Leadership Mgmt HESI EAQ

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The nurse is caring for a client with breathing difficulty and is unable to auscultate any breath sounds on one side. Which action should be implemented first by the nurse?

The priority care for clients with breathing difficulties who present with absent breath sounds is a needle thoracostomy. This procedure involves removing the fluid or abnormal air from the pleural space. Intubation is done for the client in severe respiratory distress. Supplemental oxygen should be given to the client with decreased oxygen saturation levels. Ventilation with a bag valve mask is given to clients if respirations are inadequate or absent.

A hospital’s emergency power generators were accidentally destroyed. The hospital management has decided to move the clients to another hospital. Which staff interventions are appropriate to ensure client safety? Select all that apply.

Damage to power generators is an example of an internal disaster that can pose danger to clients. Shifting clients to another hospital can help reduce the risk. Hospital staff should carry flashlights to ensure adequate lighting during the move and avoid injuries to clients and themselves. The hospital staff should use staircases to shift clients as the elevators would be non-functional due to power loss. The hospital staff would ideally wear headlamps if they are available as these can provide hands-free lighting. Glow sticks provide lighting and can be used while shifting clients. As previously mentioned, elevators are nonfunctional in the event of power loss and would not be used.

Which priority interventions should be followed by the nurse when caring for a client with malignant hyperthermia? Select all that apply.

The client should be ventilated with 100% oxygen using the highest possible flow rate when malignant hyperthermia is evident. The client should be intubated immediately with an endotracheal tube. All inhalation anesthetic agents should be stopped immediately as the client’s condition may worsen. The core body temperature should be monitored on an ongoing basis (wrong). An indwelling urinary catheter is inserted to monitor urine output, which is part of ongoing monitoring (wrong).

The nurse is assisting the registered nurse with delegation decisions regarding management of a client with shortness of breath. Which action by the nurse indicates a need for correction?

The nurse may not provide constructive feedback about the client care management during delegation decisions. The nurse may, however, provide constructive feedback to the delegatee to maximize the efficiency of the client care. The nurse may assist other registered nurses with delegation decisions by using three strategies: asking, offering, and doing. Asking involves inquiring about the client care problems and issues such as the respiratory rate. Offering involves suggesting ways to achieve desirable client care outcomes, such as asking the client to perform breathing exercises regularly. Doing involves demonstrating the specific task to improve client care—for instance, administering oxygen to the client.

A nursing student compares the pathophysiology of submersion injury in victims of freshwater drowning and victims of saltwater drowning. Which statement made by the nursing student indicates effective learning?

There is a difference in tonicity of both saltwater and freshwater with that of normal body fluids. When either saltwater or freshwater is aspirated by the submerged victim, the osmotic gradient caused by the aspirated fluid causes fluid imbalances in the body. Freshwater is hypotonic and saltwater is hypertonic. Only hypertonic saltwater draws fluid from the vascular space into the alveoli. Destruction of surfactant and alveolar-capillary membrane occurs in case of both saltwater and freshwater aspiration.

The registered nurse of a disaster management team teaches the staff nurse about Ebola. Which statements made by the staff nurse requires further teaching? Select all that apply.

Antiviral drug therapy is not yet available for Ebola infection, so it cannot be treated. Ebola is transmitted by direct contact with body fluids of the affected client. The vaccine for Ebola is not yet approved by the FDA for use in the market. Isolation of a client with Ebola is required to prevent the spread of the virus. The Ebola infection is suspected if the client experiences unexplained bleeding.

Which two factors would the nurse state influence the effectiveness of the leader? Select all that apply.

Readiness and assessment are two of the factors that influence the effectiveness of the leader. Ability and willingness are the two factors that need to be assessed to determine the level of the leader’s readiness. The attitude is related to the individual’s willingness.

The registered nurse is assigning a task to an unlicensed nursing personnel (UNP). Which key elements are considered while assessing the UNP’s ability to perform work? Select all that apply.

While assessing the work to be assigned to an unlicensed nursing personnel (UNPs), the registered nurse should consider the elements of safety, stability, and critical thinking. Attitude is one of the multiple factors that influences the effectiveness of the leader. Ethnicity is not a factor that plays a role in the process of delegation.

In which situation would activation of the emergency preparedness plan be necessary? Select all that apply.

When the number of casualties exceeds the usual resource capabilities, a disaster situation exists. The pleasure boat victims are being taken to a community hospital on a Saturday night when staffing is typically lower. Likewise, the victims of a manufacturing plant explosion are being taken to an urban hospital during the time of lower staffing. The victims of a bus accident are being taken to a community hospital on a holiday, during which staffing is generally lower. The number of victims from a senior citizen’s housing facility fire is large and could overwhelm available resources at the community hospital. The victims of food poisoning can easily be taken care of by existing staff and resources at an urban hospital on a weekday afternoon.

While caring for a client who was injured in a tornado, the nurse finds that the client is disoriented. Which is the most appropriate nursing intervention to prevent injury in the client?

Asking a family member or significant person who cares for the client to remain with the client will help to reduce confusion in the client. It is the most important intervention to prevent injury in the client. Keeping rails up on the stretcher will help to prevent injury in the client but it is not the most appropriate intervention. Keeping the stretcher in the lowest position will prevent injury but it is not the most appropriate intervention in clients. Maintaining adequate lighting in the room will help to prevent injury from a fall but it is not the most appropriate intervention in case of disoriented or confused clients.

What are the various challenges related to delegation? Select all that apply.

Providing clear direction to the delegatee aids accomplishment of the specified task in the given time. Understanding the specific skill set and capabilities of the delegatee is a crucial element in the delegation process. Selecting a delegatee with the specific skill set for the particular task is more productive than just selecting a competent individual. Maintaining an open line of communication with the delegatee, without any derogatory or offensive comments, yields a collaborative and productive work environment. Providing verbal attack feedback may not produce effective change and could undermine any long-term working relationship. Creating a working environment is an essential and easy delegation task that is essential to promoting positive work output.

The nurse is teaching a group of students about the manifestation of alkalosis in the central nervous system. Which statements by a student nurse are accurate? Select all that apply.

If clients suffer from the alkalosis, the manifestation in the nervous system would involve paresthesias. The client will also have a positive Trousseau sign and have anxiety and irritability. The Chvostek sign would also be positive, not negative. The client would show signs of anxiety and irritability. The central nervous system should have increased activity with alkalosis, not decreased.

What points should the nurse consider when delegating a task? Select all that apply.

Before selecting a delegatee for any particular task, it is important to understand the skill set and capabilities of the delegatee because selection of delegatees is based on specific skill sets. Selecting a delegatee based on his or her competency is an important aspect of delegation. Being certain about the capabilities is a crucial element of delegation. Willingness is not a crucial element for selecting a delegatee. In a rural setting the generally longer tenures of employees may make the delegation process easier.

A client with tongue occlusion has loss of gag reflex and alterations in level of consciousness. The blood gas test shows oxygen saturation as 40mm Hg and carbon dioxide saturation as 75 mm Hg. Which type of support provides immediate relief to the client?

Upper airway obstruction may occur with tongue occlusion, which is associated with loss of gag reflex and alterations in the level of consciousness. The client suffering from severe hypoxia (O 2 saturation of 40mm Hg) and who is hypercapnic (CO 2 saturation of 75 mm Hg) requires an emergency tracheotomy for relief within 2 minutes. Laryngeal repair is performed to prevent laryngealstenosis and to cover exposed cartilage. The abdominal thrust maneuver clears upper airway obstruction caused by a foreign body. Autotitrating positive airway pressure resets the pressure throughout the breathing cycle in a client with severe sleep apnea.

While caring for clients who survived an earthquake, the nurse finds the need to free up inpatient beds for disaster victims. Which clients does the nurse plan to discharge? Select all that apply.

Medical-surgical unit nurses, in collaboration with healthcare providers, decide to recommend clients for discharge to free inpatient beds for disaster victims. Clients who can be treated in long-term care and who can be cared for in rehabilitation should be discharged. Clients who have had no critical change in condition for the past 3 days should also be discharged to free up inpatient beds for disaster victims. Clients who are admitted for observation and are not bedridden can be discharged. Clients who have diagnostic evaluations and are not bedridden can be discharged.

Five victims of a shooting are identified as needing urgent care. What should the triage officer do first when these victims arrive in the emergency department?

The triage officer rapidly evaluates each person who presents to the hospital, even those who come in with triage tags in place. Client acuity is re-evaluated for appropriate disposition to the area within the ED or hospital best suited to meet the client’s medical needs. The clients will need to be triaged before being sent to the operating room. The triage officer would not be responsible for conducting laboratory testing or notifying the next of kin of the victims.

The nurse is working with a group of clients in a community health center. Which client should the nurse consider at highest risk for developing pneumonia?

A blood urea nitrogen level of 25 mg/dL, a respiratory rate of 38 breaths/min, and a blood pressure of 80/60 mm Hg are symptoms of pneumonia. Therefore client C has the highest risk for pneumonia. A 55-year-old client with abnormal uterine bleeding and tumors of 8 mm in uterus has uterine fibroids. They are benign and do not affect client A’s respiratory status. Client B, a 28-year-old with a carotene level of 90mcg/dL, creatine level of 1.8 mg/dL, and a folate level of 23 ng/mL may have hyperthyroidism but is not at risk for pneumonia. A folate level of 3 ng/mL and a haptoglobin of 16 mg/dL in client D, who is 33-years old, indicates hemolytic anemia and is not a risk for pneumonia.

The nurse is hired to work in a Magnet hospital. What should the nurse expect when providing care in this organization?

In Magnet hospitals, staff have autonomy and control over nursing practice. This would include attending care conferences to discuss client care needs. Salaries planned according to education level and assignments made according to years of experience would be expected in an environment with differentiated nursing practice. There is no care delivery method that utilizes physician input for annual performance appraisals.

What should the mental health nurse keep in mind when preparing to meet with a group of staff nurses who cared for victims of a disaster that occurred in the community? Select all that apply.

The usual arrangement for the most effective group interaction is a circular configuration of chairs. Staff involved in the incident need protected time to undergo stress debriefing, which generally lasts from 1 to 3 hours per session. Food should be available so that hunger is not a distraction. Typical "ground rules" for stress debriefing include strict confidentiality of information shared during the session and unconditional acceptance of the thoughts and feelings expressed by people within the group. This means that the session should not be audiotaped. The setting should be private. An auditorium would not be private.

The registered nurse is delegating a task for unlicensed assistive personnel l (UAP). Which client’s care would be suitable for delegation to the UAP?

The unlicensed assistive personnel (UAP) can monitor the temperature of client B every hour. Discharges from the surgical site of client A should be monitored, but the UAP may not have appropriate knowledge. Abdominal pain should be monitored in client C, but the UAP is not qualified to understand the condition of the client. Respiratory rate cannot be monitored by the UAP as it is the responsibility of the more qualified UNP.

The nurse is caring for a client with a platelet count of 50,000 cells per microliter. Which recommendation is inappropriate for the client?

A client with platelet count of 50,000 cells per microliter has thrombocytopenia. The client should be encouraged to shave with an electric razor, rather than with a straight blade. Walking with sturdy shoes or slippers preserves foot skin tissue and helps to reduce the chances of cuts. Forceful blowing of the nose can result in bleeding. The use of a soft-bristle toothbrush helps to prevent injury to the gums.

Which component of delegation is suitable to all the members on the healthcare team?

Authority is the component of delegation that is suitable for all the members on the healthcare team. Supervision is a right of delegation in which the delegator supervises the other assistive personnel to perform the task. Accountability is the component of delegation that is suitable for delegators such as registered nurses (RNs). Communication is the right of delegation in which the delegator gives the directions to perform the task.

The nursing student is comparing the causative agents of hyperthermia and hypothermia. Which causative agent is common to both conditions?

Alcohol is the causative agent that is common to both hyperthermia and hypothermia. Barbiturates and phenothiazines can cause hypothermia. Cardiovascular disease can cause hyperthermia.

The nurse leader is giving a speech on leadership skills to followers. Which questions enable the nurse leader to evaluate the understanding level of the followers? Select all that apply.

The question such as "what did you ‘hear’ in the process of this communication?" cannot be answered by a "yes" or "no" and requires a detailed explanation of the things that are taught. The questions starting with "how" are usually open-ended and require the person to answer in detail. Therefore these questions can help the nurse leader evaluate the understanding level of the followers. The questions such as "are you getting my points?", "would you all like a break?", and "can I change the topic in a little while?" can be answered by a "yes" and "no." Therefore these questions do not help the nurse leader to evaluate the understanding level of the followers.

What should the nurse educator emphasize when teaching about mass casualty incidents (MCIs)? Select all that apply

Mass casualty incidents (MCIs) involve large numbers of victims. An MCI is a man-made or natural event or disaster that causes permanent changes within a community. It overwhelms a community’s ability to respond with existing resources. MCIs always require significant assistance from resources outside the affected community.

Which priority assessments should be included by the nurse when caring for a client who is experiencing depression? Select all that apply.

The priority assessment for a client experiencing depression is to inquire about appetite, activity status, and emotional status. These helps determine the level of depression. Irritability and restlessness are secondary assessments for determining the depression level of a client.

The nursing manager issued orders to take the utmost care of a client with myocardial infarction and expects the staff to obey and follow the rules immediately. Which type of decision making is the manager using?

The autocratic method results in rapid decision-making and is more appropriate in a crisis situation. Optimizing decision making is when the nurse considers both pros and cons of each position. Laissez-faire is a "hands-off" approach, which is taken by manager who chooses to do nothing when intervention is indicated. The bureaucratic style is focused on organizational rules and policies.

Which aspects are considered when determining the willingness of a nursing assistant before delegating a task? Select all that apply.

An individual’s willingness is related to attitude, confidence, and commitment. Ability is related to knowledge and skills in a specific situation. Personality characteristics can influence the effectiveness of the delegator.

Which nursing care delivery system works well in emergency situations that necessitate prioritization of care?

*The functional method of delivering care works well in emergency and disaster situations. Each care provider knows the expectations of the assigned role and completes the tasks quickly and efficiently.* Team nursing, primary nursing, and Patient-Centered nursing delivery systems are not supported by evidence as working well in emergency situations.

Which skills would be essential for an effective nurse manager to develop and improve collaboration with others? Select all that apply.

In order to collaborate effectively, the nurse should be flexible, must be willing to listen to others, and must share information and ideas with others. The nurse manager should plan a thoughtful response, consider others’ perspective first, and not react hastily. The nurse manager should not share his or her own anger or frustration with other staff.

Which strategy of the nurse leader regarding the quality improvement (QI) process requires revising?

The quality improvement process mainly focuses on preventing errors rather than correcting them. The task of the QI process includes staff development. The team of the QI process involves the interprofessional team and the outcomes are set with the input of clients and the staff.

The direct care nurse, as a leader, finds that there is no formalized mechanism for providing input for organizational decision making. Which strategies does the nurse use in this situation? Select all that apply.

When there is no formalized mechanism for input into organizational decision making in a hospital, the direct care nurse uses some strategies for influence. These strategies include filing official complaints, creating unit campaigns, and holding informal discussions. Mobilizing volunteers for health fairs is the role of nurse as community leader. Inspiring staff in changing the workplace is the role of the nursing manager.

A client requires emergency cardiac surgery. The leader nurse wants to make the client aware of the situation and wants the client to decide what should be done. Which ethical model does the leader nurse follow here?

The patient-benefit model uses substituted judgment, that is, what the client would want for himself or herself if capable of making these issues known. The autonomy model facilitates making decisions for competent clients. In the paternalistic model the managers decide what is best for their team. The social justice model considers broad social issues and is accountable to the overall institution.

Which care settings are more suitable for unlicensed nursing personnel (UNP)? Select all that apply.

Extended care and long-term care settings are more suitable for unlicensed nursing personnel (UNP). Acute care, surgical care, and emergency care settings require highly qualified and licensed nursing professionals. Acute care, surgical care, and emergency care are not suitable for UNPs because the clients are less stable compared to those in extended care and long-term care. Since acute care, surgical care, and emergency care settings require highly qualified and licensed nursing professionals, the UNP’s role is very limited.

Which drawback indicates an improper follow-through on the part of a delegatee?

Improper follow-through on the part of a delegatee is failure to report results and findings. Improper follow-through occurs when the delegator does not understand the skills and abilities of the delegatee and does not provide clear and concise directions to the delegatee. The lack of cooperation with team members may be improved by educating, guiding, and monitoring the delegatee.

A client on diuretic therapy developed metabolic alkalosis. What does the nurse consider to be the priority nursing care while correcting alkalosis?

A client with alkalosis has hypotension and muscle weakness, which increases the risk for injury due to falls; therefore, to prevent injury, the priority nursing care is to prevent falls. Monitoring electrolytes daily until they return to normal is NOT the priority nursing care. Antiemetics are prescribed for vomiting and are given low priority. Once the client is protected from the risk of injury, diuretic therapy is adjusted.

Which element creates an integrative process that fosters effective delegation decisions by the registered nurse?

Stability is the element that creates an integrative process that fosters effective delegation decisions. Ability is the factor that needs to be assessed to determine the level the leaders determine. Liability is the person’s responsibility and accountability for individual actions. Ethnicity does not play a role in the process of delegation.

The nurse leader and the team received recognition because of a follower on the team. What could be the most important action of the nurse leader?

An effective leader generally is eager to share the rewards, appreciation, and recognition among the team. This increases team spirit and makes the followers follow eagerly. The nurse leader can share the recognition with the family, friends, and other higher professionals, but only after sharing it with the team.

The nurse manager reviews the performance report of a direct care nurse and asks the nurse to focus on "emotional intelligence" in order to be promoted as the nurse leader. Which statement would the nurse leader most likely use while advising the nurse on areas for improvement?

"Try to be more sensitive to the experiences of others." Emotional intelligence is advising the nurse to be more sensitive to the experiences of others. The process of thinking systematically requires the nurse to balance short-term and long-term objectives. Under the "explaining" process of Gardner’s tasks of leading/managing, the information type to be shared is determined. The involvement of the nurse in shaping the policies and practices of client care is an example of shared governance.

Clients are sent to an emergency department for care, and tags are given to the clients based on a priority basis. Which client should be given a red tag?

A red tag is given to indicate the need for immediate treatment due to life-threatening conditions. The client with third degree burns should be given a red tag. A client with burns between 15% and 40% should be tagged red. This condition is critical because untreated burns are prone to fluid and electrolyte problems and life-threatening infections. A client with a closed fracture may not require a red tag as his or her condition is not likely critical or in need of immediate treatment. Closed fractures usually do not cause infection since the fracture may not come in contact with the skin. A client with severe abdominal pain can be given a yellow tag. A client with bruises and superficial lacerations should be given a green tag as the client can wait for some time for suturing the lacerations.

What motivation factors would the nurse describe as forming a part of two-factor theory of leadership? Select all that apply.

The two-factor theory is comprised of motivation factors and hygiene factors. The motivation factor promotes job enrichment by creating job satisfaction. It includes recognition and achievement. The hygiene factor includes salary, status, and security, which help avoid job dissatisfaction and motivate workers by meeting their safety and security needs.

The head nurse of the emergency department is teaching a group of student nurses about Critical Incident Stress Debriefing (CISD) in emergency nursing. Which statement of the student nurse indicates a need for <b>further teaching?</b>

"The coleader is responsible for keeping unauthorized people out." A CISD team is a component of a CISM program. It is called to deal with the emotional needs of healthcare team members after a devastating event. A doorkeeper is a third member of CISD team who is responsible for keeping inappropriate people, such as media and spectators, out. The coleader is a peer of the group being debriefed. The doorkeeper talks to the person who leaves the session early and makes an effort to obtain follow-up from the person. The team leader has a background in a mental health/behavioral health-related field.

A registered nurse is teaching a nursing student about disaster management during an accidental fire in an industry. Which statement by the student indicates the need for further teaching?

"I will risk my life to move clients to a safe location if needed." The nurse should never risk injury to self or staff members while moving clients or attempting to extinguish a fire. The nurse can ask the help of ambulatory clients to rescue and move other clients who are at risk. Clients who sustain mild injuries can be asked to walk so that stretchers can be used for people in greater need. If a client has breathing difficulty, respiration should be manually maintained until the client iis rescued from the fire.

Which task can be safely delegated by a registered nurse (RN) to unlicensed nursing personnel (UNP) for a client with thrombocytopenia?

"Positioning the client" Clients with thrombocytopenia are at risk of bleeding with slight bruising. Therefore tasks that do not risk bruising the client may be delegated to the UNP. The RN should shave the client and maintain oral hygiene. Intravenous infusions should not be administered by a UNP to any client.

The registered nurse is caring for a client admitted with sudden paralysis in the legs and an inability to walk. Which interventions made by the registered nurse (RN) indicates correct active delegation? Select all that apply.

In active delegation, the RN assesses the situation, determines what is appropriate for client care, directs assistive personnel to perform certain tasks, and holds the individual accountable. Instructing the LPN to report the client’s vital signs is an active delegation that includes directing the assistive personnel to perform the task. Instructing the unlicensed nursing personnel to administer oral vitamin D3 is beyond their scope of practice. The RN assessing the client’s diagnostic and laboratory findings does not involve delegation. The RN administering an intravenous calcium gluconate injection does not involve delegation. Instructing the LPN to administer a vitamin B12 injection is within the scope of practice for the LPN.

The care delivery committee is determining whether primary nursing would be appropriate to implement in a 500-bed acute care hospital. Which information would support the selection of another care delivery approach? Select all that apply.

Short lengths of stay do not provide enough time for the primary nurse to plan, coordinate, and implement all aspects of a primary client’s needs. Nurses with limited experience may not be prepared educationally for primary nursing. Primary nursing is costly since the entire staff is made up of registered nurses. Since the organization was 120% over budget for salaries during the last quarter, the organization may not be financially able to implement primary nursing. Primary nursing does not use unlicensed assistive personnel (UAP) so only having 20 UAP for a 500-bed organization would support the implementation of primary nursing. Clients requesting one nurse to provide care would also support the implementation of primary nursing.

What are some challenges faced in the process of delegation? Select all that apply.

Limited resources, vulnerable populations receiving care, and large geographic area Delegation is a complex process. Delegating a task when resources are limited is a great challenge. Delegation is also more challenging the larger the geographic area is where the task should be performed. The process of delegation also becomes more challenging when care is being delivered to vulnerable populations. Time conservation is a benefit of the delegation process even if the decision to delegate may not be based on time-saving considerations. Providing assistance with the client’s activities of daily living is a benefit rather than a challenge of delegation.

Which performance appraisal method is used by nurse managers to measure the performance of the nurse both qualitatively and quantitatively?

The behaviorally anchored rating scale is a performance appraisal method that provides an overview of nursing standards by determining performance both qualitatively and quantitatively. The narrative method requires a manager to write a statement about the nurse`s performance. The critical incidents type is a performance appraisal method in which a manager keeps a written record of positive and negative performance. The graphic rating scale form is a performance appraisal checklist on which a manager rates the nurse’s performance on a continuum such as excellent, good, average, and poor.

The registered nurse is caring for a client with dysrhythmias. Which action should the nurse perform immediately according to priority?

The client with any life-threatening complication such as dysrhythmias should be assessed for ABCs immediately because the client may suffer with airway obstruction. Oxygen saturation should be monitored during ongoing assessments and after providing the client with initial treatment. Intravenous access should be established after performing initial assessments such as vital signs. After assessing ABCs in a client with dysrhythmias, the client should be provided with oxygen via nasal cannula or nonrebreather mask to maintain oxygen levels.

Which leadership theory focuses on the role of leaders in relational and contextual terms?

Style theories focus on what leaders do in relational and contextual terms. The two-factor leadership theory refers to using motivator factors to inspire work performance. The expectancy theory of leadership refers to providing specific feedback about positive performance. The transformational theory of leadership refers to a process in which the leader attends to the needs and motives of followers.

Which actions in the delegation process represent accountability? Select all that apply.

Monitoring client care and seeking the outcome report represents accountability of the task in case of conflicts. Assessing the ability of the delegatee and educating about the task indicates responsibility. Providing open and honest feedback to the delegatee improves work performance and client care outcomes. The nurse can assist other registered nurses with delegation decisions regarding safety issues, urgency to intervene, or potential negative client outcomes.

The nurse is caring for clients who were brought to the hospital following a large-scale disaster. Which client would be suitable for the nurse to triage with a "green" tag?

The nurse will triage the clients according to priority for providing care. The client who is injured and is able to walk may not require immediate treatment and would be issued a green tag. The client who is severely injured and who has no chances of survival is tagged black. The client who is stable and requires re-triage after observation is tagged with a yellow tag, indicating that the client is not in immediate danger. A red tag issued to the client indicates that the client requires immediate care.

A patient care associate (PCA) is delegated a task that can be completed in 2 hours. The PCA has limited knowledge and willingness regarding that particular task. Which leadership style should be implemented by the delegator in this situation?

If the ability and willingness of the delegatee is low and the work assigned to the delegatee can be completed in 2 hours, it means the nature of relationship between delegator and delegatee is limited. In such situation, the leadership style of the delegator should be telling, because it provides a fair amount of guidance and also limits the time spent on the interactions. The selling style of leadership should be used when the relationship is ongoing; that is, individuals who usually work together continue to work together. The monitoring style should be used when the delegatee has the ability and willingness, and has an established relationship with the delegator. The participating style can be implemented when the delegatee is willing to perform the task. Tip: Hershey’s Model of leadership provides solid foundation for delegation

In a long-term care facility, the care tasks for a client who is suffering with liver disease are being delegated. Which statement made by the delegator indicates the responsibility for the tasks is with the registered nurse? Select all that apply.

In a long-term care facility, the registered nurse will be responsible for supervising the licensed nursing professionals who will be the performing the delegated tasks. The registered nurse takes the responsibility of assessing alleviation of symptoms and monitoring the client on an hourly basis. Admission of the client to the ICU is the responsibility of the registered nurse. The licensed practical nurse (LPN) or the licensed vocational nurse (LVN) is responsible for taking the responsibility for the whole nursing unit. The LPN or LVN will be delegated the task of providing the treatments that are prescribed by the primary healthcare provider.

While delegating a specific task, the registered nurse says to the delegatee, "It is important that you measure the client’s blood pressure every 15 minutes." What does this situation indicate?

Telling the delegatee that it is important to take the client’s blood pressure every 15 minutes indicates that the delegatee has limited knowledge and the delegator is providing guidance. Telling a delegatee that he or she knows what to do and when to report indicates that the delegatee requires little guidance. Telling the delegatee that this is what is needed to accomplish a task indicates that the delegator is providing guidance to the delegatee. If the delegator and delegatee share mutual experiences, it indicates that the delegator and delegatee are creating mutual expectations.

A newly promoted registered nurse (RN) is about to start delegation for the first time in her career. Which experiences foster professional self-confidence in the early career stage for an RN? Select all that apply.

Clinical delegation experiences foster professional self-confidence in the early career of an RN. The nursing practicum experiences of applying theory to practice and developing clinical judgment will also advance the RN’s ability to become a successful delegator and foster professional self-confidence. Engagement with a nursing mentor fosters professional self-confidence in the early career of an RN. The RN must have the ability to comprehend the legal authority of delegation decisions.

Which statement is true regarding delegation? Select all that apply.

Open lines of communication between delegator and delegatee helps to eliminate any misunderstanding regarding delegated tasks. Delegation occurs only when at least two people are involved in a mutual work situation; one who has the authority to perform specific tasks and other who holds accountability for the task being performed. Delegation involves sharing activities with other appropriate authority to accomplish the work. When delegating a task to delegatee, the delegator retains accountability for effective client care by ensuring that the task is completed by the right person and that the person is supervised appropriately. The delegation potentials are significantly higher when caregivers such as UNPs are partnered.

The registered nurse (RN) delegates the task of caring for a client with a leg fracture to a licensed practical nurse (LPN) and asks the LPN to alert her if any issues arise. What approach is the RN taking as delegator in this instance?

The RN as delegator asks the LPN as delegatee to contact her if any issues arise while caring for the client; this approach involves the RN providing little guidance to the LPN. Supervision involves more than simply requesting that the delegatee alert the delegator if any issues arise. The delegator provides explanation when a new task is being delegated to a delegatee who has an established relationship with the delegator. The delegator and delegatee must establish mutual expectations when the delegatee has willingness and ability but the relationship is new.

Which behavior of the delegator with respect to the work delegated to a delegatee is characterized as "selling" according to the Hershey’s Model?

The delegator’s behavior when explaining or persuading the delegatee is characterized as " selling" according to Hershey’s Model. The delegator’s behavior when guiding or directing the delegatee is characterized as "telling." The delegator’s behavior when observing or monitoring the delegatee is characterized as "delegating." The delegator’s behavior when encouraging or problem solving is characterized as "participating."

Which members of the healthcare team are under dependent status when a task is delegated by the registered nurse (RN)? Select all that apply.

Unlicensed nursing personnel (UNP), the licensed practical nurse (LPN), or the licensed vocational nurse (LVN) whose function is under the direction of a registered nurse are given dependent status. The client attendant and the LVN are on dependent status when a task is delegated by the RN. The unit secretary is a member of the healthcare team but is devoid of formal preparation or legal recognition. The RN is the leader of the team and has responsibility for other members of the group. The primary healthcare provider is a member of the healthcare team but may delegate tasks to those with dependent status.

A client with chronic asthma is being cared for in the inpatient care unit. To assess the client on a regular basis would be delegated to which healthcare team member?

The registered nurse is a licensed nursing professional and is responsible for assessing the asthmatic symptoms of the client for providing care. The charge nurse is responsible for the coordination and assignment of tasks for the client’s care. The patient care associate is an unlicensed assistive personnel whose scope of practice is limited from assessing the client. The licensed practical nurse does not assess the client’s condition, but rather is responsible for providing treatment prescribed by the healthcare provider and delegated by the RN.

During the process of delegation, the delegator’s behavior is noted to be observing and monitoring. How is the relationship between the delegator and delagatee in this situation?

Observing and monitoring behavior of the delegator indicates delegating, which is done when the relationship between the delegator and delegatee is established. The delegator’s behavior is guiding or directing when the relationship between the delegator and delegatee is limited. The delegator’s behavior is encouraging or problem solving when the relationship between the delegator and delegatee is new or developing. The delegator’s behavior is explaining or persuading when the relationship between the delegator and delegatee is developing or ongoing.

Which healthcare settings are appropriate for delegating care according to the functional model of nursing? Select all that apply.

In the functional method, each healthcare provider knows the expectation of his or her assigned role and completes tasks quickly and effectively. This model works well in emergency situations and ambulatory clinics. Hospice settings are not suitable for this type of care, because in hospice care the client requires chronic and continuous care. Inpatient care settings are not suitable for the use of the functional model of care delivery because these settings need acute care and continuous care by careful monitoring. Acute care agencies are not suitable for the functional model because acute and more specific individualized care is required.

The registered nurse (RN) who delegates work to a newly hired licensed practical nurse (LPN) says, "Please tell me how you will go about performing this procedure, and I will share my expectations with you." Which behavior strategy of Hersey’s model is being applied?

When the LPN has the willingness and ability to perform a task, but the relationship is new, the RN will share his or her expectations and conditions with the LPN. This is a clinical example of participating. Participating is encouraging the delegatee to perform the task and taking an active part in problem solving, which may occur during the execution of a given task. If the LPN has limited knowledge and ability to perform a task, the RN will provide more guidance, which is an example of telling what is the task to be done and how it is to be performed. If the LPN is delegated a new task, it requires explanation from the RN. This is termed as selling in Hersey’s model, which is the process of explaining and persuading; this happens if a situation involves a new task and the relationship is ongoing. If the LPN has an established relationship and experience, he or she requires a little guidance and this is called delegation.

A registered nurse is teaching a group of newly hired licensed registered nurses, licensed practical nurses, and unlicensed nursing professionals. Which teaching strategies would be appropriate to develop competencies? Select all that apply.

Competencies can be developed through different teaching strategies such as case studies, online learning, and clinical nursing practice. These strategies can help in improving the learning ability of the student nurses, licensed practical nurses, and unlicensed nursing professionals. Teaching experience and demographics may not be required to develop competencies.

While caring for a client with severe fever, the registered nurse (RN) delegated the task to a new delegatee to assist the RN in recording the temperature. Which instruction given by the RN indicates that the delegatee is new to working with that RN?

When the work relationship is new, the registered nurse (RN) should ask the delegate to explain how he or she would perform a particular task. So, learning how the delegatee will record the temperature will help to create mutual expectations and conditions for performance. Recording the temperature every hour is the instruction given to the delegatee who has limited knowledge and limited ability to perform the task. Telling the delegatee what is necessary while recording the temperature is important to a delegatee who is new to the assigned task. A delegatee with good knowledge needs minimal guidance, but he or she should remember to report any client issues to the available RN at any time.

The behavior of four nurses in different situations is given below. Which nurse exhibits a behavior that can be characterized as delegation according to Hersey’s model?

Hersey’s model describes "delegation" as the leader’s behavior of observing or monitoring if the delegatee has the ability, willingness, and expertise to accomplish the work and there is an established relationship, as with nurse B. Nurse A exhibits guiding or directing, described as "telling," in which the delegator simply tells the individual what is the task to be done and how to perform the task. This happens if the relationship is limited. "Selling" is exhibited by nurse C and is the process of explaining and persuading, which happens if a situation involves a new task and the relationship is ongoing. "Participating" is exhibited by nurse D and is the ability of encouraging the delegatee to perform the task and taking an active part in problem solving, which may occur during the execution of a given task.

While delegating a task, the registered nurse says to the delegatee, "Please tell me how you go about performing this procedure, and I will share with you my perspective about how frequently and under what conditions we need to communicate with and report to each other." What does this indicate?

Asking a delegatee how he or she performs the procedure and sharing each other’s perspective and when to communicate indicates that the delegator and delegatee are creating mutual expectations. When the delegatee demonstrates a task, it indicates that the delegatee requires explanation. The delegator will direct the procedures to the delegatee when the delegatee has limited knowledge. The delegator will motivate the delegatee when the relationship between the delegatee and delegator is established.

Which statement effectively describes the steps to be taken by healthcare personnel when responding to healthcare facility fires?

For clients on life support, the nurse should maintain their respiratory status manually until they are removed from the fire area. The nurse should discontinue oxygen for all clients who can breathe without it. After everyone is out of danger, the nurse can seek to contain the fire by closing doors and windows and using an ABC extinguisher, if possible. Bedridden clients can be moved from the fire area in bed, by stretcher, or in a wheelchair. If required, however, one or two staff members can move these clients on blankets or carry them.

Which phase in the disaster management continuum does the nurse understand as including the attempt to limit a disaster’s impact on human health and community function?

There are five phases in the disaster management continuum, which include preparedness, mitigation, response, recovery, and evaluation. In mitigation, there will be plans for attempting to limit a disaster’s impact on human health and community function. Recovery includes focusing on stabilizing the community and returning it to the previous status. Response includes implementation of the disaster plan. Preparedness is the preparation of a protective plan that is designed before the event has occurred.

While assessing the airway patency of a client after a bomb blast, the nurse suspects severe brain injury and gives a score of 7 using the Glasgow Coma Scale (GCS). Which intervention is most appropriate for the client?

The most appropriate intervention for a client with a GCS score of 7 is preparing for endotracheal intubation and mechanical ventilation. The jaw-thrust maneuver is performed in a client if there is any risk of spinal injury. The use of large-bore catheters to maintain vascular access is done to perform resuscitation in traumatic conditions. Observing for chest wall trauma or other physical abnormalities may not be the appropriate intervention for a client with brain injury.

How should a student nurse be trained for implementing delegation in practice?

Interaction with highly qualified, clinically experienced nursing mentors fosters professional self-confidence in the student nurse. These experiences allow student nurses to build up their ability to be successful delegators. Delegation knowledge should also be reinforced in nursing continuing education programs. Didactic content about delegacy can be improved by pairing the education and the clinical experience from the healthcare practice site. The student nurse does not have enough knowledge to make master delegation decisions without adequate training.

While caring for a post-operative client, the delegator has assigned a task to a delegatee. Which statements made by the delegator indicates that the delegatee has the experience to perform the task? Select all that apply.

A delegatee with good experience may need little guidance. He or she knows what to do and when to report. As the delegatee has experience, he or she should just remember that the delegator is available at all times; the delegate can report at any time. The delegator should also make it known that the delegatee’s competencies are known. The delegator tells a delegatee who is new to a task what is necessary to perform that task. The delegator will share expectations about the delegatee’s performance when that delegatee can do the work and when he or she is new in assisting the registered nurse (RN). When the delegatee can do the work and is new in assisting the RN, the delegator tells the delegatee the appropriate conditions for notifying one another.

A green-tagged client arrives at the emergency department (ED) after a mass casualty incident (MCI) involving radiation. Which is the priority nursing action for this client?

The priority nursing action for a green-tagged client who arrives at the ED after exposure to radiation is implementing decontamination measures. This measure is the priority because it is essential that members of the healthcare team, and clients, are not exposed to the radiation while providing care. While the other nursing actions (performing a head to toe physical examination, placing a special bracelet with a disaster number, and taking a digital photo and placing it on the medication record) should occur during the admission process to the ED, these are not the priority actions.

While performing a secondary emergency assessment survey, the nurse uses the mnemonic AMPLE to determine the client’s condition after a natural disaster. Which type of assessment is performed in this scenario?

History and head-to-toe assessment involves use of the mnemonic AMPLE that includes Allergies, Medication history, Past health history, Last meal, and Events preceding illness/injury to determine the history of the client. Giving comfort measures is an emergency assessment that is used to assess, treat, and reassess for pain and anxiety. Posterior surfaces are inspected to determine bleeding, bruises, and lacerations. Facilitating family presence includes determining the caregiver’s desire to be present during invasive procedures.

While caring for an 8-year-old victim of an earthquake, the nurse finds that the child has trouble sleeping, startles easily, and experiences "flashbacks" of the disaster. What is the appropriate nursing intervention in this situation?

A client who is unable to sleep, startles easily, and experiences "flashbacks" of disasters displays symptoms of posttraumatic stress disorder (PTSD). Therefore the nurse should refer the child to a clinical psychologist or psychiatrist. Restraining the child does not address the PTSD and would be unethical. Administering sedatives may help the child sleep but would not address the PTSD. Placing the child’s favorite toy beside him or her in bed may provide comfort but would not address the underlying PTSD. Test-Taking Tip: Disasters can disturb the victims physically and mentally. Use this information to answer this question accurately.

The nurse is learning about the types of injuries caused by explosive devices used as agents of terrorism. Which statement about the injuries caused by explosive devices does the nurse know to be true?

The shock wave generated by an explosion primarily causes blast injuries to the lungs, GI tract, and middle ear. Penetrating injuries are caused when shrapnel from the explosive device penetrates the skin; damage to the middle ear is not typical of penetrating injuries. Blast injuries result from the supersonic over pressurization shock wave caused by the explosion. Crush injuries, such as blunt trauma, often result from explosions in confined spaces causing structural collapse.

The nurse administrator for a long-term care facility is implementing a disaster response plan for staff and residents. Which staff member statements indicate correct understanding of the plan? Select all that apply.

Hospitals are not the only health care agencies that are required to practice disaster drills. Long-term care (LTC) facilities are also mandated to have annual drills to prepare for mass casualty events. Part of the response plan must include a method for evacuation of residents from the facility in a timely and safe manner. Nursing homes are also required to have a disaster response plan. Long-term care facilities are not held to the same standards as hospital facilities. Insurance payment for medical care is not contingent on the implementation of a disaster response plan.

After a bomb blast in a city, why would the federal government send the Medical Reserve Corps (MRC) to the site?

The Medical Reserve Corps (MRC) helps establish first aid stations or special-needs shelters to victims of a disaster. The National Disaster Life Support Foundation renders core, basic, and advanced disaster life support training courses. International Medical Surgical Response Teams (IMSuRTs) establish fully functional field surgical facilities. A Disaster Medical Assistance Team (DMAT) is a medical relief team that is deployed to a disaster area with enough medical equipment and supplies to sustain operations for 72 hours.

The registered nurse (RN) is delegating tasks to licensed practical nurses (LPNs) regarding client care. Which factors should be considered when delegating a task to the LPN? Select all that apply.

The decisions for delegation should be based on multiple factors such as the client’s condition, complexity of the task, and predictability of outcomes. The number of LPNs may not be important information while assigning the tasks. Relationship status between the delegatee and the delegator are not important considerations for delegating a task to the LPN effectively.

The nurse is triaging a group of clients injured in a tornado using the three-tier system. Which conditions are triaged as life-threatening conditions? Select all that apply.

Stroke, active hemorrhage, chest pain with diaphoresis, and respiratory distress are life-threatening conditions and should be triaged as emergent. Clients with skin rash are categorized as nonurgent as care can be delayed without fear of deterioration. Displaced or multiple fractures are triaged as urgent, meaning they require quick treatment but are not life threatening.

Which component of delegation is considered a "two way process"?

Responsibility is a two way process. Authority is the ability to perform duties in a specific role. Supervision is defined as the "provision of guidance and oversight of a delegated nursing task." Accountability may not be a two-way process. It determines if the actions were appropriate and provides a detailed explanation of what occurred.

A client is diagnosed with cancer and is physically weak. The delegator has delegated the healthcare team members to care for the client. Which aspects of the care are most appropriate for the registered nurse (RN)? Select all that apply.

The RN is capable of providing physical and emotional aspects of care when the client is diagnosed with life-threatening conditions. The RN should take the responsibility of helping the client be hopeful about the treatment and providing emotional support to the client’s family. Vitamin supplements are administered by the licensed practical nurse. The unlicensed nursing professional can collect the medical history. Collecting urine samples is delegated to nursing assistive personnel.

Which statement is correct regarding delegation? Select all that apply.

Delegation involves two people—delegator and delegatee—with the transfer of authority to perform the task. The delegator retains accountability for the outcome of the task delegated. The delegatee holds responsibility but not accountability for the task. Assignment involves the transfer of both responsibility and accountability of the work to the delegatee. Principles of delegation outline what nurses need to know and do in relation to completing the task

What does the nurse understand is the collaborative definition of delegation according to the American Nurses Association (ANA) and the National Council of State Boards of Nursing (NCSBN)?

According to the ANA and the NCSBN, delegation is the process for the nurse to direct another person to perform nursing tasks and activities. The process of guiding, directing, and influencing the outcome of an individual’s performance of an activity is defined as supervision. The transfer of accountability and responsibility indicates assignment. According to the NCSBN, delegation is defined as the act of transferring the authority to perform a selected nursing task in a selected situation to a competent individual.

Which member of the healthcare team would the nurse claim performs functions through passive delegation?

A pharmacist performs functions through passive delegation. Unit secretaries may not be eligible to perform any activity because they do not have formal preparation and legal recognition. The licensed practical nurse does not delegate, but rather acts as a delegatee. The unlicensed assistive personnel are also delegatees.

who is accountable for the ongoing evaluation of a client’s care?

Registered nurses are accountable for the initial assessment and the ongoing evaluation of a client’s care. CNOs are accountable for establishing systems to communicate competency requirements related to delegation. The LPN directly provides care to the client. UNPs provide client care under the supervision of a registered nurse. Test-Taking Tip: Do not worry if you select the same numbered answer repeatedly, because there is no pattern to the answers.

Which of these clients can be provided care safely by unlicensed nursing personnel? Select all that apply.

The greater the stability of a client, the more likely it is that unlicensed nursing personnel (UNP) can provide safe client care. It is also easy for a UNP to care for a client who is recovering. A client with pain is anxious and agitated, and it will take the UNP time to calm the client. Client care may be affected when the client is psychologically upset and has suicidal intentions.

Which healthcare team member is familiar with all the needs of any individual client?

The charge nurse is involved in the coordination and assignment of care to individual clients. Therefore, the charge nurse is the only person familiar with all the needs of any individual client who is under care. Orderlies are unlicensed assistive personnel who are delegated to care for the client’s basic needs and do not have complete knowledge of a client’s condition. Nursing aides are not familiar with all client needs, but care for the client according to the tasks delegated to them. The patient care associate is an unlicensed nursing professional involved in basic care of the client.

Which healthcare professional would the nurse know is held accountable for the tasks performed by the patient care associate (PCA)?

The delegator is held accountable for tasks performed by the delegatee. In this situation, the delegator is the RN; therefore, the RN is held accountable for the tasks performed by the PCAs. The RN is also accountable for delegation to LVNs, UAPs, and UNPs as delegatees.

Which right is applicable when the delegator and delegatee understand a common work-related language?

When the delegator and delegatee understand a common work-related language, then right communication is applicable. Right person is applicable when the delegatee has appropriate knowledge and experience to perform a task. Right supervision is applicable when the delegator is able to monitor and evaluate the client appropriately. Right circumstance is applicable when the delegation process is applicable for the situation.

The National Council of State Boards of Nursing (NCSBN) committee has realized that the job descriptions of some healthcare professionals are inconsistent. Which healthcare member is the NCSBN referring to?

Delegation can be challenging because UNPs are educated in a formal program of study but the educational preparation and job descriptions of UNPs are not consistent. Therefore, the NCSBN has expressed concern and recommended that these educational programs have greater public authority. The registered nurses’ job descriptions are not inconsistent. Chief nursing officers have well-defined job descriptions. Licensed vocational nurses also do not have inconsistent job descriptions.

The legal authority has delegated the tasks according to the model of analysis type of care. Which statements are true regarding the model analysis? Select all that apply.

Model analysis is a type of care that benefits clients in terms of satisfaction of care being provided. In model analysis, the team nursing method is followed. It is a cost-effective system because it works with an expected ratio of unlicensed to licensed personnel. Organizational decision making occurs at lower levels in model analysis. Control of quality is lower in model analysis. There may be inadequate communication among staff members due to the higher potential for fragmentation of care. Test-Taking Tip: Be alert for details about what you are being asked to do. In this Question Type, you are asked to select all options that apply to a given situation or client. All options likely relate to the situation, but only some of the options may relate directly to the situation.

A client is hospitalized with dehydration. Which tasks are appropriate to delegate to a licensed practical nurse? Select all that apply.

The licensed practical nurse records the vital signs, administers fluids orally, and performs oral-rehydration therapy and may be under the supervision of the registered nurse. Feeding the hospitalized client and helping the client to change clothes are performed by the unlicensed nursing personnel.

The registered nurse delegates the care of a client in the immediate postoperative period to the patient care associate (PCA). Which tasks performed are in the scope of practice of the PCA? Select all that apply.

The tasks that may be delegated to the patient care associate (PCA) for postoperative client care include providing basic comfort and hygiene. Feeding the client is basic care provided by the PCA. Assisting the client with bathing is the basic hygiene provided by the PCA. Primary ambulation of a postoperative client should be done by the registered nurse or another licensed practitioner. The PCA can monitor vital signs for stable clients but would not be delegated the task of monitoring vital signs for a postoperative client. Primary teaching of leg exercises to the client should be done by the registered nurse. Test-Taking Tip: The PCA has a limited scope of practice when delivering care to the postoperative client. When answering questions related to postoperative care, be specific about the role of PCA.

The registered nurse is delegating tasks for nursing assistants caring for a client who requires more attention. Which element should be considered when selecting the suitable nursing assistant for delegation of a task?

Critical thinking is of utmost importance for selecting a suitable nursing assistant for delegation of a task in a situation where a client requires more attention, as the delegatee should be able to perform the task effectively. Time, safety, and stability are also the elements for effective delegation, but these are suitable depending on the situation for assigning a task and delegation.

Which care activities would be involved in a correct delegation process? Select all that apply.

Activities such as cleaning the client’s body and assisting the client with oral feeding can be performed by the licensed practical nurse (LPN) and unlicensed assistive personnel (UAP). It is always the responsibility of the registered nurse (RN) to guide the UAP while performing any activity. The UAP is not allowed to perform activities such as providing medication. The LPN should not evaluate the client condition; it is the responsibility of the RN. STUDY TIP: Answer every question. A question without an answer is the same as a wrong answer. Go ahead and guess. You have studied for the test and you know the material well. You are not making a random guess based on no information. You are guessing based on what you have learned and your best assessment of the question.

Which factors should be assessed to determine the level of followers’ readiness according to Hersey’s model? Select all that apply.

According to Hersey’s model, the delegator should check the ability and willingness of the delegatee before delegating any task. Information about family history may not be required for delegating a task. According to Hersey’s model, work experience and educational qualifications are not considered as factors required to determine followers’ readiness.

What is discussed in Hersey’s 2006 model related to delegation?

Hersey’s model describes situational leadership, which include the core competencies of a situational leader. Anthony and Vidal described the five rights of delegation. Hersey’s model does not include the legal authorities for delegation. Anthony and Vidal described characteristics of communication, such as information decay and information salience.

The registered nurse (RN) delegates a task to the licensed practical nurse (LPN). If the LPN fails to perform the task within acceptable standards, what would happen? Select all that apply.

If the delegated task is not performed within acceptable standards, a potential for nursing malpractice emerges. Failure to delegate and supervise within acceptable standards may extend to direct corporate liability for the institution. Whenever care is provided by staff other than a registered nurse (RN), the accountability for care remains with the delegator who is an RN. The licensure of the licensed practical nurse (LPN) would not be cancelled because the LPN is not held accountable for the situation. When the work is assigned to the LPN, only responsibility of the task is transferred.

How can registered nurses develop delegation and supervisory strategies to adapt to their changing roles? Select all that apply.

Engaging a nurse mentor helps provide guidance and facilitate problem-solving related to delegation and supervision. Reinforcing delegation knowledge through continuing education helps nurses become familiar with the changing trends in health care delivery in context of delegation. Seeking high-quality clinical delegation experience early in a nurse’s career helps nurses gain confidence in delegation skills. Practicing the nursing care process in various clinical settings helps the nurses to improve patient outcomes, but would not specifically help develop delegation and supervisory strategies. Becoming familiar with the hierarchy of authority in the health care organization may help nurses understand management-related issues. However, this knowledge would not directly help nurses develop delegation and supervisory strategies.

The registered nurse is caring for an older client who is admitted with gastric ulcer and joint pains and is unable to perform activities of daily life (ADL). The legal authority has stated, "Provide the treatment according to the client’s care sheet." Which delegatee should take up the task?

The registered nurse will delegate the task of providing medication to the client to the licensed practical nurse (LPN). The LPN’s scope of practice is to administer oral medications and to provide the treatment that is prescribed in the client’s case sheet. Orderlies are unlicensed assistive personnel who are delegated with tasks such as providing basic care, hygiene care, and assisting the clients in ADLs. Certified nursing aides are also unlicensed assistive personnel whose scope of practice does not allow them to perform tasks such as administering medications. A patient care associate is an unlicensed assistive personnel who can care for the client with basic needs such as ADLs

The registered nurse assists other registered nurses when there are no safety issues. While assisting, the registered nurse uses the strategy of asking. What is the benefit of this strategy? Select all that apply.

When there are no safety issues, the registered nurse can assist other nurses by using different strategies. The strategy of asking begins with questions related to the problem or issue regarding client care and it allows the nurse to reassess and examine the situation differently. Asking provides an opportunity to open lines of communication between the delegator and delegatee. The strategy of doing helps in demonstrating a specific task or behavior to improve client care. The strategy of offering helps in making a suggestion to facilitate the achievement of a desirable client care outcome.

The newly hired nurse is delegated the task of preparing the client care plan for a diabetic client who underwent amputation. Which task in the care plan is inappropriate according to guidelines?

The LPN’s scope of practice includes monitoring vital signs in clients with a stable condition. Instructing the LPN to monitor the vital signs of a client in an acute condition is inappropriate according to the guidelines. Administering antidiabetic medications to a diabetic client who underwent amputation should be done by the RN because the condition of the client is acute. The RN is responsible for assessing the blood glucose levels of the client who underwent amputation. The LPN is instructed to change the dressing at the amputation site.

What are the elements integrated into delegacy? Select all that apply.

The four elements that foster effective delegation decisions are safety, critical thinking, stability, and time. Leadership, critical thinking, communication, and clinical practice are the competency skills of a charge nurse.

The registered nurse (RN) delegates the tasks of caring for a client with pressure ulcers. The client suffers further tissue necrosis during treatment. What could be the reason for this condition?

The patient care associate (PCA) is not authorized to irrigate the wound as improper technique can lead to tissue damage. The RN is qualified to perform wound care; therefore, cleaning the wound is not likely to lead to tissue necrosis. Pressure ulcers are associated with pain. The LPN administering oral analgesics may relieve the pain, but it will not cause tissue necrosis. Having the licensed practical nurse (LPN) reposition the client every 1 or 2 hours will minimize the risk of tissue necrosis due to pressure ulcers.

Which factors does the registered nurse consider in the decision to delegate process? Select all that apply.

Two factors responsible for the decision to delegate process are predictability of outcomes and complexity of the task to be performed. Evaluation, nursing judgment, and pervasive functions are not factors in the decision to delegate process.

OB Modification Theory

OB Mod theory of leadership uses positive reinforcement to motivate followers to repeat constructive behaviors in the workplace. According to this theory, the leader uses punishment sparingly as the results are unpredictable in supporting the desired outcome.

Hierarchy of Needs Theory

Motivating staff by providing hierarchy of human needs indicates the application of hierarchy of needs theory of leadership.

Two-factor theory

Using motivator factors liberally to inspire work performance indicates the application of two-factor theory.

Situational-contingency theory

Assessing each situation and determining the action based on the people involved indicates the application of situational-contingency theories of leadership. The leader should present a task structure that has clarity of goals The leader should develop trust and respect between leaders and followers The leader should reward followers for their excellent work.

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