NCLEX-NCBSN MANAGEMENT OF CARE

NCLEX-NCBSN MANAGEMENT OF CARE

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NCLEX EXAM PREVIEW

110 terms kandykat1012Preview NCLEX Review - Management of Ca...26 terms ish_jayme_penafiel Preview NCLEX Safety and Infection Control...42 terms Kate383Preview NCLEX 69 terms Kat The charge nurse is making assignment for the health care team. Which of these tasks can be safely delegated to the licensed practical nurse (LPN)?Teach the initial ostomy care to a client and family members Care for a recent complicated double barrel colostomy Provide stoma care for a client with a well-functioning ostomy Assess the function of a newly created ileostomy

PROVIDE STOMA CARE FOR A CLIENT WITH A WELL-FXN OSTOMY

The care of a mature stoma and the application of an ostomy appliance may be delegated to a LPN. The condition of this client is stable, there's a low likelihood of any emergency and care of this client is not too complex. The other options require higher level care by the RN. The RN is the manager of care and is responsible for any initial teaching; the LPN can reinforce information once it has been introduced by the RN.

A nurse receives an illegible hand-written medication order. Which statement to the health care provider reflects assertive communication?"Would you please clarify what you have written so I am sure I am reading it correctly?" "Please print in the future so I do not have to spend extra time attempting to read your writing." "I cannot give this medication as it is written. I have no idea of what you mean." "I am having difficulty reading your handwriting. It would save me time if you would be more careful."

WOULD YOU PLEASE CLARIFY WHAT YOU HAVE WRITTEN SO I AM SURE I AM

READING IT CORRECTLY

Assertive communication respects the rights and responsibilities of both parties.This statement is an honest expression of concern for safe practice and a request for clarification without self-depreciation. It reflects the right of the professional to give and receive information.The 83 year-old client, who lives in a retirement community, is admitted to the hospital. The daughter reports the client no longer calls her every day, has not been participating in previously enjoyed activities, such as weekly card games, and has allowed the garden to become overgrown with weeds. The nurse should assign this client to a room with which of the following clients?A young adult who was admitted 24 hours ago for treatment following detoxification An elderly person who was admitted three hours ago with a diagnosis of cyclothymia An adolescent who was admitted the day before with a diagnosis of disruptive mood dysregulation A middle-aged person who has been on the unit for 72 hours with a diagnosis of persistent depressive disorder

A MIDDLE-AGED PERSON WHO HAS BEEN ON THE UNIT FOR 72 HOURS WITH

A DIAGNOSIS OF PERSISTENT DEPRESSIVE DISORDER

These findings suggest depression. The most therapeutic milieu for this client includes double occupancy with someone who has similar issues and/or whose condition is more stable. A secondary consideration is matching roommates' ages as closely as possible, because they potentially would share similar developmental challenges and needs. The most stable client is the one with persistent depressive disorder. Cyclothymia is an illness that's similar to bipolar disorder and disruptive mood dysregulation disorder is characterized by irritability and episodes of extreme, out-of-control behavior.A registered nurse from the float pool is assigned to the critical care unit on the evening shift. Which of these clients should be assigned to the float pool nurse?Tracheostomy of 24 hours with the client showing some respiratory distress Report of unstable angina with continuous telemetry monitoring Dopamine IV drip with vital signs monitored every five minutes Pacemaker insertion on the day shift The nurse from the float pool should be assigned to care for the most stable client, which is the client who had the pacemaker inserted on the day shift. The other clients are unstable and have potentially life-threatening conditions. In most critical care units, the nurse can titrate dopamine upward or downward; this requires the expertise of the nurse who normally works on this unit. Although tracheostomies are not limited to critical care units, a nurse unexperienced in critical care should not be assigned to the client with a newly created tracheostomy

A woman dressed in a business suit with no visible identification is at the nurses station looking at client charts. What nursing action is most appropriate?Immediately call security for this breach in client confidentiality Request to see identification and an explanation as to why the woman is viewing client charts Ignore the person; many outside vendors check charts to set up a transfer or to coordinate care Report to the nurse manager about the witnessed suspicious activity

REQUEST TO SEE ID AND AN EXPLANATION AS TO WHY THE WOMAN IS

VIEWING CLIENT CHARTS

Nurses have a duty to protect the confidentiality of client records. In fact, HIPAA and other confidentiality laws require that nurses verify the identity and authority of individuals requesting information. Acceptable verification may include a photo ID and a copy of the documentation supporting legal authority to access information. The nurse needs to determine who the person is, ask to see a valid ID, and ask for the reason for reading the chart. Security may need to be called, but the nurse first needs more information. It is each nurse's duty to do this and no one should pass it off to a manager or ignore the situation.A 90 year-old is readmitted to the hospital, less than 2 weeks after being discharged, for the same health concern. What factors contribute to hospital readmissions among older adults? (Select all that apply.) Family preferences Client health status Excellent primary care Reconciliation of medications Poor communication among providers

FAMILY PREF

CLIENT HEALTH STATUS

POOR COMMUNICATION AMONG PROVIDERS

Avoidable hospitalization, especially among older adults living in skilled nursing facilities, usually results from multiple system failures. The reasons most often cited include inadequate primary care (including inadequate discharge planning and lack of reconciliation of medications), poor care coordination, poor skilled nursing facility quality of care, poor communication among providers and even family preferences. Not all illnesses can be anticipated and clients with more complex health issues are readmitted more often, regardless of quality or coordination of care.The client is two days post-op following a hip replacement and is not transferring well from bed to chair. The nurse checks and then confirms that the client is not progressing on any part of the mobility training program. What action is the nurse's priority?Contact the family to discuss preoperative mobility problems Discuss the problem with the client's surgeon Instruct physical therapy to increase treatments to four times a day Inform the case manager of the variance in the critical pathway

INFORM THE CASE MANAGER OF THE VARIANCE IN THE CRITICAL PATHWAY

Variances in the critical pathway need to be reported to the case manager.Certain goals need to be met to move the client forward in recovery and transfer to an appropriate venue for continued rehabilitation. The RN cannot order physical therapy treatment. Previous mobility problems are not priority post- operatively. The surgeon needs to be informed about the client's lack of progress, but this is not the priority.

The nurse manager is discussing the goals of total quality management (TQM) with the health care team. Which statement correctly identifies a key element of TQM?It is an incident management technique that focuses on employee retention Top administrators are responsible for establishing plans for problem management All employees participate in systematically working toward common goals It is a reactionary approach used to investigate the root cause of a problem

ALL EMPLOYEES PARTICIPATE IN SYSTEMATICALLY WORKING TOWARD

COMMON GOALS

TQM uses a strategic and systematic approach for continual improvement of processes, products, services and the workplace culture. The focus is on improving customer satisfaction. TQM involves all employees, not just top administrators. It is a proactive, not reactive, approach to solving problems.The charge nurse on the evening shift is asked to determine which client is a candidate for discharge

following an internal disaster in the hospital at 9:00 pm.

Which of these clients should the nurse select as a potential candidate for discharge?A young adult, admitted at the beginning of the shift, with an exacerbation of asthma A middle-aged adult with a history of type 1 diabetes and one day post diabetic ketoacidosis An adolescent, admitted on the day shift to rule out acute pancreatitis, who reports a history of alcohol abuse An older adult female who is actively dying and has a "do not resuscitate" order

A MIDDLE-AGED ADULT WITH A HISTORY OF TYPE 1 DIABETES AND ONE DAY

POST DIABETIC KETOACIDOSIS

The client selected to be discharged should be one whose condition is more stable than the others and where there's less of a risk for complications or instability after discharge. Although the client with asthma has a chronic condition, s/he was just admitted and is experiencing an acute exacerbation of the condition. The adolescent is experiencing an acute condition, probably brought on by his/her alcohol abuse. Neither of these clients are stable enough for discharge. It is a humane choice to allow the client who is in the process of dying to stay in the hospital.