Test Bank Of Nursing delegation and management of patient care 2nd edition By Kathleen Motacki.

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Test Bank of Nursing delegation and management of patient care 2nd edition By Kathleen Motacki. Kathleen Burke

Chapter 03: Strategic Management and Planning

Motacki: Nursing Delegation and Management of Patient Care, 2nd Edition

 

MULTIPLE CHOICE

 

  1. When applying for a management position, the nurse should ask about the goals and plans of the hospital. Strategic plans must be developed around
a. the mission statement.
b. patient population.
c. staff input.
d. infection rates.

 

 

ANS:  A

The strategic plan of an organization must comply with the mission statement. The other factors are incorrect because although they may influence the overall plan, the plan can never stray from the mission statement.

 

DIF:    Cognitive Level: Application          REF:   page 28

 

  1. The strategic plan of an organization includes all stakeholders of the organization, including nurse managers. Which explains the benefit of including nurse managers in developing plans for the organization?
a. Nurse managers own stock in the business.
b. Nurse managers understand the clinical areas.
c. Nurse managers will be involved in implementing the changes.
d. Nurse managers have had business courses.

 

 

ANS:  C

Nurse managers will be important in the implementation of the plan at the unit level. Option A is not true. Option B is not a reason for including nurse managers. Option D is not a reason for including nurse managers.

 

DIF:    Cognitive Level: Analysis               REF:   page 28

 

  1. Nurse managers are included in strategic planning for the institution because of which principle?
a. Nurse managers have the authority to terminate employees.
b. Nurse managers encourage “buy-in” from staff.
c. Nurse managers understand the need for the plan.
d. Nurse managers understand the financial aspects of the organization.

 

 

ANS:  B

Nurse managers ensure “buy-in” of the project from staff. The other options are not the reason for including nurse managers in the planning.

 

DIF:    Cognitive Level: Analysis               REF:   page 28

 

  1. When interviewing for a position at a new facility, the nurse managers ask to review the mission, vision, and values statements because they understand that these statements provide information about the organization’s
a. fiscal responsibility.
b. direction and purpose.
c. concern for uninsured.
d. specific actions to be taken.

 

 

ANS:  B

These statements are usually generalized around the direction and purpose of the organization. Mission, vision, and value statements do not address specific areas listed in the other options.

 

DIF:    Cognitive Level: Analysis               REF:   page 28

 

  1. A health care organization incorporates information from which group into their strategic plan?
a. Local community
b. Nursing research
c. Pharmaceutical research
d. Insurance companies

 

 

ANS:  A

Information from stakeholders, which would include the members of the local community, should be incorporated into their strategic plan. The other groups are not generally a source for direction that is incorporated into the strategic plan.

 

DIF:    Cognitive Level: Application          REF:   page 28

 

  1. In developing mission and values statements, health care facilities incorporate tools to describe desirable behaviors of the organization. These tools describe behaviors such as
a. patient risks.
b. nurse/patient ratios.
c. organizational direction.
d. desired outcomes.

 

 

ANS:  C

Most tools used to describe mission and values incorporate actions that are measurable. The other behaviors are not included in organizational statements.

 

DIF:    Cognitive Level: Application          REF:   page 28

 

  1. Sometimes organizations use measurable critical success factors (CSFs) when developing their strategic plan. The CSFs include People, Service, Quality, Financial, Growth, and sometimes Community. Which of the definitions indicates the meaning of the term People?
a. The term People represents the patients served.
b. The term People represents the nurses and physicians who provide the care.
c. The term People represents the community served.
d. The term People represents the upper-level management.

 

 

ANS:  B

The term People, when used as a CSF, represents those who are attracted to an environment conducive for nurturing the best in their practice. The other definitions do not represent the meaning of the term People as a CSF.

 

DIF:    Cognitive Level: Analysis               REF:   page 32

 

  1. Strategic goals are developed as a result of which information source?
a. Environmental scan
b. Electronic medical record
c. Changes in nursing practice
d. Changes in staff ratios

 

 

ANS:  A

The environmental scan is a major source for developing strategic goals and includes the competition, economic trends, etc. The other goals do not impact strategic goal development.

 

DIF:    Cognitive Level: Analysis               REF:   page 28

 

  1. When referring to the critical success factors (CSFs) that organizations use for developing their strategic plans, the term Quality best describes which characteristic?
a. Quality is a measurement of the product produced.
b. Quality is the value of the service.
c. Quality is the outcome provided when the best people are providing the best service.
d. Quality is a characteristic of the service.

 

 

ANS:  C

Quality represents the outcome of the care being provided by the best people in an institution with the best service. The other characteristics can be a definition of the term Quality but do not apply when used as a CSF.

 

DIF:    Cognitive Level: Analysis               REF:   page 32

 

  1. When referring to the critical success factors (CSFs) that organizations use for developing their strategic plans, the term Financial best describes which characteristic?
a. Financial indicates the economic benefits achieved.
b. Financial indicates the expertise of the financial manager.
c. Financial indicates the cost to the patient.
d. Financial indicates the cost to the community.

 

 

ANS:  A

The term Financial when used as a CSF indicates the economic benefits derived from the quality of the service provided by the best people. The other options do not represent the meaning of the term Financial when used as a CSF.

 

DIF:    Cognitive Level: Analysis               REF:   page 32

 

  1. When referring to the critical success factors (CSFs) that organizations use for developing their strategic plans, the term Growth best describes which characteristic?
a. Growth is the expansion of the specific disease.
b. Growth is the aging of the population served.
c. Growth is difficult-to-access health care.
d. Growth is the expansion of the organization.

 

 

ANS:  D

Growth refers to the expansion of the organization as a result of the financial benefits received from the quality outcome resulting from the service provided by the best people. The other options do not represent the meaning of the term Growth when used as a CSF.

 

DIF:    Cognitive Level: Analysis               REF:   page 32

 

  1. When referring to the critical success factors (CSFs) that organizations use for developing their strategic plans, the term Community best describes which characteristic?
a. Community is society.
b. Community is the neighborhood surrounding the organization.
c. Community identifies the people served.
d. Community is the group of people working within the organization.

 

 

ANS:  C

The Community is the end beneficiary of the growth from the financial benefits due to the quality outcomes from the service provided by the best people. The other options represent the meaning of the term Community when used as a CSF.

 

DIF:    Cognitive Level: Analysis               REF:   page 32

 

  1. Which of the following could have an impact on strategic planning for a community hospital?
a. Change in primary orthopedic surgeon
b. Increased availability of flu shots
c. Health promotion by the local nursing school
d. Community health fairs

 

 

ANS:  A

Each surgeon has their own patient load in their practice and this would change the strategic plan. The other options reduce admissions to the hospital by reducing patient illnesses or aid in identifying diseases early.

 

DIF:    Cognitive Level: Application          REF:   page 29

 

  1. A community hospital has assessed the need for an automatic internal cardiac defibrillator for special procedures. Because of the reimbursement allowed from Medicare, which of the following best explains the decision made?
a. An environmental scan showed no interest in the community for having these placed.
b. An environmental scan showed the need for this procedure in only a few patients in the community.
c. An environmental scan showed that the cost to the patient was prohibitive.
d. An environmental scan showed the device has a high malfunction rate.

 

 

ANS:  B

This hospital determined that the cost-benefit to the hospital did not make it financially beneficial to perform these procedures. The other options would not have been determined by an environmental scan.

 

DIF:    Cognitive Level: Analysis               REF:   page 29

 

  1. Which of the following represents a short-term goal for an organization?
a. Health education to prevent the incidence of accidents due to drunk drivers
b. Heart failure education provided to every patient admitted with that diagnosis-related group
c. Building a new emergency department
d. Renovation of the intensive care unit

 

 

ANS:  B

Providing education to a specific population is achievable as a short-term goal. The other options are long-term goals.

 

DIF:    Cognitive Level: Application          REF:   page 30

 

  1. Action planning is a process by which organizations develop and implement both short-term and long-term goals. What would be expected in these plans?
a. Identification of the strengths and weaknesses for each objective
b. Identification of the impact on the community
c. Specific responsibilities and timelines for each objective
d. Specific patient population for each objective

 

 

ANS:  C

Responsibilities and timelines are set for each objective. Options A and B are incorrect because they are not part of the action planning process. Option D is incorrect because action planning usually has a more global focus.

 

DIF:    Cognitive Level: Application          REF:   page 30

 

  1. When identifying the objectives in an organization’s action plan, what would be an essential tool to use to improve performance?
a. Benchmarking to “best in class performers”
b. Patient satisfaction survey results
c. Employee satisfaction survey results
d. Patient population

 

 

ANS:  A

Most objectives will identify benchmarks that they want to reach. The other options may be used but not for every objective and therefore is not essential.

 

DIF:    Cognitive Level: Analysis               REF:   page 30

 

  1. Nurse managers involved in the development of the action plan for a unit understand that each objective is individualized such that
a. each objective has an identified population.
b. each objective has an identified resource.
c. each objective has an identified goal.
d. each objective has been identified by the CEO.

 

 

ANS:  C

Each objective has a target goal or benchmark. The other options do not apply.

 

DIF:    Cognitive Level: Application          REF:   page 30

 

  1. When establishing a unit action plan, the nurse manager identifies steps to be taken to accomplish the goal. What is most important for achieving the goal?
a. Regularly scheduled meetings
b. Administration attendance at meetings
c. Staff involvement in decisions and actions
d. Involvement of other departments

 

 

ANS:  C

Without “buy-in” from staff, the likelihood of success in the plan is remote. The other options may be necessary for success but are not the most important factors.

 

DIF:    Cognitive Level: Application          REF:   page 30

 

  1. When developing a unit-based action plan, what would the nurse manager need to do first?
a. Identify the purpose of the plan
b. Identify specific plans for each strategy
c. Monitor and update the plan
d. Identify the responsibility of each person in achieving the goal

 

 

ANS:  A

The first thing to be accomplished is identification of the purpose or mission. The other actions are incorrect because they are one of the steps taken in the process but not the first.

 

DIF:    Cognitive Level: Application          REF:   page 30

 

  1. When developing a unit-based action plan, the nurse manager would need to include which factor in making decisions for implementation?
a. Patient acuity statistics
b. Patient satisfaction survey
c. Budget
d. Staff holiday schedule

 

 

ANS:  C

Implementation must be made within the budgetary constraints of the unit. The other factors may be involved, depending on the purpose and goal established, but not in every action plan.

 

DIF:    Cognitive Level: Analysis               REF:   page 32

 

  1. Organize the following steps in developing a strategic unit-based action plan.
  2. Determine specific strategies for each goal.
  3. Select goals to be achieved.
  4. Define the purpose or mission.
  5. Monitor and update the plan
  6. Identify resources for accomplishing goals.
a. 3, 2, 1, 5, 4
b. 2, 1, 3, 4, 5
c. 1, 2, 3, 4, 5
d. 1, 2, 5, 4, 3

 

 

ANS:  A

These are the correct steps for developing a strategic unit-based action plan. The other options are not the correct steps for developing a strategic unit-based action plan.

 

DIF:    Cognitive Level: Application          REF:   page 32

 

  1. The overall purpose for strategic planning in an organization includes which of the following?
a. Increases the chance of success
b. Frees the nurse manager from day-to-day supervision
c. Shows interest in the success of the organization
d. Avoids crisis management

 

 

ANS:  A

Planning for changes using a strategy increases the chance of success. Options B and C are not a purpose for planning. Avoiding crisis management is a purpose but it can be incorporated into the success strategy.

 

DIF:    Cognitive Level: Application          REF:   page 33

 

MULTIPLE RESPONSE

 

  1. When an organization performs a strategic analysis, it is looking for ways to address the competition. Which environmental factor influences their decision making? (Select all that apply.)
a. Transfer of patients to a Level I trauma center
b. Changing demographics
c. Political climate
d. Economic considerations
e. Transfer of patients to an extended-care facility (ECF)

 

 

ANS:  B, C, D

An environmental scan can expose changes within the community population, changes in access to federal funding and to accessibility to money available for growth, and changes in access to money available for growth. Options A and E are incorrect because these conditions do not change significantly and should not affect the overall strategic plan.

 

DIF:    Cognitive Level: Analysis               REF:   page 28

 

  1. The patient satisfaction survey can influence strategic planning by using which factors? (Select all that apply.)
a. Strengths and weaknesses
b. Medication errors
c. Threats
d. Staffing shortages
e. Opportunities

 

 

ANS:  A, C, E

SWOT (Strengths, Weaknesses, Opportunities, Threats) is an acronym that can be used when performing environmental scans for the purposes of strategic planning.

The other options are incorrect because they may impact planning at the unit level but not at the organizational level.

 

DIF:    Cognitive Level: Application          REF:   page 28

Chapter 13: Delegation of Nursing Tasks

Motacki: Nursing Delegation and Management of Patient Care, 2nd Edition

 

MULTIPLE CHOICE

 

  1. Which of the following delegations by the RN would require an immediate intervention by the charge RN?
a. A UAP checks a diabetic patient’s blood glucose level.
b. An LPN assesses a patient after a fall.
c. The charge nurse makes changes to the assignments after staff is “pulled” to another area.
d. An RN assists with administering medication to another nurse’s patients during a code.

 

 

ANS:  B

It is not within the scope of practice of the LPN to assess an unstable patient and thus it would require an immediate intervention. Only RNs can assess an unstable patient. The other actions are appropriate delegation and therefore do not require intervention.

 

DIF:    Cognitive Level: Analysis               REF:   page 163

 

  1. Which of the following delegations by the RN would require an immediate intervention by the charge RN?
a. An LPN administers IVP Lasix (furosemide) to a patient in heart failure.
b. An RN administers IVP Lasix (furosemide) to a patient in heart failure.
c. An LPN obtains a blood glucose level on a diabetic patient.
d. An RN obtains a blood glucose level on a diabetic patient.

 

 

ANS:  A

It is not within the scope of practice for LPNs to administer IV medication and therefore would require an intervention. The other options are appropriate delegation and therefore do not require intervention.

 

DIF:    Cognitive Level: Analysis               REF:   pages 165-167

 

  1. Which of the following delegations require an immediate intervention by the charge RN?
a. A UAP ambulates a patient 24 hours after a cardiac catheterization.
b. A UAP ambulates a patient 24 hours after a bronchoscopy.
c. A UAP ambulates a patient 24 hours after a pneumonectomy.
d. A UAP ambulates a patient 24 hours after an echocardiogram.

 

 

ANS:  C

Ambulation for the first time after major surgery requires an assessment by an RN and thus this would require an intervention. The other options are appropriate delegation and therefore do not require intervention.

 

DIF:    Cognitive Level: Analysis               REF:   pages 161-162

 

  1. Which of the following delegations by the RN would require an immediate intervention by the charge RN?
a. A UAP removes the wrist restraints on a patient and provides ROM exercises when giving a bath.
b. An LPN assists a patient back to bed from the bathroom.
c. A UAP replaces the monitor electrodes on a patient after he has taken a shower.
d. An LPN assesses LOC on a stable patient 3 days after surgery.

 

 

ANS:  C

Replacement of electrodes requires an assessment and is not within the scope of practice of the UAP and would require an intervention. The other delegations are appropriate delegation and therefore do not require intervention.

 

DIF:    Cognitive Level: Analysis               REF:   pages 165-167

 

  1. A UAP is asked to take a patient’s temperature every 4 hours and report that temperature to the RN. Which best demonstrates the correct interpretation of right communication?
a. The UAP takes the temperature for the patient every 4 hours.
b. The UAP charts the temperature for the patient every 4 hours.
c. The UAP reports that the patient has been afebrile all day.
d. The UAP reports the temperature for the patient every 4 hours.

 

 

ANS:  D

The UAP has correctly interpreted the delegation and has appropriately acted. The other options are incorrect because they demonstrate an incorrect interpretation of the delegation.

 

DIF:    Cognitive Level: Analysis               REF:   page 165

 

  1. A patient turns his call light on and states, “I’m having trouble breathing.” Which team members should be delegated to respond to this call light?
a. RN
b. LPN
c. Senior student nurse
d. UAP

 

 

ANS:  A

Correct delegation is the RN because this patient requires an assessment to determine the cause of his difficulty breathing and the appropriate action for the nurse to take. The other team members are not within the staff member’s scope of practice to assess unstable patients.

 

DIF:    Cognitive Level: Application          REF:   pages 162-163

 

  1. A patient turns his call light on and requests someone to help him ambulate. The senior student nurse has been caring for this patient for 2 days but has only helped him to a chair in the past. Which instructions should be given to the student prior to ambulation of the patient?
a. “The patient has been ambulated before but still requires some assistance.”
b. “The patient has been ambulated before but is only able to walk with supervision and a walker.”
c. “The patient is only able to walk with a walker for the length of the hallway.”
d. “The patient has been ambulated before using a walker but needs his oxygen saturation checked if he complains of SOB (shortness of breath).”

 

 

ANS:  D

Proper delegation includes specifics about the task and the possible adverse effects and what to do about them should they occur. This answer provides all of the components for good delegation. The other options do not include specifics regarding adverse effects of the task or what should be done if they occur.

 

DIF:    Cognitive Level: Application          REF:   page 163

 

  1. The charge nurse in the ICU receives a call from the ED. They have three patients who require a bed. Which patient should be transferred first?
a. A patient admitted with an acute MI who is in the cardiac catheterization lab now for an intervention
b. A patient admitted with an acute MI and a history of CABG on a nitroglycerin drip to manage ischemic pain and tissue perfusion
c. A patient in sickle cell crisis with a PCA pump to manage his pain
d. A patient in DKA for new-onset diabetes mellitus

 

 

ANS:  B

This patient is the least stable and will require the most assessment due to titration of the nitroglycerin drip. The other options are incorrect because although the patient requires assessments once on the unit, he or she is currently stable and can wait until a bed is available.

 

DIF:    Cognitive Level: Analysis               REF:   page 166

 

  1. The nurse and UAP are working together with four patients. Which patient should the nurse assign the UAP?
a. A patient waiting for discharge instructions before going home
b. A patient who received morphine 20 minutes ago and now has the call light on
c. A patient with diabetes who needs her blood glucose checked
d. A patient returning from a bronchoscopy

 

 

ANS:  C

It is within the UAP’s scope of practice to check blood glucose levels on a diabetic patient. Options A and B are incorrect because this patient requires assessment and therefore cannot be delegated to the UAP until stability is assessed. Option D is incorrect because this patient requires assessment and therefore cannot be delegated to the UAP until stability is assessed.

 

DIF:    Cognitive Level: Application          REF:   page 166

 

  1. When incorporating the five rights of delegation, the right person is being used in which of the following situations?
a. The LPN initiates TPN to a patient as ordered.
b. The charge nurse designates a UAP to “float” to another unit.
c. The staff nurse trades weekends with another staff nurse.
d. The UAP assists a patient to the bathroom after an echocardiogram.

 

 

ANS:  D

It is within the UAP’s scope of practice to assist patients to the bathroom as long as the patient is stable in performing that action. Option A is incorrect because this is an inappropriate delegation. It is not within the LPN’s scope of practice to manage IV therapy. Option B is incorrect because this is not a delegation of a task and is merely a function of the position of the charge nurse. Option C is incorrect because it is not delegation.

 

DIF:    Cognitive Level: Analysis               REF:   page 163

 

  1. When incorporating the five rights of delegation, the right supervision is used in which of the following situations?
a. The RN assesses a patient after the UAP reports a blood glucose level of 56 mg/dL.
b. The RN administers orange juice to a patient reported by the UAP to have a blood glucose level of 56 mg/dL.
c. The RN holds the morning insulin on a patient reported by the UAP to have a blood glucose level of 56 mg/dL.
d. The RN administers the morning insulin after assessing a patient reported by the UAP to have a blood glucose level of 56 mg/dL.

 

 

ANS:  A

The UAP reports a low blood glucose level. The RN must check the patient’s response to that glucose level and may need to repeat the measurement if the patient’s assessment does not correlate with the low level, and thus the RN is supervising the performance of the UAP in that task. Options B and C would be an inappropriate action without first assessing the patient’s response and therefore accuracy of the glucose level obtained. Option D would put the patient at risk for severe hypoglycemia if the blood glucose level is accurate. The RN should assess the patient and the accuracy of the reported glucose level. If the glucose level is as stated, the appropriate action by the RN would be to hold the insulin until the blood glucose is at an appropriate level.

 

DIF:    Cognitive Level: Analysis               REF:   page 163

 

  1. When incorporating the five rights of delegation, the right communication is used when a patient’s blood pressure is low in which of the following situations?
a. The RN tells the UAP to wait to give a patient a bath because her blood pressure is too low.
b. The RN tells a UAP to recheck the patient’s blood pressure and report back to her before giving the patient a bath.
c. The UAP gives a bath to a patient with a low blood pressure.
d. The RN tells the UAP to give a patient a bath because they are unaware of the low blood pressure.

 

 

ANS:  B

Rechecking the blood pressure is the appropriate communication to ensure the safety of the patient. Option A might ensure the safety of the patient for the moment but should be followed up and the blood pressure measurement repeated. Option C could put the patient at risk because of the blood pressure. The RN has not communicated appropriately. Option D is completely inappropriate and places the patient at risk.

 

DIF:    Cognitive Level: Analysis               REF:   page 165

 

  1. When incorporating the five rights of delegation, the right task is used in which situation?
a. The UAP reinforces use of the incentive spirometer to a patient.
b. The UAP teaches the patient to use the incentive spirometer.
c. The UAP listens to breath sounds to encourage the patient to use the incentive spirometer.
d. The UAP is not allowed to work with the patient regarding use of the incentive spirometer.

 

 

ANS:  A

Although the UAP is not allowed to teach the patient about the use of the incentive spirometer, it is within his or her scope of practice to reinforce that teaching. Only the RN can teach the patient how to use the incentive spirometer. The UAP may not teach patients. UAPs may not assess. Only the RN has that responsibility. The UAP may reinforce use of the incentive spirometer.

 

DIF:    Cognitive Level: Analysis               REF:   page 163

 

  1. When incorporating the five rights of delegation, the right circumstance is used in which of the following situations?
a. The RN asks the UAP to draw a prothrombin time on a patient on a heparin drip.
b. The RN asks the UAP to draw blood on a patient with bilateral upper extremity lymphedema.
c. The RN asks the UAP to draw blood on a newly admitted patient with pneumonia.
d. The RN asks a new UAP to draw blood on a patient known to be a “hard stick.”

 

 

ANS:  C

It is within the UAP’s scope of practice to draw blood (if allowed in the institution) from patients without IV issues. The prothrombin time blood sample should not be obtained from the arm in which the heparin is running and the UAP is not qualified to know that. The site for blood draws in this patient would need to be carefully chosen by only an RN to protect the patient from injury. Option D is inappropriate delegation; the RN should draw this patient’s blood.

 

DIF:    Cognitive Level: Analysis               REF:   page 163

 

  1. After receiving the shift report, which of the following requires a priority action by the nurse?
a. Discontinue an IV line from an insertion site that appears red and at which the patient complains of pain.
b. Make assignments for the team.
c. Talk to a patient who has changed his mind about having a procedure today.
d. Round on all the patients on their team.

 

 

ANS:  A

Patient safety is a priority. The other options are not a priority for patient safety.

 

DIF:    Cognitive Level: Application          REF:   page 162

 

  1. Which of the following patients should the nurse see first after the shift report?
a. A patient with a change in heart rhythm who is complaining of lightheadedness
b. A patient with a newly placed pacemaker who is complaining of shoulder pain
c. A patient in heart failure on afterload reducers with a blood pressure 96/60 mm Hg
d. A patient in first-degree heart block

 

 

ANS:  A

The patient has complained of lightheadedness and his cardiac monitor shows an increase in heart rate. A change in heart rhythm requires a nursing assessment. Options B and C are incorrect because the complaint is predictable and is not a priority. Option D is incorrect because the patient is stable and is not a priority.

 

DIF:    Cognitive Level: Application          REF:   page 169

 

  1. The nurse is working on a medical unit with an LPN and UAP as the team members. Which tasks should the RN delegate to the LPN?
a. Vital signs on a patient about to arrive from the cardiac catheterization lab
b. Regulation of a patient’s heparin drip based on the heparin nomogram
c. Regulation of a patient’s nitroglycerin drip based on the level of pain
d. Administration of all oral medications for the team

 

 

ANS:  D

It is within the LPN’s scope of practice to administer oral medications. The other options are incorrect because the patient requires the RN’s assessment skills.

 

DIF:    Cognitive Level: Application          REF:   pages 165-167

 

  1. The nurse is working on a medical unit with an LPN and UAP as the team members. Which tasks should the RN delegate to the UAP?
a. Vital signs on all patients admitted on the previous shift
b. Vital signs on a patient being transferred from the ED
c. Vital signs on a patient being transferred from the ICU
d. Vital signs on a newly admitted stable patient

 

 

ANS:  A

It is within the scope of practice for the UAP to take vital signs on stable, predictable patients. The other options are incorrect because only the RN can make this initial assessment.

 

DIF:    Cognitive Level: Application          REF:   pages 165-167

 

  1. The nurse is working on a medical unit with an LPN and a UAP as the team members. Which tasks should the RN complete?
a. Assignments of new admissions to staff
b. Regulation of heparin drip based on the heparin nomogram
c. Vital signs on patients admitted on previous shift
d. Dressing change for a patient 4 days post I&D of a pacemaker wound

 

 

ANS:  B

Only the RN is allowed to titrate IV medications because assessment is required. Assignments of new admissions to staff should be performed by the charge nurse. Vital signs on patients admitted on previous shift can be appropriately delegated to the UAP. Dressing change for a patient 4 days post I&D of a pacemaker wound can be appropriately delegated to the LPN.

 

DIF:    Cognitive Level: Application          REF:   pages 165-167

 

  1. The nurse is working on a medical unit with an LPN and UAP as the team members. Which tasks should the RN complete?
a. Vital signs on a patient admitted from the ED
b. Turning a patient who had a CVA 4 days ago
c. Feeding a patient requiring assistance
d. Recording the I&O on a patient on strict fluid restrictions

 

 

ANS:  A

This patient requires an initial assessment, for which only the RN can be responsible. The other tasks can be delegated.

 

DIF:    Cognitive Level: Application          REF:   pages 165-167

 

  1. An agency nurse is assigned to the thoracic surgery postoperative nursing unit. Which of the following would be the best action by the charge nurse?
a. Call the agency to determine her level of experience.
b. Assign the nurse to patients ready for discharge.
c. Assign her to pass medications only.
d. Ask the nurse about her level of experience.

 

 

ANS:  D

Assignments are made based on the nurse’s knowledge and skills and the agency nurse should be asked about her experience and background. The other actions are unnecessary. Asking the RN will provide the information necessary to determine the assignment.

 

DIF:    Cognitive Level: Analysis               REF:   pages 163-165

 

  1. Which action by a UAP requires an immediate intervention by the nurse?
a. Application of a skin barrier/protection ointment
b. Releasing wrist restraints on a patient to allow ROM
c. Assisting a patient to the bedside commode
d. Obtaining a urine culture from a patient

 

 

ANS:  A

These products are medications and even topical medications are not allowed under the UAP’s scope of practice, and thus this requires an intervention. The other actions are within the scope of practice of the UAP and do not require an intervention.

 

DIF:    Cognitive Level: Analysis               REF:   pages 165-167

 

  1. Which action by a UAP requires an immediate intervention by the nurse?
a. Encouraging a patient to use the incentive spirometer
b. Encouraging a patient to ambulate 2 days after surgery
c. Checking the pH of the gastric aspirate of a patient receiving tube feedings
d. Informing the RN that a patient requests a pain medication

 

 

ANS:  C

Checking the pH of the gastric aspirate of a patient receiving tube feedings requires an assessment and is not within the scope of practice of the UAP and thus requires an intervention. The other actions are within the scope of practice of the UAP and do not require an intervention.

 

DIF:    Cognitive Level: Analysis               REF:   pages 165-167

 

  1. Which patients on an orthopedic unit should be assigned to a nurse from a cardiac unit?
a. A patient being transferred to an ECF for rehabilitation following a hip replacement
b. A patient following a hip replacement with a history of an acute MI 4 weeks ago
c. A patient with an external fixator
d. A patient to be started on a PCA pump requiring instructions

 

 

ANS:  B

With the RN’s knowledge and background for caring for cardiac patients, it is most appropriate to assign her to this patient because of the potential for cardiac issues to arise postoperatively. The other assignments are not appropriate given this nurse’s background and knowledge.

 

DIF:    Cognitive Level: Analysis               REF:   pages 163-165

 

  1. Which actions by the UAP would require immediate follow-up by the nurse?
a. Informing the nurse she was taking a break
b. Taking her lunch break on her home floor after being pulled to another floor
c. Asking the patient to let her know the next time he has a bowel movement
d. Asking another UAP to obtain a urine sample for her

 

 

ANS:  D

It is not within the scope of practice for the UAP to delegate any tasks and would require an intervention. The other actions are appropriate action by the UAP and do not require intervention.

 

DIF:    Cognitive Level: Application          REF:   pages 165-167

 

  1. A nurse must delegate some responsibilities of the care of patients on a particularly busy and chaotic day to the LPN and UAP team members. Which of the following can be appropriately delegated to the LPN?
a. Assisting with a central line insertion
b. Giving bath supplies to patients who are capable of bathing themselves
c. Rechecking the blood pressure on a patient who is having episodes of bigeminy and ventricular tachycardia
d. Transporting a patient in a wheelchair for discharge

 

 

ANS:  A

The LPN has been trained to assist the health care provider with complicated procedures. The assignments in options B and D can be delegated to the UAP. Option C is incorrect because this patient is unstable and requires an RN’s assessment.

 

DIF:    Cognitive Level: Application          REF:   pages 167-169

 

  1. Which statement made by the clinical instructor would represent feedback to a student nurse?
a. “Explain to me the actions of this medication before you give it.”
b. “Can you explain to me why Mr. W. did not receive a bath this morning?”
c. “Stop the urinary catheter insertion now. You have contaminated the catheter.”
d. “You need to use your critical thinking skills when caring for patients.”

 

 

ANS:  D

Although this may not be the most appropriate feedback, it does give the student feedback on his clinical performance. The other statements are confrontational but do not provide feedback.

 

DIF:    Cognitive Level: Analysis               REF:   page 165

 

  1. A nurse assesses a patient reported to have normal vital signs throughout the night and finds the patient in acute respiratory distress. What is the nurse’s next best action?
a. Delegate vital signs to the UAP.
b. Ask another nurse to call the health care provider.
c. Call a code.
d. Start another peripheral IV line.

 

 

ANS:  B

The nurse should stay with the patient and obtain vital signs, further assessing the patient for changes. The other actions are not appropriate.

 

DIF:    Cognitive Level: Analysis               REF:   pages 166-167

 

  1. Which order should be considered to have the highest priority when delivering care to a patient?
a. Albuterol treatment for a patient complaining of shortness of breath
b. IV diuretic for a patient in heart failure
c. Sliding-scale short-acting insulin
d. Antihypertensive for a patient admitted with negative cardiac enzymes

 

 

ANS:  A

The patient’s respiratory status has changed, so ABCs should be used to determine the highest priority medication administration. The other orders are incorrect because the patient is not at risk for loss of airway.

 

DIF:    Cognitive Level: Analysis               REF:   page 169

 

  1. Which delegation should a UAP consider to have the highest priority?
a. Obtaining a routine blood glucose level from a patient with diabetes
b. Giving a bath to a patient scheduled for a colonoscopy
c. Feeding a patient who needs assistance doing so.
d. Helping an older adult patient to the bathroom

 

 

ANS:  D

Older adult patients frequently need to get to the bathroom quickly, and if no assistance is provided, they may fall in an attempt to make it there by themselves. The other delegations do not take priority over the older adult patient needing to use the bathroom.

 

DIF:    Cognitive Level: Analysis               REF:   page 169

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