Nokea
The clinic nurse has just accessed a client's chart on the computer. The resident comes over and asks her to stay logged on because he needs to add a note to that client's chart. She should say:
- A. No problem. Just log me off when you're done.'
- B. I'll put the note in for you. What do you want to say?'
- C. Just make sure that you sign your note because it's under my log in ID.'
- D. I'm sorry, but you will have to enter the information using your own log in ID.'
Correct Answer: D
Rationale: Patient privacy and data security are paramount in healthcare, governed by laws like HIPAA. Allowing the resident to use the nurse's login violates these principles, as each provider must use their own credentials to access and modify patient records. This ensures accountability every action is traceable to the individual who performed it and protects the nurse from liability for entries she didn't make. Offering to log off after the resident's use or adding the note herself compromises this accountability, potentially leading to errors or legal issues if the resident's input is inaccurate. Asking the resident to sign the note under her ID still ties her login to his actions, which is insufficient. Requiring the resident to use his own login upholds professional standards, safeguards patient information, and maintains clear responsibility for chart entries.
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As a new nurse manager who has 'inherited' a unit with high nurse turnover and complaints of patient dissatisfaction, your first course of action would be to:
- A. Determine levels of nurse engagement on the unit
- B. Review the personnel files of nurses who have resigned
- C. Interview upper management about their vision for the unit
- D. Meet with your staff to clarify your vision for the unit
Correct Answer: A
Rationale: High turnover and patient dissatisfaction often stem from low nurse engagement disconnection from work or leadership impacting care quality. As a new manager, assessing engagement through observation, surveys, or discussions reveals root causes, like poor morale or autonomy, guiding targeted improvements. Reviewing files offers historical data but not current dynamics. Interviewing management or sharing your vision comes later understanding staff engagement first grounds your strategy in the unit's reality. Studies (e.g., Aiken) show engaged nurses improve outcomes and retention, making this the critical starting point to address both issues effectively.
A nurse manager is implementing a team nursing approach on his unit, hiring licensed practical nurses (LPNs) and assistive personnel (AP) as additional staff. Which of the following actions should the nurse manager take to facilitate acceptance of this change?
- A. Introduce the new approach and facilitate the development of a task force to plan implementation
- B. Announce the change and expect immediate compliance
- C. Train only the new staff on the approach
- D. Leave the staff to adapt on their own
Correct Answer: A
Rationale: Implementing a team nursing approach requires staff buy-in to ensure smooth adoption and effective collaboration. Introducing the new approach and creating a task force to plan its implementation actively involves the existing staff, giving them a sense of ownership and control over the change process. This strategy fosters acceptance by addressing concerns, encouraging input, and building a collaborative environment, which is critical in healthcare settings where teamwork directly impacts patient outcomes. Simply announcing the change without engagement risks resistance, as staff may feel blindsided or undervalued. Training only new staff excludes current employees, potentially creating resentment or confusion, while leaving staff to adapt independently neglects the need for structured guidance. Involving staff in planning leverages their expertise, reduces anxiety about the unknown, and aligns with leadership principles that prioritize communication and inclusion, ultimately enhancing the transition to a team-based model.
A nurse is caring for a client who has a tracheostomy and requires suctioning. Which of the following actions should the nurse take?
- A. Suction for no longer than 10 to 15 seconds
- B. Use a clean catheter each time
- C. Apply suction while inserting the catheter
- D. Hyperoxygenate the client after suctioning
Correct Answer: A
Rationale: Tracheostomy suctioning clears secretions but risks hypoxia if prolonged. Suctioning for no longer than 10-15 seconds limits oxygen deprivation per guidelines allowing recovery between passes, critical for a client reliant on a patent airway. Using a clean catheter each time compromises sterility, risking infection sterile is standard. Applying suction while inserting spreads secretions, clogging the tube, while hyperoxygenation post-suctioning helps but pre-suctioning is key to preload oxygen. The time limit balances efficacy and safety, reflecting the nurse's skill in preventing hypoxia or trauma, ensuring effective airway management in a procedure vital for respiratory stability.
As a nurse manager, you want to institute point-of-care devices on your unit. The rationale that you provide to support the point-of-care devices includes:
- A. reduction in incidents of medication error
- B. immediate documentation of care
- C. comparison of patient data with previous data
- D. immediate access to staffing schedules
Correct Answer: A
Rationale: Point-of-care devices, like bedside scanners or tablets, enhance care by enabling real-time actions. A primary rationale is reducing medication errors e.g., through bar-code scanning to verify drugs and patient identity before administration, catching mistakes instantly. This directly improves safety, a compelling argument for adoption. Immediate documentation and data comparison are benefits, streamlining workflow and informing decisions, but error reduction is a stronger, more urgent driver tied to patient outcomes. Access to staffing schedules is unrelated to clinical care delivery. Emphasizing medication error reduction highlights a tangible, evidence-supported impact, aligning with safety priorities and likely securing support for implementation.
As a nurse manager, you introduce a program that allows staff to participate in mock drills for emergency preparedness. Your rationale is that mock drills:
- A. Reduce staff accountability
- B. Increase staff confidence in emergencies
- C. Reduce patient safety
- D. Increase managerial control
Correct Answer: B
Rationale: Mock drills boost staff confidence practicing emergencies (e.g., codes) sharpens skills, cutting panic. They don't cut accountability, harm safety, or hike control readiness grows. In your unit, this preps for crises, aligning with safety where trained nurses act decisively, enhancing outcomes and team poise, a proactive step for high-stakes moments.