Question 1

The charge nurse is determining which activities to delegate to the nursing assistant.Which of the following would not be appropriate for the charge nurse to delegate to the nursing assistant?
A)Changing soiled linen
B)Taking a blood pressure on someone receiving blood
C)Removing a urinary catheter
D)Assessing a patient's lung sounds

Accepted Answer

When delegating care,the charge nurse must remember that she cannot delegate nursing judgment.Therefore,in this scenario,the nurse cannot delegate the task of assessing lung sounds.This is a task that must be performed by the nurse.Taking blood pressures,removing a urinary catheter,and changing bed linens are all activities that can be delegated.

Question 2

The nurse manager is updating unit staff on findings by The Joint Commission.Which of the following statements shows an understanding of untoward events in the hospital setting? The primary cause of untoward events is
A)"unclear,ineffective communication."
B)"unclear chain of communication for reporting."
C)"ineffective reporting of the untoward event."
D)"lack of consistent supervision of nursing staff."

Accepted Answer

Ineffective communication was identified as the root cause for nearly 70% of all sentinel events reported.The majority of those untoward events involved communication failure.The other options were not identified as the majority of all sentinel events.

Question 3

The nurse is receiving a phone order from a health care provider.How will the nurse make sure that the provider's order is received without error?
A)Advise the health care provider that the order must be written on the chart within the next 24 hours.
B)Ask the nurse in charge to come to the phone to take the order.
C)Write the order without using any unclear or unapproved abbreviations.
D)Repeat the order,write the order verbatim,and read it back to the provider.

Accepted Answer

Repeat the order,write the order verbatim,and read it back to the provider are the steps recommended to confirm that the order was understood correctly,as well as communicated correctly.The question is in regard to the receiving of the order,not specifically how it is written.The nurse will write the phone order on the chart,and later the health care provider will co-sign the order.The charge nurse does not have to take the phone order;any licensed nurse can take the phone order.

Question 4

A nurse has been assigned the following patients.Which patient is a priority to assess first?
A)A patient with abdominal pain
B)A patient who has been NPO all morning and wants to eat
C)A patient with pneumonia and O2 saturation of 88%
D)A patient complaining of ear pain

Accepted Answer

Using Maslow's hierarchy of needs or the ABCD system,the nurse should see the patient with pneumonia and low O? saturation first.Issues involving the airway are a priority,and these patients must be seen first.Next,the nurse should see the patient with abdominal pain followed by the patient with ear pain and then the patient who is NPO and wants to eat.

Question 5

A nurse is working on a medical-surgical unit and receives a phone call from a provider who would like to give orders for a new patient.What should the nurse do to make the telephone order safer for the patient? 
A)Refuse to accept the telephone order and request that the physician come to the unit to write the order.
B)Accept the order and perform a "read back."
C)Write down the telephone order as it is being given.
D)Accept the telephone order,but write it down later.
E)Ask another nurse to accept the telephone order.

Accepted Answer

The nurse should accept the order,write it down,and perform a read back.According to the Institute for Healthcare Improvement,50% of all medication errors have been directly attributed to the failure to communicate information at the point of transition.

Question 6

A nurse has received report on assigned patients and is prioritizing their care.Which of the following patients should the nurse assess first?
A)A female patient who is complaining of a headache
B)A patient who has just returned from surgery and has saturated his dressing
C)A patient with a femur fracture who is requesting pain medications
D)A male patient who needs to use the bathroom

Accepted Answer

The nurse should assess patients using Maslow's hierarchy of needs or the ABCD system.In the situation,the patient who has saturated his postoperative dressing should be seen first because an issue with the circulatory system makes the patient a priority over the others.This patient may be hemorrhaging.The patient with the femur fracture requesting pain medication should be seen next,followed by the patient with the headache who will need a more thorough assessment.The nurse can delegate taking the other patient to the bathroom to the unlicensed assistive personnel,assuming the patient is stable enough to do so.

Question 7

During clinical experience,the student nurse is assigned a patient scheduled to undergo numerous treatments.The student decides it is not possible to complete all the needed treatments in the time scheduled for this clinical day.The student nurse consults with the clinical instructor to
A)delegate.
B)prioritize.
C)procrastinate.
D)do the easiest treatment first.

Accepted Answer

Plan your care of a patient who requires multiple treatments or complex nursing care by determining the priority of the patient's problems or needs so that you can provide care to the patient's highest priority needs first.Delegation would not be the most logical or appropriate choice as the student is not working over anyone.It is not always wise to do the easiest treatment first because difficult treatments may have unexpected outcomes that may challenge time management.Procrastination is never a good approach in managing patient care.

Question 8

The nurse receives report on an assigned group of patients.Which patient would the nurse assess first?
A)A patient 2 days postoperative who is complaining of pain
B)An older adult patient reported to have increasing lethargy and confusion
C)A newly admitted patient with a serum blood urea nitrogen (BUN)of 32 mg/dL
D)A hypertensive patient complaining of severe mid-sternum pain

Accepted Answer

The patient with chest pain is at greatest risk of experiencing urgent problems and needs to be evaluated immediately.This does not mean that the nurse will not address the needs of the other patients,but the safety of the hypertensive patient is at risk if the nurse does not see her first.

Question 9

The instructor has suggested that the student nurse could improve organizational skills and manage time better by scheduling selected nursing activities in the daily assignment.Which activity should be scheduled?
A)Suctioning the tracheostomy tube of a patient
B)Administering medications
C)Assessing patient knowledge of colostomy care
D)Assisting a patient with personal hygiene

Accepted Answer

Medications are the most time-sensitive issues in nursing care delivery.Scheduling is predetermined by the physician's order.Assessment of a patient's understanding of colostomy care can be done at any time.Personal hygiene needs can be met around non-time-sensitive issues (medications,treatments)in managing the patient care.Suctioning a tracheostomy should be performed when the patient needs it;it is not scheduled.

Question 10

The nurse is reviewing I-SBAR-R with a coworker at the end of the shift.Which statement indicates that they are discussing the Situation component?
A)The nurse states the patient's name using two identifiers.
B)The nurse states that the patient was hospitalized for a broken tibia and that surgery is scheduled for later today.
C)The oncoming nurse acknowledges the info that has been received.
D)The nurse states an opinion on what is happening with the patient.

Accepted Answer

In the Situation component of I-SBAR-R,the nurse states what is going on with the patient.In this situation,the patient was hospitalized with a broken tibia,and surgery is planned for later today.The Identification component involves stating the patient's name,the Assessment component involves the nurse discussing what the nurse thinks is happening with the patient,and the Read-Back or Response component involves that the oncoming nurse repeating what the nurse has heard from the nurse who is reporting at the end of the shift.

Question 11

Which statement by the nurse manager shows understanding of what initiated the development of the team Strategies and Tools to Enhance Performance and Patient Safety (STEPPS)?
A)"The increased need for health care coverage"
B)"The need for more qualified nurses"
C)"A need for improved communication and teamwork"
D)"The increased cost of health care"

Accepted Answer

The Department of Defense (DoD)Patient Safety Program,in collaboration with the Agency for Healthcare Research and Quality (AHRQ),developed an evidence-based teamwork system focused on improving communication and teamwork skills in the health care industry to improve patient outcomes.The team was not created to solve health care coverage concerns,search for more qualified nurses,or decrease the cost of health care.The Joint Commission accredits hospitals and health care agencies.The Institute of Medicine provides national advice on issues relating to biomedical science,medicine,and health,and its mission is to serve as adviser to the nation to improve health.The Centers for Medicare is not about patient safety but about medical insurance for people older than the age of 65 years.

Question 12

The charge nurse is assigning patient care activities to the nursing care team.In supervising the team,what is the most effective activity to determine that the nursing care has been completed satisfactorily?
A)Have hourly checks with personnel to determine how effectively nursing care is being completed.
B)Review with personnel at the end of the shift regarding the status of patients and how care was delivered.
C)Discuss with each person the status of their assigned patients and what type of nursing care each will require.
D)Schedule routine patient care rounds to evaluate the patients and the nursing care that has been completed.

Accepted Answer

Supervision entails providing direction,evaluation,and follow-up by the nurse regarding the nursing care assigned.The only way the nurse can determine whether the care has been done satisfactorily is to monitor the task (hourly checks with personnel)and evaluate the patient.Waiting until the end of the shift could lead to problems not being assessed early to prevent complications.Discussing with the health care provider about the patient is a good practice,but determining the outcome of the care is what needs to be evaluated and not just telling them what type of care is required.Scheduling rounds allows the nurse to evaluate the patient;however,communication with the nursing team is important to determine if care is administered satisfactorily.

Question 13

The nurse wants to anticipate patient needs in order to increase patient satisfaction and decrease the use of call bells in the assigned section.What actions can be taken to achieve this?
A)Tell patients to turn on their call bells if they need something.
B)Perform hourly rounding on each patient.
C)Check on the patient every 2 to 3 hours.
D)Check on the patient only when medication needs to be administered.

Accepted Answer

Performing hourly rounding encourages the nurse to anticipate patients' needs,thereby increasing patient satisfaction and decreasing call bell usage.Although checking on the patients every 2 to 3 hours is appropriate,it is not the best answer because hourly rounding provides increased patient satisfaction and reduction of call bells.The nurse needs to check more frequently on patients rather than waiting until the he/she sees them when medications are administered.

Question 14

A nurse is working on a busy orthopedic floor and is on the phone with the floor manager when a physician comes up and gives a verbal order for pain medications on an assigned patient.The physician then turns to leave the unit.Which action by the nurse would be the most appropriate?
A)Write down the order and administer the medication.
B)Put the nurse manager on hold and ask the physician to write the order.
C)Ignore the physician and continue the conversation with the nurse manager.
D)Write down the order and document it as a telephone order.

Accepted Answer

The most appropriate action would be for the nurse to put the nurse manager on hold and ask the physician to write the order.The Joint Commission states that there is a big difference between verbal and telephone orders.Verbal orders should never be accepted unless there is an emergency or the physician is in a sterile environment because there is too much opportunity for a transcribing error.

Question 15

What are critical points to communicate during a shift report or hand-off communication?
A)Patient name,current physical status,activities that have contributed to current status,problems that have occurred during the shift,nursing care to address problems,and a readback or response
B)Patient name,room number and date of birth,changes in current orders,provider's visits,laboratory tests that have been completed,and physical activity of the patient
C)Patient name,health care provider,diagnosis,review of all current orders,family visits and involvement in care,review of history leading to hospitalization,and current status of the patient
D)Physician orders for past 24 hours,patient name and date of birth,medical and social history prior to hospitalization,and review of health problems since hospitalization

Accepted Answer

According to the I-SBAR-R tool-Identification (patient name),Situation (current physical status),Background (activities that contributed to current status),Assessment (problems that occurred during shift),Recommendation (nursing care to address problems),Readback or Response (receiver acknowledges information)-these are critical areas.All of the other options contain items that are not critical to a shift report.

Question 16

A nurse is discharging a patient who primarily speaks German.Which action(s)should the nurse take to communicate effectively with the patient? 
A)Contact interpreter services to interpret discharge instructions to the patient.
B)Provide discharge instructions for the patient that are written in German.
C)Ask the patient to repeat the discharge instructions back to the interpreter as he understands them.
D)Forego the interpreter because you are just showing him how to change a dressing.
E)Give the patient discharge instructions that are written in English.

Accepted Answer

The nurse should contact interpreter services and request a German-speaking interpreter.The nurse should provide all discharge instructions with the help of the interpreter and ask the patient to repeat back what he has heard.By using a Team STEPPS strategy "check back," the nurse can ensure that the patient understands the discharge instructions what he needs to do for himself when he leaves.

Question 17

The nurse calls a physician to come to the unit to assess a patient.Which of the following is the most effective telephone communication by the nurse?
A)"This is the 4100 unit troublemaker again.You probably ought to come to the unit to see Mr.Samuels.His condition doesn't seem right."
B)"This is Ann Allen on 4100.I don't quite know what to think about Mr.Samuels.I think his condition is deteriorating,and I'd like to have you see him."
C)"Sorry to bother you.This may not be important,but I'm not completely comfortable with Mr.Samuel's response to care.His blood pressure has dropped,and his pulse is elevated."
D)"This is Sheila Ryan on 4100 calling regarding your patient,Mr.Samuels.His BP has dropped from 130/90 at 8 AM to 100/70 at 10 AM.His pulse has risen from 80 to 100,and he seems restless.He received his 8 AM Cardizem."

Accepted Answer

A detailed,objective response is effective when communicating not only in person but also by telephone.Try organizing your conversation in the I-SBAR-R communication format.The other responses are subjective in nature with no descriptive assessment data to provide to the physician.

Question 18

A nurse is assigned to care for five patients.The nurse is concerned about the ability to care for this many patients.The nurse needs to
A)delegate one of the patients to someone else.
B)prioritize the needs of the patients and determine the sickest patient.
C)report this situation to the charge nurse.
D)do the easiest patients first to allow more time for sicker patients.

Accepted Answer

It is important to determine the least stable patient when planning care for multiple patients.Plan and complete the care for the patient who requires multiple treatments or complex nursing care.This patient is most likely to experience physiologic problems if the nurse does not address his or her needs.The others are cared for in the priority order determined by their stability and needs.The nurse may need to enlist the help of the charge nurse if he or she is unable to provide care,but that would not be the first action.

Question 19

What would be a good assignment for an experienced nursing assistant?
A)Help teach patients newly diagnosed with diabetes to give themselves injections.
B)Report on the quality and quantity of urine on a continuous bladder irrigation.
C)Obtain a clean-catch urine specimen from a patient.
D)Chart a diet for a patient with an eating disorder.

Accepted Answer

The nursing assistant can be assigned activities that involve standard,unchanging procedures such as helping to obtain a clean-catch urine specimen from a patient.Charting,teaching,and assessing are not assigned to the nursing assistant.

Question 20

A nurse is working with a nurse aide to care for a group of patients.Which of the following activities would be inappropriate to delegate to the nurse aide?
A)Providing discharge instructions to a patient
B)Refilling water containers
C)Obtaining a lift to help a patient out of a chair
D)Feeding a patient who is unable to feed himself

Accepted Answer

It is the nurse's responsibility to provide discharge instructions to patients and to assess their understanding of them.This task cannot be delegated to the nursing assistant.Refilling water containers,obtaining a lift to help a patient out of a chair,and feeding patients are all tasks that can be delegated to the nursing assistant.

Quiz 11: Building Nursing Management Skills

The charge nurse is determining which activities to delegate to the nursing assistant.Which of the following would not be appropriate for the charge nurse to delegate to the nursing assistant?

The nurse manager is updating unit staff on findings by The Joint Commission.Which of the following statements shows an understanding of untoward events in the hospital setting? The primary cause of untoward events is

The nurse is receiving a phone order from a health care provider.How will the nurse make sure that the provider's order is received without error?

A nurse has been assigned the following patients.Which patient is a priority to assess first?

A nurse is working on a medical-surgical unit and receives a phone call from a provider who would like to give orders for a new patient.What should the nurse do to make the telephone order safer for the patient?

A nurse has received report on assigned patients and is prioritizing their care.Which of the following patients should the nurse assess first?

During clinical experience,the student nurse is assigned a patient scheduled to undergo numerous treatments.The student decides it is not possible to complete all the needed treatments in the time scheduled for this clinical day.The student nurse consults with the clinical instructor to

The nurse receives report on an assigned group of patients.Which patient would the nurse assess first?

The instructor has suggested that the student nurse could improve organizational skills and manage time better by scheduling selected nursing activities in the daily assignment.Which activity should be scheduled?

The nurse is reviewing I-SBAR-R with a coworker at the end of the shift.Which statement indicates that they are discussing the Situation component?

Which statement by the nurse manager shows understanding of what initiated the development of the team Strategies and Tools to Enhance Performance and Patient Safety (STEPPS) ?

The charge nurse is assigning patient care activities to the nursing care team.In supervising the team,what is the most effective activity to determine that the nursing care has been completed satisfactorily?

The nurse wants to anticipate patient needs in order to increase patient satisfaction and decrease the use of call bells in the assigned section.What actions can be taken to achieve this?

A nurse is working on a busy orthopedic floor and is on the phone with the floor manager when a physician comes up and gives a verbal order for pain medications on an assigned patient.The physician then turns to leave the unit.Which action by the nurse would be the most appropriate?

What are critical points to communicate during a shift report or hand-off communication?

A nurse is discharging a patient who primarily speaks German.Which action(s) should the nurse take to communicate effectively with the patient?

The nurse calls a physician to come to the unit to assess a patient.Which of the following is the most effective telephone communication by the nurse?

A nurse is assigned to care for five patients.The nurse is concerned about the ability to care for this many patients.The nurse needs to

What would be a good assignment for an experienced nursing assistant?

A nurse is working with a nurse aide to care for a group of patients.Which of the following activities would be inappropriate to delegate to the nurse aide?