NGN Management Exam

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? Select all that apply

The nurse manager is preparing to institute SBAR for interprofessional communication. The nurse manager has based this decision on what benefits of this tool. Select all that apply.

The nurse manager in a not-for-profit healthcare facility is aware of what issues may arise due to the funding for this type of organization.

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?

In a bustling metropolitan hospital, Nurse Manager Olivia Martinez oversees a diverse team of staff nurses in a high-acuity intensive care unit (ICU). Recently, the hospital administration implemented the CUS communication system, aimed at enhancing patient safety and staff communication. Olivia has been actively training her team on this new protocol, emphasizing its importance in critical patient care scenarios.
The team comprises a mix of experienced and new nurses, each bringing different perspectives and levels of comfort with assertive communication in a high-stress environment.
During a particularly busy shift, several challenging situations arise, each handled by a different staff nurse

• Nurse A, James, an experienced nurse, is caring for a post-operative patient whose vital signs have been gradually deviating from the expected range. He approaches the attending physician, stating, "I am concerned about Mr. Davis's blood pressure trends and heart rate; I'm uncomfortable with the current management plan. I believe this could be a safety issue requiring immediate reassessment."

• Nurse B, Sophia, relatively new to the ICU, notices that the medication prescribed for her patient seems unusually high. She quietly consults a colleague, expressing her unease but hesitates to escalate the issue to the healthcare team.

• Nurse C, Michael, observes a procedural breach in infection control by a fellow nurse during a central line insertion. He immediately reports the incident to the infection control team but does not address it directly with the involved colleague.

• Nurse D, Lily, attending to a critically ill patient, is concerned about the patient's declining neurological status. She calls the on-call neurologist and says, "I need to speak to you about my patient's deteriorating condition; I think we might be missing something critical."

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?

John Lynch is admitted to the hospital with chest pain and a history of multiple chronic conditions. As the nurse assigned to his care, which of the following actions should you prioritize to effectively manage his case and coordinate his care within the health care delivery system? Select all that apply.

Mr. George Thompson, a 68-year-old Caucasian male, was admitted to the urology ward for a Transurethral Resection of the Prostate (TURP) procedure due to benign prostatic hyperplasia (BPH). 
As his discharge date approaches, the nursing team has been focusing on educating Mr. Thompson about post-TURP care to ensure a smooth transition home. He has been attentive and engaged during these sessions, asking several pertinent questions about his recovery.

While preparing Mr. Thompson for discharge following his TURP procedure, which of the following client statements should indicate a need for further teaching before discharge?

The nurse manager uses the Principles of Collaborative Relationships: Effective Communication by the American Nurses Association (ANA) to improve communication in the nursing unit and knows that these principles require the staff nurses to use what communication practices? Select all that apply.

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.

The charge nurse is notified that a new postoperative client will be coming to the unit shortly. The exhibit below identifies the beds available. What bed will the nurse hold for the new client?

Maria, a 67-year-old Hispanic female, was hospitalized for congestive heart failure exacerbation. After several days of treatment and stabilization, Maria is preparing for discharge. She lives alone and has limited mobility, requiring assistance with daily activities.
The healthcare team has been involved in her care, ensuring that she understands her medication regimen, dietary restrictions, and the importance of monitoring her weight daily.
The social worker has arranged for home health services to assist Maria with her medication management and physical therapy at home. The nurse is now responsible for finalizing Maria’s discharge plan to ensure a smooth transition back to her home environment.

Question:

Which nursing action is most critical when finalizing Maria’s discharge plan?

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?

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.

Choose the most likely options for the information missing from the statements below by selecting from the lists of options provided.

The nurse is working with an AP to provide care for a bedridden patient. The patient is unable to move or turn in bed without assistance.

The nurse may delegate the AP to and   the patient every

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?

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?

During a unit meeting, the topic of patient rights and responsibilities is raised after an incident report highlighted some misunderstandings. The unit manager decides to address the issue.
Which of the following actions by the unit manager best ensures staff understand patient rights and responsibilities?

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?

The nurse manager in a for-profit healthcare facility explains to a new staff nurse that the profits from care are used in what capacity?

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?

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 the most appropriate for the primary care nurse concerned about the patient's new neurological symptoms?

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

Sarah, a 45-year-old female with a history of hypertension and diabetes, was recently admitted to the hospital following a minor stroke. During her stay, she received care from a multidisciplinary team that included a primary care physician, a registered nurse, a physical therapist, a dietitian, and a social worker.
The primary care physician oversaw Sarah’s medical treatment, adjusting her medications and ordering necessary tests.
The registered nurse monitored her vital signs, administered medications, and provided education on managing her condition.
The physical therapist worked with Sarah on improving her mobility and strength, while the dietitian developed a meal plan to help control her blood sugar levels.
The social worker discussed Sarah’s post-discharge needs, including arranging for home health care and assisting with resources for medication management.

In managing Sarah’s care, what is the primary role of the registered nurse within the multidisciplinary team?

John, a 58-year-old male with a history of chronic obstructive pulmonary disease (COPD), was recently discharged from the hospital after a week-long stay due to an exacerbation of his condition.
Two days after discharge, John calls the clinic to report that he is experiencing increased shortness of breath and that his rescue inhaler does not seem to be working as effectively. The nurse receives this call and needs to communicate John’s condition to the on-call healthcare provider for further instructions.

When providing a telephone report to the healthcare provider about John’s condition, which information should the nurse include? Select all that apply

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?

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?

John Arler, a 68-year-old Caucasian male, arrived at the rural emergency department (ED) with complaints of chest pain and shortness of breath that began earlier in the morning. He has a known history of hypertension and type 2 diabetes.
  The decision was made to transfer John to a higher-level facility for cardiac catheterization.

Given the client's situation in a rural ED being transferred to another hospital for cardiac catheterization, which essential documents should the nurse send with the client? Select all that apply.

A newly hired nurse on a pediatric unit is struggling to manage her tasks efficiently within her shift. The charge nurse decides to observe and advise her on prioritizing and managing her tasks.
Which of the following actions by the new nurse indicates the most ineffective use of time management?