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As a patient's condition moves toward their impending death, which nursing intervention demonstrates how the focus of palliative care change?
- A. The patient is encouraged to discuss their spiritual needs.
- B. The patient is educated concerning the physical changes associated with the dying process.
- C. The patient's advance care plan is formulated and implemented.
- D. The patient's comfort needs are identified.
Correct Answer: D
Rationale: The correct answer is D because as a patient approaches death, the focus of palliative care shifts towards providing comfort and symptom management to improve their quality of life. Identifying and addressing the patient's comfort needs becomes crucial in ensuring a peaceful and dignified end-of-life experience.
A: While discussing spiritual needs can be important, the primary focus shifts towards physical comfort in the final stages of life.
B: Educating the patient about physical changes is important, but it may not be the priority as the focus shifts towards comfort care.
C: Advance care planning is essential but may have already been addressed before the patient reaches the impending death stage.
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When the nurse manager conducts a qualitative analysis of budget variances, he or she is:
- A. determining the percentage increase of supply usage from the last quarter to the current quarter.
- B. identifying the overall increase in the dollar amount of salaries paid for overtime.
- C. comparing productivity metrics across all nursing units in the facility.
- D. reconciling with current conditions the underlying assumptions on which the budget was based.
Correct Answer: D
Rationale: The correct answer is D because when a nurse manager conducts a qualitative analysis of budget variances, they need to reconcile the underlying assumptions on which the budget was based with current conditions. This involves reviewing the initial budget assumptions to see if they still hold true and adjusting them accordingly. This step ensures that the budget remains relevant and accurate.
A is incorrect because determining the percentage increase of supply usage does not involve a qualitative analysis of budget variances. B is incorrect because identifying the overall increase in the dollar amount of salaries paid for overtime is a quantitative analysis, not qualitative. C is incorrect because comparing productivity metrics across nursing units is a different type of analysis and not specifically related to budget variances.
Care delivery using the team-based approach is used on a telemetry nursing unit. The team consists of one registered nurse (RN), two licensed practical nurses (LPNs), and one unlicensed assistive personnel (UAP). Staff have been charged to improve quality of care while ensuring cost containment. Which assignments would meet both criteria?
- A. The RN administers all medications to all patients.
- B. The LPN performs sterile dressings and IV tubing changes on all central lines.
- C. The experienced UAP places telemetry electrodes and attaches to cardiac monitor.
- D. The RN administers an enema to a stable patient who has an order "administer fleet enema PRN when no bowel movement in 2 days."
Correct Answer: B
Rationale: The correct answer is B because it aligns with improving quality of care and cost containment. LPNs are trained to perform sterile procedures like dressing changes and IV tubing changes, which can enhance patient outcomes. This assignment allows the RN to focus on tasks that require their specialized skills, promoting quality care. Furthermore, utilizing LPNs for these tasks is more cost-effective than having an RN perform them.
Choices A, C, and D are incorrect:
A: Having the RN administer all medications to all patients is not utilizing the team effectively. LPNs and UAPs can handle medication administration under appropriate supervision.
C: While experienced UAPs can assist with attaching telemetry electrodes, this task does not fully utilize the skills of the LPNs and RN to improve care quality.
D: Administering an enema is within the scope of an LPN's practice, and assigning this task to the RN is not the most efficient use of resources.
A nurse is delegating to the newly hired nursing unlicensed assistive personnel (UAP) the task of assisting with oral hygiene, knowing that this assignment "does not require decisions based on the nursing process." The nurse is correctly using which of the five rights of delegation?
- A. Supervision
- B. Communication
- C. Person
- D. Circumstance
Correct Answer: C
Rationale: Correct Answer: C - Person
Rationale:
- The five rights of delegation are Right Task, Right Circumstances, Right Person, Right Direction/Communication, and Right Supervision.
- In this scenario, choosing the Right Person means delegating tasks to individuals with appropriate skills and abilities, such as UAP assisting with oral hygiene.
- This choice is correct as the nurse is delegating a task that falls within the UAP's scope of practice without requiring nursing process decisions.
A student nurse assigned to work with the charge nurse is given the opportunity to help revise the nursing assessment form. She receives several compliments from management and her nursing instructor for her creative suggestions. The student nurse enjoys the project and attention she is receiving and begins to prolong the conclusion of the project. Although she constantly adds new information, she filters this out slowly to others. The student nurse is subject to the time management obstacle of:
- A. need for perfection.
- B. fear of losing creativity.
- C. unclear goals.
- D. fear of completion.
Correct Answer: D
Rationale: The correct answer is D: fear of completion. This is because the student nurse is prolonging the conclusion of the project despite constantly adding new information and filtering it out slowly to others. This behavior indicates a reluctance to finish the project, likely due to a fear of moving on to the next stage or fear of evaluation. The student nurse is enjoying the attention and positive feedback, leading to a delay in completing the task.
A: The need for perfection is not the primary obstacle in this scenario as the student nurse is not necessarily striving for perfection but rather avoiding completion.
B: Fear of losing creativity is not the main issue here as the student nurse is still adding new information, indicating creativity is not the concern.
C: Unclear goals do not seem to be the obstacle as the student nurse is actively engaged in the project and receiving positive feedback.
A nurse responsible for staffing a medical-surgical unit must consider: (select all that apply)
- A. the patient census.
- B. physical layout of the unit.
- C. complexity of care required.
- D. educational level of all staff.
Correct Answer: A
Rationale: The correct answer is A: the patient census. This is crucial for determining the appropriate number of staff needed to provide safe and effective care based on the current number of patients. The patient census directly impacts workload and patient acuity levels. Choices B, C, and D are incorrect because although they may be important factors to consider when staffing a medical-surgical unit, they are not as directly related to determining the immediate staffing needs based on the current patient load. The physical layout of the unit, complexity of care required, and educational level of staff are important for overall unit operations and quality of care but do not have the same immediate impact on staffing decisions as the patient census.