LD 151 Final Review

1. LD 151 Final Review Critical Thinking Delegation, Care Priority, Problem-Solving , Communication

2. T/F • Delegation is and essential decision-making skill

3. MC • When the licensed nurse is performing a delegation, he/she is : • A. Transferring the authority to perform nursing care to a C.N.A. • B. Transferring his/her responsibility for nursing care to another individual • C. Transferring to a competent individual the authority to perform a selected nursing task in a specific situation • D. Authorizing a trained staff member to perform a nursing task to any client who would need it.

4. MC • Related to the Oregon Board of Nursing rules, which of the following would be eligible to be considered for delegation: • A. A certified nursing assistant • B. An unlicensed nursing assistant • C. A certified medication assistant • D. A nursing student

5. MC • When a nurse manager uses his/her available staff to deliver safe, cost-effective health care, he/she is demonstrating: • A. The purpose of delegation • B. The rules of delegation • C. The mission of delegation • D. The networking feature of delegation

6. MC • To be accountable is to be legally responsible for outcomes. A person may be held liable for any related consequences. The “delegator” is responsible for: • A. Making client-care assignments to any personnel who fit the job description • B. Delegating any personnel who fit the job description for eligibility for delegation • C. The decision to delegate, an assessment of the situation, planning outcomes, providing proper communication and supervision • D. The decision to delegate, delegation, and outcome determination. Nothing further.

7. MC • “Adequate” nursing supervision encompasses: • A. a check-in at the end of the shift to determine outcome of delegation • B. Instructions to the delegating person with clarification as needed. After this, the delegated person is expected to perform independently. • C. A 5 minute conference at the beginning and end of the day to determine how the delegated individual thought the day and tasks went. • D. the provision of guidance or direction, evaluation, and follow-up by the licensed nursed

8. MR • Before delegation, the licensed nurse must identify the roles of available staff. 3 sources provide guidelines for safe delegation. These are: • A. The state’s Nurse Practice Act • B. Institution’s policy and procedure manual • C. Job description • D. NLN’s publications

9. MC • Five rights have been identified to practice safe delegation. The “right task” refers to: • A. tasks of basic nursing care that can legally be delegated • B. any task of nursing care that a licensed nurse would normally perform • C. Complex tasks of nursing care • D. Tasks of nursing care that can be performed within the assessment and judgment of the delegated person

10. MR • The licensed nurse cannot and should not delegated which of the following: • A. his/her own personal accountability for the outcomes • B. management skills such as praise or discipline of employees • C. nursing actions that require professional judgment • D. patients who are stable and whose outcome of care is predictable

11. MC • In guiding the delegating nurse to confirm the “right circumstance” for appropriate delegation, the outcome of care needs to be: • A. within the UAP’s assessment ability • B. reasonable • C. predictable • D. B and C

12. MC • Some common guidelines are available to help a delegating nurse make an appropriate decision as to the “right person” to delegate. Which of the following would be considered and appropriate guideline? • A. stable patients with predictable outcomes • B. Need for basic nursing care such as: routine VS, bathing, feeding and transferring • C. a person who demonstrates accountability for accepting the delegation and reporting information to the licensed nurse as requested • D. all of the above

13. MR • In giving the “right direction or communication” to the person being delegated, the licensed nurse needs to evaluate whether instructions were clear and understood. Which of the following principles guide the nurse’s communication? • A. Clear • B. Concise • C. Correct • D. Complete

14. MC • The “right supervision and evaluation” is reflected by the quality of care and progress of a client toward desired outcomes. To evaluate this progress the nurse must provide which of the following for the delegated individual? • A. Monitoring of delivery of care • B. Assigning the patient and asking the UAP to report–in at the end of shift • C. Giving independence to the UAP without on site observation of care • D. All of the above

15. MR • Identify which of the following would be nursing tasks that can be delegated: • A. tasks that have a low potential for harm • B. tasks with minimum complexity • C. minimum problem-solving required • D. low predictability of outcome • E. low predictability of stability

16. MC • Priority setting is a complex step in the decision-making process and is used to: • A. simplify the structural process of the organization • B. used to rank patient needs • C. determine the order of nursing activities • D. B and C

17. MR • The principles that assist in arranging nursing activities to meet the needs of the most critical patients include: • A. the urgency of the need • B. the importance of the need • C. the significance of the need • D. the preference of the client

18. Fill-in • _______ _______________ is an important skill to develop for managing a busy nursing unit.

19. MC • Based on Maslow’s Hierarchy of Needs theory, which needs always take precedence (with a rare exception)? • A. Safety • B. Physiological • C. Self-actualization • D. Security

20. MR • Other models of prioritizing needs include Craven and Hinle’s “high, medium, and low” priorities. Of the following, indicate the high-priority situations: • A. Life-threatening illness or injury • B. Threat to patient safety • C. Pain and anxiety relief • D. Urgent events that are not life-threatening

21. Other • List 3 high-priority situations.

22. Other • List 3 medium priority situations

23. Other • List 3 low-priority situations.

24. MC • When a nurse is prioritizing his/her time, __________ always takes precedence: • A. Assessment • B. Analysis • C. Goals and measurable outcomes • D. All of the above

25. MC • When implementing the established priorities and nursing activities, which of the following should be performed first? • A. needs that would not be affected if not able to attend to until a later time or date • B. nursing actions necessary to prevent harm • C. perform nursing actions that, if left until a later time, could result in unhealthy consequences or physical or emotional impairment • D. A and C

26. T/F • Re-evaluating the plan as the patient status or the situation changes is important in order to monitor for improvement or deterioration in the patient’s progress toward the outcome criteria established in the plan of care.

27. MR • During shift report, Andi, a new LPN, was informed by the off-going nurse that Mr. D. had not received his bath prior to this morning’s surgery and that she should do this first. Andi proceeded to perform the bath right after shift report. During the bath, a staff member came in and said that Mr. C. was having chest pain and shortness of breath as was mentioned during report. Which pitfall of priority setting did Andi demonstrate?

28. MR • A. Completion of the easiest task first • B. Acceptance of other’s priorities without assessing the variables • C. Inadequate assessment and evaluation of patient needs • D. Failure to identify tasks that cannot be delayed without serious consequences

29. T/F • Problem-solving and decision-making are practical application of critical thinking skills.

30. MR • The ability to solve problems effectively contributes to: • A. the delivery of safe nursing care • B. competent nursing care • C. shorter hospital/facility stays • D. less staff time per patient

31. MC • Problems – something difficult to solve or decide – can be related to which of the following? • A. patient • B. coworkers • C. mechanical breakdown • D. personal issues • E. all of the above

32. MC • Problem –solving involves first: • A. identifying the problem • B. making choices • C. brainstorming a plan • D. implementing a plan

33. Complete • Nursing Process differs from generic problem-solving in that it is: __________ __________.

34. Other • Steps in the Nursing Process style of problem-solving include the following. Place a number in front of each one in the appropriate order: __ Analysis __ Outcome Identification __ Develop a list of possible strategies __ Assessment __ Plan __ Evaluation __ Implementation

35. MC • Two employees were experiencing conflict between them. Using good interpersonal skills to assist in conflict resolution, the nurse manager brought the parties together to discuss their issues and allow the parties to work out their own solution. This is an example of what problem-solving strategy? • A. Do it yourself • B. Assign someone • C. Influence others • D. Doing nothing

36. Other • List 3 of the 5 pitfalls in Problem-solving and give an example of each.

37. MC Mrs. T. was experiencing a significant amount of pre-operative anxiety the evening before her surgery. The LPN on shift that evening, took some time to sit with her and let the patient talk. Through attentive listening, appropriate explanations, and nursing support, the patient was able to find calm and comfort. This style of communication by the nurse would be called: A. collegial B. social C. therapeutic D. a and b

38. Complete • The most significant feature of therapeutic communication is that it is _______ _______.

39. MC • Skills that result in enhanced relationships with colleagues, improved patient care, and better documentation describe which level of communication? • A. Collegial • B. Social • C. Therapeutic • D. All of the above • E. None of the above

40. T/F • Non-verbal communication takes place in all 3 levels of communication

41. MR • Two responsibilities are upon the sender of verbal messages. These are: • A. The sender must be bilingual at a minimum • B. The sender must send clear messages • C. The sender must verify that these messages are being accurately interpreted by the receiver • D. All significant messages must be sent prior to start of first med pass for each shift

42. MC • Collaboration is significant part of communication in the nurse’s work life. Collaboration means “two or more people working together to a common end”. When delegating a task of nursing care, the nurse is responsible for: • A. continuity of care • B. ensuring that the right direction or communication is given • C. understanding is verified at the end of the shift before report • D. Checking to see that the information is basically understood

43. MR • Physician notification is another important task in the nurse’s job. Identify the guidelines below that will make this task easier and more efficient: • A. Obtain all pertinent data before making the call • B. Check with other staff to see if anyone else needs to talk with the same MD • C. Listen carefully; repeat orders back to the MD for confirmation • D. Identify yourself, the unit, the patient and the purpose of the call

44. Other • The patient chart is a legal document of the quality of care for each patient. List 5 items that require charting for any patient: