2. Ask the charge nurse to evaluate the intervention. A copy of select parts of the medical recording, according to facility policy, is another form of communication that will support continuity of care. Select all that apply Some general guidelines are necessary, with input from clients and family to individualize any special requests with assistance from the facility. 2. Who should the nurse see first? It results in an exchange of ideas, problem solving expression of feelings, decision making, and personal growth). Vaginal delivery of fetal demise, C-section with pneumonia, 32 week gestation with lymphoma. This client needs ongoing monitoring which is within the scope of practice for the LPN. Which of the following statements should the nurse identify as an indication that the client needs further instruction? A nurse is caring for a client who is postoperative. A nurse is caring for a client who has a new diagnosis of type 1 diabetes mellitus. c. Environment This includes medication enemas. A nurse has completed an informed consent form with a client. b. I'll use the cleansing wipes from the front to back 4. Draining the colostomy bag on a client with diarrhea. a. Hold the penis at a 30 to 45 degree angle when inserting the catheter Client diagnosed with inoperative brain tumor who is confused. Make nursing assignments appropriate to the skill level . Include any relevant statements the client made about the ulcer, 64. The body needs vitamin B12 to make red blood cells. Gather and apply dressings to open wounds. The client is receiving IV fluids through an IV catheter inserted in the basilic vein on the right forearm. 1. d. Voided 30 mL frequently A nurse is providing discharge teaching about clean intermittent self-catheterization for a client who has a benign prostatic hyperplasia. Which actions should be instituted by each unit's charge nurse? PURPOSE AND SCOPE: Supports FMCNA's mission,vision, core values and customer service philosophy. Write N next to the nonessential clauses and E next to the essential clauses. This client is not the nurse's first priority. 4. The RN with 5 years' experience in the Labor and Delivery unit. The women's health charge nurse is making assignments for the next shift. When completing an incident report about the pressure ulcer, the nurse should take which of the following actions? Which of the following statements should the nurse identify as an indication that the client understands the discharge information? d. Social conversation, a. 5. Incorrect: The nurse may trust the UAP; however, the nurse has not been able to determine the competency of the new staff member. The charge nurse delegates a licensed practical nurse (LPN) to perform an intervention that is not within the scope of practice for the LPN. Incorrect: Gloves should be worn to remove dentures and a gauze used to grasp the dentures. What actions should a nurse take to provide continuity of care when discharging a client diagnosed with hemiparesis to a long-term care facility for rehabilitation? 6. Client admitted 24 hours ago with a diagnosis of a stroke, who is now reporting a headache that intensifies when moving in the bed. A nurse is engaging in relationship counseling with a male client. Incorrect: Dealing with a client's emotional state requires a formative evaluation to gauge readiness and requires the knowledge of the RN. a. There is a trailing zero after the prescribed dose. a. Which of the following statements should the nurse identify as an indication that the client requires further clarification? Pick up the tray and tell the UAP that they didn't do a good job. and 16 g of fat. d. Remove tea and coffee from meal trays, b. Try different methods of oral care on unresponsive clients to see what works best. Which of the following actions should the nurse take regarding informed consent? Select all that apply. To remove gastric acid that might cause dyspepsia Incorrect: If a report is made to the BON, it should be a factual documentation of specific events and actions, not a statement of impairment. Obtain a client's consent Irrigate a client's ear canal. Which tasks should the charge nurse complete at the end of the shift before leaving for the day? Which of the following approaches should the nurse use when using confrontation? Which of the following statements should the nurse identify as an indication the client needs further teaching? Remove all metal necklaces a. EXAMPLE: Of my three brothers and sisters, my sister Giselle has the better sense of humor. The nurse asks the client, "Are you feeling anxious about the results of your colonoscopy?" The third client would be the one needing a dressing change. A newly licensed nurse is seeking advice from her preceptor about the need to purchase personal professional liability insurance. The nurse asks why the client needs to know this. What is the primary factor for the charge nurse to consider when delegating care? Incorrect: Just because the UAP is able to accomplish all daily assignments efficiently does not mean more work could be handled as effectively. A charge nurse is making client care assignments. Respite care allows the primary caregiver time away from day-to-day care responsibilities 1. Which of the following actions should the nurse take first? Taking the report from the ED could be delayed but is a courtesy to the ED and will provide information about the client that will be useful in making assignments for the next shift. 1. A nurse is working with an assistive personnel (AP) to Relax her abdominal muscles when she lifts an object Collecting I & O totals for unit clients at the end of shift. c. Hold an object away from her body as she lifts it The charge nurse must triage and assign clients to appropriate staff. The nurse has another priority. 4. Briefly assess every client. The client was lying on the floor next to his bed (nurse should document what they actually see), 68. Which clients should be assigned to the CNA? b. Charge Nurse II- CNII - jobs.freseniusmedicalcare.com d. Resistance is evident as subgroups form in this stage, c. Discard the tablet and obtain another dose of medication, 35. b. b. d. Places clean linen that touched the floor in the soiled linen bag, d. Decreased calcium excretion (prolonged immobility leads to the breakdown of bone tissue; result is decreased calcium excretion), 26. 2. 10. Correct: A thoracentesis is performed to remove fluid from the pleural cavity and improve the client's respiratory status. *HURST REVIEW Qbank/Customize Quiz - Manageme, *HURST REVIEW Qbank/Customize Quiz - Adult He, *HURST REVIEW Qbank/Customize Quiz - Basic Ca, *HURST REVIEW Qbank/Customize Quiz - Fundamen, ***HURST REVIEW NCLEX-RN Readiness Exam 1***, The Language of Composition: Reading, Writing, Rhetoric, Lawrence Scanlon, Renee H. Shea, Robin Dissin Aufses, Edge Reading, Writing and Language: Level C, David W. Moore, Deborah Short, Michael W. Smith. 3. In the following sentences, circle each incorrectly used lowercase letter. Incorrect: A client scheduled for surgery after a mastectomy is still able to make decisions. The stem does not indicate any loss of neurological function resulting from the seizure activity. Incorrect: Aplastic anemia is a blood disorder in which the body's bone marrow doesn't make enough new blood cells. c. Take the client to the bathroom every 2 hr 1. c. I will begin upon the client's admission to the facility Cleanse the wound with 0.9% sodium chloride saline irrigation before obtaining the specimen 2. 2. Which of the following tasks should the nurse delegate to assistive personnel (AP)? a. e. Talking with the client's partner, 79. Which of the following tasks should the nurse delegate to AP? (Select all that apply.) Select all that apply Notify the primary healthcare provider. A charge nurse is making client care assignments. 1, 3 & 5. A nurse is caring for a client who is scheduled for an elective surgical procedure. Nothing life threatening, but an assessment needs to be made regarding the ulcer. d. I'll carry heavy objects close to my body, d. Places clean linen that touched the floor in the soiled linen bag, 25. 2. Solved 77. The nurse in a long-term care facility is making - Chegg 3. 76. A client receives a wrong medication. The client was lying on the floor next to his bed PDF 8 steps for making effective nurse-patient assignments 2. 4. The nurse can also accept the assignment; however, that nurse should document professional concern for client safety and the process you used to inform the facility (manager) of your concerns. So, the UAP can assist a client to brush and floss teeth. When assigning nurses to patients, the charge nurse must consider the acuity of the patient's condition, the skills of the nurse, and the availability of other staff members. Incorrect: While it is true that the nurse manager is ultimately responsible for implementing and announcing new schedule changes, doing so without any staff input can create discontent in the work environment. 3. When a family member asks how respite care can help, which of the following responses should the nurse provide? 2. It's unfortunate that I have to be in the hospital for this treatment (TENS units are portable; they can be used at home), 45. Relief of urinary retention 1. A charge nurse role includes front line nurse supervisor, resource nurse, bed manager, peer reviewer, patient advocate, other charge nurse duties, and staff scheduler. 1. 4. 3. Something new could have occurred with the clients, making the assignments too heavy. Incorrect: A colostomy client with diarrhea will have a lot of drainage requiring frequent emptying of the colostomy bag. c. I should purchase a carbon monoxide detector for my home b. 5. d. I'll put a heating pad on my ankle at bedtime tonight, d. I have a set of my brothers' crutches in the basement I can also use (the client should not use crutches that belong to someone else; the crutches must fit body dimensions), 17. a. c. Shivering (shivering is a systemic response to cold therapy as the body attempts to promote heat production), 77. e. Assessing a mole on the client's shoulder, Latin GCSE Vocab - 1st and 2nd Declension Adj, NUR 204 ATI Psychosocial Integrity Ch. d. The nature and invasiveness of the surgical procedure, d. The nurse has already considered alternatives to restraints, 89. Measure urine output when client voids. Which of the following is the priority action by the nurse? b. A nurse is completing discharge teaching with a client. Focus on the client's present circumstances instead of his personal stories d. What have you done in the past to cope with this issue? So, this client who is receiving PRN pain medication is certainly someone that the LPN could be assigned to. Incorrect: Hanging a new bag of TPN is parenteral therapy requiring a central line. Asking for an explanation 2. b. b. I can detect the presence of carbon monoxide by a metallic odor a. Incorrect: The client does need to be cleaned out below the tumor so that the primary care provider can see the area of concern and complete the biopsy. This client would be the priority based on the need for prompt recognition and treatment of the neutropenia and signs of infection present. A. Transporting a client who experienced a stroke 72 hr ago to the radiology department The first client who needs treatment is the one with multiple injuries from a motor vehicle accident. Client with cast to right leg requiring pain medication. Perform catheterization when you recognize the urge to void The nurse is using which level of communication at this time? Incorrect: The administration of parenteral pain medications is not in the scope of practice for the LPN/LVN. 3. Prepare a list of clients who could quickly be discharged or transferred. Provide a between meal supplement to the client. c. Nonfat milk Bargaining Correct. c. Tie linen bags securely at the top 1. d. Discussing intake and output 28 week gestation of bed rest, postpartum with HELLP syndrome, breast reconstruction. c. Inform the surgical team to cancel the client's surgery Providing a passive response d. To identify delayed gastric emptying, a. Auscultate breath should at least ever 2 hr (priority action the nurse should contribute to the plan of care when using the ABC approach to client care in auscultating breath sounds to determine the client's need for suctioning; with inactivity, secretions can pool in the airways, diminishing breath sounds and causing crackles and dyspnea), 43. Incorrect: Restricting visitation to two hours is not appropriate, particularly for families traveling long distances to visit a client. 4. d. I shouldn't advice you about what is ultimately a personal decision, b. b. b. b. Irrigate the NG tube with 100 mL of sterile water 2. 2. 2. e. Suctioning a client's new tracheostomy tube, 93. A charge nurse is making assignments for an oncoming shift. Narrative interaction (involves asking a client to share personal stories so the nurse can better understand the context of a client's life in the working phase of a nurse-client relationship), 47. Correct: Nurses must use and recognize appropriate terminology and abbreviations to avoid potential client harm. 3. b. 4. A client receiving heparin injections for deep vein thrombosis. Which of the following items should the nurse offer the client? 1. c. Contact the provider to question the dosage (when a nurse believes there is an error in a prescription, the nurse must question the provider). Select all that apply Incorrect: The charge nurse cannot change the scope of practice for the LPN by evaluating the intervention. A nurse is assessing a client who is experiencing prostatic hypertrophy. The charge nurse should be informed that the delegated intervention is not appropriate according to the state's Nurse Practice Act. This can prevent harm to client's. d. Discard the prepared medications and begin again after returning, d. I will wear synthetic clothing and woolen socks when using my oxygen (woolen and synthetic materials can generate static electricity and oxygen is a flammable gas - the client should wear cotton), 73. 1. c. Distended bladder 1. a. Correct: The nurse manager is aware that open communication with staff is vital to increase workplace satisfaction and staff retention. d. Explain oral hygiene to a client receiving chemo Which of the following responses should the nurse provide? Place the pack on a sterile work surface c. Discard the tablet and obtain another dose of medication When handling any disaster, a facility must have a "command center" that is operated by outside personnel such as a Fire chief, Police, Swat or other outside emergency persons. A nurse just back from maternity leave. Review the action of insulin therapy Yes! Even though this nurse just had a baby, there is no risk of her transmitting this virus to her child. This template is beneficial for nursing students and veteran nurses alike, and can be used in any unit. 3. Keep a personal copy of this documentation, provide a copy to the immediate supervisor, and send a copy to the Local Unit Officer. Also, making a surgical bed for the client returning from surgery is a basic procedure. Encourage client to express grief related to loss of independence. a. This will take a lot of time, and the charge nurse can get the information needed from the nurses caring for the clients in order to make appropriate client assignments for the next shift. Client who received blunt abdominal trauma in a motor vehicle accident who is reporting a worsening of the abdominal pain. 3. butter, which contain 16 g of protein, 7 g of carbohydrates, 3. Client diagnosed with Crohn's disease who had three semi-formed stools over the past shift. d. Question the charge nurses about the care deficits that might have contributed to the ulcer's development, b. Thus they are kept in charge of basic patient care like administration of tests, medicines and proper provision of the required treatment. Following a passenger train derailment, local hospitals are notified to activate disaster protocols on all floors. It is the nurse's responsibility to communicate the client's condition and care plan to the receiving facility nurse in order to support continuity of care. A charge nurse is reviewing the list of tasks that have been delegated to the assistive personnel (AP) by the staff nurse. The nurse should initiate a referral with which of the following members of the interprofessional health care team? Occupational therapist Initiate oxygen and IV lines as needed. Documentation is a communication tool for the interprofessional health care team. What was the rationale for this plan? This would be out of the UAP's scope of practice. 3. A nurse is discharging a client who has come to the outpatient clinic with an ankle sprain. Based on a concept analysis of the charge nurse role, the author looks at a theory-gap analysis regarding how patient a Hearing loss Gather supplies to prepare room for isolation. 3. The nurse also needs to be aware of the color and amount of urine voided. 2. Which observation of denture care by the unlicensed assistive personnel (UAP) would require the nurse to intervene? Increased insulin production c. I'll clean the inside of the container with a wipe 3. Report of feeling pressure 6. As a charge nurse, you're a frontline leaderthe first reflection of your organizationand you need to ensure you are meeting the organization's goals and values. Of my three brothers and sisters, my sister Giselle has the best sense of humor. Incorrect: The client does need to have food; however, there is another action that should be performed first. Which nursing intervention should the charge nurse implement? Explain administration is demanding a decreased overtime. It happened so long ago - just get over it!" A nurse is planning care for a female client who has an indwelling urinary catheter. Client reporting epigastric pain and nausea after eating. The RN is assigned to care for an unemployed 26-year-old woman, newly diagnosed with acquired immunodeficiency syndrome (AIDS). Thoracentesis reporting shortness of breath. Nothing by mouth (NPO). _________________ (magnanimous), a. generous 2. Assigning blame for the changes to administration will not help staff adjust. (Select all that apply) Which response by the LPN is appropriate in response to the inappropriate delegation? a. Client assignments are based on client acuity and nurses do not necessarily have the same number of clients. Which task should the nurse take responsibility for completing? 2. Problems in Delegation: A Busy Day on the Floor - Quizlet d. When asking if the client took his medications this morning, 82. This protein is released by cells in the stomach. Which of the following nursing statements indicates the nurse understands when discharge plans should be implemented? 3. The best practice committee utilizes current research in their recommendations. Turn on local news for up-to-date information on the train derailment. What task would be best to assign to the LPN/LVN? Take vital signs every two hours for the patient with the cholecystectomy in Room 6022. Which of the following instructions should the nurse give to the client prior to the procedure? Monitor for GI upset 30 minutes after meals. d. Move to the opposite side of the pack and open the fourth flap, 54. 4. A nurse is performing care activities for a client in the zone of touch that requires his consent. Wears a gown when entering the room of a client who requires contact precautions Incorrect: Most adults have already been exposed to the virus and are not at risk for adverse effects of the infection. A list of current medications is sent to the facility. The LPN/LVN can reinforce teaching. The charge nurse is making client assignments for a neuro-medical floor. 4. The nurse is using which of the following therapeutic communication techniques? Correct: The LPN/LVN can monitor for behavioral changes and can look for potential safety hazards. The nurse has just completed a 12 hour shift. d. Custard Offer to take one of the clients. 3. Change the subject when the client behaves defiantly Review a low-sodium diet for a client with hypertension. 4. b. Discuss the competency of the surgeon 4. Give magnesium citrate 296 mL at 3 PM today. A nurse is assessing a client at a follow-up clinic for acute low back pain. The charge nurse is developing patient care assignments for the evening shift and needs to assign clients to a licensed practical nurse/licensed vocational nurse (LPN/LVN) and a certified nursing assistant (CNA). A lack of rapid eye movement (REM) sleep Dentures should be stored in a denture cup. a. Incorrect: No, the monitoring is too specific for the med-surg nurse. The expected standard of care was strict bed rest), 96. Handoff and Nursing Report Sheet. A nurse is talking with a client who is about to start using transcutaneous electrical nerve stimulation (TENS) to manage chronic pain. 2. Correct: Talking to the nurses about client concerns and completing the client assignment sheet for oncoming staff will provide for a thorough shift change report. Semi-formed stools are great news! 2. When determining if the client is eating a well-balanced diet This is an appropriate prescription. c. I will complete the smoking cessation program I started b. Assist a client to ambulate using a gait belt 2. A nurse is orienting a new assistive personal (AP) to the unit. 2. Correct: Did you notice the hint? d. 216, 22. d. Anger, b. 4. Currently, your census is 11, with one empty bed. 3. c. Malpractice c. I will place an area rug at the entry of my bathroom Incorrect: Obtaining the urinary output of a client at the end of the shift is appropriate for the nursing assistant and should be documented and reported to the RN. This client needs careful monitoring and specialized care. Dr. Frankenstein had seen himself as a(n) ?\underline{? Correct: The nurse's level of fatigue must be considered especially under conditions of mandatory overtime. Simply accept the assignment since overtime is mandatory. The nurse is evaluating care provided by an unlicensed assistive personnel (UAP). Write the letter of your choice on the answer line. Incorrect: The nurse cannot assign teaching to the UAP. d. Transporting a cerebrospinal fluid specimen to the lab The unit is short one staff member and will receive a nurse from the medical surgical unit. Underline the adjective clause in each sentence. The client states, "I am so nervous about what the doctor might find during the test." c. Explore the client's feelings about dietary modifications Airborne A client post pacemaker insertion, awaiting discharge instructions. b. The charge nurse on each unit needs to prepare a list of possible discharges or transfers to be given to the appropriate primary healthcare providers for further action. Correct: If suspicious behavior occurs, it is important to keep careful, objective records. 4. b. Wash the tablet off with alcohol and place it in a clean medicine cup This could be devastating to the client if the decimal point is missed and the client receives 200 mg instead of the intended 20 mg of lisinopril. Female client stating she has been raped. Which task would be appropriate for the nurse to assign to an unlicensed assistive personnel (UAP)? Request that the nursing assistant obtain equipment for the client's care while the RN talks with the client and the family. 1. Incorrect: Although this action appears to be opening lines of communication, the nurse manager is actually fostering animosity in a situation where the outcome is already predetermined. Evaluate client's safety risk factors. Of the following barriers to learning the nurse identifies with this client, which should the nurse interpret as a need to postpone the session? b. d. Otorhinolaryngologist, c. Irrigating a client's abdominal wound The report should contain consequences. Which of the following actions is an example of a violation of confidentiality? Which clients should the nurse assign to the LPN/LVN based on skill level and scope of practice? A charge nurse is making client care assignments. 3. a. 1. Monitor client for pain while assisting with ambulation. The nurse is planning care for a client admitted with Alzheimer's Disease. a. Which of the following instructions should the nurse include? Because facilities generally prefer some type of consistent schedule for staffing purposes, older visitation policies were often very restrictive. which client would be most appropriate to assign a licensed practical nurse (lpn)? If you give the magnesium citrate, which is a laxative, what will happen? d. Left forearm, b. A nurse is administering a cold therapy application to a client. Obtain a bedside commode for the client's use Place the client in low Fowler's position Prior to shift report, the charge nurse is making assignments for the nurses on the shift. Additionally, off-duty personnel may be needed and should be alerted to stand by; however, the command center alone makes the determination whether extra personnel should be called in, or if it would put more individuals in jeopardy. b. b. c. The emphasis is on the client's complete recovery from the illness or injury 4. 2. Client diagnosed with hemorrhoids who had some spotting of bright red blood on toilet tissue with last bowel movement. A nurse is caring for a client who frequently attempts to remove his IV catheter. During report, the nurse notes that the float nurse appears disheveled, flushed, and is trembling slightly while drinking coffee. Total abdominal hysterectomy, bladder suspension with A&P repair, client with breast reduction. Charge Nurse - RN | Fresenius Karriere In which harmonic number n is the string vibrating? Incorrect: This will take some time and would be best accomplished by sitting with the family to discuss options. e. Throw rugs, d. I will take my medications at the first sign of an attack, 41. I am feeling much better since my discharge from the hospital and I think my kidneys are working again." b. 3. This situation needs advanced monitoring and care, so this nurse with very little postpartum experience would not be the most appropriate to assign to this client. Refuse the assignment, being prepared for disciplinary action. d. Sleep apnea A client diagnosed with terminal cancer wants information about an Advanced Directive for end-of-life care. c. I'll bear weight on my ankle for 10 minutes every hour 4. b. I'll rewrap my ankle starting from the knee down This client is stable and predictable. A nurse who is breastfeeding her 4 month old. Select all that apply It is quicker to administer medications intravenously in the hospital 5. Incorrect: Moistening the dentures will ease insertion. This client is at a high risk of infection. The RN with 8 years' experience in the Intensive Care Unit. 2. The LPN/LVN can gather data, but the RN is responsible for validating and interpreting that data to assess and evaluate. Occupational therapist (an occupational therapist assists clients who have physical challenges to use adaptive devices and strategies to help with self-care activities such as feeding). What task would be appropriate for a nurse caring for a client diagnosed with gastroesophageal reflux to delegate to an unlicensed assistive personnel (UAP)? The nurse is focusing on which of the following elements of the communication process? What information should the nurse include? Which of the following interventions should the nurse include? a. Select all that apply The second client that needs to be seen by the nurse is the client having weakness, a sign of hypoglycemia. Following a large hurricane, multiple clients arrive at the emergency room for treatment. The client asks about his medications and their effects.
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a charge nurse is making client care assignments