NGN Management Exam

Complete the sentences by choosing the most probable option for the missing information that corresponds with the same numbered list of options provided.

In nursing care for elderly patients, especially those with Alzheimer's disease, delegator-related barriers can significantly affect the quality of care.
One of the primary delegator barriers is(are) the   in assigning responsibilities.
The nurse must be clear about their delegating tasks, especially since Alzheimer's patients require consistent, specialized care.
Furthermore, the delegator might harbor doubts about the competence or training of the delegatee in handling Alzheimer's patients, leading to hesitancy in assigning critical tasks.
This hesitancy can disrupt
Additionally, there may be a lack of understanding or communication about the specific needs and preferences of the patient.
A 72-year-old with Alzheimer's might have particular routines or triggers, and any oversight due to poor delegation can result in episodes of for the patient.
Effective delegation, therefore, is crucial in ensuring seamless, patient-centered care for those with Alzheimer's disease.

John Reynolds, a 54-year-old Caucasian male, was admitted to the hospital for treatment of severe pneumonia. His health history included chronic obstructive pulmonary disease (COPD) and a mild penicillin allergy.
During his treatment, a critical incident occurred. John was prescribed a specific medication that was intended for intramuscular injection, as per his treatment plan. However, due to a miscommunication, the medication was incorrectly administered intravenously by a staff nurse. Shortly after the administration, John experienced a respiratory arrest, a life-threatening event requiring immediate resuscitation and intensive care. He was stabilized and then transferred to the intensive care unit for further monitoring and treatment.

This incident prompted an immediate response from the nurse manager, who recognized the gravity of the error and its implications. The nurse manager began a thorough review of the circumstances leading to the error and was preparing to address the situation with the healthcare team and hospital administration.

In the context of the serious medication error involving John Reynolds, which led to his respiratory arrest and subsequent transfer to the intensive care unit, the nurse manager acknowledges that this type of error is known as:

Emma, a 68-year-old woman with chronic obstructive pulmonary disease (COPD), has been hospitalized for an exacerbation. After a week of treatment, her condition has stabilized, and she is ready for discharge. The nurse is preparing Emma for her transition from the hospital to her home setting and aims to ensure that she is well-equipped to manage her condition at home.
Which of the following actions should the nurse prioritize or not when providing Emma with information on discharge procedures to her home setting?

In a busy urban hospital, Registered Nurse (RN) Elizabeth Williams is working on a bustling medical-surgical unit. She is functioning as a team leader for a diverse group of five patients, each with unique medical needs. Assisting her are a Licensed Practical Nurse (LPN), Jenna Smith, and a Certified Nurse’s Aide (CNA), Michael Brown. The patients under their care include:

1. Patient A, a 65-year-old male with pneumonia, requires frequent respiratory assessments and nebulizer treatments.
2. Patient B, a 58-year-old female recovering from abdominal surgery, needs wound care and monitoring for signs of infection.
3. Patient C, a 70-year-old male with type 2 diabetes, requires regular blood sugar monitoring and insulin administration.
4. Patient D, a 45-year-old female with a fractured leg, needs pain management and assistance with mobility.
5. Patient E, an 80-year-old female with dementia, requires constant supervision to prevent wandering and assistance with basic activities of daily living.

Elizabeth must efficiently delegate tasks to Jenna and Michael, ensuring that each patient receives appropriate and timely care. She is aware of the scope of practice for both the LPN and CNA and must decide which tasks are suitable for delegation.

Considering the patient cases and team composition, which of the following actions should not be delegated to the CNA, Michael Brown? Select all that apply.

The postanesthesia care unit (PACU) nurse reports to the unit nurse at the bedside of a patient who just had surgery for a total hip replacement. Approximately 20 minutes after the patient’s admission to the unit, the patient experienced a period of respiratory depression that was later attributed to medication received in the PACU. What error during the nurse-to-nurse handover may have contributed to this patient’s problem?

An elderly patient with a history of hypertension and diabetes presents with new symptoms suggestive of a neurological issue. The primary care nurse realizes that a referral may be necessary.
Which of the following actions is most appropriate for the primary care nurse concerned about the patient's new neurological symptoms?

Margaret Lee, a 65-year-old Asian woman, was admitted to the cardiology unit with a diagnosis of congestive heart failure. Her past medical history includes hypertension, type 2 diabetes, and a previous myocardial infarction.

Upon admission, Margaret's vital signs were stable, and she was comfortable, with the Nurse’s notes indicating she was in good spirits, engaging with staff, and adhering to her treatment plan. However, during a routine check, the nurse observed that Margaret had suddenly become short of breath. Her respiratory rate had increased to 28 breaths per minute, and she appeared visibly distressed.
Oxygen saturation had dropped to 88% on room air, a significant decrease from her previous readings of 95%. The nurse quickly administered supplemental oxygen, which improved her saturation to 92%. Recognizing the urgency of the situation, the nurse prepared to contact the healthcare provider (HCP) using the SBAR (Situation, Background, Assessment, Recommendation) communication format to ensure clarity and efficiency in the communication.

As the nurse prepares to use the SBAR format to communicate with the healthcare provider about Margaret Lee’s sudden onset of shortness of breath, which of the following should be included when addressing the "Situation" in the SBAR format?

Robert Johnson, a 58-year-old Black male with advanced congestive heart failure (CHF), was admitted to a large acute care facility for exacerbation of his condition.
Robert has a complex medical history including type 2 diabetes, chronic obstructive pulmonary disease (COPD), and hypertension.
The healthcare team observed that Robert's adherence to his complex medication regimen and dietary restrictions was inconsistent, potentially contributing to his frequent hospitalizations.
His case highlighted the need for a more collaborative approach in the management of his care, involving not just the healthcare professionals but also Robert and his family in decision-making processes.

In the context of the complex healthcare needs of patients like Robert Johnson, what result do the nurse leaders of a large acute care facility expect to see by implementing shared decision-making in each nursing unit?

The nurse is conducting pre-operative assessments on a group of clients scheduled for surgeries later in the day. Among the various assessments, determining the risk for latex allergies is critical to avoid potential complications during and after the surgical procedure.
Which two client has the greatest risk for latex allergies? Select all that apply

On a cardiac telemetry unit, a newly admitted patient with a history of atrial fibrillation requires urgent medication. The attending physician gives an oral order for the medication, and the nurse needs to verify and implement it.
Which of the following steps should the nurse prioritize when receiving an oral order for urgent medication?

Maria Garcia, a 40-year-old Hispanic woman with a history of Type 1 Diabetes and recent acute kidney injury, was admitted to a specialized renal unit in a tertiary care hospital. 
Maria's complex health situation is further complicated by her limited health literacy and difficulty understanding her condition and treatment plan.
The healthcare team, including a diabetes educator and renal dietitian, has been involved in her care, but there's a growing realization among the nursing staff that current care approaches are not effectively meeting her needs.

In the context of Maria Garcia's case, where current care strategies seem insufficient, what is the first step nurses should take in integrating evidence-based practice (EBP) in a nursing unit?

In a large teaching hospital, Nurse Manager Laura Anderson oversees a team of dedicated nurses in the general surgery unit. Among her staff is Sarah Thompson, a competent and generally meticulous staff nurse with three years of experience. Recently, Sarah was involved in a critical incident where she inadvertently administered the wrong medication to a 47-year-old male patient, Mr. Johnson, who was recovering from a minor surgical procedure. The medication error led to a severe allergic reaction, causing anaphylaxis and subsequently necessitating an emergency surgical intervention to address complications arising from the reaction.

Sarah had correctly checked the patient's identity and reviewed his medication chart, but in a moment of distraction, picked up and administered a medication intended for another patient with a similar name.
Upon realizing her mistake, Sarah immediately reported the error to her superiors and was instrumental in the prompt initiation of corrective measures. However, the incident deeply affected her, leading to feelings of guilt and anxiety about her professional competence.

In the aftermath of the incident, Nurse Manager Laura Anderson is closely monitoring Sarah’s well-being and performance, understanding that such an event can have significant emotional and professional repercussions. Laura anticipates that Sarah may experience a range of reactions:

Given the situation, what type of reaction does the nurse manager expect Sarah Thompson to experience following the medication error that led to a patient requiring surgery?

A student nurse is on her clinical rotation in a medical-surgical ward. She has been shadowing a registered nurse for the past few weeks and has been gradually given more responsibilities. Today, she's been asked to perform a new procedure on a real patient for the first time. She recalls practicing the procedure in the simulation lab but is unsure about some specifics. Wanting to ensure patient safety and the correct process, she decided to approach her clinical instructor.
By asking her clinical instructor a clarifying question regarding the procedure, the student nurse demonstrates which critical thinking attitude?

Elizabeth Thompson, a 52-year-old African American female with a history of rheumatoid arthritis and recently diagnosed stage II breast cancer, was admitted to the oncology ward following her first round of chemotherapy.
Elizabeth has been struggling with severe fatigue, occasional shortness of breath, and a lack of appetite.
Her vital signs at admission were: blood pressure 130/85 mmHg, heart rate 88 bpm, respiratory rate 18 breaths per minute, and oxygen saturation 96% on room air.
The nurse’s notes highlighted her concerns about managing her pain and maintaining her independence during her hospital stay.
Elizabeth lives alone and has expressed feelings of anxiety regarding her diagnosis and treatment plan.
Her lab results showed mild anemia and slightly elevated liver enzymes, which the healthcare team attributes to her chemotherapy.
Additionally, she reported a persistent dry cough, which was noted during her physical examination.
The multidisciplinary team, including a dietician, physiotherapist, and social worker, has been involved in her care plan to address her nutritional needs, physical mobility, and psychosocial support.

Considering the comprehensive care needs of Elizabeth Thompson, how does the optimal healing environment, as a component of the Patient-Centered Care Quality and Safety Education in Nursing (QSEN) competency, assist the patient?

The staff nurses from an orthopedic surgery unit are dissatisfied with the admission process of a patient following surgery. The nurses stated that there might be four to five admissions within 1 hour as they are discharged from the postanesthesia recovery unit.
With many patients arriving simultaneously, the staff cannot give them the comparative assessment they deserve and complete the admission process.
The director of nursing suggests that these nurses observe the system that the women’s health unit uses for the multiple admissions that happen simultaneously due to deliveries and female surgeries.
What problem-solving technique is the director of nursing using?

A newly graduated nurse has just joined a fast-paced surgical unit. On her first day, she is paired with an experienced nurse for orientation. While touring the unit, the experienced nurse emphasizes the importance of familiarizing oneself with the hospital's policies and procedures.
The new nurse, eager but anxious, inquires why adherence to these guidelines is so crucial.
Which statement made by the experienced nurse best reinforces the importance of complying with the organization’s policies and procedures?

The nurse manager is making rounds on her unit, keenly observing the day-to-day operations, staff interactions, and overall environment. As she navigates through different areas, she witnesses a series of events involving various staff members. Given her role, she understands the importance of ensuring a safe, respectful, and efficient working environment.
Which situation, if observed, would warrant immediate action by the nurse manager?

The nurse is working in a busy surgical unit. Today, there are several clients scheduled for surgeries. The nurse is responsible for ensuring that pre-operative protocols, including blood glucose level checks, are followed to ensure patient safety.
The nurse should review the glucose level of which client(s) going to surgery today. Select all that apply.