RN446 Collaborative Healthcare
1. The nurse performs triage after a multiple car crash involving 32 victims. What finding indicates a client will require a black tag for triage? Answers: A – D A. Penetrating head wound. B. Second and third degree burns to 60% of the body. C. Open fracture to lower left leg. D. Sucking chest wound. 2. The new graduate works on the acute care floor at a local hospital. What statements made by the graduate to the preceptor indicate that the graduate is experiencing the rejection phase of reality shock? Select all that apply. Answers: A – E A. “I wonder if I made the right career choice. This is harder than it was when I was in nursing school.” B. “I really feel that I can make a difference with my clients and give the best possible care. C. I am worried about Performing some of the procedures without my instructor’s present. D. “I am so glad that I chose this profession, it is what I was meant to do. E. “I just feel like I am working so hard and no one else cares about the clients as much as I do.” 3. The charge nurse prepares to make shift assignments on the medical-surgical unit. Review the postoperative client’s electronic health record. For each assignment, click to specify if the assignment is appropriate or not appropriate. Note: Each row must have one response option selected. Assignment Appropriate An RN with 15 years of ED experience who floated to the unit. An LP/LVN who has been on the unit for one year. An LPN/LVN who floated from ● the labor and delivery unit. An RN who has been on the unit for five years. A new graduate in their first week after orientation. Not Appropriate 4. The nurse manager revises the budget for the fiscal year and identifies the productive versus non-productive time for staffing purposes. When identifying the non-productive time, which factors does the manager consider? Select all that apply. Answers: A – E A. Orientation of new nurses on the unit. B. The actual time that the nurses on the unit worked. C. A staff member that was out of work sick for 3 weeks. D. The provision of an educational program with mandatory attendance by staff. E. Two employees that terminated employment with a hire of one employee. 5. A nurse working in a behavioral health unit suspects that another nurse is developing a sexual relationship with a client. The nurse has observed them touching and kissing when thinking they are unobserved. Which actions should the nurse observing this behavior take? Select all that apply. Answers: A – E A. Note date, times, and the names of the individuals that are involved in the behavior. B. Report the behavior observed to the supervisor using facts. C. Get another staff member to be a witness to the behavior observed. D. Inform the offending nurse that you are aware of what is being done with the client. E. Take a picture of the behavior that is occurring and email it anonymously to the supervisor. 6. The nursing supervisor sends an email to a nurse regarding confusion over a change in the work schedule. Which statement in the email demonstrates a barrier to manager-subordinate communication? Click to identify the statement that indicates the external climate that is the barrier to communication. Select your answer by clicking the desired location on the image below. To move a pin, click another location on the image. To remove a pin, click it once. EMAIL COMMUNICATION Dear Ms. Clay, I hope this email finds you doing well. Please be aware that there was a change in the schedule that created a vacancy in staffing. I have placed you to work in that vacancy at your request for overtime when we last spoke. I understand that this may have conflicted with your personal plans for that day, but I am the supervisor and responsible for completing this schedule. Sincerely, Supervisor Thomas 7. The client is most likely experiencing a(n) due to the medication. The most common medication for the treatment of this situation is Before administering this medication, the nurse should first Answers 1 – 3 1. Select answer choice adverse effect allergic reaction therapeutic effect 2. Select answer choice diphenhydramine albuterol acetaminophen 3. Select answer choice add ampicillin to the allergy list check for additional allergies stop the ampicillin infusion 8. The nurse manager is tasked with taking charge of a large project that will prevent other duties from being performed. In which situations would it be best for the manager to delegate some of the responsibilities they will be unable to complete? Select all that apply. Answers: A – E A. There are tasks that the manager has no interest in doing and would rather someone else do them. B. Another staff member has expertise in an area that the manager does not. C. The delegation of responsibilities to others will increase the productivity of the unit. D The manager will get to choose what tasks they prefer to do. E The delegation will promote a learning opportunity for a staff member. 9. The nurse manager of the perioperative department assesses a change to cross-train staff to fill in the deficits left by four nurses leaving the unit. Prior to implementation, which steps should the manager take in order to facilitate a smooth transition? Place the options in order of implementation, from first to last. 1. Evaluate the outcome of the implemented staffing change 2. Discuss the implementation of the process with all involved verbally and in writing. 3. Assess the organization’s communication hierarchy. 4. Determine who will be affected by the new staffing process 5. Meet with the directors of the ancillary units this change will affect. 10. A novice nurse states to the preceptor, ‘I just feel so overwhelmed with how much I don’t know. I just thought this would be an easier transition into practice.” What is the best response by the preceptor? Answers: A – D A. “It is going to take you many years before you feel confident in your abilities.” B. “I understand your frustration and I am here to help you with this transition to practice.” C. “You didn’t really think that nursing school would teach you everything, did you?” D. “Welcome to the real world! You may as well get used to that feeling.” 11. The nurse working in the skilled long-term care unit delegates several tasks to the unlicensed assistive personnel (UAP) to complete prior to the end of the shift. Which skills delegated demonstrate that the nurse has appropriately delegated to the UAP? Select all that apply. Answers: A – E A. Assessing the gastric residual from a client receiving enteral feedings. B Ambulating a client in the hallway. C. Obtaining vital signs for 6 clients. D. Transporting a client to the physical therapy department by wheelchair. E. Notifying the health care provider of a client’s loose stools. 12. The nurse manager has a disciplinary conference with a nurse that has been reported by several peers for behavioral issues with staff and clients. The nurse states, “They are all out to get me because they don’t like me and want me to quit.” What is the best response by the nurse manager at the onset of the meeting to this statement? Answers: A – D A. “It seems to me that you are not enjoying your work on the unit and may want to consider another place.” B. “The ultimate goal is to work cooperatively with each other for the best client outcomes.” C. “It is difficult for your peers to enjoy their working relationship with you.” D. “Consider this a verbal warning, and if the behavior continues, you will be terminated.” 13. A school bus accident has occurred with the transport of 20 children to the emergency department. While triaging these clients, which child will the nurse see first? Answers: A – D A. A 11-year-old with a laceration of the scalp approximately 6 cm long B. A 12-year-old with ecchymosis of the right eye and pain in the jaw. C. A 7-year-old with a closed upper extremity fracture and laceration to the lower left leg. D. A 9-year-old with no audible breath sounds on the left and tracheal deviation. 14. The nurse is in the emergency department (ED) working when several clients are brought in after a nuclear reactor within 30 miles of the town began leaking, and people began experiencing symptoms. What actions by the nurse and disaster team are an initial priority? Select all that apply. Answers: A – E A. Take biologic samples to determine the agent. B. Remove clothing and place it in plastic belonging bags. C. Use a radiation survey meter for external contamination. D. Take a detailed past health history. E. Decontaminate the clients outside of the ED. 15. A client admitted to the labor and delivery unit is to receive magnesium sulfate for preeclampsia. The registered nurse (RN) delegates tasks to the licensed practical/vocational nurse (LP/LVN). Which task is most appropriate for the RN to delegate to the LPN/LVN? Answers: A – D A. Notify the health care provider of decreased fetal movement and deep tendon reflexes upon the last assessment. B. Pull calcium gluconate from the medication dispensary for the client. C. Assess the client and fetus prior to the start of magnesium sulfate infusion. D. In two hours after the start of the magnesium sulfate, assess and document fetal findings. 16. A client informs the nurse that they do not want to go to a long-term care facility, but family members are insistent that this is the only option that is acceptable. Which statement made by the nurse demonstrates advocacy for the client? Answers: A – D A. “Why don’t you tell them you will go for 6 months only and then re-evaluate.” B. “I will schedule a meeting with you and your family so that we can discuss options.” C. “They love you and want to do what is in your best interest.” D. “Tell them that you will do as you please since you are an adult.” 17. 17. A firefighter was thrown due to a blast from a building when trying to evacuate people from inside. What should the nurse focus the immediate assessment on related to this type of injury? Answers: A – D A Tympanic membrane rupture.. B Burns to 80% of the body. C Loss of consciousness, and head injuries. D Exacerbation of an asthma attack. 18. The acute care unit hires a new manager to oversee the clinical operation of the unit. What behaviors demonstrated by the new manager indicate that their style of leadership is democratic? Select all that apply. Answers: A – E A. Encourages group participation when developing protocols for clients on ventilators. B. The manager gives very little direction when making changes to unit policies. C. A nurse completes a BS and is not acknowledged by the manager for this achievement. D. After a unit project is completed, the manager credits the team with the outcome. E. The manager gives constructive feedback to a new employee within 30 days of hire. 19. The director of a medical-surgical unit is concerned with the high nurse turnover on the unit. What actions by the director may improve the retention and obtainment rate? Select all that apply. Answers: A – E A. Introduce collaborative decision-making, so staff feels a part of a team. B. Inform the staff there will be an increase in overtime to fill the vacancies. C. Meet with staff individually and as a group to determine goals for the unit. D. Create an environment that empowers the staff and promotes autonomy. E. Determine budgetary allowances for staff support personnel. 20. A staff nurse has been promoted to clinical manager on the acute care floor. Which action by the nurse demonstrates a democratic approach to management style? A. After a nurse makes a medication error, the input from the manager is punitive and without support. B. When asked by a staff member to review a policy change that was completed, no critique is given C. Doesn’t provide structure or guidance when assigning a nurse to be the staff scheduler D. Asks for the input of all staff members when making a change to the staffing policy for overtime 21. A novice nurse begins working in perioperative services and is being precepted by an expert nurse that is certified as an operating room nurse. The expert nurse tells the novice, “I have no idea why they hired someone with no experience. Just puts more work on me.” What is the best response by the novice nurse? Answers: A – D A. “I don’t want to be a burden to you and will just follow you around and watch what you do.” B. “I would like to be a productive member of this team, and with your expertise and help, I believe I can.” C. “If you don’t want to precept me, I will go to the manager and ask for someone who does.” D. “There was a job opening and I thought this would be an interesting place to start my career as a nurse.” 22. A nurse documents the care of a client that has developed compartment syndrome after having a cast applied on the left leg after a fractured tibia and fibula. Click to identify the documentation by the nurse that would be of most concern indicating negligence. Select your answer by clicking the desired location on the image below. To move a pin, click another location on the image. To remove a pin, click it once. NURSING NOTES 1200 Right leg cast warm and dry. Toes cool to touch with capillary refill over 3.2 seconds. Elevated the leg on 2 pillows with instructions for the client to notify the nurse if numbness or tingling occurs. 1500 Toes dusky with no capillary refill observed. Notified provider who states, “I will be there in 10 minutes.” 1645 Provider arrives and removes cast. Orders given to prepare the client for emergency fasciotomy. 23. A new graduate nurse seeks out a mentor in order to help through the transition into the realm of nursing on a medical unit at the hospital. What attributes should the nurse determine would be the best fit for a mentor? Select all that apply. Answers: A – E А. An experienced nurse that is willing to give advice and provide guidance whenever needed. B. A nurse that is willing to help support and guide the new graduate throughout the transition and after. C. A new nurse that has been through the transition recently and can give the new graduate a better perspective. D. A nurse that is a positive role model and will help the new graduate facilitate placement in the facility. E. A nurse that goes over the policy and procedures and has the new graduate follow whatever they do. 24. A truck driver delivering chemicals to a company overcorrected and went into a ditch, spilling the substance from the truck. The driver is transported to the hospital with injuries and contamination from the spill. What is the first action by the nurse? Answers: A – D A. Obtain a health history. B. Remove the clothing and any jewelry. C. Rinse the client with water. D. Wash with soap and water and rinse. 25. A nurse states to the charge nurse at the nurses station, “I am sick of this! Why do I have the worst clients when the other nurse gets to pick and choose who they get?” What actions will be best for the charge nurse to take? Select all that apply. Answers: A – E A Ignore the behavior until the nurse is ready to talk calmly. B Address the conflict immediately and privately. C Work with the nurse to find a win-win situation for all involved. D .Inform the nurse that the assignment is set, and it will have to be worked out later. E Assist the nurse in identifying alternate measures to manage the conflict. 26. Review the electronic health record. For each factor in the client’s care, click to specify if the factor would be considered or would not be considered if the incident becomes a malpractice case. Note: Each row must have one response option selected. Possible Factors Would Be Considered Would Not Be Considered Time between nursing notes Not assisting client to the bathroom when requested Nurses experience level Age of the nurse Client’s code status Nurse’s education level 27. Examplify W7 NR446 CJE Leadership Be The nurse manager promotes workplace advocacy for staff members. Which behaviors demonstrated by staff indicate to the manager that further education is required to meet the safety initiatives? Select all that apply. Answers: A – E A. When irrigating a wound, the nurse is not wearing safety goggles to cover the eyes. B. The unlicensed assistive personnel (UAP) gets too close to an agitated client. C. A nurse is observed administering care to a client with the bed in the lowest position. D. The nurse calls the housekeeping department to clean a spill in the hallway. E. A nurse is observed recapping a needle after administering insulin to a client. 28. 11/19 0830 Temprature 100.4 °F (38.0 °C), heart rate 102, respiratory rate 22, blood pressure 130/86, 02 saturation 92%. Auscultation of lung fields anterior and posterior reveal fine crackles in the left base. Acetaminophen 650 mg PO administered for fever > 101 °F (38.3 °C). Awake, alert, and oriented x 4. Potassium level 6.2 mE/L. Oxygen 2L/minute via nasal cannula, and chest x-ray reveals consolidation in the left lower lobe. Repeat chest x-ray in the morning. Sputum culture and sensitivity (not obtained in the ED). The nurse prepares to complete the SBAR reporting form prior to transferring a client from the emergency department to the acute care unit. Which information should be placed in the “A” category of the SBAR? Select all that apply. Answers: A – A Administered acetaminophen for fever > 101 °F (38.3 °C) B Obtain sputum culture C Repeat chest x-ray in the morning D Mental status E Potassium level F. vital sign 29. The nurse manager plans to implement a policy change to staff scheduling but does not inform the staff about the change until the first new schedule is displayed. What outcomes will this change likely have since the manager did not communicate with staff? Select all that apply. Answers: A – E A. Staff will accept the change without questioning the reason. B. Staff will not understand what precipitated the change. C. There will be resistance to the change with discord. D. Staff will feel disregarded in their role on the unit. E. Staff will realize that the manager is looking for optimal scheduling outcomes. 30. A nurse determines that a facility is fraudulent in their billing practices and is concerned about being involved with this issue. When considering whistleblowing, what is the first action by the nurse? Answers: A – D A. Consider all aspects of the issue with thoughtful consideration. B. Call the insurance companies and inform them of what is happening. C. Go to the CEO of the company and inform them they will be reported. D. Go public with the information to a news reporter. 31. The nurse requests staffing assistance from the nurse manager for a busy shift in the cardiac step-down unit. Another nurse is floated to the unit from the postpartum unit to assist. Which client assignment would be best delegated to the float nurse? Answers: A – D A. A client with a nitroglycerin drip for treatment of chest pain and hypertension. B. A client three days postoperative after a coronary artery bypass graft and ambulating in the room. C. D. A client with a new left ventricular assist device (LVAD) that needs education regarding going home with the device. A client status post insertion of a permanent pacemaker with implanted defibrillator. 32. A nurse identifies that a co-worker has labile mood swings, frequently tardy, and leaving for long breaks throughout the shift and has an unkempt appearance. The co-worker has requested that the nurse co-sign narcotic wastes after stating the syringe was placed in the biohazard container. Which actions by the nurse are appropriate? Select all that apply. Answers: A – E A. Confront the co-worker and ask if they are using illegal substances. B. Talk to the other staff members on the unit to see if they are observing the same behaviors. C. Use a video to record the co-worker’s behavior to present to the supervisor. D. Inform the co-worker of the inability to sign for a narcotic waste that was not observed. E Discuss the concerns with the nurse manager. 33. The nurse manager performs a critical incident performance appraisal for a nurse. When performing the appraisal, what will the nurse manager prioritize? Answers: A – D A Use a rating scale to indicate the degree to which the job performance criteria are met. B Observe, collect, and record specific instances of the employee’s performance on the job. C. Choose several people from the appraisal team and proceed to evaluate one another’s job performance. D. Place a checkmark in a column as to whether the employee meets the standards of job performance. 34. Nursing Notes 8/19 0800 Handoff report received from M.P, RN, regarding client. The client coded last night but was revived. The client is now resting in bed. Family is at the bedside. Provider to visit this morning. 0900 After the provider spoke with the family, the decision was made to make the client DNR. Client is currently on 2L oxygen via NC. Review the electronic health record. M.P., the nurse who cared for the client the previous shift, calls to ask how the client is doing. Which responses by the current nurse are most appropriate? Select all that apply. Answers: A – H A “Unfortunately, I cannot talk about a client you are not caring for.” B. “She is okay right now. Her vital signs are stable, but I know her family is discussing options.” C. “She is not doing well. Her family should really consider going home with hospice care.” D. “You should ask the charge nurse for that information.” E. “I am sure she will be okay. F “She is doing well.” G. “HIPAA states that I can only disclose information on a need-to-know basis.” H “You know they made her a DNR, right?” 35. The nurse manager prepares to meet with a nurse whose performance on the unit has not met the expectations required. Several other staff members have complained and requested not to work with the nurse. What action should the manager take prior to the meeting with the nurse? Answers: A – D A. Notify human resources that termination is the only possible outcome of the meeting. B. Obtain the nurse’s personnel file and review the documents for past performance. C. Discuss the nurse’s performance with other members of the health care team. D. Ask the nurse what personal problems are affecting the ability to perform adequately. 36. During a mass disaster related to injuries from a tornado, the triage nurse is confronted by a member of the media requesting information about the clients. What is the best response by the nurse to the media representative? Answers: A – D A. “There are several seriously injured people here, but I can take some time to talk with you since I need a break.” B.”I will locate our media representative when the crisis is over, and have you talk with them.” C. “You will have to wait until I finish triaging clients before I can give you that information.” D. “Can’t you see that we are in the middle of a crisis, and I need to focus all of my attention on the injured?” 37. The nurse cares for a group of clients on a busy unit. When delivering care to the clients, which actions place the nurse at risk for professional negligence? Select all that apply. Answers: A – E A. Morphine sulfate 4 mg IV is ordered for a client after an appendectomy, and morphine sulfate 6 mg is administered with resultant respiratory depression. B. The nurse places 3 side rails up after the client requests they are helpful for moving and turning in the bed. C. Medications for a client with myasthenia gravis are administered 2 hours after scheduled, and the client is unable to swallow. D. The nurse bypasses the barcode system to administer medications on a client, and the incorrect medication is given. E. The nurse determines that the IV phenytoin to be administered will not be compatible with the D5W that is hanging and removes it. 38. The nurse assigns unlicensed assistive personnel (UAP) to perform glucose checks and observes that several clients have uncharacteristically different readings than previous levels after the task is complete. What action was essential for the nurse to take prior to assigning this task to the UAP? Answers: A – D A. Check documented competency for this skill. B. Have the UAP’s task performance observed by another UAP. C. Ensure the UAP is aware of the previous readings by others. D. Review the correct way to document the skill after performance. 39.The nurse manager conducts panel-style interviews for a staff position. Which questions asked by a member of the panel would require intervention by the nurse manager that is not appropriate for an interview question? Select all that apply. Answers: A – E A. What was your reason for leaving your previous position at the clinic? B. Do you have a particular religious preference that would prevent you from working holidays? C. How many children do you have? D. Do you hold a current license in the state of practice? E. Can you tell us your qualifications for this position? 40. The novice nurse states to a previous preceptor, “I can’t get anything done in time. My medications were all late and the clients were angry. What am I doing wrong? Maybe this is not a good fit for me.” What are the best responses by the preceptor? Select all that apply. A. l have the same issues when l gets busy and just try and do tasks as they come to me in order. B. Determine the time it will take to complete a task and consider tracking the shorter time frame tasks first. C. Let’s talk about what worked for you when you prioritized clinical activities in nursing school. D. Think through each situation and change your priorities as required throughout the shift. E. It would be beneficial to keep a note pad in your pocket and write down reminders of what needs to be completed. 41. A novice nurse works in a hospice facility since graduation a year ago. The novice nurse states to the preceptor, “It’s all the same and I am becoming numb to the emotions that I had at first.” What is the best response by the preceptor? Answers: A – D A.”I feel like this all of the time because I give my all to this place and don’t get much in return.” B. “It sounds like you are experiencing burnout and may want to consider switching to another type of nursing.” C. “Compassion fatigue is common in this field, and we should identify some of your stress triggers.” D. “Don’t bring your work home with you. This is just a job, and you should leave it when you walk out.” 42. The nurse is a member of a task force in order to evaluate a new curriculum change statewide. When performing in the role of opinion seeker of the task force, what behavior demonstrated would correlate with this group task role? Answers: A – D A Keeps the group moving toward action related to the wound policy change. B Seeks opinions of others in the group that clarify or reflect similar values. Takes notes and documents all the achievements from the group meetings. C D Compares the group suggestions about the wound policy with the standard of care. 43. Nursing Notes Vital Signs Time 1730 Blood Pressure 85/48 Heart Rate 160 Respiratory Rate 34 Temperatur e 102.0 F 38.9 С Sp02 89% RA . 4/14 1730 Client had been found by assistive personnel at 1300, lethargic and confused. Report from emergency department nurse indicated the client was treated for a urinary tract infection 3 weeks ago, for which he took a course of levofloxacin PO 500 mg daily. Assisted living facility staff indicated the client’s daughter is the health care surrogate. Her contact information was provided. RN called client’s daughter. The following six questions are part of an unfolding case study. A 90-year-old client is admitted to the medical unit from an assisted living facility. Which information is most important for the nurse to obtain from the daughter? Select all that apply. Answers: A – H A Past medical history B. Social history C Code status D Family medical history E Ambulation ability F Post-mortem care preferences G Organ donation status H Advance directive 44. Nursing Notes 4/14 1730 Client admitted to medical unit from assisted living facility. Had been found by assistive personnel at 1300, lethargic and confused. Report from emergency department nurse indicated the client was treated for a urinary tract infection 3 weeks ago, for which he took a course of levofloxacin 500 mg daily. Assisted living facility staff indicated the client’s daughter is the health care surrogate. Her contact information was provided. RN called client’s daughter. 2000 Client transferred to step-down critical care unit for further management of care. Client’s daughter was called and arrived just before transfer to unit. Client is difficult to arouse and unable to answer questions. RN discussed plan of care with daughter and attempted to clarify client’s code status and whether the client has an advanced directive. Daughter stated to the nurse, “I have always helped my dad make his medical decisions. I think he has an advanced directive, but I don’t know what it says or where it is. I will call his lawyer tomorrow to see if they have a copy, but what happens until then?” The nurse responds to the daughter’s question at 2000. For each statement by the nurse to the client’s daughter, click to specify if the comment is correct or incorrect based on the daughter’s statements. RN Statement ‘The advance directive typically names a durable power of attorney for health care, which is important for us to know.” “You can let the doctor know your wishes for your dad, and he will enter the code status prescriptions based on that.” “Since your dad cannot express his decisions to us right now, we need to ensure the correct person is making those decisions.” “Until we have a definitive answer on your dad’s wishes or know who can legally make decisions for him, we must consider his status Full Code.” “The provider ultimately makes the code status decision based on many Correct Incorrect factors, but the provider will discuss that with you.” 45. The nurse documents follow-up with the client’s daughter and client updates in the nursing notes at 0900. Click to identify the intervention at 1200 the nurse should question. Select your answer by clicking the desired location on the image below. To move a pin, click another location on the image. To remove a pin, click it once. NURSING NOTES 1200 Client transferred to ICU this morning. Client remains on CPAP and CRRT. Client blood pressures began to trend down, and intravenous drip started to support blood pressure within prescribed parameters. Client work of breathing increasing, and team prepares intubation kit for potential emergency intubation procedure. Central line inserted under sterile procedure to support multiple medical needs. 46. Nursing Notes 4/5 0900 Clients’ daughter comes and provides RN with client advance directive paperwork. Nurse notifies provider the paperwork has been obtained. Upon review of paperwork, client code status is entered as DNR/DNI. The daughter is also named as the durable power of attorney for health care. Client did have some respiratory decline over the night. CPAP applied overnight with Fi02 around 70% to maintain oxygen parameters. Client with decreased urinary output; indwelling urinary catheter placed for strict intake and output monitoring. AM labs indicate client is in severe acute kidney failure and continuous renal replacement therapy (CRRT) is prescribed. Client to be transferred to the intensive care unit for initiation of this therapy. Client remains on continuous intravenous fluids for hydration and intravenous antibiotics for infection. 1200 Client transferred to ICU this morning. Client remains on CPAP and CRRT. Client blood pressures began to trend down, and intravenous drip started to support blood pressure within prescribed parameters. Client work of breathing increasing, and team prepares intubation kit for potential emergency intubation procedure. Central line inserted under sterile procedure to support, multiple, medical needs. 1400 Client BP stabilizing on pressure support drip. Client arousable to touch, but unable to answer questions or follow commands. Client continues on CPAP with Fi02 increased to 80% to maintain oxygen saturations above 90%, Client with increasing work of breathing and may require additional breathing support. Client daughter to be updated regarding plan of care. Indwelling urinary catheter remains in place. Client being turned Q2H and requires turning and repositioning now, Incontinence pad changed during repositioning to cluster care. Oral care performed per protocol. Client temperature 101.8 °F (38.7 C). Acetaminophen suppository administered PRN for fever. For each action, click to specify which health care team member can perform each task based on scope of practice for this registered nurse (RN), licensed practicing nurse (LP), and unlicensed assistive personnel (UAP). Note: Each row must have one response option selected. Interventions RN Only RN or LPN/LVN RN, LPN/LVN, or UAP Reposition client Contact health care surrogate Perform oral care Perform physical assessment Administer suppository 47. Which interprofessional team members should the supervising nurse ensure are included in the meeting on 4/16? Select all that apply. Answers: A – H A Social worker B Physical therapist C Unit manager D Case manager E Hospital chaplain F Client’s health care provider G Dietician H Client’s current nurse 48. 4/17 0200 Client daughter called RN into room, stating she believed client had stopped breathing. Respirations and pulse checked. No chest rise and absent apical pulse confirmed with 2 RNs and provider notified. Client daughter offered support and time with her father. 0445 Client daughter left facility. Post-mortem care performed. Hospital Coordinator notified and client transported to the morgue. Review the electronic health record and the conversation between the registered nurse (RN) and the nurse manager. Nurse Manager: “I heard you had a tough shift last night. Let’s talk about it.” Registered Nurse: Tearful. “My client passed last night. I don’t know how nurses can deal with this day after day when they work. I don’t think I will make it that long as a nurse if I keep working here l just don’t know what to do. For each recommendation, click to specify if the recommendation is indicated or not indicated. Recommendations Indicated Not Indicated Unpaid time off after each client death Peer-to-peer support group Discounted yoga membership Debriefing opportunities after difficult client situations Coping strategies 49. Preceptor Report 6/4 Currently precepting N.L, a new RN hired for this unit. N.L. graduated in May; this is his first nursing job. N.L. has been late 2 out of 3 days this week. The importance of arriving on time has been discussed. He also takes frequent bathroom breaks. We have discussed the need to be available for our clients and to respond quickly to various situations. 6/30 N.L. has continued to arrive late. He has started being more helpful to other nurses by offering to give medications. The narcotic count has been off twice in the past two weeks, with N.L. being the last person to give the narcotic with the off count. Review the preceptor report and complete the following sentences by choosing from the lists of options. The preceptor is seeing signs of possible(1) The best course of action is to(2) Depending on their state, they may also need to report it to the(3) due to their nursing license requirements. Answers 1 – 3 1.Select answer choice 2.Select answer choice 3 Select answer choice. 1. Select answer choice drug diversion. unprofessionalism alcohol dependency 2. Select answer choice report it to hospital security. ask other nurses their observations. report it to the nurse manager. 3.Select answer choice board of nursing local police board of ethics
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