Test Bank on The Concepts for Nursing Practice 2nd Edition by Giddens

Test Bank on The Concepts for Nursing Practice 2nd Edition by Giddens Giddens: Concepts for Nursing Practice, 2nd Edition Health Disparities Concept 54: Health Disparities Giddens: Concepts for Nursing Practice, 2nd Edition MULTIPLE CHOICE 1. The nurse is caring for a Chinese patient diagnosed with cancer who is suffering from pain, yet refuses analgesia administration. What type of health disparities is this patient exhibiting? a. Avoidable and acceptable b. Avoidable and unacceptable c. Unavoidable and acceptable d. Unavoidable and unacceptable ANS: B Health disparities that are avoidable and unacceptable unfortunately occur in healthcare settings and these are the targets of interventions. For example, a disparity in cancer pain management exists between Asians and Whites. This difference is attributable to Asian cultural values and attitudes related to cancer pain and pain medication distinguished from the cultural values of Whites. The disparity is avoidable if Asian cancer patients are adequately educated and instructed on cancer pain management strategies including pain medication and complementary and alternative medicine. Also, this disparity is unacceptable because this gives an unnecessary burden of pain to Asian cancer patients that could be easily managed by using existing strategies. REF: Page 504 OBJ: NCLEX® Client Needs Category: Safe and Effective Care Environment 2. An experienced nurse tells the student nurse, “I have found that most Hispanic immigrants live in unsanitary conditions but are hard workers.” How should the student nurse best classify this statement? a. Stereotyping b. Prejudice c. Discrimination d. Misinformed ANS: A Stereotyping often leads to biased clinical decision-making. Stereotyping refers to the process by which people use social categories (e.g., gender or race/ethnicity) in acquiring, processing, and recalling information about others. Both implicit and explicit negative attitudes and stereotypes of healthcare providers significantly shape interactions with patients, influence how information is recalled, and guide expectations and inferences in systematic ways. Stereotyping often occurs subconsciously, unlike prejudice or discrimination. Prejudice, which refers to unjustified negative attitudes based on a person’s group membership, is another source of biased clinical decision-making. Discrimination refers to the actual mistreatment of individuals based on race, gender, ethnicity, etc. The nurse is not misinformed as the nurse has practiced for some time and made a statement based on observation and experience. REF: Page 506 OBJ: NCLEX® Client Needs Category: Safe and Effective Care Environment 3. Which type of health disparities are most frequently encountered by nurses in clinical and community settings? a. Avoidable and acceptable b. Avoidable and unacceptable c. Unavoidable and acceptable d. Unavoidable and unacceptable ANS: B Although there are many types of health disparities, the avoidable and unacceptable health disparities are the ones that healthcare providers, including nurses, frequently encounter in clinical and community settings. Furthermore, these are the health disparities that healthcare providers need to target to intervene. REF: Page 504 OBJ: NCLEX® Client Needs Category: Safe and Effective Care Environment 4. The nurse is caring for diverse population groups at a health clinic. Which of the following patients demonstrates a potential health disparity group? a. A 26-year-old woman who is receiving follow-up after a car accident. b. A 30-year-old immigrant who does not speak English. c. A 28-year-old man who needs a tetanus booster. d. A 12-month-old with an appointment for immunizations. ANS: B Poor health literacy skills are an example of a health disparity that limits an individual’s ability to access or communicate about health care needs. Patients who are receiving needed care are not experiencing a gap between health need and actual care. REF: Page 506 OBJ: NCLEX® Client Needs Category: Safe and Effective Care Environment 5. Which is the best strategy the nurse manager should include when working to reduce health care disparities on a medical-surgical unit? a. Less diverse workforce b. Increase interpreter availability c. Authoritarian leadership d. Annual staff training ANS: B Key elements are cultural competence that can reduce health disparities include: a diverse workforce; interpreter availability; finding common ground versus authoritarian leadership; frequent staff training and updating staff as needed throughout the year. REF: Page 506 |Page 507 OBJ: NCLEX® Client Needs Category: Safe and Effective Care Environment 6. A new nurse requires further teaching when failing to identify which practice as a health disparity? a. Annual mammogram b. Early prenatal care c. Blood pressure screening d. Frequent fast food meals ANS: D Preventive care, screening, and health promotion activities are not considered health disparities. Examples include mammograms, prenatal care, and blood pressure checks. Frequent fast food meals, containing high fat content, is considered a health disparity due to possible lack of money or access to healthy meals. REF: Page 504 |Page 505 OBJ: NCLEX® Client Needs Category: Safe and Effective Care Environment 7. Before beginning work on a culturally diverse hospital unit, the nurse should perform which action first? a. Improve self-awareness of one’s own biases b. Attend an anti-discrimination rally or march c. Build rapport and trust with the patients d. Take a foreign language class ANS: A Before working with culturally diverse groups, the nurse should first identify own biases and assumptions in order to objectively and competently care for patients. Attending a rally or march may not raise awareness of various biases. The nurse should establish rapport and trust when working with patients, after self-awareness is appreciated. Taking a foreign language may be helpful; however the first step is self-awareness. REF: Page 506 OBJ: NCLEX® Client Needs Category: Safe and Effective Care Environment 8. The nurse who has been hired to work on an oncology unit identifies which group of women as being at highest risk of developing breast cancer? a. African b. Caucasian c. Asian d. Hispanic ANS: C Breast cancer is the most common cancer in Asian women in the U.S., but Asian women have relatively lower rates of breast cancer screening than African American and white women in the U.S. Furthermore, disparities in breast cancer screening reportedly result from: low income, lack of a local mammography center, lack of transportation to a mammography center, lack of a usual healthcare provider, lack of a recommendation from a healthcare provider to get mammography screening, lack of awareness of breast cancer risks and screening methods, and cultural and language differences. REF: Page 506 OBJ: NCLEX® Client Needs Category: Safe and Effective Care Environment MULTIPLE RESPONSE 1. A healthcare provider whose native country is India is explaining the treatment plan to a patient. The patient tells the nurse she is having trouble understanding the provider but is embarrassed about asking to repeat the information over and over. The nurse should assess for which results due to this disparity in provider-patient communication? (Select all that apply.) a. Patient dissatisfaction b. Optimal health outcome c. Poor adherence d. Increased patient confidence e. Improved communication ANS: A, C When sociocultural differences between healthcare providers and patients are not appreciated or communicated effectively in clinical encounters, patient dissatisfaction, poor adherence, poorer health outcomes, and racial/ethnic disparities in healthcare easily happen. REF: Page 507 OBJ: NCLEX® Client Needs Category: Safe and Effective Care Environment 2. The nurse in the immunization clinic should place emphasis on educating and reaching which groups about the disease preventing effects of immunizations? (Select all that apply.) a. Caucasian b. African American c. Low income d. Middle income e. High income ANS: B, C, D The 2013 National Healthcare Disparities Report documented that African American children or children from poor, low- income, and middle-income households were less likely to receive all the recommended vaccinations compared with white children or children from high-income households in 2011. REF: Page 507 OBJ: NCLEX® Client Needs Category: Safe and Effective Care Environment Chapter 14: Delegation in the Clinical Setting Zerwekh: Evolve Resources for Nursing Today, 9th Edition MULTIPLE CHOICE 1. Which task could a staff nurse delegate to a certified nursing assistant (CNA)? a. Evaluating a patient’s response to pain b. Making rounds with a physician c. Feeding a stroke patient who has minimal dysphagia d. Assessing a patient’s central venous line site ANS: C Feeding a stroke patient who has minimal dysphagia is an appropriate delegation of a nursing intervention to a CNA. The nurse cannot delegate the task of assessing the patient or making rounds with the physician to the CNA. Nursing interventions such as assessment and evaluation of pain, management of central line sites, or performing tracheotomy or colostomy care are within the scope of professional nursing, as is making rounds with a physician. PTS: 1 DIF: Cognitive Level: Application/Applying REF: p. 306 |p. 308 OBJ: Delegate tasks successfully based on outcomes. TOP: Delegation in the clinical setting MSC: NCLEX®: Safe and effective care environment—management of care 2. The nurse has just given a patient an opioid medication for pain relief. Because the nurse must leave the unit for lunch and a 1-hour meeting, the task of evaluating the patient’s response to the pain medication must be delegated. To whom should the nurse delegate this responsibility? a. Nursing assistant b. Student nurse c. Licensed practical nurse d. Nurse manager ANS: D Evaluating the patient’s response to pain medication is an activity within the scope of the registered professional nurse (who in this situation is the nurse manager). The licensed practical nurse can administer the pain medication. The student nurse could assist the professional nurse in the evaluation of the patient’s response to the pain medication; however, the nurse leaving the unit cannot delegate this responsibility to a student. This nursing intervention is outside the scope of practice of the nursing assistant. PTS: 1 DIF: Cognitive Level: Application/Applying REF: p. 308 OBJ: Delegate tasks successfully based on outcomes. TOP: Delegation in the clinical setting MSC: NCLEX®: Safe and effective care environment—management of care 3. The nurse has a full assignment. The charge nurse adds a newly admitted patient who will require close monitoring. Which task can the nurse delegate to the CNA who is co-assigned to the same patients? a. Teaching insulin self-administration b. Updating a care plan c. Evaluating goal attainment for a patient who is learning to walk with a below-the-knee prosthesis d. Bathing an unconscious patient ANS: D Bathing a patient is an appropriate nursing intervention within the role and responsibilities and scope of practice of the CNA. Teaching clients, updating nursing care plans, and evaluating patient responses to treatment plans are within the scope of practice of the registered professional nurse. PTS: 1 DIF: Cognitive Level: Application/Applying REF: p. 306 |p. 308 OBJ: Delegate tasks successfully based on outcomes. TOP: Delegation in the clinical setting MSC: NCLEX®: Safe and effective care environment—management of care 4. Based on the goal of making optimal use of the level of preparation of the licensed practical nurse (LPN), which task should the nurse (RN) delegate to the LPN? a. Assisting with a lumbar puncture b. Transporting a patient to the radiology department c. Restocking the sterile supplies d. Distributing afternoon nutrition supplements ANS: A Assisting with a procedure, such as a lumbar puncture, is within the scope of practice of the LPN. Transporting clients, restocking supplies, and distributing nutrition supplements are nursing interventions that can be carried out by a certified nursing assistant (CNA). PTS: 1 DIF: Cognitive Level: Application/Applying REF: p. 307 OBJ: Delegate tasks successfully based on outcomes. TOP: Delegation in the clinical setting MSC: NCLEX®: Safe and effective care environment—management of care 5. There is a temporary agency registered nurse assigned to the nursing unit. You have no knowledge of this nurse’s skills, and you want to assign the nurse to a patient who has a fresh tracheostomy. How should you handle this situation? a. Assign the nurse to the patient with the tracheostomy and hope for the best. b. Ask the nurse about his or her competency to care for the patient with the tracheostomy. c. Assign the patient to another nurse, and use the temporary agency nurse to do simple care tasks. d. Call the agency and ask for a nurse skilled in the care of a patient with a tracheostomy. ANS: B Float and temporary nurses should be asked about their competency at the beginning of a shift or assignment. Never assume that an individual knows something; be sure to ask. Delegation of an activity should always be followed by an anticipated response from that nurse as to whether or not he/she feels capable of performing the task. It would be appropriate to check on this nurse frequently to evaluate his/her delivery of care or to offer assistance. It would be okay to call the agency to verify the nurse’s skill competencies, but talking with the nurse would still be the first action. PTS: 1 DIF: Cognitive Level: Application/Applying REF: p. 312 OBJ: Understand and apply the five rights of delegation in nursing practice. TOP: Delegation in the clinical setting MSC: NCLEX®: Safe and effective care environment—management of care 6. What would be the best example of delegation? a. Transferring to another nurse the responsibility of caring for a patient requiring a blood transfusion b. Providing guidance to an LPN to hang blood on a patient c. Assigning a series of nursing unit tasks to the certified nursing assistant d. Assisting a new nurse to understand the rules and regulations of the Nurse Practice Act ANS: A Transferring to another nurse the responsibility of caring for a patient requiring a blood transfusion is the best example of delegation. Delegation involves transferring to a competent nurse a specific task or responsibility for nursing care. The person who delegated the responsibility maintains responsibility for following guidelines for appropriate delegation. Providing guidance to an LPN and explaining to a new nurse about the Nurse Practice Act would be teaching and/or supervision rather than delegating a specific task or responsibility. Assigning to a CNA certain tasks is not delegation because there is no transferring of a specific task or responsibility of nursing care to that person. PTS: 1 DIF: Cognitive Level: Application/Applying REF: p. 302 OBJ: Define the operational terms delegation, supervision, and accountability. TOP: Definition of delegation MSC: NCLEX®: Safe and effective care environment—management of care 7. What would be the best example of supervision? a. Assigning nursing care for a group of five patients to a nurse b. Following up with a CNA on the assigned task of ambulation and feeding two patients c. Assigning a urinary catheterization and collection of sterile culture to an LPN d. Scheduling the LPN to administer medications on the unit for the afternoon ANS: B Supervision is the provision of guidance, direction, and follow-up for the accomplishment of an assigned task. The nurse would follow up with the CNA to determine whether the tasks were completed and whether any problems occurred. Assigning nursing care for a group of patients or a specific procedure are examples of delegation, as is scheduling an LPN to administer medications. PTS: 1 DIF: Cognitive Level: Application/Applying REF: p. 302 OBJ: Define the operational terms delegation, supervision, and accountability. TOP: Definition of supervision MSC: NCLEX®: Safe and effective care environment—management of care 8. What are potential causes of performance inadequacies? a. The person to whom the task was assigned had appropriate educational qualifications to complete the task. b. The task was assigned to a person capable of carrying out the assignment. c. The person who delegated the task confirmed the recipient’s ability to perform the task. d. The person to whom the task was assigned did not understand what the task involved. ANS: D A potential cause of performance inadequacy would be where a person was assigned a task that he/she did not understand. A principle of delegation is that the person to whom the task is assigned should verify that he/she understands and can perform the task. When the person is capable, has appropriate educational qualifications, and the nurse has confirmed that person is able to perform the task, then there would be no performance inadequacy. PTS: 1 DIF: Cognitive Level: Comprehension/Understanding REF: Critical Thinking Box 14.3 OBJ: Understand and apply the five rights of delegation in nursing practice. TOP: Evaluating performance MSC: NCLEX®: Safe and effective care environment—management of care 9. Which of the following represents appropriate feedback for an assignment to an LPN? a. “Did you understand the assignment that you received in the staff report?” b. “Have you completed the urinary catheterization and care of the new patient?” c. “The patient in Room 430 looks much better, and you did a good job of making the patient comfortable.” d. “I know you are busy; however, you need to get caught up with your pain medications.” ANS: C Telling the LPN that he or she did a good job of making a patient comfortable is appropriate feedback on an assignment. Feedback is a process of informing someone of how well or how poorly a delegated task was performed. Asking understanding of an assignment or whether a procedure was performed is not giving feedback but determining if what is supposed to be done is understood or whether the task (urinary catheterization) has been completed. The pain medications may have been delegated; however, if this task was delegated, the feedback does not tell the LPN what he or she is doing right or wrong. PTS: 1 DIF: Cognitive Level: Application/Applying REF: p. 309 OBJ: Provide reciprocal feedback for the effective evaluation of the delegate’s performance. TOP: Providing feedback MSC: NCLEX®: Safe and effective care environment—management of care 10. The nurse needs to discuss a problem with the nursing assistant. The nursing assistant has left several rooms cluttered with trash and not cleaned appropriately. Which comment by the nurse would be the best way to approach the problem? a. “I checked on the four rooms you were assigned, and they are really a mess.” b. “Have you had a problem completing your work assignment today?” c. “All four of the patient rooms assigned to you today are messy with a lot of trash in them.” d. “Family members have been really upset today. Why have you not cleaned up the rooms assigned to you?” ANS: B Providing an open-ended question to determine if there was some difficulty with an assignment is an appropriate method to assess this situation. When correcting or telling a person that he/she did something wrong, it is best to start by giving that person an opportunity to provide some input into the situation. This can be accomplished by asking the nursing assistant if there was any problems completing the assignment today. Asking why-type questions can put the person on the defensive and does not allow the CNA to provide an explanation of why the rooms were cluttered. Telling the CNA that the rooms were cluttered and messy does not address the issue of how it occurred. PTS: 1 DIF: Cognitive Level: Application/Applying REF: Critical Thinking Box 14.6 OBJ: Provide reciprocal feedback for the effective evaluation of the delegate’s performance. TOP: Providing feedback MSC: NCLEX®: Safe and effective care environment—management of care 11. Which of the following tasks can the nurse safely delegate to the nursing assistant? a. Assessing the patients who are being discharged later today b. Giving discharge instructions to a patient c. Helping a patient select food according to the specified diet d. Educating the patient on what foods to eat for his/her diet plan ANS: C The nurse can safely delegate the job of helping the patient select food according to a specified diet. The nurse is responsible for assessing patients, giving discharge instructions, and educating the patient on what foods to eat for the diet plan. PTS: 1 DIF: Cognitive Level: Application/Applying REF: p. 306 |p. 308 OBJ: Understand and apply the five rights of delegation in nursing practice. TOP: What does delegation mean? MSC: NCLEX®: Safe and effective care environment 12. Determine how the registered nurse’s role is different from that of the LPN in assessment of the patient. a. Collects data during the health history and physical exam b. Contributes to the development of the care plan c. Assist in updating the care plan d. Uses findings from the assessment to create a care plan ANS: D The registered nurse differs from the LPN in that the RN uses assessment findings to create a care plan for the patient. The LPN focuses on collecting data during the health history and exam, contributes to the development of the care plan, and assists in updating the care plan. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 307 OBJ: Understand and apply the five rights of delegation in nursing practice. TOP: Delegation MSC: NCLEX®: Safe and effective care environment 13. A registered nurse is feeling overwhelmed. Which of the following would be most appropriate for the registered nurse to delegate to an LPN? a. An initial assessment on a new patient b. Educational teaching on diabetes management c. Creating a care plan for a patient d. Updating the care plan for a patient who is postop day 2 ANS: D The registered nurse could delegate updating the care plan for a patient who is postop day 2. The RN should not delegate an initial assessment, teaching, or creating a care plan for a patient. These responsibilities are not within the scope of practice for the LPN and must be completed by the registered nurse. PTS: 1 DIF: Cognitive Level: Application/Applying REF: p. 307 OBJ: Understand and apply the five rights of delegation in nursing practice. TOP: Delegation MSC: NCLEX®: Safe and effective care environment 14. A day shift nurse has come into work and notices that the glucometers were not tested overnight as they typically are. What is the best way for the nurse to question the nurse assistant in order to give feedback? a. “Why didn’t you test the glucometers?” b. “What did you do last night?” c. “How was your night? I noticed the glucometers weren’t tested.” d. “Couldn’t you have asked one of the nurses to check the glucometers if you were busy?” ANS: C When giving an individual negative feedback, the nurse should also ask for the nurse assistant’s feedback. If the nurse becomes accusatory, the nursing assistant may become defensive, which does not help solve the issue of the glucometers not being tested. Asking, “How was your night? I noticed the glucometers weren’t tested” gives the nursing assistant a chance to respond and explain what happened. PTS: 1 DIF: Cognitive Level: Application/Applying REF: Critical Thinking Box 14.6 OBJ: Provide reciprocal feedback for the effective evaluation of the delegate’s performance. TOP: The right supervision and delegation MSC: NCLEX®: Safe and effective care environment 15. A nurse is reviewing delegation with a graduate nurse. The nurse knows that the teaching has been successful when the graduate nurse states which of the following? a. “The nurse can delegate assessments to the nurse assistants.” b. “The nurse must create the care plan based on assessment findings.” c. “The nursing assistants cannot perform bed baths on postsurgical patients.” d. “The LPN can perform discharge teaching.” ANS: B The teaching has been successful when the graduate nurse states: “The nurse must create the care plan based on assessment findings.” The nurse is solely responsible for this action. The nurse cannot delegate assessments to the nursing assistants; this must be completed by the nurse. Performing discharge teaching is a requirement of the nurse, not the LPN. Nursing assistants can perform bed baths on postsurgical patients. PTS: 1 DIF: Cognitive Level: Evaluation/Evaluating REF: pp. 307-308 OBJ: Understand and apply the five rights of delegation in nursing practice. TOP: The right task MSC: NCLEX®: Safe and effective care environment 16. What should the nurse do to assess competence before delegating a task to an LPN? a. Ask if the LPN has previous experience performing the task. b. Ask if the LPN is willing to perform the task. c. Ask another nurse if the LPN is competent. d. Assume the LPN is competent due to her years of service. ANS: A In order to assess competence, the nurse should ask the LPN if he or she has experience performing the task. Based on the answer, the nurse can then ask more questions if needed to determine competency. PTS: 1 DIF: Cognitive Level: Application/Applying REF: p. 312 OBJ: Understand and apply the five rights of delegation in nursing practice. TOP: The right circumstances MSC: NCLEX®: Safe and effective care environment 17. Which of the following statements indicates the nurse’s understanding of accountability in the delegation process? a. “I am solely accountable for the actions of the delegate.” b. “I am accountable for assessing the delegate’s competency before delegation.” c. “The delegate is responsible for telling the nurse if he/she is competent.” d. “The manager is responsible for providing feedback to the delegate.” ANS: B The nurse is accountable for assessing the delegate’s competency before delegation and providing feedback after the task has been completed. The delegate is solely responsible for his or her actions, not the nurse. PTS: 1 DIF: Cognitive Level: Evaluation/Evaluating REF: p. 304 OBJ: Define the operational terms delegation, supervision, and accountability. TOP: Accountability MSC: NCLEX®: Safe and effective care environment 18. To optimally use the level of preparation of the LPN who previously worked in an emergency department, which task should the registered nurse delegate to the LPN? a. Transporting a patient to the laboratory b. Assisting with a thoracentesis c. Restocking and counting the sterile supplies d. Passing afternoon nutrition supplements and waters ANS: B Although the LPN/LVN could be delegated appropriately to do all of these tasks, assisting with procedures (e.g., the thoracentesis) would make best use of the LPN’s emergency department educational preparation. The other activities would be appropriate to delegate to a nursing assistant. PTS: 1 DIF: Cognitive Level: Application/Applying REF: p. 307 OBJ: Understand and apply the five rights of delegation in nursing practice. TOP: Delegation in the clinical setting MSC: NCLEX®: Safe and effective care environment—management of care 19. The charge nurse is assigning patients for care. There are two registered nurses (RNs), an LPN, and a certified nursing assistant (CNA). The charge nurse would assign which of the following patients to the LPN? a. An older adult who is receiving IV chemotherapy through a central line and will need a dressing change b. An adult patient diagnosed with insulin-dependent diabetes who will need dressing changes on several stasis ulcers on the lower extremities c. An adult patient with a right fractured femur and right arm in a cast who needs to urinate d. An older patient with terminal cancer who will be transferred to hospice ANS: B The patient with diabetes will need stasis ulcer care, which is within the scope of practice of the LPN. The patient receiving chemotherapy through a central line would be assigned to the registered nurse. The nursing assistant would help the female patient with the fractures with the bedpan. The nurse should facilitate the transfer of the hospice patient. PTS: 1 DIF: Cognitive Level: Application/Applying REF: p. 307 OBJ: Understand and apply the five rights of delegation in nursing practice. TOP: Delegation in the clinical setting MSC: NCLEX®: Safe and effective care environment—management of care 20. The nurse is making assignments for the team. There are two LPNs and a nursing assistant on the team. Which of the following assignments would the nurse choose for him/herself? a. A patient with left-sided paralysis who needs help with bathing b. A patient with a chest tube who is ambulating in the hall c. A patient receiving chemotherapy for bone cancer d. A patient receiving tube feedings with a J-tube ANS: C The patient with the highest acuity would be the patient receiving chemotherapy for bone cancer. The nurse would be managing delivery of chemotherapy drugs and pain control with narcotics as ordered. The other patients are within the scope of care for the LPN and the nursing assistant. PTS: 1 DIF: Cognitive Level: Application/Applying REF: p. 309 OBJ: Understand and apply the five rights of delegation in nursing practice. TOP: Selecting right person MSC: NCLEX®: Safe and effective care environment—management of care 21. A patient in the medical-surgical unit is diagnosed with anemia and complains of weakness. Which of the following assignments could be given to the nursing assistant? a. Organize the patient’s meal tray for dinner. b. Talk with the patient about managing rest and activities. c. Get a diet history and list of the patient’s favorite foods. d. Take an apical pulse and listen to the lungs for crackles. ANS: A The only assignment that fits the scope of practice for the nursing assistant would be to organize the patient’s tray. Talking with the patient and obtaining a diet history would be nurse functions, as would listening to the lungs for crackles. PTS: 1 DIF: Cognitive Level: Application/Applying REF: p. 308 OBJ: Understand and apply the five rights of delegation in nursing practice. TOP: Delegation in the clinical setting MSC: NCLEX®: Safe and effective care environment—management of care 22. An experienced nursing assistant could be assigned by the nurse to do which of the following? a. Help teach new diabetic clients to give themselves injections. b. Report on quality and quantity of urine, and adjust drip rate on continuous bladder irrigation. c. Assist the client to obtain a clean-catch urine specimen. d. Chart the dietary intake of a client with an eating disorder. ANS: C The nursing assistant can be assigned activities that involve standard, unchanging procedures, such as helping to obtain a clean-catch urine specimen from a client. Teaching, working with complicated procedures (continuous bladder irrigation), and monitoring dietary intake of a person having an eating disorder would need to be assigned to the nurse because they involve assessment and evaluation. PTS: 1 DIF: Cognitive Level: Application/Applying REF: Figure 14.1 OBJ: Understand and apply the five rights of delegation in nursing practice. TOP: Delegation in the clinical setting MSC: NCLEX®: Safe and effective care environment—management of care 23. The nurse is preparing assignments in a pediatric unit for the night shift. Which of the following would be appropriate to assign the LPN? a. A 5-year-old child who had an appendectomy about 6 hours ago b. A 4-year-old child admitted for severe epiglottitis who is running a fever of 102° F c. A 6-year-old child admitted with dehydration and receiving IV therapy d. A 7-year-old child who received inhalation burns 2 days ago and has a tracheostomy ANS: A The child who is postoperative for the appendectomy would be an appropriate assignment for the LVN/LPV. This child’s problem has a predictable outcome. The children with epiglottitis, dehydration, and burns will need to be evaluated and monitored for complications, which is the scope of practice and responsibility of the nurse. PTS: 1 DIF: Cognitive Level: Application/Applying REF: p. 307 OBJ: Understand and apply the five rights of delegation in nursing practice. TOP: Delegation in the clinical setting MSC: NCLEX®: Safe and effective care environment—management of care MULTIPLE RESPONSE 1. Which of the following statements made by the charge nurse indicate appropriate delegation? (Select all that apply.) a. The LPN can delegate dressing changes to the nursing assistant. b. The LPN can administer a DPT immunization to a child. c. The LPN can add a dose of chemotherapy to an existing IV infusion. d. The nursing assistant can transfer a paraplegic patient from a wheelchair to the bed. e. The nursing assistant can assess vital signs on a patient 15 minutes after the transfusion has been started. ANS: B, D Only nurses can delegate to other personnel. LPNs can administer routine medications, such as immunization, but not chemotherapy drugs. A nursing assistant can transfer patients, provide basic hygiene measures, and assess vital signs. PTS: 1 DIF: Cognitive Level: Application/Applying REF: Figure 14.1 OBJ: Understand and apply the five rights of delegation in nursing practice. TOP: Providing feedback MSC: NCLEX®: Safe and effective care environment—management of care 2. The Delegation Decision Tree, which was prepared and adopted by the ANA and NCSBN, has specific steps. Identify the steps in this Decision Tree. (Select all that apply.) a. Monitoring b. Surveillance and supervision c. Read back and response d. Assessment and planning e. Evaluation f. Communication ANS: B, D, E, F There are four steps to the ANA and NCSBN Delegation Decision Tree. They are in order as follows: Step 1: Assessment and planning. Step 2: Communication: Must be a two-way process involving the nurse who assesses the nursing assistive personnel’s understanding of the delegated task and the nursing assistive person who asks questions regarding the delegation and seeks clarification of expectations if needed. Step 3: Surveillance and supervision: The purpose of surveillance and monitoring is related to nurse’s responsibility for patient care within the context of a patient population. The nurse supervises the delegation by monitoring the performance of the task or function and assures compliance with standards of practice, policies, and procedures. Frequency, level, and nature of monitoring vary with needs of patient and experience of assistant. Step 4: Evaluation and feedback: Evaluation is often the forgotten step in delegation and should include a determination if the delegation was successful and discussion of parameters to determine the effectiveness of the delegation. (ANA 2012 pp.) PTS: 1 DIF: Cognitive Level: Application/Applying REF: pp. 302-304 OBJ: Delegate tasks successfully based on outcomes.| Define the operational terms delegation, supervision, and accountability. TOP: Delegation decision tree MSC: NCLEX®: Safe and effective care environment—management of care 3. Which actions by the nurse show an understanding of what the nurse is accountable for? (Select all that apply.) a. Assessing patients according to priority b. Determining the need to delegate a task to a nursing assistant c. Deciding that the nursing assistant is competent to perform the task delegated d. Following up to determine completion of the task that was delegated e. Delegating assessments of low-acuity patients to the nursing assistant ANS: A, B, C, D Nurses show understanding of what they are accountable for by assessing patients according to priority, determining the need to delegate, deciding whether the nursing assistant is competent to perform that task, and following up to determine completion of the task that was delegated. Nurses should not delegate assessment of any patient to a nursing assistant. Assessment must be completed by the nurse. PTS: 1 DIF: Cognitive Level: Application/Applying REF: pp. 304-305 OBJ: Understand and apply the five rights of delegation in nursing practice. TOP: Delegation MSC: NCLEX®: Safe and effective care environment 4. The charge nurse is determining tasks that can be delegated to keep the unit running smoothly. What factors should the charge nurse consider before delegating? (Select all that apply.) a. Staff who are working b. Acuity of patients c. Unit tasks needing to be done d. Teaching obligations of the nurses e. How many patients are waiting for beds on the unit ANS: A, B, C, D The charge nurse should consider other factors such as the staff that are working, acuity of patients, any unit tasks that need to be done, and teaching obligations of the nurses before beginning to delegate. These factors will determine what kind of delegation can be safely handled by the staff. PTS: 1 DIF: Cognitive Level: Application/Applying REF: pp. 302-304 OBJ: Understand and apply the five rights of delegation in nursing practice. TOP: Delegation MSC: NCLEX®: Safe and effective care environment 5. The nurse is preparing to delegate work to the nurse aide. What can be done to ensure that work is delegated in a manner that is understood by the nurse aide? (Select all that apply.) a. Determine if the nurse aide understands what is being asked. b. Ensure that the directions given are in accordance with policy. c. Delegate more difficult tasks because the nurse aide is experienced. d. Ask the nurse aide if he/she has the information needed to complete the task. e. Refrain from delegating and complete the tasks him/herself. ANS: A, B, D The nurse should determine if the nurse aide understands what is being asked. The nurse can do this by asking the nurse aide to repeat the directions back, or read back. The nurse should also ensure that the directions given are in accordance with policy and ask the nurse aide if he/she has the information needed to complete the task. The nurse should not delegate more difficult tasks because the nurse aide is experienced or refrain from delegating and completing all tasks by him/herself. PTS: 1 DIF: Cognitive Level: Application/Applying REF: Critical Thinking Box 14.5 OBJ: Apply the “four C’s” of initial direction for clear understanding of your expectations. TOP: Delegation MSC: NCLEX®: Safe and effective care environment 6. Which statement(s) will help the nurse give feedback to a coworker? (Select all that apply.) a. “Can you tell me what happened?” b. “You did a great job positioning the postoperative patient.” c. “What do you think can be done to ensure that the blood pressures are charted?” d. “I don’t understand why you didn’t do what I asked you to do.” e. “I only gave you one job to complete.” ANS: A, B, C When giving feedback, the nurse should practice using the feedback formula. This includes asking for the other person’s input (“Can you tell me what happened?”), giving credit for accomplishments (“You did a great job positioning the postoperative patient”), and asking for the other person’s thoughts on resolutions (“What do you think can be done to ensure that the blood pressures are charted?”). The statements “I don’t understand why you didn’t do what I asked you to do” and “I only gave you one job to complete” would not be helpful in providing feedback to the coworker because they could cause the coworker to become defensive. PTS: 1 DIF: Cognitive Level: Application/Applying REF: Critical Thinking Box 14.6 OBJ: Provide reciprocal feedback for the effective evaluation of the delegate’s performance. TOP: The right supervision and evaluation MSC: NCLEX®: Safe and effective care environment 7. The nurse manager understands the causes of performance weaknesses when making which of the following statements? (Select all that apply.) a. “The employee does not know what is expected.” b. “The employee is getting adequate feedback.” c. “The employee requires additional education.” d. “The employee lacks motivation.” e. “The employee needs additional supervision.” ANS: A, C, D, E There are several causes of performance weaknesses, including not knowing what the expectations are, not getting adequate feedback, not having enough education to perform the job, lack of motivation, and requiring additional supervision. PTS: 1 DIF: Cognitive Level: Comprehension/Understanding REF: Critical Thinking Box 14.3 OBJ: Provide reciprocal feedback for the effective evaluation of the delegate’s performance. TOP: The right circumstances MSC: NCLEX®: Safe and effective care environment 8. A nurse manager is discussing the “five rights of clinical delegation.” Which statements indicates understanding? (Select all that apply.) a. “The nurse should determine if the task can safely be delegated.” b. “The nurse should determine if this is a task that will fit into the schedule.” c. “The nurse should delegate the task to the right person.” d. “The nurse should determine whether this is a task that would enhance learning.” e. “The nurse should provide feedback to the delegate.” ANS: A, C, E To safely delegate, the nurse manager should determine the following: The right task—determining whether the task can be delegated The right circumstance—according to the NCSBN, the appropriate client setting, available resources, and consideration of other relevant factors The right person—matching the task to the right (qualified) person The right direction and communication—clear expectations of what needs to be done The right supervision and evaluation—acknowledgment that the person understands the information and is capable of completing the task and giving them feedback and evaluation PTS: 1 DIF: Cognitive Level: Comprehension/Understanding REF: p. 305 OBJ: Understand and apply the five rights of delegation in nursing practice. TOP: Definition of delegation MSC: NCLEX®: Safe and effective care environment—management of care Anxiety Concept 34: Anxiety Giddens: Concepts for Nursing Practice, 2nd Edition MULTIPLE CHOICE 1. A patient complains of insomnia during his stay in the hospital. Which nursing diagnosis would be a top priority for this patient? a. Anxiety related to hospitalization b. Ineffective Coping related to hospitalization c. Denial related to hospitalization d. High Risk for Insomnia related to hospitalization ANS: A The information about the patient indicates that anxiety is an appropriate nursing diagnosis. The patient’s data do not support Defensive Coping, Ineffective Denial, or Risk-Prone Health Behavior as problems for this patient. REF: Page 327 OBJ: NCLEX® Client Needs Category: Psychosocial Integrity 2. A female patient is anxious after receiving the news that she needs a breast biopsy to rule out breast cancer. The nurse is assisting with a breast biopsy. Which relaxation technique will be best to use at this time? a. Massage b. Meditation c. Guided imagery d. Relaxation breathing ANS: D Relaxation breathing is the easiest of the relaxation techniques to use. It will be difficult for the nurse to provide massage while assisting with the biopsy. Meditation and guided imagery require more time to practice and learn. REF: Page 332 OBJ: NCLEX® Client Needs Category: Psychosocial Integrity 3. The nurse is teaching a hospitalized patient to use mindfulness to reduce anxiety. Which statement by the nurse is appropriate? a. “How do you feel about what happened to you as a child?” b. “How do you feel about what is going on right now?” c. “Remember a time when you were calm.” d. “Tap your hands until the feeling goes away.”