Leadership and Management Care Quiz

Leadership and Management Care Quiz A nurse is preparing a client who speaks limited English for surgery. Which of the following is the most appropriate nursing action in obtaining informed consent from this client?

Select one:

• Do nothing as this is the provider's primary concern.
• The nurse should explain the procedures using pictures and hand gestures.
• Have the nurse respond to the client's concerns so the provider can prepare for

surgery.

• Seek the assistance of a nurse on the floor who is fluent in the client's language.

(ANS- d. Seek the assistance of a nurse on the floor who is fluent in the client's language.

The nurse is responsible for ensuring that the client understands the information provided regarding the procedure.

A nurse is performing initial teaching with a client who will be receiving electroconvulsive therapy (ECT). Which statement by the client indicates a need for further teaching?

Select one:

• "My Dilantin dose will be increased several days before the procedure."
• "Before the procedure, I will have an EKG to assess for heart irregularities."
• "I will need to continue taking my regular blood pressure medication."
• "I will stop taking my lithium for 2 weeks prior to my procedure."

(ANS- a. "My Dilantin dose will be increased several days before the procedure."

Because the therapeutic action of ECT is to induce seizures, any medications that affect the client's seizure threshold must be decreased or discontinued several days before the procedure.Any cardiac conditions, such as dysrhythmias, should be monitored and treated before the procedure

A daughter of a client with a terminal illness pulls a nurse to the side and says, "Although my mother's living will states she is not to be resuscitated, the family wants everything done to save her if she has a cardiac arrest." How should the nurse respond?

Select one:

• "The living will documents your mother's wishes and must be followed."
• "I will contact the provider to make him aware of your request."
• "If your mother has a cardiac arrest, we will begin resuscitation if you wish."
• "Since the living will is a legal document a lawyer will have to make the

changes." (ANS- a. "The living will documents your mother's wishes and must be followed."

A living will is a document that expresses the client's wishes regarding medical treatment in the event the client becomes incapacitated and is facing end-of-life issues. The client's wishes should be followed by the health care provider.

A provider informs the wife of a comatose client with terminal cancer that she will need to sign the consent for insertion of a gastrostomy feeding tube. The nurse knows this is against the client's wishes. What is the appropriate action by the nurse?

Select one:

• Inform the wife she cannot sign the consent
• Prepare the consent for the wife to sign.
• Ask the provider for an order for a NG tube instead.
• Consult the hospital's ethics committee.

(ANS- d. Consult the hospital's ethics committee.

If the nurse believes the provider's actions are directly against the client's wishes, the nurse should contact the hospital's ethics committee. These committees are typically multidisciplinary and are organized to consciously and reflectively consider significant and often difficult issues related to client care. Any nurse can consult the hospital's ethics committee when deemed necessary.

Unless the client has designed another person as his health care power of attorney, the wife, as immediate next of kin, can legally sign the consent for the procedure if she wishes.

A client is seeking treatment for stress related to unexpected loss of employment and is engaging in the stress management technique of cognitive reframing. Which of the following statements would indicate to the nurse that the client understands this stress management technique?

Select one:

• "I have excellent job skills; I just need to find a new employer."
• "When I do my daily yoga exercises, I feel so much better."
• "Once I decided what was most important to me, things got easier."
• "I can visualize the perfect interview and being offered a new job."

(ANS- a. "I have excellent job skills; I just need to find a new employer."

Cognitive reframing is a simple and effective technique for reducing stress by looking at things in a more positive light in order to experience them as less stressful. Cognitive reframing for this client would involve building confidence in job skills and searching for a new job.

A nurse is preparing a client with terminal illness for discharge to a nursing home when he states: "I don't want to go to a nursing home to die. I would rather die at home." What would be the most appropriate action by the nurse?

Select one:

• Contact the client's case manager.
• Continue to make the discharge arrangements.
• Assess the client's reasons for feeling this way.
• Inform the provider of the client's decision.

(ANS- a. Contact the client's case manager.

Contact the client's case manager would be the most appropriate action by the nurse. The case manger would be able to determine if the client's wishes could be carried out.

A client is hospitalized for multiple rib fractures following a motor vehicle accident (MVA). The results of an arterial blood gas (ABG's) are; pH 7.30, pCO2 48, HCO3 26 and pO2 91 on 2 L/min of oxygen per nasal cannula. Which of the following interventions has the highest priority?

Select one:

• Assist the client to deep breathe, splinting with a pillow.
• Increase the client's O2 delivery to 4 L/min.
• Administer an anti-anxiety agent to calm the client.
• Notify the health care provider of the abnormal ABG's.

(ANS- a. Assist the client to deep breathe, splinting with a pillow.

The client is experiencing respiratory acidosis from hypoventilation caused by painful respirations due to fractured ribs. Splinting the chest wall with a pillow will decrease pain associated with deep breathing. Deeper breaths will allow for better gas exchange, which will correct the acidosis.

The nurse is caring for a client admitted with diverticulitis. The client reports severe abdominal pain and assessment reveals that the client's abdomen is rigid and tender. The client's vital signs are: T: 101.8 F (38C); HR: 120; B/P: 100/50. Urine output was less than 300 ml during the previous eight hours. The client states the pain is "worse than before". What is the priority nursing intervention for this client?

Select one:

• Encourage the client to increase fluids
• Administer the prescribed scheduled antibiotic
• Notify the client's health care provider
• Administer bisacodyl suppository as needed

(ANS- c. Notify the client's health care provider

The client is febrile, tachycardic and hypotensive with verbalization of increased worsening abdominal pain. These are signs of possible rupture of the diverticulum, pelvic abscess, or bowel obstruction and the provider needs to be notified.