code Blue (select all that apply)

A

DO NOT PICK RACE!

42
Q

Kala, a unit manager, in discussing a role the CEO would like her to perform, makes the following statement, I will sit on the hospital taskforce on improving morale if you send me to the hospital’s leadership training classes next week, so I can further develop my skills and thus become more effective.” Which of the following conflict management styles is Kala using?

a. collaborating
b. avoiding
c. negotiating
d. accommodating

A

c. negotiating

43
Q

Patient high-risk fall with previous events - what does nurse manager have to do to decrease personal liability?

A
  • Complete an incident report
  • Objectively written incident report (not filed in chart/do not include in normal medical record)
  • EMR is where incident report is filled out
44
Q

Define the terms “ethics”, “ethical dilemmas” and “ethical decision making”.

A

Ethics- an expected behavior of a certain group in relation to what is considered right and wrong.
Ethical Dilemmas- problems for which more than one choice can be made and the choice is influenced by the values and beliefs of the decision makers.
Ethical Decision Making- the process by which a decision is made about an ethical issue.

45
Q

The principle that requires nurses to uphold a professional code of ethics, to practice within the code of ethics, and to remain competent is which of the following?

a. Veracity
b. Autonomy
c. Fidelity
d. Honesty

A

c. Fidelity
Fidelity refers to promise keeping or upholding one’s promise to practice as a reasonable and prudent nurse would do and in an ethically competent manner

46
Q

A member of a patient’s family calls the nurse manager of the palliative

care unit to express concern that a member of the family, who died on the weekend, had requested analgesics from the RNs on duty. An RN came with the analgesic nearly 45 minutes
later, just after the patient had died. The manager is aware that the unit was especially busy that weekend because many patients were seriously ill, staff had called in ill, and the staffing manager was unable to completely replace staff who were absent. The manager is deeply troubled that the family member had to die in pain because it violates what she knows should have been done. This manager is experiencing:
a. Compromised agency.
b. Moral distress.
c. Moral sensitivity.
d. Moral dilemma.

A

b. Moral distress.

47
Q
Ms. Viola questioned if her staffing ratios demand the use of high-level delegation  strategies. What “delegation right” is she assessing?


A. Task
B. Circumstances 
C. Person
D. Communication/Direction
A

B. Circumstances

48
Q

In the delegation process, all of the following factors need to be assessed EXCEPT:
A. Patient’s condition.
B. Complexity of the task to be performed.
C.Medical insurance of the patient.
D. Predictability of outcomes.

A

C. Medical insurance of the patient.

49
Q

Delegation, a multifaceted decision-making process, is implemented for all of the following reasons EXCEPT to:
A. Improve the work performance of staff.
B. Decrease the registered nurses’ accountability
C. Achieve nursing goals.
D. Improve patient care outcomes.

A

B. Decrease the registered nurses’ accountability

50
Q

An LVN tells you a patient’s vital signs are off. What do you need to do?

A

First assess the patient yourself to confrim

51
Q

Pt. comes into ED with appendicitis and needs surgery but refuses and wants to go home what does AMA say?

A

AMA (Nurse must advise pt about risks/benefits) causation- is failure to provide adequate education(resulting in physical harm)

  • Teach what will happen without surgery – could die from infection
  • Can sign own AMA at 18
52
Q

CH 5 A patient refuses a simple procedure that you believe is in the patient’s best interest. The two ethical principles that are directly in conflict in such a situation are:

a. Fidelity and justice.
b. Veracity and fidelity.
c. Autonomy and beneficence.
d. Paternalism and respect for others.

A

c. Autonomy and beneficence.

Autonomy refers to the freedom to make a choice (e.g., refuse a procedure), and beneficence to doing good (performing a procedure that will benefit the patient).

53
Q

Which ethical principle is primarily involved in informed consent?

a. Veracity
b. Autonomy
c. Beneficence
d. Nonmaleficence

A

b. Autonomy

54
Q

The hospital getting a lot of Portuguese males with heart conditions. In order to facilitate a patient-nurse relationship, what is the best action for the nurse to take?

A

Invite a community leader to teach staff about Portuguese culture

55
Q

Define professional negligence (aka malpractice). Failure to…

A

failure of a person with professional education and skills to act in a reasonable and prudent manner.
-Common causes of malpractice or negligence among nurses include the failure to follow standards of care, communicate appropriately, access and monitor patients, and act as a patient advocate.

56
Q

In the Emergency Department waiting room, you notice a patient sitting, with his head in his hands, who has been waiting for about 5 hours for relief of his headache. When you approach him to ask him how he is doing, he says, “I can’t believe that I have to wait this long for help! Do you know what it is like to be in pain for 10 hours?” Your response to him would be:
a. “It is frustrating to wait when you are in pain and when you are expecting to receive relief
right away.”
b. “Don’t talk to me. If you are going to be rude, then you will not receive treatment here.”
c. “We are very busy and don’t have enough staff to deal with problems such as yours.”
d. “Perhaps you should go elsewhere. We do not have time for you here, as many more sick patients are waiting.”

A

a. “It is frustrating to wait when you are in pain and when you are expecting to receive relief
right away.”

57
Q

You are a member of a team assigned to care for 15 general medical/surgical clients. You have all worked well together in the past in this same type of care. If you are assigned to coordinate this team’s work, your best strategy, based on the Hersey and Blanchard model, would be to:

a. Have a list of tasks to be accomplished and tell each member of the team what he or she must do.
b. Encourage people to discuss their frustrations in providing this care.
c. Ignore them—they’ve done it before.
d. Provide minimal direction and let them come to you with questions.

A

d. Provide minimal direction and let them come to you with questions.
According to the Hersey and Blanchard model, when ability (skills, job knowledge) and willingness are strong, the role of the delegator is less (“delegating behavior”).

58
Q

During staff development programs, staff nurses verbalize their frustration about their workloads and having to delegate so many tasks to others. One of the main reasons that delegation has emerged as an issue is because of:

a. The amount of paperwork required to complete care.
b. The complexity of client care.
c. Earlier discharge practices.
d. The numbers of other disciplines present on a given unit.

A

b. The complexity of client care.

59
Q

A brand new licensed RN is assigned to a ventilator pt – as a leader what would you do??

A

Reassign, assess because she may not be ready for that pt; you as the leader will be liable

60
Q

As a senior manager, you notice that there have been several resignations on a unit where a new charge nurse has been hired. You suspect that the new charge nurse may be demonstrating bullying behaviors, but staff say little about their relationship with the charge nurse. Your decisions about intervention would be based on which assumptions?

a. The staff nurses would tell you if the charge nurse was engaging in relational violence.
b. It would be unusual for leaders to engage in violence and bullying behavior.
c. Bullying is primarily related to feelings of marginalization and jealousy among peers.
d. Initiating confidential exit interviews will assist in determining if leader violence or bullying is occurring.

A

d. Initiating confidential exit interviews will assist in determining if leader violence or bullying is occurring.

61
Q

New nurse on unit with multicultural patients – CNA tells you don’t get on the bad side of the charge nurse – new RN observes another nurse forcing a patient to take an herbal supplement, what do you do?

A

determine importance of herbal medication to family

62
Q

CNA being rude/mean to pt who had stroke and cannot talk… what would you do?

A

Take them aside and respond constructively

63
Q

One means of ensuring that nurses floated to other patient care areas in healthcare organizations are qualified to work in those areas is:

a. Employing additional staff to assist with orientation processes.
b. Cross-educating staff members to other areas of the institution.
c. Transferring patients to units where the staffing pattern is optimal.
d. Orienting staff members to all patient care areas as part of their general orientation to the institution.

A

b. Cross-educating staff members to other areas of the institution.

64
Q

During a staff shortage, you hire an RN from a temporary agency. The RN administers a wrong IV medication that results in cardiac arrest and a difficult recovery for the patient. Liability in this situation:

a. Is limited to the temporary agency.
b. Is restricted to the RN.
c. Could include the RN, the agency, and your institution.
d. May depend on the patient’s belief regarding the employment relationship.

A

d. May depend on the patient’s belief regarding the employment relationship.

65
Q

Legal responsibility as charge nurse – what you need to consider when making an assignment?

A
  • SKILL LEVEL and knowledge base, acuity, ratio
66
Q

The ANA code of ethics serves what purpose? (4 purposes)

A
  • Inform the public of the minimum standards acceptable for conduct by members of the discipline & assist the public in understanding a discipline’s professional responsibilities.
  • Outline the major ethical considerations of the profession.
  • Provide to its members guidelines for professional practice.
  • Serve as a guide for the discipline’s self-regulations.
67
Q

Define delegation:

A

Delegation- transfer the authority and responsibility to another team member to complete a task while retaining the accountability
-(from the book) Delegation is achieving performance of care outcomes by sharing activities w/ others who have the appropriate authority to accomplish the work.
● Occurs only when 2 people are involved in a mutual work situation & one of the individuals has accountability & the other has some authority to perform a specific task.

68
Q

What are the 5 rights of delegation?

A
  • Task
  • Circumstance
  • Person
  • Direction/ communication
  • Supervision