In which situation is the nurse manager utilizing an autocratic leadership style?
- A. The nurse manager provides the solution for a unit problem.
- B. The nurse manager allows the staff to solve their own unit problem.
- C. The nurse manager proposes several alternatives and has the unit staff vote on the best proposal.
- D. The nurse manager arranges for a staff meeting where all unit employees can share proposals to solve a problem.
Correct Answer: A
Rationale: The autocratic style of leadership is task oriented and directive. The leader uses his or her power and position in an authoritarian manner to set and implement organizational goals or solutions. Decisions are made without input from the staff. The situational leadership style uses a style depending on the situation and events. Democratic styles best empower staff toward excellence because this style of leadership allows nurses to provide input regarding the decision-making process and an opportunity to grow professionally. Participatory leadership encourages input from the staff.
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The nurse manager is developing an educational session for nursing staff on the components of informed consent and the information to be shared with a client to obtain informed consent. Which information should the nurse manager include in the session? Select all that apply.
- A. The client needs to be informed of the prognosis if the test, procedure, or treatment is refused.
- B. The client cannot refuse a test, procedure, or treatment once the test, procedure, or treatment is started.
- C. The name(s) of the persons performing the test or procedure or providing treatment should be documented on the informed consent form.
- D. A description of the complications and risks of the test, procedure, or treatment, as well as anticipated pain or discomfort, needs to be explained to the client.
- E. The nurse is responsible for obtaining the client's signature on an informed consent form even if the client has questions about the test, procedure, or treatment to be performed.
Correct Answer: A,C,D
Rationale: Informed consent is a person's agreement to allow something to happen based on full disclosure of risks, benefits, alternatives, and consequences of refusal. The primary health care provider (HCP) is responsible for conveying information and obtaining the informed consent. The nurse may be the person who actually ensures that the client signs the informed consent form; however, the nurse does this only after the HCP has instructed the client, and it has been determined that the client has understood the information. The following factors are required for informed consent: a brief, complete explanation of the test, procedure, or treatment; names and qualifications of persons performing and assisting in the test, procedure, or treatment; a description of the complications and risks, as well as anticipated pain or discomfort; an explanation of alternative therapies to the proposed test, procedure, or treatment, as well as the risks of doing nothing; and the client's right to refuse the test, procedure, or treatment even after it has been started.
The nurse is administering a dose of prescribed intravenous hydralazine to a client. To provide a safe environment, the nurse should ensure that which safety measure is in place before injecting the medication?
- A. Central line
- B. Thermometer
- C. Foley catheter
- D. Blood pressure cuff
Correct Answer: D
Rationale: Hydralazine is an antihypertensive medication used in the management of moderate to severe hypertension. The blood pressure and pulse should be monitored frequently after administration, so a blood pressure cuff is the item to have in place. Although intravenous access is needed, a central line is unnecessary. The other options are also unnecessary and are unrelated to the administration of this medication.
A client receiving prescribed heparin therapy for a diagnosis of an acute myocardial infarction has an activated partial thromboplastin time (aPTT) value of 100 seconds. Before reporting the results to the primary health care provider, the nurse verifies that which medication is available for use if prescribed?
- A. Vitamin \mathrm{K
- B. Vitamin B_{12
- C. Methylene blue
- D. Protamine sulfate
Correct Answer: D
Rationale: Heparin is an anticoagulant. Therapeutic values of the aPTT for clients on heparin range between 60 and 70 seconds, depending on the control value. A value of 100 seconds indicates that the client has received too much heparin and is at risk for bleeding. The antidote for heparin overdosage is protamine sulfate and may be prescribed. Vitamin \mathrm{K is the antidote for warfarin sodium overdosage. Methylene blue is an antidote for cyanide poisoning. Vitamin \mathrm{B}_{12 is used to treat clients with pernicious anemia.
Which statements describe the characteristics of team nursing? Select all that apply.
- A. A registered nurse leads a team of staff members.
- B. Each nurse assumes responsibility for a specific task.
- C. Team members provide direct care to groups of clients.
- D. Unlicensed assistive personnel are given a client assignment.
- E. The registered nurse assumes responsibility for a caseload of clients over time.
- F. Team nursing maintains continuity of care across nursing shifts, days, and home care visits.
Correct Answer: A,C,D
Rationale: In team nursing, a registered nurse (RN) leads a team that is composed of other RNs, licensed practical or licensed vocational nurses, and unlicensed assistive personnel and technicians. The team members provide direct client care to groups of clients under the direct supervision of the RN team leader. In this model, unlicensed assistive personnel are given client assignments rather than being assigned particular nursing tasks. In functional nursing, tasks are divided, with one nurse assuming responsibility for specific tasks. Primary nursing is a model in which the RN assumes responsibility for a caseload of clients over time. In primary nursing, continuity of care across nursing shifts, days, and home care visits is maintained.
After receiving detailed information about a colonoscopy from the primary health care provider (HCP), the nurse asks the client to sign the informed consent form and discovers that the client cannot write. Which is the best intervention for the nurse to implement?
- A. Contact the provider to obtain informed consent.
- B. Obtain a verbal informed consent from the client.
- C. Have two nurses witness the client sign with an X.
- D. Clarify information to the client with another nurse.
Correct Answer: C
Rationale: Nurses are responsible to ensure that the signed informed consent form is in the client's medical record before a procedure and for clarifying facts that have already been presented by the HCP. Nonetheless, the person performing the procedure obtains informed consent and provides the explanations to the client. Informed consent can be obtained verbally, but that is also the responsibility of the HCP. Clients who cannot write may sign an informed consent with an X in the presence of two witnesses. Nurses can serve as a witness to the client's signature but not to the fact that the client is informed.
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