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A hospital administrator has implemented a change in the method of assigning nurses to client care units. A group of registered nurses is resistant to the change, and the nursing administrator anticipates that the nurses will not facilitate the process of change. Which approach is best for the administrator to take initially in dealing with the resistance?
- A. Cancel the implementation of the change.
- B. Implement the change first on a trial basis.
- C. Delay implementing the change for a few weeks.
- D. Encourage the nurses to verbalize feelings regarding the change.
Correct Answer: D
Rationale: Face-to-face meetings to address the issue at hand will allow verbalization of feelings, identification of problems and issues, and the development of strategies to solve the problem. Option 1 will not address the problem. Option 2 is not the initial intervention. Option 3 may provide a temporary solution to the resistance but will not specifically address the concern.
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A registered nurse is delegating activities to the nursing staff. Which activities can be safely assigned to the unlicensed assistive personnel (UAP)? Select all that apply.
- A. Collecting a urine specimen from a client
- B. Obtaining frequent oral temperatures on a client
- C. Assessing a client who returned from the recovery room 6 hours ago
- D. Assisting a post-cardiac catheterization client who needs to lie flat to eat lunch
- E. Accompanying a client being discharged to meet his spouse at the hospital exit door
Correct Answer: A,B,D,E
Rationale: Unlicensed assistive personnel (UAP) are trained to perform noninvasive tasks and those that meet basic client needs, such as collecting specimens, taking vital signs, assisting with activities of daily living, and escorting clients. Therefore, collecting a urine specimen, obtaining frequent oral temperatures, assisting a post-cardiac catheterization client to eat lunch while lying flat, and accompanying a client to the hospital exit are appropriate tasks for the UAP. Assessing a client who returned from the recovery room requires clinical judgment and is a task for a licensed nurse, as it involves evaluating the client's condition and identifying potential complications.
An older client had an open reduction with internal fixation (ORIF) for a hip fracture 4 days ago. Which measure should the nurse implement to provide safe care?
- A. Provide ice chips instead of drinking water.
- B. Instruct the client to call for help before getting up.
- C. Minimize opioid administration to prevent dizziness.
- D. Tell the client to roll to the affected side first before getting up.
Correct Answer: B
Rationale: The nurse instructs the client to call for help before getting up because the client has multiple risk factors for falls, is of older age, has postoperative status, and may also be receiving opioid analgesia. Restricting fluid intake with ice chips is not indicated; besides, adequate hydration is important for maintaining cardiac output and renal function, for keeping respiratory secretions thin, and in preventing constipation. The nurse administers opioid analgesics as indicated and fulfills the nurse's duty owed to the client by acting to resolve pain. The nurse instructs the client to roll to the unaffected side to get up to prevent excessive stress on the fragile surgical wound.
The nurse reviews wound culture results and learns that an assigned client has methicillin-resistant Staphylococcus aureus (MRSA) in a wound bed. Which type of transmission-based precautions should the nurse implement for this client?
- A. Enteric precautions
- B. Droplet precautions
- C. Contact precautions
- D. Airborne precautions
Correct Answer: C
Rationale: Contact precautions include standard precautions and require the use of barrier precautions such as gloves and goggles. Contact precautions are used for clients who have diarrhea, draining wounds, or methicillin-resistant infections. The goal of these precautions is to eliminate disease transmission resulting either from direct contact with the client or from indirect contact through inanimate objects or surfaces that the pathogen has contaminated, such as instruments, linens, dressing materials, or hands. Enteric precautions are initiated if the organism is transmitted via the gastrointestinal tract. Droplet and airborne precautions are used if the organism is transmitted via the respiratory tract.
The nurse notes that a client's lithium level is 3.9 \mathrm{mEq} / \mathrm{L}(3.9 \mathrm{mmol} / \mathrm{L}) . Based on this data, which priority intervention should the nurse implement?
- A. Determining visual acuity
- B. Assisting with ambulation
- C. Monitoring intake and output
- D. Instituting seizure precautions
Correct Answer: D
Rationale: The lithium level must be monitored closely in a client taking lithium. A therapeutic regimen is designed to attain a serum lithium level of 0.8 to 1.2 \mathrm{mEq} / \mathrm{L}(0.8 to 1.2 \mathrm{mmol} / \mathrm{L}) for maintenance treatment. A level of 3.9 \mathrm{mEq} / \mathrm{L (3.9 \mathrm{mmol} / \mathrm{L}) is in the toxic range, and seizures may occur at levels of 3.5 \mathrm{mEq} / \mathrm{L (3.5 \mathrm{mmol} / \mathrm{L}) and higher. While the remaining options are appropriate interventions, they are not the priority because they are not related to the possibility of toxicity.
A client who is admitted to the hospital for an unrelated medical problem is diagnosed with urethritis caused by chlamydial infection. The unlicensed assistive personnel (UAP) assigned to the client asks the nurse what measures are necessary to prevent contraction of the infection during care. The nurse tells the UAP that which intervention is needed for infection control?
- A. Enteric precautions should be instituted for the client.
- B. Gloves and mask should be used when in the client's room.
- C. Contact isolation should be initiated because the disease is highly contagious.
- D. Standard precautions are sufficient because the disease is transmitted sexually.
Correct Answer: D
Rationale: Chlamydia is a sexually transmitted infection. Caregivers cannot acquire the disease during administration of care, and standard precautions are the only measure that needs to be used. Recognizing the necessary precautions will help you in identifying the remaining options as incorrect.