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The old client had to walk along the hall to reach the examination room. During assessment the nurse hears an S4. Which is the best intervention at this moment?
- A. Practice an EKG
- B. Administer nitroglycerin sublingual
- C. Allow rest recumbent for 30 minutes
- D. Call MD immediately
Correct Answer: C
Rationale: An S4 in an elder post-walk suggests diastolic stiffness the nurse allows 30 minutes recumbent rest, not EKG, nitroglycerin, or calling. S4 often reflects aging or exertion, not acute ischemia; rest distinguishes transient from persistent findings. EKG or nitroglycerin assumes angina, and calling escalates prematurely. Leadership opts for this imagine a tired patient; rest clarifies if S4 persists, guiding next steps. This reflects nursing's prudent assessment, ensuring accurate cardiac care in geriatrics effectively.
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In Hospital STV, senior administration is strongly oriented toward fiscal and social conservatism. The nursing department is deeply concerned with the provision of quality to the community, which includes a high number of poor and unemployed. To accomplish the goals of the nursing department, resources need to be allocated that administration is not able to allocate. Nursing and administration:
- A. Are engaged in shared governance
- B. Are involved in an irreconcilable conflict of interests
- C. Represent separate subcultures in the institution
- D. Represent union and nonunion conflict
Correct Answer: C
Rationale: Hospital STV's administration and nursing department reflect distinct subcultures administration's fiscal conservatism versus nursing's quality focus for a needy community. Subcultures within organizations have unique values and goals, here creating tension over resource allocation. This isn't shared governance (collaborative decision-making), irreconcilable conflict (not proven unresolvable), or union disputes (no union mentioned). These separate ideologies can coexist, potentially constructively, but currently highlight differing priorities, fitting the subculture concept where groups within an institution operate with distinct, sometimes clashing, perspectives.
Which describes an informal leader?
- A. Competencies and continuing education
- B. The leader of the team because of years of experience in the department
- C. The nurse has the responsibility for giving nursing care to the client from admission until discharge
- D. A team leader has the task of coordinating the total care of a group of patients
Correct Answer: B
Rationale: Informal leaders arise from experience, unlike competencies, care duty, or formal roles. Nurse managers like veteran RNs value these, contrasting with titles. They're key in healthcare for influence, aligning leadership with organic guidance.
Nurse receives four phone calls from pregnant women in their last trimester of pregnancy. Which call should be answered first?
- A. Client can't sleep supine because shortness of breath
- B. Client with frequent heartburn
- C. Client who can't remove wedding ring
- D. Client with frequent non-painful uterine contractions
Correct Answer: A
Rationale: The nurse must prioritize the client with shortness of breath when supine, a potential sign of late-pregnancy complications like preeclampsia or heart strain, over heartburn, ring tightness, or non-painful contractions. Dyspnea signals respiratory or cardiac distress say, from fluid overload needing urgent assessment to prevent maternal-fetal harm. Heartburn's common, ring issues suggest edema (less acute), and contractions could be Braxton Hicks, not immediate labor. In nursing leadership, triaging this call first ensures safety; a delay might miss hypoxia, risking oxygen delivery to the fetus. Picture a 38-week pregnant woman gasping this demands swift action, guiding care prioritization in high-stakes obstetric settings effectively.
The nurse is working with a group of students who are learning a high-risk procedure. How should the nurse best ensure learning while protecting the safety of clients?
- A. Create an unfolding case study featuring the procedure
- B. Use simulation for the students to practice the skill
- C. Help the students use a decision-making model to choose the safest technique
- D. Teach the students about the traditional problem-solving process before they practice the procedure
Correct Answer: B
Rationale: Simulation lets students master a high-risk procedure like intubation safely, unlike case studies, decision models, or problem-solving lessons. In nursing, hands-on practice in a controlled setting minimizes patient risk while building skill confidence. Case studies inform, models guide choices, and problem-solving teaches theory none replace real-time rehearsal. Leadership prioritizes this, ensuring novices like these students refine techniques (e.g., catheter insertion) without harm, safeguarding care quality in clinical training environments effectively.
A nurse-manager has made a decision and is now preparing to evaluate the decision. What question should best guide the nurse's evaluation process?
- A. Is evaluation necessary when using a good decision-making model?
- B. Can evaluation be eliminated if the problem is resolved?
- C. Is every party happy with the outcomes of the decision?
- D. Did the outcomes align with the original objectives?
Correct Answer: D
Rationale: Evaluating a decision, this nurse-manager should ask if outcomes match objectives like reduced errors post-training not model necessity, problem closure, or universal happiness. In nursing leadership, comparing goals (e.g., better handoffs) to results (e.g., fewer incidents) reveals decision quality, refining future choices. Models don't skip evaluation, resolution doesn't end reflection, and satisfaction isn't the metric alignment is. This focus ensures a safe care environment, as seen when assessing a protocol's impact, guiding managers to tweak or sustain actions for patient benefit.