NR224 / NR 224: Fundamentals Exam 1 (Latest Update) Chamberlain College of Nursing

NR224 / NR 224: Fundamentals Exam 1 (Latest Update) Chamberlain College of Nursing What order should the nurse follow during the delegation decision-making process when delegating client care? 1.Assessing the health needs exhibited by the client 2.Assessing the abilities demonstrated by unlicensed personnel 3.Seeking client care issues 4.Ensuring the stability of the client 5. Monitoring the task 6.Providing feedback to unlicensed personnel Correct Answer: The delegation process starts with assessing the health needs of the client and the skills of unlicensed personnel (UNP). The key component of delegation decision-making is assessing the UNP's ability to perform the work, including, safety, critical thinking, stability, and time. It is also vital to make client care decisions at the same time. The nurse has to make sure that the client is stable and steady to ensure the best care. The greater the stability of a client, the more likely the UNP can provide safe client care. The nurse should then monitor the task being performed by the UNP. The nurse should also maintain an open line of communication with the UNP to seek client care updates and limitations. The nurse should always provide direct feedback to the UNP for professional growth and development to improve client care outcomes. The registered nurse (RN) is delegating tasks to several health care team members caring for a client with a bacterial infection and high fever. Which statements by the registered nurse would be most appropriate for the licensed practical nurse (LPN)? Select all that apply. Correct1 "You should administer an antipyretic after the meal." 2 "You should assess the client's condition." 3 "You should change the bed sheets and dress the client every day." Correct4 "You should administer prescribed antibiotics to the client twice a day." Correct5 "You should collect data that can be used in the assessment of client's condition." Correct Answer: The delegator can delegate tasks such as administration of antipyretic for the client who has fever. This particular task should be delegated only to the licensed nursing personnel, such as LPN. The delegator can delegate the task such as administration of antiallergic medication to the licensed professional, such as LPN. The RN is responsible for all the assessments performed, but the UAP or LPN can collect the data that can be used for the assessment. The RN is responsible for assessing the client's condition. The RN should delegate basic tasks such as changing the bed sheets and dressing the client to unlicensed nursing personnel. Which client's care can the registered nurse (RN) safely delegate to unlicensed nursing personnel (UNP) based on the given data? Correct1 Client A, with chronic hypertension and stable vitals 2 Client B, with drainage from diabetic foot 3 Client C, with myocardial infarction due to atherosclerosis 4 Client D, with foot ulcers from peripheral vascular disease Correct Answer: Care of client A can be safely delegated because the chronic hypertension with stable vitals is not generally associated with any complications. Client B with drainage from diabetic foot is at a risk of aggravating foot issues, so this client's care cannot be safely delegated. Client C with myocardial infarction due to atherosclerosis is at a risk of cardiovascular instability and care should not be delegated. Client D has a risk of foot ulcers due to peripheral heart disease so this client's care also cannot be safely delegated to the UNP. The nurse is delegating someone to care for a client with diabetes mellitus. Which instruction given by the nurse better explains the selling relationship with the delegatee? 1 "Record the client's blood glucose level each morning." 2 "You may approach me for further assistance and questions. Thank you." 3 "I will guide and assist you while you learn how to check the client's blood glucose." Correct4 "You will take complete care of the client with diabetes and make sure to record the blood glucose level." Correct Answer: Selling includes ongoing relationships with an explanation of the delegated new task. This is better explained in the statement, "You have to take complete care of the client with diabetes and make sure that you record the blood glucose level." Telling is ordering the delegate to record the client's blood glucose level each morning. Delegation, involving established relationships and expertise, is better explained by, "You may approach me for further assistance and questions. Thank you." Participation is mutual involvement to accomplish the task. It is better explained by the statement, "I will guide and assist you while you learn how to check the client's blood glucose." 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? 1 Asking questions about the client's respiratory rate 2 Asking the client to perform breathing exercises regularly 3 Administering oxygen to the client with shortness of breath Correct4 Providing constructive feedback about client care management Correct Answer: 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 registered nurse (RN) is caring for a client who has severe abdominal pain. The RN plans to work with the assistance of an unlicensed nursing personnel (UNP). The RN starts the client care. What should the RN consider during the process of active delegation? Select all that apply. Correct1 Assessing the level of the client's abdominal pain Correct2 Directing the UNP to assist the client while toileting 3 Advising the client to take pain medication when needed Correct4 Ensuring that the UNP is accountable for successful completion of the task 5 Explaining to the client about the reason and cause of abdominal pain Correct Answer: In active delegation the RN assesses the client's situation to ensure the client is stable enough to be handed over to the UNP. The RN can then delegate specific basic tasks to the UNP such as oral care and toileting. The RN then holds the UNP accountable for successful completion of the task. It is within the scope of practice of the RN to advise the client to take pain medication in accordance with the primary health care provider's prescription. Likewise, the RN can explain the reason and cause of the condition diagnosed by the primary health care provider. These tasks are considered passive delegation. A nurse is assisting another registered nurse in the intensive care unit who is caring for a client with uncontrolled blood pressure. Which action on the part of the nurse indicates "offering" during delegation decisions? 1 "Did you check the client's blood pressure this morning?" Correct2 "You can use this stethoscope and sphygmomanometer to take the blood pressure." 3 "Would you fetch me the client's laboratory reports? I'll record the blood pressure." 4 "How is the client doing this morning? Let me look at yesterday's blood pressure report." Correct Answer: Offering involves making a suggestion to facilitate the achievement of a desirable client care outcome. The statement, "You can use this stethoscope and sphygmomanometer to take the blood pressure," is an example of offering. Asking begins with questions related to the problem or issue regarding client care. "Did you check the client's blood pressure this morning?" is an example of asking. Doing involves demonstrating the specific task or behavior needed to improve client care. "Would you fetch me the client's laboratory reports? I'll record the blood pressure," is an example of doing. "How is the client doing this morning? Let me look at yesterday's blood pressure report," is an example of supervision. Which behavior does the delegator adopt when communicating with the delegatee if the relationship between them is new, the delegatee has limited knowledge, and the delegator does not expect the relationship to be ongoing? Correct1 Telling 2 Selling 3 Delegating 4 Participating Correct Answer: According to Hersey's Situational Leadership Model, if the relationship between a delegator and a delegatee with limited knowledge is new and is not going to be ongoing, the delegator's behavior is characterized as "telling." Delegator's behavior is characterized as "selling" if the delegatee and delegator have an ongoing relationship and a new task is being delegated. The delegator's behavior is characterized as "delegating" when the delegatee has expertise and an established relationship with the delegator. If the delegatee has willingness and ability, but the relationship with the delegator is new, then the delegator's behavior is characterized as "participating." Which action in the delegation process represents accountability? 1 Providing open and honest feedback to the delegatee 2 Assisting other registered nurses with delegation decisions Correct3 Monitoring the client care given and determining outcomes 4 Assessing the ability of the delegatee and educating him or her about the task Correct Answer: Monitoring client care and determining outcomes represents accountability of the task in case of conflicts. 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 when there are safety issues, an urgent need to intervene, or potential negative client outcomes. Assessing the ability of the delegatee and educating him or her about the task indicates responsibility. The client is admitted to the medical unit with a diagnosis of pulmonary edema. The client care is assigned to the registered nurse (RN) by the charge nurse. The RN admits and provides a written plan and assigns the client to a licensed practical nurse. Which healthcare personnel is accountable and responsible for the client if there is development of any complications in the client? 1 Charge nurse 2 Associate nurse Correct3 Registered nurse 4 Licensed practical nurse Correct Answer: The registered nurse is responsible and accountable for the client if complications develop. The registered nurse is responsible for the client because he or she delegated client care and wrote the care plan. The charge nurse may be accountable but may not be responsible since the charge nurse gets the task in the absence of the RN. The associate nurse is responsible for the client's condition if the primary nurse's written plan is implemented by the associate nurse. The licensed practical nurse (LPN) is not responsible because the LPN follows the written plan given by the RN. A delegator, working in collaboration with a delegatee, allots responsibilities and explains the various procedures and techniques needed to accomplish the task. Which action is the delegator performing, according to the Hersey model? 1 Guiding and directing 2 Observing or monitoring Correct3 Explaining and persuading 4 Encouraging or problem solving Correct Answer: Hersey's model describes the leader's behavior as explaining or persuading, which is characterized as "selling." In this situation, the delegator is assigning the work to the delegatee and explaining the various procedures and techniques to accomplish the specified task. A leader's behavior described as guiding or directing is characterized as "telling," in which the delegate simply assigns the task to the delegatee. The leader's behavior of observing or monitoring is characterized as "delegating," in which the delegator is responsible and accountable for the entire task. A leader's behavior that is encouraging or problem solving is characterized as "participating," in which the delegator establishes a working environment in which to complete the task in the specified time. Which questions should the nurse consider to assess and ensure delegation to the right person? Select all that apply. Correct1 Is the prospective delegatee a willing and able employee? 2 Does the delegatee understand the directions and expected results of the task? 3 Does the delegatee understand how, what, and when to report to the delegator? 4 Is it clear that the delegatee will provide feedback related to the task when appropriate? Correct5 Does the delegatee have the knowledge and experience to perform the specific task safely? Correct Answer: The right delegatee is chosen on the basis of the person's willingness and ability. The nurse should assess the knowledge and experience of the prospective delegatee to perform the specific task safely and fulfill the expected outcomes. Right direction and documentation are assessed by the delegatee's ability to understand the directions and expected results of the task. It can also be assessed on the basis of the delegatee's understanding of how, what, and when to report to the delegator. The right supervision is providing feedback to the delegatee, related to the task, when appropriate. Which statements are true regarding the primary nursing care developed by Marie Manthey as a method for organizing client care? Select all that apply. Correct1 The associate nurse provides input into the client's plan of care. 2 The charge nurse will be accountable for the care from admission to discharge. Correct3 If the client develops complications, the associate nurse should notify the primary nurse. 4 According to the associate nurse's care specifications, the primary nurse should provide care. Correct5 The registered nurse functions autonomously as the primary nurse throughout the client's hospital stay. Correct Answer: The associate nurse cares for the client according to the care specifications provided by the primary nurse in the care plan. The associate nurse provides input to the client's plan care if the associate nurse notices any complications and also notifies the primary nurse for alterations in the care plan. The registered nurse functions autonomously as the client's primary nurse by taking the responsibility and accountability of the client care from admission through discharge. It is the primary nurse, rather than the charge nurse, who will be accountable for the care of the client from the admission through discharge. According to the primary nurse's care specifications, the associate nurse should provide care. The registered nurse is teaching a newly hired nurse about active delegation. Which statement made by the newly hired nurse indicates the need for further teaching? 1 "I will evaluate the client's pain status." 2 "I will assess the client's laboratory findings." 3 "I will instruct the unlicensed assistive personnel (UAP) to wash the client." Correct4 "I will instruct the licensed vocational nurse (LVN) to administer intravenous (IV) medications." Correct Answer: In active delegation, the registered nurse (RN) assesses the client's situation, determines what is appropriate for client care, directs assistive personnel to perform certain tasks, and holds the individuals accountable. Instructing the LVN to administer intravenous (IV) medications is beyond the practice scope for an LVN. Evaluating the client's pain status is a part of active delegation. Assessing the client's laboratory findings is active delegation. Instructing the UAP to wash the client is an active delegation as the RN is directing a task that is to be performed by the UAP for the client. Which component of delegation is suitable to all the members on the healthcare team? Correct1 Authority 2 Supervision 3 Accountability 4 Communication Correct Answer: 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 registered nurse is delegating work to four delegatees. Which delegatee has an established relationship with the delegator? 1 Delegatee A Correct2 Delegatee B 3 Delegatee C 4 Delegatee D Correct Answer: According to Hersey's model, if the relationship between the delegator and delegatee is established, the behavior of the delegator is "observing or monitoring." Telling delegate B that his or her method is correct and to continue doing it in the same way indicates that the delegator is monitoring the delegatee's actions, which indicates an established relationship. Which component of delegation is considered a "two way process"? 1 Authority 2 Supervision Correct3 Responsibility 4 Accountability Correct Answer: 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 presents to the physician with a rash. The physician orders the application of a topical medication. Which healthcare team member will most likely carry out this order? 1 Nurse manager (NM) 2 Registered nurse (RN) Correct3 Licensed practical nurse (LPN) 4 Unlicensed assistive personnel (UAP) Correct Answer: The LPN administers oral and topical medications and monitors all vital signs. The NM is the designated individual to whom all nursing professionals are answerable regarding a given task. The RN is responsible for performing the administration of intravenous medications and the delegation of tasks to LPNs and UAPs. The UAP assistive personnel performs all hygiene tasks. 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? 1 Telling 2 Selling 3 Delegating Correct4 Participating Correct Answer: 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. The nurse is caring for four different clients with different health conditions. Which client care task delegated to the licensed vocational nurse (LVN) would be appropriate to develop a suitable care outcome? 1 Client 1 2 Client 2 3 Client 3 Correct4 Client 4 Correct Answer: Providing oral medication to the client who has undergone hysterectomy can be done by the licensed vocational nurse (LVN). The LVN is not eligible to write a nursing care plan for the client with hysterectomy; this must be performed only by the registered nurse (RN). An LVN cannot provide intravenous fluids. Continuous peritoneal dialysis is not performed by an LVN; this procedure requires a more experienced practitioner such as an RN. When delegating a task, the delegator says, "Please tell me how you are going to perform this procedure, and I will share my expectations regarding how we need to communicate with each other." What can be inferred about the delegatee? 1 The delegatee has expertise and an established relationship with the delegator. 2 The delegatee has limited knowledge and ability to perform the task. Correct3 The delegatee has willingness and ability, but the relationship is new. 4 The delegatee has an established relationship with the delegator, but a new task has been delegated. Correct Answer: When the delegatee has the willingness and ability to perform the task but the relationship is new, the delegator tries to establish mutual expectations and conditions for performing the task. The delegator must open the lines of communication with the delegatee. When the delegatee has expertise and an established relationship with the delegator, the delegator asks the delegatee to communicate if any issue or concern arises. When the delegatee has limited knowledge and ability to perform the task, the delegator would provide more guidance to the delegatee by giving detailed instructions. If the delegatee has an established relationship with the delegator but a new task has been delegated, the delegator will need to provide explanation of what is needed to accomplish the task. When evaluating a task performed by a delegatee, the registered nurse finds that the delegatee fails to provide appropriate feedback. Which right of delegation is compromised in this situation? 1 Right task 2 Right person Correct3 Right supervision Incorrect4 Right communication Correct Answer: The "right supervision" includes assessing whether the delegatee can provide feedback related to the task when appropriate. "Right task" involves providing tasks to the delegatee in accordance with legal and institutional policies. "Right person" involves delegating tasks to team members who are competent and show willingness towards the task. "Right communication" involves the delegator providing clear, concise instructions and the delegate understanding those instructions. A critically injured client was brought to the hospital following a car accident and the client should be immediately triaged for determining the nature and acuity of the injuries. Who is delegated to perform the task? 1 Nurse manager Correct2 Registered nurse 3 Licensed practical nurse Incorrect4 Primary healthcare provider Correct Answer: When the client arrives at the hospital after a trauma, it is the responsibility of the registered nurse to determine the nature and acuity of injuries. The nurse manager should usually be the delegator for the registered nurses and healthcare providers. Licensed practical nurses' scope of practice does not include caring for critically ill emergency clients. A primary healthcare provider should treat the client by providing required medications and diagnoses. Which statement is true regarding delegation? Select all that apply. 1 The delegatees are accountable for effective client care. Correct2 Open lines of communication must occur bet