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In evaluating a staff nurse who demonstrates inconsistent performance, which intervention should the nurse- manager employ?
- A. Evaluate the nurse's performance using standards of practice, citing both strengths and weaknesses with emphasis on ways to improve practice.
- B. Focus on the strengths of the staff nurse; discuss any weaknesses verbally but avoid documenting the nurse's negative behaviors.
- C. Emphasize the nurse's areas of weakness in light of the inconsistent performance observed and discuss how to improve in each of these areas.
- D. Focus on a discussion of how the inconsistency in the staff nurse's performance disrupts the routine of all of the staff members on the unit.
Correct Answer: A
Rationale: Evaluating using standards provides objective feedback, balancing strengths and weaknesses to guide improvement. Focusing only on strengths or weaknesses, or discussing team disruption, may demotivate or fail to address performance issues effectively.
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The healthcare provider prescribes an oral medication to be given daily for 3 days. However, the medication was also given on the fourth day. Which intervention is most important for the charge nurse to implement?
- A. Inform the pharmacist who dispensed the medication.
- B. Evaluate the client for symptoms of a drug overdose.
- C. Report the medication error to the nursing supervisor.
- D. Review the medication transcription with the nurse.
Correct Answer: B
Rationale: Evaluating for overdose symptoms ensures client safety, addressing potential harm from the error. Informing the pharmacist, reporting, and reviewing transcription are secondary actions.
The practical nurse reports that a client with a deep vein thrombosis (DVT) was mistakenly given heparin in addition to the prescribed warfarin. Which priority action should the nurse take?
- A. Notify the healthcare provider.
- B. Monitor for signs of bleeding.
- C. Complete an adverse occurrence report.
- D. Obtain blood for coagulation studies.
Correct Answer: A
Rationale: Notifying the healthcare provider ensures prompt intervention to reverse anticoagulation and prevent bleeding. Monitoring, reporting, and testing are important but follow provider notification.
The nurse determines that an elderly client with pneumonia has a nursing problem of 'altered nutrition, less than body requirements.' Which instruction should the nurse give the unlicensed assistive personnel (UAP) helping with the care of this client?
- A. Offer to assist the client with meal preparation and feeding.
- B. Thicken the client's liquids if aspiration seems likely.
- C. Listen to the client's breath sounds before and after meals.
- D. Assist the client in selecting high protein foods on the menu.
Correct Answer: A
Rationale: Assisting with feeding is within the UAP's scope and addresses the client's nutritional needs. Thickening liquids, listening to breath sounds, and selecting foods require RN judgment.
The charge nurse needs to determine if an additional nurse should be called to help staff the unit for the next shift. Which information is most important for the charge nurse to consider when making this decision?
- A. The acuity level of the clients on the unit.
- B. The physicians' plans to perform procedures on the unit.
- C. The number of clients leaving the unit for diagnostic tests.
- D. The skill level of the personnel staffing the unit.
Correct Answer: A
Rationale: Client acuity determines the intensity of care needed, directly impacting staffing requirements. Procedures, diagnostic tests, and staff skills are secondary considerations.
A client with influenza is admitted to the medical unit. The nurse observes an unlicensed assistive personnel (UAP) preparing to enter the client's room to take vital signs and assist with personal care. The UAP has applied gloves and a gown. Which action should the nurse take?
- A. Review the need for the UAP to wear a face mask while in close contact with the client.
- B. Remind the UAP to apply a fitted respirator mask before entering the client's room.
- C. Assign the UAP to provide care for another client and assume full care of the client.
- D. Instruct the UAP to notify the nurse of any changes in the client's respiratory status.
Correct Answer: A
Rationale: Reviewing the need for a face mask ensures proper droplet precautions for influenza, completing the UAP's PPE. A respirator is unnecessary, reassigning the UAP is impractical, and monitoring respiratory changes is secondary to infection control.