Nursing Questions about Leadership and Management (26-30)

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26. A nurse notes that a postoperative client has not been obtaining relief from pain with the prescribed opioid analgesics when a particular licensed practical nurse (LPN) is assigned to the client. The appropriate action for the nurse to take is to:

a) reassign  the LPN to the care of clients not receiving opioids
b) notify the physician that the client needs an increase in opioid dosage
c) review the client's medication administration record immediately and discuss the observations with the nursing supervisor
d) confront the LPN with the information about the client having pain control problems and ask if the LPN is using the opioids personally

27. A medication nurse is supervising a newly hired licensed practical nurse (LPN) during the administration of oral pyridostigmine bromide (Mestinon) to a client with myasthenia gravis. Which observation by the medication nurse would indicate safe practice by the LPN?

a) asking the client to take sips of water
b) asking the client to lie down on his right side
c) asking the client to look up at the ceiling for  30 seconds
d) instructing the client to void before taking the medication

28. During orientation, a graduate nurse learns that the nursing model of practice implemented in the facility is a primary nursing approach. When the nurse attends report on the medical unit, the nurse will verify with the staff which of the following characteristics of primary nursing?

a)  critical paths are used when providing client care
b) the nurse manager assigns tasks to the staff members
c) a registered nurse (RN) leads nursing staff in providing care to a group of clients
d) a single RN is responsible for planning and providing individualized nursing care to clients

29. A clinical nurse manager conducts an inservice educational session for the staff nurses about case management. The clinical nurse manager determines that a review of the material needs to be done if a staff nurse stated that case management:

a)  manages client care by managing the client care environment
b) maximizes hospital revenues while providing for optimal client care
c) is designed to promote appropriate use of hospital personnel and material resources
d) represents a primary health prevention focus managed by a single case manager

30. A nurse manager is reviewing the critical paths of the clients on the nursing unit. The nurse manager collaborates with each nurse assigned to the clients and performs a variance analysis. Which of the following would indicate the need for further action and analysis?

a)  a client is performing his own colostomy care
b) purulent drainage is noted from a postoperative wound incision
c) a 1-day postoperative client has a temperature of 98.8F
d) a client newly diagnosed with diabetes mellitus is preparing his own insulin for injection





Nursing Questions about Leadership and Management
Answers and Rationale

26) C

- In this situation, the nurse has noted an unusual occurrence, but before deciding what action to take next, the nurse needs more data than just suspicion. This can be obtained by reviewing the client's record. State and federal labor and opioid regulations, as well as institutional policies and procedures, must be followed. It is therefore most appropriate that the nurse discuss the situation with the nursing supervisor before taking further action. The client does not need an increase in opioids. To reassign the LPN to clients not receiving opioids ignores the issue. A confrontation is not the most advisable action because it could result in an argumentative situation.

27) A

- Myasthenia gravis can affect the client's ability to swallow. The primary assessment is to determine the client's ability to handle oral medications or any oral substance. Options B and C are not appropriate. Option B could result in aspiration and option C has no useful purpose. There is no specific reason for the client to void before taking this medication.

28) D

- Primary nursing is concerned with keeping the nurse at the bedside actively involved in direct care while planning goal-directed, individualized client care. Option A identifies a component of case management. Option B identifies functional nursing. Option C identifies team nursing.

29) D

- Case management represents an interdisciplinary health care delivery system to promote appropriate use of hospital personnel and material resources to maximize hospital revenues while providing for optimal client care. It manages client care by managing the client care environment.

30) C 

- Variances are actual deviations or detours from the critical paths. Variances can be either positive or negative, or avoidable or unavoidable and can be caused by a variety of things. Positive variance occurs when the client achieves maximum benefit and is discharged earlier than anticipated. Negative variance occurs when untoward events prevent a timely discharge. Variance analysis occurs continually in order to anticipate and recognize negative variance early so that appropriate action can be taken. Option B is the only option that identifies the need for further action.




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Nursing Questions about Leadership and Management (1-5)


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Nursing Questions about Leadership and Management (31-35)