The team at PRH has decided to implement a new discharge class for all patients newly diagnosed with diabetes. After starting the program, several patient's wind up having complications relating to not recieving their insulin on time and it is determine that the reason was because the discharge class was during the 10:00am med pass and their insulin was delayed. The nurse manager would be demonstrating transformational leadership style by doing which of the following?
Ask nurse who made the suggestion to have the discharge class from 10am-12am why she suggested it and ask the team for better suggestions.
Use the sandwich method to find out why the nurses did not administer the insulin before the patient's were brought to the discharge class.
Take responsibility for this negative outcome and work with team to rectify it.
Reassign the workload so that an RN could be at the class to give insulin.
A hospital is instituting a new safety measure at thel, the nurses will now being using a fingerprint scanner to enter the dispensing machine that contains narcotics. The machines have been sent to replace 5 machines on med-surg floors out of the hospitals total of 70 dispensing machines. Which stage of Lewin's theory of change is taking place?
Force field anlysis
Incentives provided by CMS & HCAHPS would be directly effected by all of the following except?
TJC pt. safety goals
Clinical core measures
improvement & consistency
pt. survey measuring satisfaction with care
Select from the following, those two items most involved in safeguarding the public from nurses.
Nurse Practice Act
National Council of State Boards of Nursing (NCSBN)
National League of Nursing
Board of Nursing (BON)
American Nurses Association (ANA)
A traveling nurse arrives in Texas to begin her work at a community health clinic. She is told that they have a needle exchange facility on the hospital campus where nurses teach patient's harm reduction strategies to safely inject heroin. After deciding that she would be competent to complete the task, the best resource to find out if this is task is within the nursing scope of practice is?
The charge nurse notes that Kim left her patient on the commode for 35 minutes while going to obtain a suppository. The pt. was then given the suppository and got back in bed but had significant pain for the rest of the day. What is the best way for the charge nurse to communicate his feedback?
"Kim you probably were just busy but why did 304 get left on the commode for 35 minutes?"
" Kim, you have been overall very attentive to Mrs J. in 304. I did notice and am concerned that she was on the commode for 35 minutes earlier. It makes me uncomfortable that this happened because it is a safety issue. You are one of my most timely and attentive nurses. Tell me about what happened and how i can support you.
"Do you want me to give Mrs. J to someone else? I noticed she was on the commode for 35 minutes. That really makes me concerned and uncomfortable, it is a safety issue with her being elderly."
"Kim, leaving Mrs. J on the commode for such a long time is a safety issue and I can not have nurse's putting patient's at risk. Tell me why she was left there ?"
The best approach to problem solving to use for conflict negotiation is?
A nurse you work with has been refusing to have a meaningful conversation with you, she also will not cosign any of your medications when you have asked. Today in handoff she said "Just write your handoff down and hand it to me, it will probably be easier to understand without you saying like every other word." This is an example of?
dominant style of interaction
A nurse educator is going to be providing teaching on the root cause analysis. She is assessing nurses for knowledge regarding the theory, which nurse requires further teaching?
"It establishes cause and effect."
" It allows us to understand the problem, then we come up with a solution and implement Lewin's change theory."
"It includes assessing Equipment, process, and people."
"It is a STEP situation monitoring effort."
All of the following are clinical criteria for diagnosing Substance abuse in the DSM 5 except?
Repeated use leading to failure to fufill role obligations
desire to cut down
continued use despite social or interpersonal problems
repeated use leading to physically hazardous situations
A nurse is assessing the A in the CAGE tool when asking which question?
Do you feel alone because of your drinking problem?
Do you have access to supports to help you stop drinking?
Do you feel annoyed when people ask about your drinking?
Do you always drink more than you planned?
A patient who has made the statement "That is it, I don't want to drink anymore. I have lost my family, my life, my home. I am ready to not be a god damn drunk anymore, I need to be sober by Christmas." is in what stage of change?
What are the 5 As
Ask, assess, adapt, advise, arrange
Ask, allow, adapt, arrange, admit
Ask, assess, advise, arrange, admit
ask, advise, assess, assist, arrange
A pt. was brought to the ER by family, they say that the pt's last drink was at midnight. When should the nurse expect withdrawal symptoms to begin?
24 hrs later
The inpatient psych nurse has been assigned a patient who is a longterm alcohol abuser with severe cirrhosis. The patient is on day 1 of detox and has a bp of 165/101, HR: 96, LFTs are elevated but all other vital signs are WNL. Which intervention should the nurse perform ?
Instruct the patient about completing 90 meetings in 90 days
Administer lorazepam (ativan) as ordered
Administer oxazepam (serax) as ordered
Encourage the pt to attend all groups
roleplay just say no activities
All of the following are assessed on the CINA based on observation except
Out of the patial agonist/antagonist's used for opiod addiction which medication has the least potential for OD?
Risk factors for aggressive behaviors include all of the following except?
Past history of violence
Current behavior: prodromal
A client is very angry because staff can not locate an item that has been locked up when he was admitted. The best response by the nurse is?
"We put everything in the same place for each patient yours was not there."
"I know it mustbe frustrating that we can't find your things, I'm sorry we haven't been able to find it yet. Can you remember any details about when you came in so that i can help you more?"
"You really need to come down before i can continue looking. I can't help you when you are yelling at me."
"I'm sorry your so angry but we have done everything we can and need to get back to the other patients."
An instructor asks the class to yell out answers for characteristics of victims of intimate partner violence. The teacher selects which of the following to write on the board as correct answers?
grew up in abusive homes
pregnancy & moves towards independence increases violence
low self esteem
likely to abuse drugs
Sheila tells the community nurse that her boyfriend has been abusive and she is afraid of him, but she doesn’t want to leave. The client asks the nurse for assistance. Which nursing interventions are appropriate in this situation? Select all that apply.
Help Sheila to develop a plan to ensure safety, including phone numbers for emergency help.
Reinforce concern for Sheila’s safety and her right to be free of abuse
Report the abuse to the authorities
Tell her to leave because things will not improve
A 19 year old male patient arrives on the unit he is in college and is catholic. He has a diagnosis of MDD and has no previous attempts of suicide in his history. He lives with his parents and has a diagnosis of cystic fibrosis. He has positive SI with a plan to hang himself with a belt, pt stated "just like Robin Williams, my favorite actor" How many risk factors for suicide does this patient exhibit?
A pt. who is being discharged the next day from the unit starts giving away a lot of his clothing and books to the other patients, he appears much happier than he has the last couple days. When asked about his plans for when he returns home by another pt. you hear him respond "dont worry about me George im going to a better place." What is the best response by the nurse?
Your not feeling suicidal with your discharge coming up are you?
Are you feeling okay Henry?
Henry it really looks like the medicine is working, you are so cheerful and giving. I am so happy you are doing better, good for you.
Sometimes people who are feeling suicidal give away things that matter to them, and their mood improves Henry, Do you feel this way? Tell me about it.
The most dangerous complication of bed rest is?
renal calculi & UTI
The mother of a pediatric patient with a congenital hip dysplasia shows that she needs further teaching when she states?
My baby will need to wear the pavlick harness continuously for 3-6 months
Im so glad that my baby had the barlow and ortolani tests before 3 months so that she could be diagnosed
If she needs surgery I want to wait till she is older and understands whats going on
I know its not my fault, its probably due to the fact that she was breech and a twin
Pts at risk for osteoporosis include all but who?
65 year old asian male 30 pack year history
70 year old thin sedentary white female
Obese 30 year old female pot smoker
Pt. on long term steroids for IBD, malabsorption
You would diagnose the condition that teriparatide (forteo) treats by all of the following except?
increased serum Ca
bone density scan
crush fractures in vertebrae, hip fractures, colles fractures
Gout diets exclude all of the following except?
A pt. who has been chronically immobile would be at risk which complication related to mineral imbalance?
The hospitalist continues Mrs. M.'s risedronate (Actonel) from her home medications. He writes the order : 5mg with water at least 30 min before dinner daily. You know the incorrect part of this order to be?
A client was infected with TB 10 years ago but never developed the disease. He’ began cancer treatment over 9 weeks ago. Which signs and symptoms would be indicative of active infection? Select all that apply (4)
initial dry cough that started 6 weeks ago and has grown productive
fatigue & malaise
low grade fever & night sweats
You are providing teaching to a patient who had a 19mm PPD skin test and positive chest xray. He is being admitted to the hospital to obtain sputum cultures and start antibiotics immediately after. You know the patient needs further teaching when he says?
I will need to take four drugs must likely; isoniazid, rifampin, pyrazinamide, ethambutol
I will be on four drugs for the initial 8 weeks and then some other combination for 18 weeks.
I will be in a special room in the hospital and everyone that takes care of me will be wearing masks
as long as i take my meds i won't have the active disease and need to spit into the cup again
A pt. is on the med-surg floor after an esophagectomy and hemigastrectomy. This morning he was ambulating well in the halls, required only his scheduled pain medication and received a visitor. When you assess the patient after your lunch break he is exhibiting a heart rate of 135, respiratory rate of 40 with shallow depth and is complaining of chest pain and difficulty breathing. What is the very first thing the nurse should do being concerned that this patient has a tension pneumothorax?
check clamps on the chest tubes
call code blue
place pt in semifowlers to optimize expansion
When admitting a patient the nurse will assess the patient for all of the following risk factors for pulmonary embolism except?
When communicating in an SBAR to a resident about a pt with a positive D-Dimer. What should the nurse recommend?
I think we need to start IV heparin right away
We really should get a spiral ct scan
Would you like me to go ahead and book the V/Q scan?
I think we should do an ultrasound of the lower extremities and a spiral CT
All of the following are true about COPD except?
Lung sounds are often diminished in the absence of infection
emphysema and chronic bronchitis usually often coexist
blood vessels thicken
air flows in with difficulty but flows out with ease
PFTs can diagnose and monitor the progression of COPDS
AAT deficiency will make a pt present much earlier with COPD
O2 therapy 2-4L/min via NC or 40% venturi (retainers 1-2L/min)
Appropriate nursing interventions for a pediatric pt with Cystic fibrosis to optimize the clearance of secretions includes?
Working with respiratory therapy to schedule Chest PT before meals during the pt's favorite TV show
administering clindamycin via PICC line
placing the two CF patients at opposite ends of the unit to decrease transmission of super bugs
providing pancreatic enzyme replacement before each meal
offering frequent high calorie snacks of the child's favorite foods
A pt with COPD admitted for exacerbation has become short of breath at rest. Baseline blood gas show
What update in patient data would the nurse need to address first?
Patient in tripod position
Increased productiveness of cough
Arterial pH of 7.26
Arterial PaCO2 of 50
The nurse is monitoring a client who is receiving IV theophylline (aminophylline) for control of an acute episode of his chronic respiratory condition. What nursing observations would cause the nurse the most concern?
Blurred vision, halos surrounding lights, and diplopia
Hypokalemia, diarrhea, and bradycardia
Bradycardia, pulse oximetry of 90%, irregular respirations
Restlessness, tachycardia, nausea, and vomiting
On the first postoperative day after a right lower lobe (RLL) lobectomy, the client deep-breathes and coughs but has difficulty raising mucus. What nursing observation would indicate the client is not adequately clearing secretions?
Chest x-ray film showing right-sided pleural fluid
A few scattered crackles on RLL on auscultation
Increase in PaCO2 from 35 to 45 mm Hg
Decrease in forced vital capacity
What source of data provides the nurse with the most accurate assessment of the pulmonary status of a client being treated with a water-sealed chest drainage system?
volume of fluid drained
quality of breath sounds
client's level of SOB
A client is confined to bed with a fracture of the left femur. He begins receiving subcutaneous heparin injections. What is the purpose of this medication?
prevent thrombophlebitis and pulmonary emboli associated with immobility
To decrease the incidence of fat emboli associated with long bone fractures
To prevent venous stasis, which promotes vascular complications associated with immobility
To promote vascular perfusion by preventing formation of microemboli in the left leg
The nursing instructor realizes that the teaching was effective about the differences between osteoarthritis and gouty arthritis when the student states?
Gouty arthritis requires immediate methotrexate therapy while osteoarthritis is treated just by symptom control
Osteoarthritis is autoimmune, gout is not
Gout is caused by increased uric acid levels and osteoarthritis is just a normal part of aging
Gouty arthritis has a pattern of acute attacks while osteoarthritis is a gradual onset involving weight bearing joints primarily
Thiamine, which is often ordered with folate would be ordered to prevent/ treat what condition in a chronic alcohol abuser?
A patient on which drug must avoid substances such as hand sanitizer, nail polish remover, mouthwash, cold medicine as well as warfarin, metronidazole and cephalosporins while on the medication and for 2 weeks after d/c
chlordiazepoxide hydrochloride (librium)