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Prioritization Delegation and Assignment 3rd Edition LaCharity Kumagai Instructors Manual

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Prioritization Delegation and Assignment 3rd Edition LaCharity Kumagai Instructors Manual

ISBN-13: 978-0323113434

ISBN-10: 0323113435

Includes Instructors Manual, Suggest Uses and Unfolding case studies.

Description

Prioritization Delegation and Assignment 3rd Edition LaCharity Kumagai Test Bank

ISBN-13: 978-0323113434

ISBN-10: 0323113435

 

 

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Free Nursing Test Questions:

Answer Key

CHAPTER 6: Respiratory Problems, pages 31-34
appropriate according to best practice for emergency
care of a patient with an anterior nosebleed. Focus:
Delegation, supervision, assignment; QSEN: TC, S,
EBP; Concept: Clotting
1 . Ans: 1, 2, 4
Th e experienced LPN/LVN is capable
6 . Ans:
3
Th e UAP can remind patients about actions
that have already been taught by the nurse and are
part of the patient’s plan of care. Discussing and
teaching require additional education and training.
Th ese actions are within the scope of practice of the
RN. Th e RN can delegate medication administration
to an LPN/LVN. Focus: Delegation, supervision;
QSEN: TC; Concept: Collaboration
7 . Ans:
1,
2
Th e new RN is at an early point in her
of gathering data and making observations, including
noting breath
sounds and performing
pulse oximetry.
Administering
medications,
such as those

delivered
via MDIs,
is within the scope of practice

of
the LPN/LVN.
Independently
completing the admission
assessment,
developing
the nursing care
plan,

and
evaluating
a patient’s
abilities require
additional
education
and skills within the scope of practice of
the
professional
RN.
Focus:

Delegation,
supervision;

QSEN:

TC;

Concept:

Collaboration

2
. Ans:
2
For patients with chronic emphysema, the
orientation. Th e most appropriate patients to assign to
her are those in stable condition who require routine
care. Th e patient with the lobectomy will require
the care of an experienced nurse, who will perform
frequent assessments and monitoring for postoperative
complications.
Th

e patient admitted with newlydiagnosed
esophageal
cancer
will also benefi
t from

care
by
an experienced
nurse.
Th

is patient may have
questions and needs a comprehensive admission assessment.
As the new
nurse advances through
her
orientation,
you
will want to work
with him or her
in
providing
care
for these patients with more
complex
needs.
Th

e newly-diagnosed diabetic patient will
need much teaching as well as careful monitoring.
Focus: Assignment, delegation, supervision; QSEN:
TC, S; Concept: Collaboration
8 . Ans: 1, 2, 4, 5 Bedding should be washed in hot
water to destroy dust mites. All of the other points
are accurate and appropriate to a teaching plan for
a patient with a new diagnosis of asthma. Focus:
Prioritization; QSEN: PCC, S; Concept: Patient
Education
9 . Ans: 1, 3, 2, 5, 4, 6 Before each use, the cap is
removed and the inhaler is shaken according to the
instructions in the package insert. Next the patient
should breathe out completely. As the patient begins
to breathe in deeply through the mouth, the canister
should be pressed down to release 1 puff (dose) of
the medication. Th e patient should continue to
breathe in slowly over 3 to 5 seconds and then hold
the breath for at least 10 seconds to allow the medication
to reach
deep into the lungs.
Th

e patient should
wait at least 1 minute between puff s from the inhaler.
stimulus to breathe is a low serum oxygen level (the
normal stimulus is a high carbon dioxide level). Th is
patient’s oxygen fl ow is too high and is causing a high
serum oxygen level, which results in a decreased respiratory
rate.
If you
do not intervene,
the patient is at
risk
for respiratory
arrest.
Crackles,
barrel
chest,
and
assumption
of a sitting position leaning over
the
nightstand
are
common in patients with chronic
emphysema.
Focus:

Prioritization;
QSEN:

S;
Concept:

Clinical
Judgment

3
. Ans:
1
When the oxygen fl ow rate is higher than
4 L/min, the mucous membranes can be dried out.
Th e best treatment is to add humidifi cation to the
oxygen delivery system. Applying water-soluble jelly
to the nares can also help decrease mucosal irritation.
None of the other options will treat the problem.
Focus: Prioritization; QSEN: TC, S; Concept:
Caregiving
4 . Ans:
3
When tracheostomy care is performed, a
sterile fi eld is set up and sterile technique is used.
Standard precautions such as washing hands must also
be maintained but are not enough when performing
tracheostomy care. Th e presence of a tracheostomy
tube provides direct access to the lungs for organisms,
so sterile technique is used to prevent infection. All of
the other steps are correct and appropriate. Focus:
Delegation, supervision; QSEN: TC, S, EBP; Concept:
Health Care Quality
5 . Ans: 2, 3, 4, 5
Th e correct position for a patient with
an anterior nosebleed is upright and leaning forward
to prevent blood from entering the stomach and to
avoid aspiration. All of the other instructions are
Copyright © 2014 by Mosby, an imprint of Elsevier Inc. Copyright © 2011, 2006 by Mosby, Inc., an affi liate of Elsevier Inc. All rights reserved.
e1
Answer Key
e2
Focus: Prioritization; QSEN: TC, S; Concept:
Patient Education
1 0 . Ans: 1
Assisting patients with positioning and
bronchodilator and is at risk for respiratory complications.
Th

is patient’s needs are urgent. Th e other
patients need to be assessed as soon as possible, but
none of their situations is urgent. In COPD patients,
pulse oximetry
oxygen
saturations of more

than
90% are
acceptable.
Focus:

Prioritization;

QSEN:

S;
Concept:

Clinical
Judgment

1
6 . Ans:
activities of daily living (ADLs) is within the educational
preparation
and scope of practice of UAPs.

Teaching,
instructing,
and assessing patients all require
additional education
and skills and are
more

appropriate
to the scope of practice of licensed

nurses.
Focus:

Delegation,
supervision;
QSEN:

TC;

Concept:

Collaboration

1
1 . Ans:
3
UAPs can remind the patient to perform
1
Experienced LPNs/LVNs can use observa-
tion of patients to gather data regarding how well
patients perform interventions that have already been
taught. Assisting patients with ADLs is more appropriately
delegated to UAPs.
Planning
and consulting
require
additional education
and skills,
appropriate
to
the
RN’s
scope of practice.
Focus:

Delegation,
supervision;
QSEN:

TC,
QI;
Concept:

Collaboration

1
2 . Ans:
4
A patient who did not have the pneumonia
actions that are already part of the plan of care. Assisting
the patient into the best position to facilitate
coughing
requires
specialized
knowledge and understanding
that is beyond
the scope of practice of the
basic
UAP.
However,
an experienced
UAP
could assist
the
patient with positioning
after
the UAP
and the
patient
had been taught the proper
technique.
UAPs

would
still be under the supervision
of the RN.

Teaching
patients about adequate fl
uid
intake and
techniques
that facilitate coughing requires
additional
education
and skill,
and is within the scope of practice
of
the RN.
Focus:

Delegation,
supervision;
QSEN:

TC,
S;
Concept:

Collaboration

1
7 . Ans:
vaccination or fl u shot is at increased risk for developing
pneumonia or infl
uenza.
An elevated
temperature

indicates
some form of infection,
which may be respiratory
in origin.
All of the other vital sign values are

slightly
elevated
but are
not a cause
for immediate
concern.
Focus:

Delegation,
supervision;
QSEN:

TC,

S;
Concept:

Infection

1
3 . Ans: 2
3
Many surgical patients are taught about
Th e UAP’s training includes how to moni-
coughing, deep breathing, and the use of incentive
spirometry preoperatively. To care for the patient with
TB in isolation, the nurse must be fi tted for a higheffi

ciency
particulate
air (HEPA)
respirator
mask.
Th
e
bronchoscopy
patient needs specialized
and careful

assessment
and monitoring
after
the procedure,
and
the
ventilator-dependent
patient needs a nurse who is
familiar
with ventilator
care.
Both of these patients
need
experienced
nurses.
Focus:

Assignment;
QSEN:

TC;
Concept:

Leadership

1
8 . Ans:
tor and record intake and output. After the nurse has
taught the patient about the importance of adequate
nutritional intake for energy, the UAP can remind
and encourage the patient to take in adequate nutrition.
Instructing
patients and planning activities

require
more
education
and skill,
and are
appropriate
to the RN’s
scope of practice.
Monitoring

the
patient’s
cardiovascular
response
to activity
is a

complex
process
requiring
additional education,

training,
and skill,
and falls within the RN’s
scope

of
practice.
Focus:

Delegation,
supervision;
QSEN:

TC;
Concept:

Collaboration

1
4 . Ans:
2
Patients taking isoniazid must continue
2
Continuous bubbling indicates an air leak
taking the drug for 6 months. Th e other three statements
are
accurate and indicate
an understanding of
TB.
Family
members should be tested because
of
their
repeated
exposure
to the patient.
Covering
the
nose
and mouth when sneezing or coughing,
and
placing
tissues in plastic bags,
help prevent
transmission
of the causative
organism.
Th

e dietary changes
are recommended for patients with TB. Focus: Prioritization;
QSEN:

PCC,
S;
Concept:

Leadership
that must be identifi ed. With the physician’s order,
you can apply a padded clamp to the drainage tubing
close to the occlusive dressing. If the bubbling stops,
the air leak may be at the chest tube insertion, which
will require you to notify the physician. If the air bubbling
does not stop when you
apply
the padded clamp,

the
air leak is between
the clamp
and the drainage
system,
and you
must
assess the system
carefully
to
locate
the leak.
Chest tube drainage of 10 to 15 mL/hr

is
acceptable.
Chest tube dressings
are
not changed
daily
but may be reinforced.
Th

e patient’s reports of
pain need to be assessed and treated. Th is is important
but is not as urgent
as investigating
a chest tube
leak.
Focus:

Delegation,
supervision;
QSEN:

TC,
S;

Concept:

Gas Exchange

1
5 . Ans: 4
1 9 . Ans:
1
Patients who have recently experienced
trauma are at risk for deep vein thrombosis and pulmonary
embolus.
None
of the other fi
ndings
are
risk

factors
for pulmonary
embolus.
Prolonged
immobilization
is also a risk
factor for deep vein
thrombosis

and
pulmonary
embolus,
but this period
of bed rest

was
very
short.
Focus:

Prioritization;
QSEN:

S;

Concept:

Clinical
Judgment

2
0 . Ans:
4
An LPN/LVN who has been trained to
Th e patient with asthma did not achieve
relief from shortness of breath after using the
auscultate lung sounds can gather data by routine
assessment and observation, under supervision of an
RN. Independently evaluating patients, assessing for
symptoms of respiratory failure, and monitoring and
interpreting laboratory values require additional education
and skill,
appropriate
to the scope of practice
Copyright © 2014 by Mosby, an imprint of Elsevier Inc. Copyright © 2011, 2006 by Mosby, Inc., an affi liate of Elsevier Inc. All rights reserved.
e3
of the RN. Focus: Delegation, supervision; QSEN:
TC; Concept: Collaboration
2 1 . Ans:
1,
2,
3,
5
While a patient is receiving antico-
the right leg elevated above the heart to reduce swelling
and pain.
Th

e presence of ecchymoses may point
to a need to do more patient teaching about avoiding
injury while taking anticoagulants but does not indicate
that the physician
needs to be called.
Focus:

Prioritization;
QSEN:

TC,
S;
Concept:

Clinical

Judgment

2
7 . Ans: 2
agulation therapy, it is important to avoid trauma to
the rectal tissue, which could cause bleeding (e.g.,
avoid rectal thermometers and enemas). All of the
other instructions are appropriate to the care of a
patient receiving anticoagulants. Focus: Delegation,
supervision; QSEN: TC, S; Concept: Collaboration
2 2 . Ans:
Manual ventilation of the patient will allow
1
A nonrebreather mask can deliver nearly
you to deliver an Fi o 2 of 100% to the patient while
you attempt to determine the cause of the highpressure
alarm.
Th
e
patient may need reassurance,

suctioning,
and/or insertion
of an oral airway,
but

the
fi
rst
step should be assessing the reason
for the

high-pressure
alarm and resolving
the hypoxemia.

Focus:

Prioritization;
QSEN:

S;
Concept:

Gas

Exchange

2
8 . Ans:
100% oxygen. When the patient’s oxygenation status
does not improve adequately in response to delivery
of oxygen at this high concentration, refractory hypoxemia
is present.
Usually
at this stage,
the patient is
working
very
hard
to breathe
and may go into respiratory
arrest
unless health care
providers
intervene
by

providing
intubation and mechanical
ventilation
to
decrease
the patient’s
work
of breathing.
Focus:

Prioritization;
QSEN:

S;
Concept:

Clinical
Judgment

2
3 . Ans:
4
Th e patient’s history and symptoms suggest
3
Th e endotracheal tube should be marked at
the level where it touches the incisor tooth or nares.
Th is mark is used to verify that the tube has not
shifted. Th e other three actions are appropriate after
endotracheal tube placement. Th e priority at this
time is to verify that the tube has been correctly
placed. Focus: Delegation, supervision, prioritization;
QSEN: TC, S; Concept: Leadership
2 4 . Ans:
2
Th e UAP’s educational preparation includes
the development of ARDS, which will require intubation
and mechanical
ventilation.
Th

e maximum oxygen
delivery
with a nasal cannula
is an Fi
o

2

of 44%.

Th

is is achieved with the oxygen fl ow at 6 L/minRemember,
increasing the fl ow to 10 L/min will not be helpful.
Helping the patient to cough and deep breathe will
not improve the lung stiff ness that is causing his respiratory
distress.
Morphine
sulfate will only
decrease
the
respiratory
drive
and further
contribute
to his hypoxemia.
Focus:

Prioritization;
QSEN:

S,
TC;
Concept:

Clinical
Judgment

2
9 . Ans:
measuring vital signs, and an experienced UAP would
know how to check oxygen saturation by pulse oximetry.
Assessing and observing
the patient,
as well
as
checking
ventilator
settings,
require
the additional
education
and skills of the RN.
Focus:

Delegation,

supervision;
QSEN:

TC;

Concept:

Collaboration

2
5 . Ans:
3
Removal of large quantities of fl uid from
4
Infections are always a threat for the patient
the pleural space can cause fl uid to shift from the
circulation into the pleural space, causing hypotension
and tachycardia.
Th

e patient may need to receive
IV fl uids to correct this. Th e other data indicate that
the patient needs ongoing monitoring and/or interventions
but would
not be unusual fi
ndings
for a
patient
with this diagnosis or after
this procedure.

Focus:

Prioritization;
QSEN:

S,
TC;
Concept:

Clinical
Judgment

3
0 . Ans:
Copyright © 2014 by Mosby, an imprint of Elsevier Inc. Copyright © 2011, 2006 by Mosby, Inc., an affi liate of Elsevier Inc. All rights reserved.
Answer Key
receiving mechanical ventilation. Th e endotracheal
tube bypasses the body’s normal air-fi ltering mechanisms
and provides
a direct
access route
for bacteria

or
viruses
to the lower
parts
of the respiratory
system.

Focus:

Prioritization;
QSEN:

TC,
S;
Concept:

Infection

2
6 . Ans:
3
Research indicates that nursing actions such
3
Confusion in a patient this age is unusual
and may be an indication of intracerebral bleeding
associated with enoxaparin use. Th e right leg symptoms
are
consistent with a resolving
deep vein
thrombosis;
the patient may need teaching about keeping
as maintaining the head of the bed at 30 to 45 degrees
decrease the incidence of VAP. Th ese actions are
part of the standard of care for patients who require
mechanical ventilation. Th e other actions are also
appropriate for this patient but will not decrease the
incidence of VAP. Focus: Prioritization; QSEN: EBP, S;
Concept: Evidence
QSEN Key: PCC, Patient-Centered Care; TC, Teamwork & Collaboration; EBP, Evidence-Based Practice; QI, Quality Improvement; S, Safety; I, Informatics