Saunders Leadership/Management
A case manager is reviewing the records of the clients in the nursing unit. Which occurrence, if noted in a client's record,
would the nurse identify as a positive variance?
1.
A client is performing colostomy irrigations.
2.
The client with a leg ulcer is demonstrating signs of wound healing.
3.
A postoperative client is discharged home 1 day earlier than expected.
4.
The client with diabetes mellitus is administering insulin injections appropriately. - ANS -3.
A postoperative client is discharged home 1 day earlier than expected.
Variances are actual deviations or detours from the critical path. Variances are positive or negative, avoidable or
unavoidable, and may be caused by a variety of factors. A positive variance occurs when the client achieves maximum
benefits and is discharged earlier than anticipated on his or her critical path. The correct option is the only one that
identifies a positive variance. Options 1, 2, and 4 demonstrate progression on a critical path, but they are not specifically
associated with the definition of a positive variance.
\A child with an autism spectrum disorder (ASD) is being admitted to the hospital for diagnostic tests. Which room
assignment is the most appropriate for the child?
1.
,Private room
2.
Semiprivate room
3.
4-bed ward room
4.
Contact isolation room - ANS -1.
Private room
ASDs are complex neurodevelopmental disorders of unknown etiology composed of qualitative alterations in social
interaction and verbal impairment with repetitive, restricted, and stereotype behavioral patterns. Children with ASDs are
unable to relate to persons or respond to social and emotional cues. Characteristically, these children engage in repetitive
behaviors, including head banging, twirling in circles, biting themselves, and flapping their hands or arms. Abnormal
communication patterns include verbal and nonverbal communication. A child with an ASD needs decreased stimulation,
with limited visual and auditory distractions. A private room would be the best environment, allowing for control of visual
and auditory distractions. The semiprivate and 4-bed ward rooms would be too stimulating for the child with an ASD. ASD
is not a disorder that requires contact isolation
\A client admitted voluntarily for treatment of an anxiety disorder demands to be released from the hospital. Which action
should the nurse take initially?
1.
Contact the client's health care provider (HCP).
2.
Call the client's family to arrange for transportation.
,3.
Attempt to persuade the client to stay "for only a few more days."
4.
Tell the client that leaving would likely result in an involuntary commitment. - ANS -1.
Contact the client's health care provider (HCP).
In general, clients seek voluntary admission. Voluntary clients have the right to demand and obtain release. The nurse
needs to be familiar with the state and facility policies and procedures. The initial nursing action is to contact the HCP,
who has the authority to discuss discharge with the client. While arranging for safe transportation is appropriate, it is
premature in this situation and should be done only with the client's permission. While it is appropriate to discuss why the
client feels the need to leave and the possible outcomes of leaving against medical advice, attempting to get the client to
agree to staying "for only a few more days" has little value and will not likely be successful. Many states require that the
client submit a written release notice to the facility psychiatrist, who reevaluates the client's condition for possible
conversion to involuntary status if necessary, according to criteria established by law. While this is a possibility, it should
not be used as a threat with the client.
\A client has refused to eat more than a few spoonfuls of breakfast. The health care provider has prescribed that tube
feedings be initiated if the client fails to eat at least half of a meal because the client has been losing weight for 2 months.
The nurse enters the room, looks at the tray, and states, "If you don't eat any more than that, I'm going to have to put a
tube down your throat and get a feeding in that way." The client begins to cry and tries to eat more. Based on the nurse's
actions, the nurse may be accused of which legal tort?
1.
Assault
2.
Battery
3.
, Slander
4.
Invasion of privacy - ANS -1.
Assault
Assault occurs when a person puts another person in fear of harmful or offensive contact and the victim fears and
believes that harm will occur as a result of the threat. In this situation, the nurse could be accused of the tort of assault.
Battery is the intentional touching of another's body without the person's consent. Slander is verbal communication that is
false and harms the reputation of another. Invasion of privacy is committed when the nurse intrudes into the client's
personal affairs or violates confidentiality.
\A client has refused to eat more than a few spoonfuls of breakfast. The health care provider has prescribed that tube
feedings be initiated if the client fails to eat at least half of a meal because the client has lost a significant amount of
weight during the previous 2 months. The nurse enters the room, looks at the tray, and states, "If you don't eat any more
than that, I'm going to have to put a tube down your throat and get a feeding in that way." The client begins crying and
tries to eat more. Based on the nurse's actions, the nurse may be accused of which violation?
1.
Assault
2.
Battery
3.
Slander
4.
Invasion of privacy - ANS -1.
Assault
A case manager is reviewing the records of the clients in the nursing unit. Which occurrence, if noted in a client's record,
would the nurse identify as a positive variance?
1.
A client is performing colostomy irrigations.
2.
The client with a leg ulcer is demonstrating signs of wound healing.
3.
A postoperative client is discharged home 1 day earlier than expected.
4.
The client with diabetes mellitus is administering insulin injections appropriately. - ANS -3.
A postoperative client is discharged home 1 day earlier than expected.
Variances are actual deviations or detours from the critical path. Variances are positive or negative, avoidable or
unavoidable, and may be caused by a variety of factors. A positive variance occurs when the client achieves maximum
benefits and is discharged earlier than anticipated on his or her critical path. The correct option is the only one that
identifies a positive variance. Options 1, 2, and 4 demonstrate progression on a critical path, but they are not specifically
associated with the definition of a positive variance.
\A child with an autism spectrum disorder (ASD) is being admitted to the hospital for diagnostic tests. Which room
assignment is the most appropriate for the child?
1.
,Private room
2.
Semiprivate room
3.
4-bed ward room
4.
Contact isolation room - ANS -1.
Private room
ASDs are complex neurodevelopmental disorders of unknown etiology composed of qualitative alterations in social
interaction and verbal impairment with repetitive, restricted, and stereotype behavioral patterns. Children with ASDs are
unable to relate to persons or respond to social and emotional cues. Characteristically, these children engage in repetitive
behaviors, including head banging, twirling in circles, biting themselves, and flapping their hands or arms. Abnormal
communication patterns include verbal and nonverbal communication. A child with an ASD needs decreased stimulation,
with limited visual and auditory distractions. A private room would be the best environment, allowing for control of visual
and auditory distractions. The semiprivate and 4-bed ward rooms would be too stimulating for the child with an ASD. ASD
is not a disorder that requires contact isolation
\A client admitted voluntarily for treatment of an anxiety disorder demands to be released from the hospital. Which action
should the nurse take initially?
1.
Contact the client's health care provider (HCP).
2.
Call the client's family to arrange for transportation.
,3.
Attempt to persuade the client to stay "for only a few more days."
4.
Tell the client that leaving would likely result in an involuntary commitment. - ANS -1.
Contact the client's health care provider (HCP).
In general, clients seek voluntary admission. Voluntary clients have the right to demand and obtain release. The nurse
needs to be familiar with the state and facility policies and procedures. The initial nursing action is to contact the HCP,
who has the authority to discuss discharge with the client. While arranging for safe transportation is appropriate, it is
premature in this situation and should be done only with the client's permission. While it is appropriate to discuss why the
client feels the need to leave and the possible outcomes of leaving against medical advice, attempting to get the client to
agree to staying "for only a few more days" has little value and will not likely be successful. Many states require that the
client submit a written release notice to the facility psychiatrist, who reevaluates the client's condition for possible
conversion to involuntary status if necessary, according to criteria established by law. While this is a possibility, it should
not be used as a threat with the client.
\A client has refused to eat more than a few spoonfuls of breakfast. The health care provider has prescribed that tube
feedings be initiated if the client fails to eat at least half of a meal because the client has been losing weight for 2 months.
The nurse enters the room, looks at the tray, and states, "If you don't eat any more than that, I'm going to have to put a
tube down your throat and get a feeding in that way." The client begins to cry and tries to eat more. Based on the nurse's
actions, the nurse may be accused of which legal tort?
1.
Assault
2.
Battery
3.
, Slander
4.
Invasion of privacy - ANS -1.
Assault
Assault occurs when a person puts another person in fear of harmful or offensive contact and the victim fears and
believes that harm will occur as a result of the threat. In this situation, the nurse could be accused of the tort of assault.
Battery is the intentional touching of another's body without the person's consent. Slander is verbal communication that is
false and harms the reputation of another. Invasion of privacy is committed when the nurse intrudes into the client's
personal affairs or violates confidentiality.
\A client has refused to eat more than a few spoonfuls of breakfast. The health care provider has prescribed that tube
feedings be initiated if the client fails to eat at least half of a meal because the client has lost a significant amount of
weight during the previous 2 months. The nurse enters the room, looks at the tray, and states, "If you don't eat any more
than that, I'm going to have to put a tube down your throat and get a feeding in that way." The client begins crying and
tries to eat more. Based on the nurse's actions, the nurse may be accused of which violation?
1.
Assault
2.
Battery
3.
Slander
4.
Invasion of privacy - ANS -1.
Assault
