Question 1

Three types of supervision identified are:

Accepted Answer

Hansten and Washburn's (2004)three levels of supervision include: 1)unsupervised,2)initial direction and periodic supervision,and 3)continuous supervision.These levels are based upon the type of task delegated,education,competency,experience,and working relationship of all of the people involved.

Question 2

The act of being responsible for the actions or inactions of yourself and others in nursing is called:

Accepted Answer

Accountability is being responsible for the actions (or inactions)of oneself and of others.Authority refers to a right to delegate based upon the state's Nurse Practice Act and nursing management.Assignment refers to the duties (e.g.,patients)assigned to individuals generally on a daily/shift basis.Delegation is the transferring of the authority to perform selected tasks in selected situations to a competent individual.

Question 3

Five factors to consider when _____ are: potential for harm,complexity of the task,amount of problem solving and innovation required,predictability of outcome,and level of patient interaction.

Accepted Answer

The American Association of Colleges of Nursing (AACN [2004])reminds us that the potential for consequences and likely effects must be considered when delegating patient care.The five factors noted above should be contemplated before delegating care.While supervision also takes into account these important factors,they are not prerequisites before supervision can take place.

Question 4

Delegation is:

Accepted Answer

The act of delegation involves trust,empowerment,responsibility,and authority to viably complete the assigned task.It also involves the transfer of responsibility for the performance of actions,but the accountability for the outcomes remains with the delegator; it does not shift to the person who is performing the task (ANA,2006).The nurse retains the accountability for the delegation (NCSBN,2006).Delegation is also a legal and management concept involving the four-step process of: 1)assessment,2)planning,3)intervention,and 4)evaluation.Action,although a means of accomplishing the task goals,is not a part of this four-step process.

Question 5

What is the one phase of the nursing process that may be delegated to the NAP?

Accepted Answer

Delegated activities for the NAP usually fall within the implementation phase of the nursing process.The assessment,analysis,diagnosis,planning,teaching,and evaluation stages of the nursing process may not be delegated to the NAP.

Question 6

People who have an external locus of control have a strong:

Accepted Answer

Individuals who have an external locus of control believe in fate,luck,and chance.They also tend to rely more upon external factors such as fate and luck than on their own internal abilities to accomplish tasks,meet goals,or control their environment.

Question 7

Patient X is a 64-year-old male cardiac patient in the telemetry unit post-CABG.He is very demanding and expects his needs to be met immediately if not sooner.He refuses to have any female staff members care for him.It is the end of shift and he appears to be stable in normal sinus rhythm.He has removed his telemetry electrodes,is sitting up on the side of the bed,has thrown an empty tissue box across the room,and seems to be trying to get out of bed and walk.He is now coughing loudly and is demanding his pain medication in a loud booming voice that carries across the unit.The type of care that he requires now is:

Accepted Answer

This patient,who is a post-operative cardiac patient,appears to be stable,but is agitated.He needs direct patient care from a nurse to assess his current state regarding agitation,to replace his electrodes,and to assist in easing his fears and need for control (demands).While team work would be great in a situation such as this,it is not essential until the cause for his agitation has been assessed and determined,unless he is a very large man and additional assistance is required to help get him back into bed.Indirect care,such as charting the situation,would also be beneficial,but is not the most urgent need for this patient.

Question 8

A new graduate nurse assigns a NAP to provide basic ADL (activities of daily living)to several patients on the unit.The NAP obtains vital signs and helps to bathe and feed patients assigned.The nurse is:

Accepted Answer

Through the act of delegation,the nurse is accountable for the actions or inactions of the NAP as well as those of herself.In the situation described above,the nurse is responsible for the actions of the NAP as well as the act of delegation of tasks according to the education and experience level of the NAP.

Question 9

People with an internal locus of control have a strong:

Accepted Answer

An internal locus of control is demonstrated by a person relying upon their own abilities and personal initiative to take action and not requiring assistance in decision making.Therefore,they may rely more upon internal abilities and skills than external forces such as fate,luck,or chance.

Question 10

The degree to which people perceive they have control over their environment is called:

Accepted Answer

How people perceive that they have control over their environment is referred to as environmental control (Poole,Davidhizar,& Giger,1995).There are two types of environmental control.The first type of perceived control is an internal locus of control,by which the individual relies upon inner (internal)resources to handle stimuli from the environment.The second type of perceived control is an external locus of control.In this type of perceived control,the individual relies more upon external sources such as luck,fate,or chance rather than internal abilities to control what is experienced from the environment.

Question 11

Who has the legal authority for nursing practice/action according to each state?

Accepted Answer

The legal authority for nursing practice lies with the state's Nurse Practice Act.While individual State Boards of Nursing operate under this act,they themselves are not the legal authority.The Joint Commission provides guidelines and standards for safe nursing practice according to evidence-based practice guidelines,and the Joint Commission does have the capacity to accredit health care facilities,but the Joint Commission is not the legal authority for nurse practice.NCLEX is not the legal authority for nursing actions,but does play a significant role in the decision-making process regarding who is qualified for licensure.

Question 12

Which of the following is not part of the five steps in the NCSBN decision-making tree used for delegation?

Accepted Answer

The NCSBN delegation decision-making tree consists of: assessment and planning,communication,surveillance and supervision,and evaluation and feedback.While intervention and supervision are important decision-making factors,they are not as vital as these other components as they relate to the delegation of NAP.

Question 13

NAP competence is built upon a number of factors.Which of the following is not one of these factors?

Accepted Answer

NAP competence is built upon certain criteria.These criteria include: formal training and assessment,orientation to specific settings and patient types,communication skills,interpersonal skills,and the experience of the nurse aide in assisting the nurse to provide safe nursing care.

Question 14

The obligation to correctly perform one's assigned duties is called:

Accepted Answer

The act of being responsible (responsibility)for one's actions is a top priority for all health care workers,nurses in particular.The act of being responsible includes: reliability,dependability,the obligation to accomplish work once the assignment has been accepted,and the desire to perform at an acceptable level in accordance with one's educational and experience levels.

Question 15

It has been stated that the only purpose of _____ is to get the job done in the most efficient manner using the appropriate resources.

Accepted Answer

While delegation is not a means of intimidating or isolating the new or experienced nurse,it is a way of providing a means by which patient care can be distributed efficiently,utilizing the most appropriate resources (staff)to enhance desired outcomes.

Question 16

The use of interpersonal decision making,psychomotor skills,and the application of knowledge expected in the role of a licensed health care professional in the context of public health welfare and safety is an example of:

Accepted Answer

According to the NCSBN (1996),competence is defined as "the ability to apply knowledge and interpersonal decision making,and psychomotor skills expected for the practice of public health safety and welfare." It concerns the ethical and safe practice in a designated role and a specific setting according to state laws and regulations.

Question 17

When making patient assignments,it is important to consider:

Accepted Answer

An assignment is a distribution of work that each staff member is to accomplish during a given time frame according to the scope of practice.An NAP should not be assigned to irrigate a colostomy or do a dressing change of a stage II decubitus ulcer even if the NAP is very experienced.Willingness to be a team player and skill level are important,but should not be the sole factors when making assignments.

Question 18

The provision of guidance,direction,evaluation,and follow-up by a licensed nurse for tasks provided by an NAP (nursing assistive personnel)is called:

Accepted Answer

According to the ANA (Joint Statement on Delegation,ANA and National Council of State Boards of Nursing [NCSBN],2005),supervision is "the active process of directing,guiding,and influencing the outcome of an individual's performance of an activity." The supervisory nurse provides clear direction and information to staff concerning what tasks are to be accomplished,for what patients,at what time,and how the tasks are to be done.

Question 19

Delegation is important for which reason?

Accepted Answer

While delegation,as defined by the ANA (2006),is "the transfer of responsibility for the performance of an activity from one individual to another while retaining accountability for the outcome," the RN can use this skill to organize how staff are utilized to meet patient care needs.When delegating tasks to nursing personnel,some factors the RN should take into consideration include: 1)the patient's condition (acuity),2)staff skills and experience level,3)complexity of the task assigned,4)staff workload,5)desired outcomes,and 6)the amount of supervision required to achieve the desired outcomes for the shift.

Question 20

Poole,Davidhizar,and Giger (1995)noted several cultural phenomena to be considered when working with culturally diverse staff.They are:

Accepted Answer

Six cultural phenomena suggested by Poole,Davidhizar,and Giger (1995)that should be considered when delegating tasks to culturally diverse nursing staff are: 1)social organization,2)time,3)space,4)environmental control (locus of control),5)biological variations,and 6)communication.All of these factors can impact how staff organize and perform their tasks.While traditional barriers and cultural expectations and norms are also important factors to be considered,they are not described by Poole et al.(1995)as being as critical as the six noted above.

Quiz 8: Delegation of Patient Care