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Several nurses are elected by their peers to serve on a negotiating committee to recommend new healthcare benefits. After the new benefits plan is developed and approved, which action is most important for the nurses working on this committee to implement?
- A. Announce the new plan at a special employee wellness event.
- B. Determine staff opinion of current healthcare insurance costs.
- C. Survey the nurses to see who wants to keep the old benefits plan.
- D. Be available to all shifts to discuss the changes in health benefits.
Correct Answer: D
Rationale: Being available to discuss changes ensures clear communication and addresses concerns across all shifts, fostering acceptance. Announcing at an event, assessing current costs, or surveying preferences are less critical post-approval.
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Several nurses who work on a postoperative surgical unit have reported to the charge nurse their concerns about a particular surgeon's treatment of clients during invasive procedures. Adult clients are often in tears after this particular physician performs central IV line insertions or other invasive procedures. After the charge nurse confronts the healthcare provider who dismisses the concerns, the charge nurse reports the surgeon's behavior to the nurse manager who listens but does nothing about the situation. What action is most important for the charge nurse to take?
- A. Confront the nurse manager as a group and ask why nothing has been done to change the surgeon's behavior.
- B. Attend procedures performed by the surgeon and demand halting the procedure if the client becomes distressed.
- C. Document client reactions to invasive procedures performed by the physician in their medical record.
- D. Report the physician's lack of concern for clients' pain during invasive procedures to the Director of Nursing.
Correct Answer: D
Rationale: Reporting the physician's lack of concern to the Director of Nursing is the most effective action as it escalates the issue to a higher authority with the power to investigate and implement corrective measures, ensuring client safety and welfare. Confronting the nurse manager as a group may create conflict without resolving the issue. Attending procedures and intervening directly could be seen as insubordination and may compromise client safety. Documenting reactions is important but does not address the root cause of the surgeon's behavior.
A male client is admitted with difficulty breathing related to a recent diagnosis of metastatic lung cancer. He tells the nurse that he does not want to be hooked up to any machines. His vital signs are heart rate 120 beats/minute, blood pressure 98/50 mm Hg, respirations 30 breaths/minute, and oxygen saturation 88%. Which action should the nurse take?
- A. Obtain the client's legal records for power of attorney.
- B. Give analgesic medications as needed (PRN).
- C. Discontinue the intravenous infusion.
- D. Ask the palliative care team to speak with the client.
Correct Answer: D
Rationale: Consulting palliative care respects the client's wish to avoid machines and provides holistic end-of-life support. Power of attorney, analgesics, and IV discontinuation are secondary or inappropriate.
The nurse determines that an IV vesicant chemotherapy infusion is infiltrated. In responding to this finding, which task can the nurse delegate to the unlicensed assistive personnel (UAP)?
- A. Record the patient's pulse volume distal to the IV site every hour.
- B. Reapply cold compresses to the site of the extravasation every hour.
- C. Dispose of the IV tubing after the infusion is discontinued.
- D. Teach the patient about the need to keep the extremity elevated.
Correct Answer: C
Rationale: Disposing of IV tubing is a routine task within the UAP's scope. Recording pulse volume, reapplying compresses, and teaching require clinical judgment, which are RN responsibilities.
A fire is reported in the kitchen on the first floor of a three-floor community hospital, and the operator notifies the charge nurse on the third floor to start evacuation procedures. Which intervention should the charge nurse implement?
- A. Instruct unlicensed assistive personnel (UAPs) to transfer all non-ambulatory clients via wheelchairs.
- B. Instruct the nursing staff to evacuate ambulatory clients to the nearest fire exits.
- C. Shut all doors to client rooms and tell everyone to stay in their rooms until the fire department arrives.
- D. Announce in a calm voice that all visitors should proceed immediately to the first floor via the service elevators.
Correct Answer: C
Rationale: Shutting doors and keeping everyone in rooms follows the RACE protocol (Rescue, Alarm, Contain, Extinguish), containing the fire and protecting from smoke. Evacuating clients or using elevators during a fire risks exposure to danger.
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.