Nurs 450 Exam Questions and Complete
Solutions
Delegation ✅Transferring the authority to perform a selected nursing task in a selected
situation to another team member while maintaining accountability
Assignment ✅Transferring the author, accountability, and responsibility to another
member of health care team
The NCSBN 5 rights of Delegation (National Council of State Boards of Nursing)RN
✅1. Right task (consider credentials, nurse practice act, and agency policy)
2. Right circumstances (consider patient's condition and degree of supervision required)
3. Right person (consider skills and abilities of individual)
4. Right communication (specific instructions)
5. Monitoring and evaluation of patient and staff member performance)
RN Scope of practice ✅-Care of complex or unstable patients or care with uncertain
outcomes
-initiate the nursing process (develop plan of care)
-client education
-blood products
-IV push
LPN Scope of Practice ✅-care of stable client
-gather data (technically cannot assess)
-contribute to care plan
-reinforce teaching
-perform skills with predictable outcomes
-administer medications (no IVP, chemo, or blood products)
UAP scope of practice (Unlicensed Assistive Personnel) ✅-stable client
-obtain vital signs
-record I & O
-hygiene care
-positioning and ambulation
-feeding
The RN CANNOT delegation what you can EAT: ✅-E: evaluation
-A: Assessment
-T: Teaching
,Clinical Judgement ✅-Interpretation or conclusion about a patient's needs, concerns,
or health problems, and/or the decision to take action (or not), use or modify standard
approaches, or improvise new ones as deemed appropriate by the patient's response
-Nursing process is framework but does not describe how decisions are made
-influenced by knowledge and attitudes
-not task oriented- differentiates professional from technical
-compares assessments to: known normals, patient baseline, and pattern recognition
Situated Clinical Reasoning ✅-failure to recognize acute confusion in elderly was
attributed to :
--attitudes and knowledge about normal aging
--lack of awareness of significance of confusion
--inadequate knowledge of patient states
Role of Reflection ✅1. Reflection in action:
-adjusting to patient responses
--reflecting on what happened to patient and adjusting your care
2. Reflection on action
-what you learn from a clinical experience
-development of clinical judgement
--when you go home and reflect on what happened during the day
Failure to rescue ✅clinicians inability to save a hospitalized patient's life when he
experiences a complication
-a condition not present on admission
-most codes are preventable-- warning signs that patient is going downhill
Successful Rescue ✅1. Surveillance
-ongoing interpretation and synthesis
-Recognize emerging complications
2. Rescue
-mobilize resources
--SBAR
--Anticipate what is needed
--Rapid response team
Indicators of emerging complications ✅-change in LOC
-pain
-dyspnea
-change in vitals
-change in labs
-urine output (perfusion)
Prioritization ✅-Essential aspect of clinical judgment
-Framework:
, --ABC's
--Maslow
--assess before intervening
--systemic before local ("life before limb")
--acute before chronic
--actual before potential
--unexpected before expected
-Frameworks are guidelines not black and white
Maslow's Hierarchy of Needs ✅1. physiological- breathing, food, water, sex, sleep,
homeostasis, excretion
2. Safety- security of body, or employment, of resources, of mortality, of the family, of
health, of property
3. Love/Belonging- friendship, family, sexual intimacy
4. Esteem- self esteem, confidence, achievement, respect of others, respect by others
5. Self actualization- morality, creativity, spontaneity, problem solving, lack of prejudice,
acceptance of facts
Prioritization situations ✅-physiological over psychological
-acute over chronic
-unstable over stable
-unpredictable over predictable
Leadership Styles ✅1. Authoritative or Autocratic
2. Democratic
3. Laissez- Faire
4. Transformational
5. Transactional
Authoritative/Autocratic ✅-makes decisions for group
-motivates by coercion
-communication occurs down the chain of command
-work output by staff is usually high
-good style for crisis situations and bureaucratic
-effective for employees with little or no formal education
-doesn't allow input from group
-dictator or paternalistic
-high control
Democratic Leadership ✅-includes group input when considering which decisions are
made
-motivates by supporting staff achievements
-communication occurs up and down the chain of command
-work output by staff is usually of good quality
-supportive/ participatory
-moderate control
Solutions
Delegation ✅Transferring the authority to perform a selected nursing task in a selected
situation to another team member while maintaining accountability
Assignment ✅Transferring the author, accountability, and responsibility to another
member of health care team
The NCSBN 5 rights of Delegation (National Council of State Boards of Nursing)RN
✅1. Right task (consider credentials, nurse practice act, and agency policy)
2. Right circumstances (consider patient's condition and degree of supervision required)
3. Right person (consider skills and abilities of individual)
4. Right communication (specific instructions)
5. Monitoring and evaluation of patient and staff member performance)
RN Scope of practice ✅-Care of complex or unstable patients or care with uncertain
outcomes
-initiate the nursing process (develop plan of care)
-client education
-blood products
-IV push
LPN Scope of Practice ✅-care of stable client
-gather data (technically cannot assess)
-contribute to care plan
-reinforce teaching
-perform skills with predictable outcomes
-administer medications (no IVP, chemo, or blood products)
UAP scope of practice (Unlicensed Assistive Personnel) ✅-stable client
-obtain vital signs
-record I & O
-hygiene care
-positioning and ambulation
-feeding
The RN CANNOT delegation what you can EAT: ✅-E: evaluation
-A: Assessment
-T: Teaching
,Clinical Judgement ✅-Interpretation or conclusion about a patient's needs, concerns,
or health problems, and/or the decision to take action (or not), use or modify standard
approaches, or improvise new ones as deemed appropriate by the patient's response
-Nursing process is framework but does not describe how decisions are made
-influenced by knowledge and attitudes
-not task oriented- differentiates professional from technical
-compares assessments to: known normals, patient baseline, and pattern recognition
Situated Clinical Reasoning ✅-failure to recognize acute confusion in elderly was
attributed to :
--attitudes and knowledge about normal aging
--lack of awareness of significance of confusion
--inadequate knowledge of patient states
Role of Reflection ✅1. Reflection in action:
-adjusting to patient responses
--reflecting on what happened to patient and adjusting your care
2. Reflection on action
-what you learn from a clinical experience
-development of clinical judgement
--when you go home and reflect on what happened during the day
Failure to rescue ✅clinicians inability to save a hospitalized patient's life when he
experiences a complication
-a condition not present on admission
-most codes are preventable-- warning signs that patient is going downhill
Successful Rescue ✅1. Surveillance
-ongoing interpretation and synthesis
-Recognize emerging complications
2. Rescue
-mobilize resources
--SBAR
--Anticipate what is needed
--Rapid response team
Indicators of emerging complications ✅-change in LOC
-pain
-dyspnea
-change in vitals
-change in labs
-urine output (perfusion)
Prioritization ✅-Essential aspect of clinical judgment
-Framework:
, --ABC's
--Maslow
--assess before intervening
--systemic before local ("life before limb")
--acute before chronic
--actual before potential
--unexpected before expected
-Frameworks are guidelines not black and white
Maslow's Hierarchy of Needs ✅1. physiological- breathing, food, water, sex, sleep,
homeostasis, excretion
2. Safety- security of body, or employment, of resources, of mortality, of the family, of
health, of property
3. Love/Belonging- friendship, family, sexual intimacy
4. Esteem- self esteem, confidence, achievement, respect of others, respect by others
5. Self actualization- morality, creativity, spontaneity, problem solving, lack of prejudice,
acceptance of facts
Prioritization situations ✅-physiological over psychological
-acute over chronic
-unstable over stable
-unpredictable over predictable
Leadership Styles ✅1. Authoritative or Autocratic
2. Democratic
3. Laissez- Faire
4. Transformational
5. Transactional
Authoritative/Autocratic ✅-makes decisions for group
-motivates by coercion
-communication occurs down the chain of command
-work output by staff is usually high
-good style for crisis situations and bureaucratic
-effective for employees with little or no formal education
-doesn't allow input from group
-dictator or paternalistic
-high control
Democratic Leadership ✅-includes group input when considering which decisions are
made
-motivates by supporting staff achievements
-communication occurs up and down the chain of command
-work output by staff is usually of good quality
-supportive/ participatory
-moderate control
