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An older female client who was recently widowed has become increasingly confused and disoriented. Her family tells the healthcare provider's office nurse that it is imperative for their mother to be admitted to the hospital for medical evaluation. The client is a member of a managed healthcare plan. Which information is best for the nurse to provide this family?
- A. Managed healthcare plans do not pay for any in-hospital medical evaluations.
- B. Healthcare costs are escalating because clients want to have diagnostic testing conducted in the hospital.
- C. The client is grieving normally in response to her husband's death and hospitalization is not necessary.
- D. Managed care providers have mandatory pre-certification requirements for hospitalization.
Correct Answer: D
Rationale: Informing about pre-certification requirements is factual and guides the family on necessary steps for hospitalization. Other options are inaccurate, insensitive, or dismissive of the client's medical needs.
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The nurse manager decides to report a staff nurse to the Peer Review Committee (PRC). Which activity merits this action?
- A. Administered two medications to the same client at the wrong time.
- B. Documented data in the clinical record before assessing client's condition.
- C. Served a diet tray to a client who was NPO for a scheduled procedure.
- D. Changed work assignments without prior approval from charge nurse.
Correct Answer: B
Rationale: Falsifying documentation by recording data before assessment is a serious ethical breach, warranting PRC review. Medication errors, serving a tray, or changing assignments are less severe and can be addressed through counseling.
A nurse who works in a long-term care facility is delegating aspects of client care to unlicensed assistive personnel (UAP). Which assignment(s) should the nurse delegate? (Select all that apply.)
- A. Identify locations of skin lesions on a newly admitted client.
- B. Empty the ostomy bag for a client with a temporary colostomy.
- C. Provide a complete bed bath for a comatose client.
- D. Perform foot care including toenail trimming and heel care.
- E. Give mouth care to an elderly client who has a tracheostomy.
Correct Answer: B,C
Rationale: Emptying an ostomy bag and providing a bed bath are routine tasks within the UAP's scope. Identifying lesions, performing foot care, and giving tracheostomy mouth care require clinical judgment and are RN tasks.
A client with life-threatening injuries from a gunshot wound to the abdomen is mechanically ventilated and sedated. The client has a large family present who are asking multiple and repetitive questions. Which intervention should the nurse implement first?
- A. Let each family member ask a question one at a time.
- B. Request the healthcare provider to speak with the family.
- C. Ask the family to identify a specific spokesperson.
- D. Page a chaplain on call to be present for questions.
Correct Answer: C
Rationale: Designating a spokesperson streamlines communication, reducing repetitive questions and respecting client privacy. Individual questioning, provider involvement, or chaplain support are less immediate solutions.
The nurse receives a change-of-shift report from the prior nurse assigned to a group of clients on a post-surgical unit. Which client requires the most immediate intervention by the nurse?
- A. A client who had an abdominal-perineal resection 3 days ago has no drainage on the dressing and is reporting chills.
- B. A client who fell from a ladder and has a collapsed left lower lung with 100 mL drainage in a chest tube collection container.
- C. A client who was admitted 4 hours ago with a gunshot wound and has a dressing with 2 cm-sized dark red drainage.
- D. A client who is post-mastectomy 2 days ago and has 50 mL of serosanguineous fluid in a Jackson-Pratt drain.
Correct Answer: A
Rationale: The client with no drainage and chills may have an infection or sepsis, which are life-threatening complications requiring immediate assessment and physician notification. The chest tube drainage is normal, the gunshot wound drainage is not excessive, and the mastectomy drain output is expected, making these less urgent.
A staff nurse has been tardy for morning shift assignments for the past three days and provides no explanation for arriving late. Which approach is best for the nurse manager to use when addressing this staff member's tardiness?
- A. Caution the nurse that one more tardiness will result in probational employment.
- B. Offer to switch the nurse's shift assignments to afternoons or evenings.
- C. Stress the expectation that the nurse will arrive on time for all scheduled shifts.
- D. Have the nurse sign a copy of the hospital employee attendance policy.
Correct Answer: C
Rationale: Stressing punctuality expectations communicates the importance of timeliness clearly and respectfully. Threatening probation is overly punitive, changing shifts may not solve the issue, and signing a policy is less effective than direct communication.