NURS 446 LEADERSHIP PRACTICE REAL STUDY GUIDE EXAM 2026

NURS 446 LEADERSHIP PRACTICE REAL STUDY GUIDE EXAM 2026 Plan priorities based on - -Purpose of care Current clinical picture Picture of the outcome or result ABCDE principle: Used when? Define parts? - --used this when figuring out which patient goes first! A (Airway): Ensure patent airway. Stabilize cervical spine if neck/head trauma is suspected B (Breathing): Assess for respirations & ventilatory effort C (Circulation): Check heart rate, blood pressure, cap refill, check for bleeding too D (Disability): Assess client's level of consciousness. Think neuro* E (Exposure): Undress patient, assess client's body. Also could be under environment in the book. Assess the whole body Maslow's Hierarchy of Needs - -(level 1) Physiological Needs, (level 2) Safety and Security, (level 3) Relationships, Love and Affection, (level 4) Self Esteem, (level 5) Self Actualization Levels of priority setting: Level 1? Level 2? Level 3? - -level 1: abcs Level 2: mental status changes, acute pain, abnormal labs/tests NURS 446 NURS 446 Level 3: risk categories, at risk groups- safety and infection along with chronic problems Prioritization of client care: Just review - -UNSTABLE over STABLE ACUTE over CHRONIC problems SYSTEMIC over LOCAL problems Compliation over expected findings what does this mean? - -Complication: medical emergency Stroke patient, ICP is a complication. Expected findings would be unsteady gait and numbness. We would pick ICP over numbness Delegation - -The assignment of new or additional responsibilities to a subordinate Assignment nurse? - -distribution of work to each staff member RN can delegate what? - -what you can EAT: -evaluate -assess -teach -nursing process -initial client education or assessment -tasks the required clinical judgement Five Right of Delegation - -1. Right task 2. Right circumstances 3. Right person 4. Right direction/communication 5. Right supervision Five right of delegation: Right direction and communication- Four C's of this - --clear -concise -correct -complete RN delegate to PN - --medication everything besides IV -Enteral feeding -all task excepts blood administion and IV push -reassessment, reinforcement of patient teaching RN delegate to AP - --ADLS NURS 446 NURS 446 NURS 446 -ambulating -feeding patient without swallowing precautions -positioning -vitals on stable -bed making Speciment collection (not sterile) -I/O -basic CPR Ethics - -the principles of right and wrong that guide an individual in making decisions Applied ethics - -The manner in which principles of ethics are incorporated into professional conduct. Ethical theory - -varies ideas and principles used to make judgement between right and wrong Morals - -values and ideas to make decision from right from wrong Ethical Principles - -standards of what is right/wrong with regard to important social values and norms Ethical principles that impact nurses - --moral indifference -moral uncertainlty or conflict (unsure about morals for a situation) -moral distress- knows the right thing but unable to do it -moral outrage -moral or ethical delium Autonomy - -patient has right for own body, freedom to pick what they want Example: leaving AMA Beneficence - -doing good for the best interest for the patient Nonmaleficence - -do no harm Paternalism - -person who takes charge of a patient decision when the patient cannot make their own choices -healthcare professional takes over for patient who is altered or SI Utility define? - -used for MCI by doing the most good for the most amount of people Justice define - -treating people fairly Veracity - -telling the truth NURS 446 NURS 446 Fidelity - -keeping a promise: tell a patient you will be back in 20min and actually following through Code of ethics for nurses - -made by the american nurses association in 1950 to support the ethical obligation of nursing Outlines the important general values, duties, and responsibilites that flow from specific role of being a nurse International council of nurses code of ethics for nurses - -made in 1953 Makes it clear that nursing has respect for human rights including right to life, to dignity and to be treated with respect Guide nurses in everyday choices and it supports their refusal to care How to ID an ethical dilemmas - --cannot be solved solely by review data -involved conflict between two moral imperatives -anwer will have a profound effect of the situation or client Many cant be solved by a nurse, charge nurse or doctor needs to be a board Steps in ethical decision making - --identify whether or not the issue is indeed an ethical dilemma -state the ethical dilemma including all surrounding issues and individuals involved -list and analyze all possible options for resolving the dilemma and review implications of each option -select option that is in concert with the ethical principle applicable to this situation, the decision maker's values and beliefs, and the profession's values set forth for client care; justify why chosen over other options -apply this decision to the dilemma and evaluate the outcomes Other strategies for ethical decision making: Traditional problem solving ? - --define the objectives -gather data -take your times -make as many solutions -remove emotions Other strategies for ethical decision making: NURS 446 NURS 446 MORAL decision making model - -M: message the delium as in who should be involved in the decision making process O: outline your option, go through each alternative and go through the bad and the good Review critiea and resolve weigh the option against the ones in the decisions Affirms position and Act on the stragies and how you will set forth in it Look back: go over how it went Common Ethical Dilemmas - -Patients rights: care plans -advance directives End of life issues: organ donation Advance directives - -a living will; a document, written in advance, that states the patient's wishes regarding end-of-life care. Durable power of attorney: document that puts somone in charge of the patient when patient is unable to do so Futility of Care define? - -Intervention cant change the patho of the condition it is futility which means it is useless and pointless. So they don't have to do this. Need a MD signature for this Connected to Nonmaleficence Negligence - -Omission to do something that a reasonable person would do. Or doing something that someone wouldn't do. Reasonable/prudent - -Used to describe a person who has the average judgment, intelligence, foresight, and skill that would be expected of a person with similar training and experience. R/t to negligence like a not doing an action that a reasonable/prudent person would take in same situation Standard of care - -Level of skills that is required for a certain type of job Minimum requirement for acceptable level of care Malpractice - -Failure for a professional to act in a way that doesn't meet their standard of care Components of professional negligence: five elements must be present for malpractice to be considered ? - -Duty to care Standard of care Care that should be done by a