Management of Care Webinar

Justine Buick, MSN, RN

1. The nurse is about to make rounds after receiving the change of shift report at 1500. Who should the nurse see first?

1. A 54-year-old client 4 hours post-cardiac catheterization who has mild discomfort at the access site2. A client newly diagnosed with diabetes mellitus who needs reinforcement of sick day management guidelines3. A client who arrived 30 minutes ago from the post-anesthesia care unit4. A client with pneumonia who has received two doses of IV antibiotics and has an oxygen saturation level of 93%

2. Which client is most appropriate to assign to an LPN/LVN, under the supervision of an RN?

1. Client with oral cancer who is scheduled in the morning for a glossectomy.2. Obese client returned from surgery after a vertical banded gastroplasty.3. Client with anorexia nervosa who has muscle weakness and decreased urine output.4. Client with intermittent nausea and vomiting related to chemotherapy.

3. A nurse is delegating care of clients to the unassisted assistive personnel (UAP) and the licensed practical nurse (LPN). Which tasks should the nurse give the the UAP and LPN?

1. UAP: measure vital signs; LPN: give oral medications on assigned clients2. UAP: change a non-infected dressing; LPN: administer IV piggyback medications3. UAP: ambulate a client who had a CVA; LPN: assess two clients4. UAP: measure vital signs; LPN: complete a head-to-toe assessment on a newly admitted client

4. A client who is newly admitted requests information about advance directives. The nurse should include which of the following statements in the discussion? Select all that apply.

1. “An advance directive may not be changed.”2. “Advanced directives are only discussed with terminally ill clients.”3. “You will need to designate a relative to act as your health care proxy.”4. “I will give you a pamphlet with written information about advance directives.”5. “A living will is part of an advance directive.”

5. A nurse is participating in an interdisciplinary conference for clients on the medical surgical floor. Which client would best benefit for further discussion at the conference?

1. A client with diabetes mellitus and a chronic foot ulcer getting daily dressing changes.2. A older client with a BMI of 21.9 being discharged after a knee replacement.3. A client being discharged who is recovering from acute kidney failure and a urine output of 420 mL in the last 8 hours.4. A client with chronic pain being managed with massage, warm packs and NSAIDs.

6. The nurse is caring for a group of clients. Which client would be unable to sign an informed consent?

1. A minor who is being treated for a chylamydia infection2. A client who received 2 mg of hydromorphone 1 hour ago.3. A client whose primary language is Spanish and understands very little English.4. A client who is alert and oriented to person, place and time.

7. A client has a new diagnosis of stage IV lung cancer. When the partner requests the diagnosis be withheld from the client, which of the following actions should be done first by the nurse?

1. Withhold the diagnosis from the client.2. Contact the institution's ethics committee.3. Document the request in the medical record.4. Request additional information from the partner.

8. A charge nurse reviews abbreviations and doses used in client documentation. Which of the following is an approved entry? Select all that apply.

1. Enoxaparin 30 mg SC BID2. Zolpidem 5.0 mg PO qhs3. Digoxin .125 mg IV q 24 h4. Furosemide 60 mg PO daily5. MS 0.1 mg IV q 1 hr prn

9. A client who has stage IV pancreatic cancer decides to discontinue all treatment. Which of the following actions is most important for the nurse to take?

1. Offer advice on alternative treatments.2. Encourage the client to reconsider.3. Ask the client to discuss the decision.4. Request a mental health consultation.

10. Which client should the charge nurse on the pediatric unit assign to the most experienced nurse?

1. The 4-year-old child diagnosed with hemophillia receiving factor VIII.2. The 8-year-old child with headaches who is scheduled for a CT scan.3. The 6-year-old child recovering from a sickle cell crisis.4. The 11-year-old child newly diagnosed with rheumatoid arthritis.

11. The nurse educator is teaching new graduates about the Nurse Practice Act. What would the nurse include in the teaching? Select all that apply.

1. It defines the scope of practice for nurses.2. There is one Nurse Practice Act for the entire country.3. Each state has it's own Nurse Practice Act. 4. The Nurse Practice Act establishes a Board of Nursing.5. It includes the ethical principles for nursing.

12. A bladder irrigation is prescribed for a client who has an occluded indwelling urinary catheter. Which of the following actions is best to take when the nurse is unsure of how to perform this procedure?

1. Refuse to perform and notify the provider.2. Refer to the policy and procedure manual.3. Instill the solution slowly and observe for signs of pain.4. Delay irrigation and inform the next nurse assigned.

13. The client brought to the ED is alert and oriented but has oxygen saturation (SpO2) levels ranging from 88% to 90%. The nurse applies oxygen at 2 liters per nasal cannula, but there is no improvement in SpO2. Oxygen per mask is initiated at 40% with little improvement. Radiograph films reveal no obvious injury or fractures. Suddenly the client loses consciousness, has a respiratory arrest, and subsequently dies. During resuscitation efforts, it was determined that the nurse failed to open the oxygen tank valve and the client had not been receiving oxygen. The nurse should conclude that the key ethical principle involved in this situation is which principle?

1. Nonmaleficence2. Fidelity3. Veracity4. Justice

14. The nurse was caring for a client when the client fell onto the floor when transferring from the bed to the wheelchair. After the client was deemed stable and the HCP notified, what would the nurse do? Select all that apply.

1. Document the occurrence.2. Submit an incident report.3. Document that an incident report was completed.4. Put the incident report in the client's medical file.5. Report the incident to the county health department.

15. Which of the following is an example of assault by the nurse?

1. The nurse holds the client down to give an IM shot without an order for restraints.2. The nurse threatens the client with restraints if the client won't take the medication.3. The nurse waits four hours before telling the HCP that the client refused blood pressure medications resulting in a stroke.4. The client refuses a medication, but the nurse gives the medication later without telling the client what it is.

17. A nurse is conducting an in-service on reportable conditions. Which examples, by the nurse, are reportable by law? Select all that apply.

1. A client's culture swab returned positive with influenza.2. An older adult with burn marks on the chest.3. A client's blood culture returned back positive for hepatitis B.4. A client reports, “my partner just beat me up.”5. A client newly diagnosed with COPD.

18. The pediatric client, newly diagnosed with cystic fibrosis is being discharged home. The client's parents are anxious, asking many questions about the child's nutrition, medication regimen, nebulizer treatments, and chest percussion. They are expressing concerns about financial hardship. Which health care disciplines should be included in the planned interdisciplinary care conference? Select all that apply.

1. Nurse2. Dietitian3. Social worker4. Nursing assistant5. Respiratory therapist

19. The nurse is planning care for four clients on a pediatric unit. Prioritize the order in which the nurse should plan to attend to the clients.

1. The 13-year-old waiting to be admitted from the emergency department after receiving stitches for facial lacerations from a dog bite.2. The 9-year-old whose mother is present to receive teaching about wound care for her child's left leg skin graft in anticipation of discharge tomorrow.3. The 5-year-old client with an infected leg wound who is scheduled for a dressing change now.4. The 2-year-old client whose temperature has risen to 103.8F (39.9C).

20. A charge nurse prepares for a mass casualty. Which of the following clients would be most appropriate to recommend for discharge?

1. A middle aged adult two days following a cholecystectomy.2. An older adult recently admitted with a syncopal episode.3. An adolescent client who is confused after falling today at school.4. A young adult client admitted yesterday with suspected tuberculosis.

Questions?

Next time: Safety & Infection

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