Exit hesi leadership and management

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EXAMINATIONVSTUDVGUIDEV2022


• LegalVAspectsVofVNursing
o OftenVanVNCLEX-
RN®VquestionVasksVwhoVshouldVexplainVaVsurgicalVprocedureVtoVtheVclient.VTheVanswerVisVtheVheal
thVcareVprovider.VRememberVthatVitVisVtheVnurse’sVresponsibilityVtoVbeVsureVthatVtheVoperativeVperm
itVisVsignedVandVisVonVtheVchart.VItVisVnotVtheVnurse’sVresponsibilityVtoVexplainVtheVprocedureVtoVthe
Vclient.

o OftenVquestionsVareVaskedVregardingVtheVGoodVSamaritanVAct,VwhichVisVtheVmeansVofVprotecting
VaVnurseVwhenVsheVorVheVisVperformingVemergencyVcare.

▪ GoodVSamaritanVAct:VProtectsVhealthVpractitionersVagainstVmalpracticeVclaimsVforVcareV
providedVinVemergencyVsituationsV(e.g.,VtheVnurseVgivesVaidVatVtheVsceneVtoVanVautomobi
leVaccidentVvictim).
o IfVtheVnurseVcarriesVoutVaVhealthVcareVprovider’sVprescriptionVforVwhichVheVorVsheVisVnotVpreparedVa
ndVdoesVnotVinformVtheVhealthVcareVproviderVofVhisVorVherVlackVofVpreparation,VtheVnurseVisVsolelyVl
iableVforVanyVdamages.
▪ IfVtheVnurseVinformsVtheVhealthVcareVproviderVofVhisVorVherVlackVofVpreparationVinVcarryingVo
utVaVprescriptionVandVcarriesVoutVtheVprescriptionVanyway,VtheVnurseVandVtheVhealthVcareVp
roviderVareVliableVforVanyVdamages.
o AssignmentsVareVoftenVtestedVonVtheVNCLEX-
RN.VTheVNurseVPracticeVActsVofVeachVstateVgovernsVpoliciesVrelatedVtoVmakingVassignments.VUsuall
y,VwhenVdeterminingVwhoVshouldVbeVassignedVtoVdoVaVsterileVdressingVchange,VforVexample,VaVlicens
edVnurseVshouldVbeVchosen—
thatVis,VanVRNVorVlicensedVpracticalVnurseV(LPN)VthatVhasVbeenVcheckedVoffVonVthisVprocedure.
o RestraintsVofVanyVkindVmayVconstituteVfalseVimprisonment.VFreedomVfromVunlawfulVrestraintVis
VaVbasicVhumanVrightVandVisVprotectedVbyVlaw.

▪ ApplyVrestraintsVproperly;VcheckVrestraintsVfrequentlyVtoVseeVthatVtheyVareVnotVcausingVinjur
yVandVrecordVsuchVmonitoring;VremoveVrestraintsVasVsoonVasVpossible;VuseVrestraintsVonlyVa
sVaVlastVresort
o AVpatientVmustVgiveVwrittenVconsentVbeforeVhealthVcareVprovidersVcanVuseVorVdiscloseVpersonalVheal
thVinformation;VhealthVcareVprovidersVmustVgiveVpatientsVnoticeVaboutVproviders’VresponsibilitiesVr
egardingVpatientVconfidentiality;VpatientsVmustVhaveVaccessVtoVtheirVmedicalVrecords;VprovidersVwho
VrestrictVaccessVmustVexplainVwhyVandVmustVofferVpatientsVaVdescriptionVofVtheVcomplaintVprocess;V

patientsVhaveVtheVrightVtoVrequestVthatVchangesVbeVmadeVinVtheirVmedicalVrecordsVtoVcorrectVinaccu
racies;VhealthVcareVprovidersVmustVfollowVspecificVtrackingVproceduresVforVanyVdisclosuresVmadeVt
hatVensureVaccountabilityVforVmaintenanceVofVpatientVconfidentiality;VpatientsVhaveVtheVrightVtoVre
questVthatVhealthVcareVprovidersVrestrictVtheVuseVandVdisclosureVofVtheirVpersonalVhealthVinformati
on,VthoughVtheVproviderVmayVdeclineVtoVdoVso.
• LeadershipVandVManagement
o AssertiveVcommunicationVstartsVwithV“IVneed”VratherVthanVwithV“YouVmust.”
o MotivationVcomesVfromVwithinVanVindividual.VAVnurseVleaderVcanVprovideVanVenvironmentVthatVwi
llVpromoteVmotivationVthroughVpositiveVfeedback,Vrespect,VandVseekingVinput.VLookVforVresponsesVt
hatVdemonstrateVtheseVbehaviors.
o EffectiveVleadershipVinvolvesVassertiveVmanagementVskillsV(i.e.Vdemocratic/participative).VLookVfo
rVresponsesVthatVdemonstrateVthatVtheVnurseVisVusingVassertiveVcommunicationVskills.
o DelegatingVtoVtheVrightVpersonVrequiresVthatVtheVnurseVbeVawareVofVtheVqualificationsVofVtheVdel
egator:VappropriateVeducation,Vtraining,Vskills,Vexperience,VandVdemonstratedVandVdocumented

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competence.
▪ FiveVRightsVofVDelegationV(asVdefinedVbyVtheVNationalVCouncilVofVStateVBoardsVofVNursing)
• RightVtask:VIsVthisVaVtaskVthatVcanVbeVdelegatedVbyVaVnurse?
• RightVcircumstance:VConsideringVtheVsettingVandVavailableVresources,Vshoul
dVdelegationVtakeVplace?
• RightVperson:VIsVtheVtaskVbeingVdelegatedVbyVtheVrightVpersonVtoVtheVrightVperson?
• RightVdirection/communication:VIsVtheVnurseVprovidingVaVclear,VconciseVdescription

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ofVtheVtask,VincludingVlimitsVandVexpectations?
• RightVsupervision:VOnceVtheVtaskVhasVbeenVdelegated,VisVappropriateVsupervisio
nVmaintained.
▪ UAPsVgenerallyVdoVnotVperformVinvasiveVorVsterileVprocedures.
▪ TheVRNVisVaccountableVforVadheringVtoVtheVthreeVbasicVaspectsVofVsupervisionVwhenVdel
egatingVtoVotherVhealthVcareVpersonnel,VsuchVasVLPNs,VgraduateVnurses,VinexperiencedVn
urses,VstudentVnurses,VandVUAPs.
▪ RememberVtheVnursingVprocess:VAssessments,Vanalysis,Vdiagnosis,Vplanning,VandVevaluatio
nV(anyVactivityVrequiringVnursingVjudgment)VmayVnotVbeVdelegatedVtoVUAP.VDelegatedVactivit
iesVfallVwithinVtheVimplementationVphaseVofVtheVnursingVprocess.
▪ PrioritiesVoftenVcenterVonVwhichVclientVshouldVbeVassessedVfirstVbyVtheVnurse.VAskVyourse
lf:VWhichVclientVisVtheVmostVcriticallyVill?VWhichVclientVisVmostVlikelyVtoVexperienceVaVsignifi
cantVchangeVinVcondition?VWhichVclientVrequiresVassessmentVbyVanVRN?
▪ DelegationVisVasVfollows:
• InsertingVaVFoleyVcatheterVisVaVsterileVinvasiveVprocedureVandVshouldVnotVbeVdelegate
dVtoVaVUAP
• MeasuringVandVrecordingVintakeVandVoutputVfallsVwithinVtheVimplementationVphaseVof
theVnursingVprocessVandVdoesVnotVrequireVnursingVjudgment.VHowever,VevaluationV
ofVtheVintakeVandVoutputV(I&O)VmustVbeVdoneVbyVtheVnurse.
• ClientVteachingVrequiresVtheVabilitiesVofVaVnurseVandVshouldVnotVbeVdelegated.VTheV
UAPVmayVbeVinstructedVtoVreportVanythingVunusualVthatVisVobservedVandVanyVsymp
tomsVreportedVbyVtheVclient,VbutVthisVdoesVnotVreplaceVassessmentVbyVtheVnurse.
• AssessmentVmustVbeVperformedVbyVtheVnurseVandVshouldVnotVbeVdelegated.VTheVUA
PVmayVbeVinstructedVtoVreportVanythingVunusualVthatVisVobserved,VorVanyVsymptom
sVreportedVbyVtheVclient,VbutVthisVdoesVnotVreplaceVassessmentVbyVtheVnurse.
o TheVnurseVmanagerVmustVanalyzeVallVtheVdesiredVoutcomesVinvolvedVwhenVassigningVroomsVforVc
lientsVorVassigningVclientVcareVresponsibilities.VAVclientVwithVanVinfectionVshouldVnotVbeVassignedVt
oVshareVaVroomVwithVaVsurgicalVorVimmunocompromisedVclient.VAVnurse’sVclientVcareVmanagemen
tVshouldVbeVbasedVonVtheVnurse’sVabilities,VtheVindividualVclient’sVneeds,VandVtheVneedsVofVtheVenti
reVgroupVofVassignedVclients.VSafetyVandVinfectionVcontrolVareVhighVpriorities.
o ChangeVcausesVanxiety.VAnVeffectiveVnurseVchangeVagentVusesVproblem-
solvingVskillsVtoVrecognizeVfactorsVsuchVasVanxietyVthatVcontributeVtoVresistanceVtoVchangeVandVuse
sVdecision-
makingVandVinterpersonalVskillsVtoVovercomeVthatVresistance.VInterventionsVthatVdemonstrateVthese
VskillsVincludeVseekingVinput,VshowingVrespect,VvaluingVopinions,VandVbuildingVtrust.

• DisasterVNursing
o ItVisVimportantVtoVrememberVthatVinVdisasterVandVbioterrorismVmanagement,VtheVnurseVmu
stVconsiderVbothVtheVindividualVandVtheVcommunity.

AdvancedVClinicalVConcepts

• RespiratoryVFailure
o ARDSVisVanVunexpected,VcatastrophicVpulmonaryVcomplicationVoccurringVinVaVpersonVwithVnoVprev
iousVpulmonaryVproblems.VClientsVareVcriticallyVillVandVareVmanagedVinVanVintensiveVcareVsetting.VTh
eVmortalityVrateVisVhighV(50%).

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EXAMINATIONVSTUDVGUIDEV2022
o InterventionsVtoVpreventVcomplicationsVofVclientsVonVmechanicalVventilationVwithVARDS:
▪ ElevateVheadVofVbedV(HOB)VtoVatVleastV30Vdegrees.
▪ AssistVwithVdailyVawakeningV(“sedationVvacation”).
▪ ImplementVaVcomprehensiveVoralVhygieneVprogram.
▪ ImplementVaVcomprehensiveVmobilizationVprogram.
o SuctionVonlyVwhenVsecretionsVareVpresent.
o BeforeVdrawingVaVsampleVforVABGsVfromVtheVradialVartery,VperformVtheVAllenVtestVtoVassessVcollater
alVcirculation.
▪ MakeVtheVclient’sVhandVblanchVbyVobliteratingVbothVtheVradialVandVtheVulnarVpulses.VThe
nVreleaseVtheVpressureVoverVtheVulnarVarteryVonly.VIfVflowVthroughVtheVulnarVarteryVisVgo
od,