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71. A student nurse is developing a plan of care for a paranoid client with a nursing diagnosis of Disturbed thought processes. The registered nurse reviews the interventions developed by the student and suggests revising the plan if the student has documented which intervention?
a) sit with the client and hold the client's hand
b) display a nonjudmental attitude
c) use simple and clear language when speaking to the client
d) diffuse angry and hostile verbal attacks with nondefensive stand
72. A benzodiazepine anxiolytic has been prescribed for a client for the management of anxiety, and a student nurse prepares to provide instructions to the client regarding the administration of the medication. The registered nurse who is supervising the student intervenes if the student plans to tell the client which of the following?
a) avoid driving or other activities requiring alertness until the response to the medication
b) do not skip medication doses and do not double up on missed doses
c) double a dose if a dose was missed
d) avoid the use of alcohol while taking the medication
73. A nurse is reviewing the critical paths of the clients on the nursing unit. In performing a variance analysis, which of the following would indicate the need for further action and analysis?
a) clear breath sounds in client with congestive heart failure
b) a postoperative client who develops a cough and a fever
c) the absence of a wound infection in a client who had a coronary artery bypass graft
d) a client with diabetes mellitus demonstrating accurate use of a glucometer following teaching
74. A nurse is told that the nursing model used in the nursing facility is a functional nursing approach. The nurse understands that planning care delivery will be based on which characteristic of this type of nursing model of practice?
a) a task approach methods is used to provide care to clients
b) a single registered nurse (RN) is responsible for providing nursing care to a group of clients
c) managed care concepts and tools are used in providing client care
d) nursing personnel are led by a RN in providing care to a group of clients
75. A nurse manager has implemented a change in the method of documenting nursing care. A licensed practical nurse (LPN) is resistant to the change and is not taking an active part in facilitating the process of change. Which of the following would be the best approach in dealing with the LPN?
a) ignore the resistance
b) tell the LPN that the registered nurse will do all of the documentation
c) confront the LPN, and encourage verbalization of feelings regarding the change
d) tell the LPN that she must comply with the change
Nursing Management Styles
Answers and Rationale
- When caring for a paranoid client, the nurse must avoid any physical contact. The nurse should ask the client's permission if touch is necessary because touch may be interpreted as a physical or sexual assault. The nurse should use simple and clear language when speaking to the client to prevent misinterpretation and to clarify the nurse's intent and actions. A warm approach is avoided because it can be frightening to a person who needs emotional distance. Anger and hostile verbal attacks are diffused with a nondefensive stand. The anger a paranoid client expresses is often displaced, and when a staff member becomes defensive, anger of both the client and staff member escalates. A nondefensive and nonjudgmental attitude provides an environment in which feelings can be explored more easily.
- The client should be instructed to take the medication exactly as directed and not to skip or double up on the doses. The client should also be instructed not to increase doses or to abruptly withdraw the medication. Abrupt withdrawal may cause tremors, nausea, vomiting, and abdominal or muscle cramps. The client is also advised to avoid driving or other activities requiring alertness until response to the medication is known and to avoid taking alcohol or other central nervous system depressants concurrently with this medication.
- Variances are actual deviations or detours from the critical paths. Variances can be positive or negative, avoidable or unavoidable, and can be caused by a variety of things. Positive variance occurs when the client achieves maximum benefit and is discharged earlier than anticipated. Negative variance occurs when untoward events prevent a timely discharge. Variance analysis occurs continually in order to anticipate and recognize negative variance early so that appropriate action can be taken.
- In functional nursing, a task approach method is used to provide care to clients. Option B exemplifies primary nursing. Option C exemplifies a component of case management. Option D exemplifies team nursing.
- Confrontation is an important strategy to meet resistance head-on. Face-to-face meetings to confront the subject at hand will allow verbalization of feelings, identification of problems and subjects, and development of strategies to solve the problem. Option A will not address the problem. Option B might provide a temporary solution to the resistance but will not specifically address the concern. Option D might produce additional resistance.
After you reviewed your answers through its rationale, you can also go back to the first page to start from the beginning:
Nursing Management Styles (1-5)
Or proceed to the next set of questions:
Nursing Management Styles (76-80)