Deck 14: Leading, Delegating, and Collaborating

Question 1

The RN is planning care for the day. Which would be the most appropriate task to assign to the nursing assistant?

A) Collecting a 24-hour urine specimen
B) Feeding the patient who has difficulty swallowing
C) Changing the dressing on an abdominal wound
D) Monitoring a tube feeding

Answer 1

A
The nursing assistant is qualified to collect a 24-hour urine specimen. An LPN/LVN can change the dressing on an abdominal wound. Feeding the patient with dysphagia and monitoring a tube feeding calls for the specialized knowledge of the RN.

Question 2

All of these nursing actions are included in the plan of care for a patient who is malnourished. Which action is appropriate for the RN to delegate to a nursing assistant?

A) Assist the patient in choosing high-nutrition items from the menu.
B) Monitor the patient for skin breakdown over the bony prominences.
C) Assess the patient's strength while ambulating the patient in the room.
D) Offer the patient the ordered nutritional supplement between meals.

Answer 2

D
Feeding the patient and assisting with oral intake are included in nursing assistant education and scope of practice. Assessing the patient's strength and assisting the patient in choosing high-nutrition foods require LPN/LVN- or RN-level education and scope of practice.

Question 3

A nurse manager must confront an employee about excessive absenteeism. During the confrontation with this employee, which introductory statement is most appropriate?

A) "Is there something occurring in your life that is interfering with your attendance at work?"
B) "What is your understanding of our absenteeism policy and being placed on probation?"
C) "You are always calling in sick and leaving the staff in a real mess."
D) "Let's pull the policy manual out and read the absenteeism policy together."

Answer 3

A
Similar to a focused patient assessment when a complaint pain is given, a manager must also assess and gather more information about an employee's excessive absenteeism. With this in mind, the statement asking about the employee's life occurrences interfering with work is an appropriate way to start this conversation. Asking the employee about the absenteeism policy and offering to read the policy together give no opportunity to engage in a healthy discussion. Attacking the employee by saying "You are always calling in sick and leaving the staff in a real mess" is not a respectful and professional way to begin this conversation.

Question 4

The best way for a nurse to determine that a newly hired certified nursing assistant (CNA) is competent to transfer a patient safely from the bed to the commode would be to

A) look in the CNA's personnel file to determine previous experience.
B) observe the CNA perform the procedure the first time and discuss the outcome.
C) have the CNA explain the procedure before doing it.
D) establish that the CNA is comfortable performing the transfer.

Question 5

Holiday scheduling is always a sensitive issue on the nursing unit, and the manager is trying something different this year. The manager says that whoever works the most extra shifts when asked to do so will get first pick for the holiday schedule. Which type of conflict resolution does this represent?

A) Competition resolution
B) Win-win resolution
C) Sacrifice resolution
D) Active resolution

Question 6

A nurse is assigned to care for a patient who has been admitted with an opiate overdose and tells the nursing supervisor, "This is a waste of my time. The patient will be back on the needle right after being discharged." The most appropriate response by the nursing supervisor is

A) "Your lack of professionalism will make it difficult for you to provide adequate care."
B) "You know we are obligated to provide appropriate care no matter how we feel."
C) "It is important to recognize these feelings and then figure out how to deal with them."
D) "Since you feel so strongly, perhaps you should be assigned to care for a different patient."

Question 7

Nurse A is in conflict with Nurse B regarding holiday scheduling. Because Nurse A really wants to avoid being in this conflict, and because Nurse A just wants to fill the holiday schedule, Nurse A agrees to give up one favored holiday. This is an example of which type of conflict resolution?

A) Competition resolution
B) Win-win resolution
C) Sacrifice resolution
D) Active resolution

Question 8

A charge nurse and staff nurse are in disagreement over the team assignment for the shift that is about to begin. What is the charge nurse's best first step to resolving the conflict collaboratively?

A) Determine the shared goal.
B) Open a respectful dialogue to bring forth each point of view.
C) Design a plan to meet the shared goal.
D) Determine the roles of those involved in the plan.

Question 9

Which of these nursing interventions for the patient who has had right-sided breast-conservation surgery and axillary lymph node dissection is appropriate to assign to an LPN/LVN?

A) Teaching the patient how to avoid injury to the right arm
B) Administering an analgesic 30 minutes before the scheduled arm exercises
C) Assessing the patient's range of motion for the right arm
D) Evaluating the patient's understanding of discharge instructions about drain care

Question 10

Which patient should be assigned to an experienced LPN/LVN?

A) One day post-op coronary artery bypass graft (CABG) who is on telemetry with T 37.1° C, BP 95/50, P 92, R 18
B) Two day post-op appendectomy with T 36.8° C, BP 118/78, P 78, R 18
C) Snake bite 2 days prior with hematuria, melena, and blood seepage at the IV site with stable vital signs
D) One day post cerebral vascular accident (CVA) on a heparin drip experiencing increasing hemiplegia, with stable vital signs

Question 11

Which statement best reflects that the nurse manager has taken the first action in the decision-making process?

A) "We could hire four additional nursing assistants."
B) "We need to decrease patient falls."
C) "Patient falls have decreased by 20%."
D) "Here is the revised staffing schedule."

Question 12

Which of these tasks is appropriate for the RN to delegate to a licensed practical nurse/license vocational nurse (LPN/LVN)?

A) Documenting patient teaching about a routine surgical procedure
B) Teaching a patient how to self-administer insulin
C) Administering an oral medication to a patient
D) Completing the initial assessment and plan of care

Question 13

Which statement by the RN best represents the "right communication" when delegating a task to an unlicensed individual?

A) "Feed the patient and watch for cheeking and choking."
B) "I want you to help the patient to eat his lunch. You should elevate the head and feed him slowly enough so he does not choke."
C) "Feed the patient his pureed diet at lunchtime. Elevate the head of the bed to 90 degrees and make certain he swallows each bite."
D) "Assist the patient with lunch, and make sure he sits up and doesn't store food in his cheek in between bites."

Question 14

A newly admitted patient has several orders the physician has written. As manager of care, a graduate RN knows that three of the following tasks can be routinely delegated to a nursing assistant, but one of them must be reserved for the RN to complete. Which task must the RN complete?

A) Reminding to use the incentive spirometer
B) Irrigating of a urinary catheter
C) Conducting fingerstick glucose tests
D) Collecting data for intake and output

Question 15

Which patient described below most needs an advocate?

A) A 68-year-old female patient who tells you that she always relies on her husband to decide what is best.
B) An 80-year-old patient who states, "Why do people talk over my head as if I was a child?"
C) A 4-year-old patient whose mother visits each evening but goes home to care for her other two children each night.
D) A 36-year-old patient who states, "I really wish this surgery wasn't necessary. I want to look at my other choices, again."

Question 16

A family member of an elderly Hispanic patient admitted to the hospital tells the nurse that the patient has traditional beliefs about health and illness. Being a patient advocate, the best action by the nurse is to

A) avoid asking any questions unless the patient initiates conversation.
B) obtain further information about the patient's cultural beliefs from the family member.
C) ask the patient whether it is important that cultural healers are contacted.
D) explain the usual hospital routines for meal times, care, and family visits.

Question 17

In a patient care conference one of the nurses makes a controversial statement about the patient's behavior. The other health care providers raise their eyebrows, and silence follows the original comment. A democratic leader would

A) agree with the comment about the patient, and direct the group to the next topic on the agenda.
B) ignore the statement about the patient's behavior and the nurse's judgmental attitude.
C) gather input from the group about the patient's behavior, and elicit suggestions about how to best work with the patient.
D) respond to the nurse that the comment is judgmental and inappropriate, and ask the nurse to stay after the meeting.

Question 18

The nurse is a very busy charge nurse with responsibilities for a unit with 24 acute care patients. An experienced nursing assistant is assigned to the unit. The nursing assistant notes that the IV pump is beeping because the tubing appears kinked. The assistant unkinks the tubing, and this resets the pump. The assistant reports the action to the nurse. It is most important that the nurse

A) thank the nursing assistant for taking the initiative to correct the problem and to "keep up the good work."
B) provide the assistant with additional instructions on safety in IV management.
C) warn the other staff to watch out for the nursing assistant because she works beyond her scope.
D) explain that help is appreciated; however, legally the nursing assistant cannot perform the action.

Question 19

Which question or statement by the nurse is most helpful in ensuring that a nursing assistant new to the unit understands what is expected of the assistant?

A) "Are you ready to begin work now?"
B) "Now, repeat for me what I have just asked you to do."
C) "Do you know what I expect from you?"
D) "Let me know if you need any help."

Question 20

While talking with the nursing supervisor, a graduate RN expresses frustration that a Mexican American client always has several family members at the bedside. The most appropriate action by the nursing supervisor to help the graduate RN become a patient advocate is to

A) ask about the graduate RN's personal beliefs about family support during hospitalization.
B) remind the graduate RN that this cultural practice is important to the family and the patient.
C) suggest that the graduate RN ask family members to leave the room during patient care.
D) have the graduate RN explain to the family that too many visitors will tire the patient.

Question 21

According to the American Nurses Association (ANA), which elements of nursing cannot be delegated? (Select all that apply.)

A) Initial and subsequent nursing assessments requiring professional judgment
B) The determination of nursing diagnoses, goals, plans of care, and progress
C) Interventions that require the application of professional knowledge and skills
D) Interventions that require additional knowledge and skills
E) Routine daily care elements including recording vital signs