Prioritization, Delegation, Management

2y ago
70 Views
29 Downloads
3.61 MB
501 Pages
Last View : 1m ago
Last Download : 2m ago
Upload by : Konnor Frawley
Transcription

3313 FM i-xii 14/03/14 5:13 PM Page iPrioritization,Delegation, &Managementof Care for theNCLEX-RN Exam

3313 FM i-xii 14/03/14 5:13 PM Page iiDavis’s Success SeriesQ&A Course Review and NCLEX Prep99Thousands of NCLEX-style questions99Alternate-item-format questions99Rationales for correct and incorrect answers99Test-taking tipsVisit www.fadavis.comKeyword: Success Series to learn more.Davis Mobile APPSDownload today from yourfavorite app store!www.FADavis.com

3313 FM i-xii 14/03/14 5:13 PM Page iiiPrioritization,Delegation, &Managementof Care for theNCLEX-RN ExamRay A. Hargrove-Huttel, RN, PhDKathryn Cadenhead Colgrove, RN, MS, CNS

3313 FM i-xii 14/03/14 5:13 PM Page ivF. A. Davis Company1915 Arch StreetPhiladelphia, PA 19103www.fadavis.comCopyright 2014 by F. A. Davis CompanyCopyright 2014 by F. A. Davis Company. All rights reserved. This book is protected by copyright.No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by anymeans, electronic, mechanical, photocopying, recording, or otherwise, without written permission fromthe publisher.Printed in the United States of AmericaLast digit indicates print number: 10 9 8 7 6 5 4 3 2 1Publisher, Nursing: Robert G. MartoneDirector of Content Development: Darlene D. PedersenProject Editor: Jacalyn C. ClayElectronic Project Editor: Sandra A. GlennieIllustration and Design Manager: Carolyn O’BrienAs new scientific information becomes available through basic and clinical research, recommendedtreatments and drug therapies undergo changes. The author(s) and publisher have done everythingpossible to make this book accurate, up to date, and in accord with accepted standards at the time ofpublication. The author(s), editors, and publisher are not responsible for errors or omissions or forconsequences from application of the book, and make no warranty, expressed or implied, in regardto the contents of the book. Any practice described in this book should be applied by the reader inaccordance with professional standards of care used in regard to the unique circumstances that mayapply in each situation. The reader is advised always to check product information (package inserts)for changes and new information regarding dose and contraindications before administering any drug.Caution is especially urged when using new or infrequently ordered drugs.Library of Congress Cataloging-in-Publication DataLibrary of Congress Cataloging-in-Publication DataISBN: 978-0-8036-3313-1Authorization to photocopy items for internal or personal use, or the internal or personal use of specificclients, is granted by F. A. Davis Company for users registered with the Copyright Clearance Center(CCC) Transactional Reporting Service, provided that the fee of .25 per copy is paid directly toCCC, 222 Rosewood Drive, Danvers, MA 01923. For those organizations that have been granted aphotocopy license by CCC, a separate system of payment has been arranged. The fee code for users ofthe Transactional Reporting Service is: 978-0-8036-3313-1/14 0 .25.

3313 FM i-xii 14/03/14 5:13 PM Page vThank you to all the nursing students, nursing faculty, and nursing colleagues wehave had the privilege to work with during our careers. We want to thank RobertMartone for his vision and support, who was there when our writing career startedand has been with us every step of the way. Our thanks to computer extraordinaireGlada Norris, who fixes our mistakes, makes the questions look “pretty,” and isresponsible for making this book possible. Thank you to Kathryn McAfee who codesall the questions, leaving us time to write the questions.I want to thank all my friends for love, support, and prayers as I battled ovariancancer this last year. Thanks to aunts, uncles, and cousins, my Los Angeles friends,my Trinity Valley Community College friends, my Texas friends, my Hawaiianfriends, and the Lee girls. My thanks to my sisters Gail and Debbie, my nephewBen, and Paula who brought me home and cared for me. I thank my childrenTeresa and Aaron for making me want to get up every day and fight the fight.As always, I dedicate this book to my parents, T/Sgt Leo R. Hargrove and Nancy,who made me believe I can do anything. I am an ovarian cancer survivor.—R AY A. H ARGROVE -H UTTEL(This was Ray’s dedication. Ray lost her battle with cancer on December 23,2012. She is much loved and greatly missed. -Kathy Colgrove)I would like to dedicate this book to the memory of my mother, Mary Cadenhead,and grandmother, Elsie Rogers. They always told me I could accomplish anythingI wanted to accomplish. I would also like to dedicate this book to my husband, Larry,children, Laurie and Todd and Larry Jr. and Mai, and grandchildren, Chris,Ashley, Justin C., Justin A., Connor, Sawyer, and Carson—without their supportand patience the book would not have been possible.—K ATHRYN C ADENHEAD C OLGROVEv

3313 FM i-xii 14/03/14 5:13 PM Page vi

3313 FM i-xii 14/03/14 5:13 PM Page viiReviewersDebra Bailey, RN, PhD candidate, FNP, CDEAssociate Professor of Nursing, DepartmentHead Health SciencesColorado Mesa UniversityGrand Junction, ColoradoPatricia A. Bicknell, EdD, APRN,ACNS-BC, CNLAssistant Professor of Nursing; Track Coordinatorfor Clinical Nurse Leader (CNL)La Salle UniversityPhiladelphia, PennsylvaniaDonna Bowles, EdD, MSN, CNEAssociate ProfessorIndiana University SoutheastNew Albany, IndianaDiane Cohen, RN, MSNProfessorMassBay Community CollegeFramingham, MassachusettsDiane L. Cooper-McLean, RN, BSN, MSNNursing InstructorFaulkner State Community CollegeBay Minette, AlabamaPamela DeWitt, RN, MN, CNEResidential FacultyPhoenix CollegeDepartment of NursingPhoenix, ArizonaKathleen Walsh Free, MSN, RN-C, APRN-BCClinical ProfessorIndiana University SoutheastNew Albany, IndianaMaria McCormick, MSN, MS, RNFacultySpencerian CollegeLouisville, KentuckyMary Ann Siciliano McLaughlin, MSN, RNFaculty, UMDNJ School of NursingUMDNJ School of NursingStratford, New JerseyElizabeth Murray, PhD, RN, CNEAssistant ProfessorFlorida Gulf Coast University School ofNursingFort Myers, FloridaL. Jane Rosati, EdD, MSN, RN-BCAssistant Chair/Program Manager of theADN ProgramDaytona State CollegeDaytona Beach, FloridaFaye Sigman, PhDProfessor of NursingDyersburg StateDyersburg, TennesseeThomas Worms, RN, MSNProfessor of NursingTruman CollegeChicago, IllinoisPolly Gerber Zimmermann, RN, MS, MBA,CEN, FAENAssociate ProfessorHarry S Truman CollegeChicago, IllinoisLynn D. Kennedy, MSN, RNAssistant Professor of NursingFrancis Marion UniversityFlorence, South Carolinavii

3313 FM i-xii 14/03/14 5:13 PM Page viii

3313 FM i-xii 14/03/14 5:13 PM Page ixTable of Contents1Introduction to Prioritization, Assignment,Delegation, and ManagementNCSBN BLUEPRINT FOR QUESTIONSGUIDELINES FOR MAKING A DECISIONTYPES OF QUESTIONSPUTTING THE PIECES TOGETHER2Cardiovascular Management3Peripheral Vascular Management4Respiratory Management5Gastrointestinal Management6Renal and Genitourinary ManagementQUESTIONSCARDIAC CLINICAL SCENARIOANSWERS AND RATIONALESCLINICAL SCENARIO ANSWERS AND RATIONALESQUESTIONSPERIPHERAL VASCULAR DISEASES CLINICAL SCENARIOANSWERS AND RATIONALESCLINICAL SCENARIO ANSWERS AND RATIONALESQUESTIONSRESPIRATORY CLINICAL SCENARIOANSWERS AND RATIONALESCLINICAL SCENARIO ANSWERS AND RATIONALESQUESTIONSGASTROINTESTINAL CLINICAL SCENARIOANSWERS AND RATIONALESCLINICAL SCENARIO ANSWERS AND RATIONALESQUESTIONSRENAL AND GENITOURINARY CLINICAL SCENARIOANSWERS AND RATIONALESCLINICAL SCENARIO ANSWERS AND 120122139141141152154171ix

3313 FM i-xii 14/03/14 5:13 PM Page xxTABLEOFCONTENTS7Neurological Management8Endocrine Management9Integumentary ManagementQUESTIONSNEUROLOGICAL CLINICAL SCENARIOANSWERS AND RATIONALESCLINICAL SCENARIO ANSWERS AND RATIONALESQUESTIONSENDOCRINE CLINICAL SCENARIOANSWERS AND RATIONALESCLINICAL SCENARIO ANSWERS AND RATIONALESQUESTIONSINTEGUMENTARY CLINICAL SCENARIOANSWERS AND RATIONALESCLINICAL SCENARIO ANSWERS AND RATIONALES10Hematological and Immunological Management11Women’s Health Management12Pediatric Health Management13Mental Health ManagementQUESTIONSHEMATOLOGICAL AND IMMUNOLOGICAL CLINICAL SCENARIOANSWERS AND RATIONALESCLINICAL SCENARIO ANSWERS AND RATIONALESQUESTIONSMATERNAL-CHILD CLINICAL SCENARIOANSWERS AND RATIONALESCLINICAL SCENARIO ANSWERS AND RATIONALESQUESTIONSPEDIATRIC CLINICAL SCENARIOANSWERS AND RATIONALESCLINICAL SCENARIO ANSWERS AND RATIONALESQUESTIONSMENTAL HEALTH CLINICAL SCENARIOANSWERS AND RATIONALESCLINICAL SCENARIO ANSWERS AND 363363376378394

3313 FM i-xii 14/03/14 5:13 PM Page xiTABLE14Case Studies: Care of Clients in Various Settings15Comprehensive ExamMEDICAL NURSING CASE STUDYCRITICAL CARE NURSING CASE STUDYOUTPATIENT NURSING CASE STUDYHOME HEALTH CASE STUDYMENTAL HEALTH NURSING CASE STUDYMATERNAL-CHILD CASE STUDYANSWERS TO CASE NSANSWERS AND RATIONALES429429446Appendix A: Normal Laboratory Values469Glossary of English Words Commonly Encountered onNursing Examinations471Index475

3313 FM i-xii 14/03/14 5:13 PM Page xii

3313 Ch01 001–006 14/03/14 4:45 PM Page 1Introduction to Prioritization,Assignment, Delegation,and Management1Each problem that I solved became a rule which servedafterwards to solve other problems.—Rene DescartesThis book is designed to assist the student nurse in nursing school and in taking nursingexaminations, particularly the NCLEX-RN exam for licensure as a registered nurse (RN).Prioritization, Delegation & Management of Care for the NCLEX-RN Exam focuses on aspectsof management such as setting priorities for client care, delegating and assigning nursingtasks, and managing clients and staff. It contains practice questions on these topics in a widevariety of nursing arenas, including medical, surgical, critical care, pediatric, geriatric, rehabilitation, home health, and mental health nursing. Answers—and why each possible responseis correct or incorrect—are given for all questions.Management, prioritizing, and delegation questions are some of the most difficultquestions for the student and new graduate to answer because there is no reference bookin which to find the correct answers. Answers to these types of questions require knowledge of basic scientific principles, standards of care, pathophysiology, and psychosocialbehaviors, and leadership qualities and the ability to think critically. It is important tonote that the test taker may not always agree with the authors’ rationale for the correctanswer. It is poor test taking to read rationales for the incorrect answers; the studentswill remember reading the rationale but not if the rationale was for the correct or incorrect answer.Many of the answers in this book include tips to help the test taker. Termed “MakingNursing Decisions,” these tips provide help for the student in identifying exactly what thequestion is asking, in analyzing the question, and in determining the correct response.A Comprehensive Examination with answers and rationales is also included for each fieldof nursing.Practice questions and answers and practice examinations are valuable in preparing for anexamination, but the test taker should remember that there is no substitute for studying thematerial.(For general information on how to prepare for an examination and on the types of questions used in nursing examinations, refer to Fundamentals Success: A Q&A Review ApplyingCritical Thinking to Test Taking by Patricia Nugent, RN, MA, MS, EdD, and Barbara Vitale,RN, MA.)NCSBN BLUEPRINT FOR QUESTIONSThe National Council of State Boards of Nursing (NCSBN) provides a blueprint that assistsnursing faculty in developing test questions for the NCLEX-RN . Content included inmanagement of care provides and directs nursing care that enhances the care delivery settingto protect clients, family/significant others, and healthcare personnel. Related contentincludes, but is not limited to, advance directives, advocacy, case management, client rights,collaboration with the interdisciplinary team, delegation, establishing priorities, ethical1

3313 Ch01 001–006 14/03/14 4:45 PM Page 22PRIORITIZATION, DELEGATION,ANDMANAGEMENTOFCAREFOR THENCLEX-RN EXAMpractice, informed consent, information technology, and performance improvement. Othertopics also include legal rights and responsibilities, referrals, resource management, staffeducation, supervision, confidentiality/information security, and continuity of care. Thequestions in this book follow this blueprint.GUIDELINES FOR MAKING A DECISIONNurses* base their decisions on many different bodies of information in order to arrive at acourse of action. Among the basic guidelines to apply in nursing practice—and in answeringtest questions—are the nursing process and Maslow’s Hierarchy of Needs.The Nursing ProcessOne of the basic guidelines to apply in nursing practice is the nursing process, which consistsof five steps—assessment, nursing diagnosis, planning, intervention, and evaluation—usuallycompleted in a systematic order.Many questions can be answered based on “assessment.” If a priority-setting question asksthe test taker which step to implement first, the test taker should look for an answer thatwould assess for the problem discussed in the stem of the question.EXAMPLEThe nurse is caring for a client diagnosed with congestive heart failure who is currently complaining of dyspnea. Which intervention should the nurse implement first?1. Administer furosemide (Lasix), a loop diuretic, IVP.2. Check the client for adventitious lung sounds.3. Ask the respiratory therapist to administer a treatment.4. Notify the healthcare provider.Answer: 2Checking for adventitious lung sounds is assessing the client to determine the extent of theclient’s breathing difficulties causing the dyspnea.There are numerous words, such as “check,” that can be used to indicate assessment.The test taker should not discard an option because the word “assess” or “assessment” isnot used. Alternatively, the test taker shouldn’t assume that an option is correct merelybecause the word “assess” is used. The test taker must also be aware that the assessmentdata must match the problem stated in the stem, regardless of terminology. The nursemust assess for the correct information. If option 2 in the above example said, “Assess urinary output,” it would not be a correct option even though it includes the word “assess,”since urinary output is not related to heart failure or breathing difficulties. In addition,the test taker should be aware that assessment is not always the correct answer when thequestion asks which should be done first. Suppose, for example, that the above questionhad listed option 3 as “Apply oxygen via nasal cannula at 2 LPM.” In that case, assessmentdoes not come first. The nurse would first attempt to relieve the client’s distress and thenassess.When a question asks what a nurse should do next, the test taker should determine fromthe information given in the question which steps in the nursing process have been completedand then choose an option that matches the next step in the nursing process.In this book, the term “nurse,” unless otherwise specified, refers to a licensed registered nurse (RN). An RN canassign tasks to an LPN or delegate to unlicensed assistive personnel (UAP), which may be known under otherterms such as medical assistant or nurse’s aide. An LPN can delegate tasks to UAP. Each state will have specificregulations that govern what duties/tasks can be delegated/assigned to each of these types of personnel.The term “healthcare provider,” as used in this book, refers to a client’s primary provider of medical care. Itincludes physicians (including osteopathic physicians), nurse practitioners (NPs), and physician assistants(PAs). Depending on state regulations, many NPs and some PAs have prescriptive authority at least forsome categories of prescribed drugs.

3313 Ch01 001–006 14/03/14 4:45 PM Page 3CHAPTER 1 INTRODUCTIONTOPRIORITIZATION, ASSIGNMENT, DELEGATION,ANDMANAGEMENTThe client diagnosed with peptic ulcer disease has a blood pressure of 88/42, an apicalpulse of 132, and respirations are 28. The nurse writes the nursing diagnosis “alteredtissue perfusion related to decreased circulatory volume.” Which intervention should thenurse implement first?1. Notify the laboratory to draw a type & crossmatch.2. Assess the client’s abdomen for tenderness.3. Insert an 18-gauge catheter and infuse lactated Ringer’s.4. Check the client’s pulse oximeter reading.Answer: 31. Notifying the laboratory for a type & crossmatch would be an appropriate interventionsince the client is showing signs of hypovolemia, but it is not the first intervention becauseit would not directly support the client’s circulatory volume.2. The stem of the question has provided enough assessment data to indicate the client’sproblem of hypovolemia. Further assessment data are not needed.3. The vital signs indicate hypovolemia, which is a life-threatening emergency that requiresthe nurse to intervene to support the client’s circulatory volume. The nurse can do this byinfusing lactated Ringer’s.4. A pulse oximeter reading would not support the client’s circulatory volume.The nurse has assessed the client and formulated a nursing diagnosis. The next step inthe nursing process is implementation. The nurse should proceed to a nursing interventionappropriate to the situation.These types of questions are designed to determine if the test taker can set priorities inclient care.Maslow’s Hierarchy of NeedsIf the test taker has looked at the question and the nursing process can’t help in determiningthe correct option, then using a tool such as Maslow’s Hierarchy of Needs (Fig. 1-1) canassist in choosing the correct answer.Remember that the bottom of the pyramid—physiological needs—represents the toppriority in instituting nursing interventions. If a question asks the test taker to determinewhich is the priority intervention and a physiological need is listed among the options, thenthat is the priority. If a physiological need is not listed, safety and security take priority, andso on up the pyramid.SelfActualizationEsteem andSelf RespectBelongingness and AffectionSafety and SecurityPhysiological NeedsFigure 1–1. Maslow’s Hierarchy ofNeeds.INTRODUCTIONEXAMPLE3

3313 Ch01 001–006 14/03/14 4:45 PM Page 44PRIORITIZATION, DELEGATION,ANDMANAGEMENTOFCAREFOR THENCLEX-RN EXAMTYPES OF QUESTIONSMost of the questions on the NCLEX-RN are multiple choice. The questions involveprioritizing client care, delegating staff tasks, and managing issues dealing with clients andstaff. These questions may include interpreting medication administration records (MARs),knowing when notifying the primary healthcare provider (HCP) is priority, and knowingwhich tasks can be assigned to a licensed practical nurse (LPN) or unlicensed assistive personnel (UAP) and which must be performed by a registered nurse (RN).Some questions on the NCLEX-RN are termed alternate-format questions and including choosing more than one option that correctly answers a question, ranking procedures oractions in correct order, drop-and-drag questions, and fill-in-the-blank questions.EXAMPLEThe nurse is assigning tasks to the UAP. Which is an appropriate delegation to the UAP?Select all that apply.1. Check the area around an incisional wound for redness.2. Help a client with an upper limb cast to eat.3. Assist a patient recovering from a hysterectomy to walk to the bathroom.4. Explain to a client being discharged how to empty and clean the colostomy.5. Transport a client with a suspected fractured tibia to the x-ray department.Prioritizing Questions/Setting PrioritiesIn test questions that ask the nurse which action to take first, two or more of the options willbe appropriate nursing interventions f

Table of Contents 1 Introduction to Prioritization, Assignment, Delegation, and Management 1 NCSBN BLUEPRINT FOR QUESTIONS 1 GUIDELINES FOR MAKING A DECISION 2 TYPES OF QUESTIONS 4 PUTTING THE PIECES TOGETHER 5 2 Cardiovascular Management 7 QUESTIONS 7 CARDIAC CLINICAL SCENARIO 20 ANSWERS AND RATIONALES 22 CLINICAL SCENARIO ANSWERS AND RATIONALES 40 3 Peripheral Vascular Management 43

Related Documents:

Cross-Forest Delegation GALsync v7 2007 Exchange Online Microsoft Federation GALsync v7 2010 2003 Public folders 2 GALsync v4 1 2010 2007 Microsoft Federation or Cross-Forest Delegation GALsync v7 2010 2010 Microsoft Federation or Cross-Forest Delegation GALsync v7 GALsync v7 2010 2013 Microsoft Federation or Cross-Forest Delegation

p r o g r a m o v e r v i e w p a g e 3 e f f e c t i v e t e a m l e a d e r s h i p v e r s i o n 1 . 0 activity – good delegation 35 activity – your approach to delegation 37 steps in the delegation process 38 activity – delegation stoppers!38 some common reasons for not delegating 39 work d

Successful Delegation Above and Beyond Regulation and Accreditation HCCA 2011 Compliance Institute - 207 April 2011 Joyce Hall, RN, CPHQ, CHC . Successful Delegation Relationships Share Best Practice Tips, Tools and Ideas. 2 3 Defining Delegation A formal process by which an organization gives another entity the authority to perform certain .

Requirements Prioritization Case Study Using AHP ABSTRACT: This article describes a tradeoff analysis that can be done to select a suitable requirements prioritization method and the results of trying one meth-od, AHP, in a case study. It is a companion article to the requirements prioritiza-tion introduction.

Jun 18, 2021 · Title: ADvantage RPA 3D-Process Value Discovery & Prioritization Framework Author: HCL Technologies Subject: HCL's ADvantage RPA 3D-Process Value Discovery & Prioritization framework is a 3 dimensional (business, technology & benefit analysis), 35 point-based automation opportunity a

Procurement Procedures Procurement 2.4 Procurement authority 38 2.5 Modification of individual procurement authority 38 2.5.1 Delegation of procurement authority 38 2.5.2 Delegation of procurement authority to UNFPA officers at headquarters 38 2.5.3 Delegation of procurement authority to field office managers 41

practice and determines the appropriate delegation of tasks consistent with the nurse’s obligation to provide optimum patient care” (Fowler, 2008, p. 156). All decisions related to delegation, as well as assignment, are based on the

USING INQUIRY-BASED APPROACHES IN TRADITIONAL PRACTICAL ACTIVITIES Luca Szalay1, Zoltán Tóth2 1Eötvös LorándUniversity, Faculty of Science, Institute of Chemistry, Pázmány Pétersétány1/A, H-1117 Budapest, Hungary, luca@chem.elte.hu 2University of Debrecen, Faculty of Science and Technology, Department of Inorganic and Analytical Chemistry,, Egyetem tér1., H-4010 Debrecen, Hungary,