Nursing Management Styles (NCLEX 71-75)

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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

71) A
- 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.

72) C
- 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.

73) B
- 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.

74) A
- 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.

75) C
- 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)

Nursing Management Styles (NCLEX 66-70)

Welcome to Nursing Management Styles. Enjoy answering and I hope that NCLEX Review and Secrets can somehow help you in your future examination. Good Luck.

66. A physician wrote an order for wrist restraints to be applied to a client. The nurse instructs the nursing assistant to apply the restraints. When checking the client, which observation would indicate that the nursing assistant performed unsafe care?

a) a safety (hitch) knot was used to secure the restraints
b) restraints were released every 2 hours
c) restraints were applied snugly and tightly
d) the call light was placed within reach of the client's hand

67. A registered nurse assigns a new nursing graduate to care for a client with a diagnosis of active tuberculosis, and the registered nurse explains the use of a particulate respirator to the graduate. Which observation indicates that the new nursing graduate understands how the particulate respirator operates?

a) the nosepiece is readjusted if air is detected escaping around the nose
b) another particulate respirator is obtained if air is escaping around the nose
c) the new nursing graduate states that a fit check is not needed
d) the new nursing graduate states that a fit check is necessary only when putting on the respirator for the first time

68. A registered nurse has instructed a new nursing graduate about the procedure for weaning a client from a ventilator by using a T-piece. The registered nurse determines that the new nursing graduate nurse states which of the following to be part of the procedure?

a) removing the client from the mechanical ventilator for a short period
b) connecting the T-piece to the client's artificial airway
c) providing supplemental oxygen through the T-piece at an Flo2 that is 10% higher than the ventilator setting
d) gradually decreasing the respiratory rate on the ventilator until the client takes over all of the work of breathing

69. A registered nurse is mentoring a new nurse hired to work in the nursing unit. The registered nurse determines that the new nurse is competent to provide safe effective care for a client on a ventilator when the registered nurse notes that the new nurse:

a) has the ventilator routinely assessed by the respiratory therapist
b) realizes that the ventilator readings provide information without human error
c) teaches family members how to reset controls during their visits if necessary
d) establishes a rest pattern before morning care

70. A nursing student develops a plan of care for a client who will be returning from the operating room after a mastoidectomy. The registered nurse reviews the plan of care and instructs the student to revise the plan if which intervention is listed?

a) assess client for pain, dizziness, or nausea
b) keep the head of the bed elevated to 30 degrees
c) instruct the client to lie on the affected side
d) assess for signs of injury to cranial nerve VII

Nursing Management Styles
Answers and Rationale

66) C
- Restraints should never be applied tightly because they could impair the circulation. A safety (hitch) knot may be used on the restraint because it can easily be released in an emergency. Restraints must be released at least every 2 hours (or per agency policy) to inspect the skin for abnormalities and to provide range-of-motion exercises. The call light must always be at the client's reach in case the client needs assistance.

67) A
- Personal protective equipment, called particulate respirators, is required for all health care workers entering a tuberculosis isolation room. When fitted and used properly, these respirators filter droplet nuclei. It is important that no air escapes around the nose while wearing the respirator. The strap needs to be adjusted if air is escaping. It is important to exhale forcefully while placing both hands over the apparatus. It is necessary to perform a fit check each time the nurse uses the mask.

68) D
- The T-piece or Briggs device requires that the client is removed from the mechanical ventilation for a short time, usually beginning with a 5-minute period. The ventilator is disconnected and the T-piece is connected to the client's artificial airway. Supplemental oxygen is provided through the device, often at a FIo2 that is 10% higher than the ventilator setting. Option 4 describes the process of weaning via synchronized intermittent mandatory ventilation.

69) A
- Ventilators need to be assessed routinely by the respiratory therapist. Ventilators are machines, and machines can fail. Therefore, option B is not a reasonable option. Family members should not reset ventilator controls. Although option D is considered good nursing practice for the comfort of the client, it is not the priority option.

70) C
- Following mastoidectomy, the nurse should monitor vital signs and inspect the dressing for drainage or bleeding. The nurse should assess for signs of facial nerve injury to cranial nerve VII and assess the client for pain, dizziness, or nausea. The head of the bed should be elevated at least 30 degrees, and the client is instructed to lie on the unaffected side. The client would probably have sutures and an outer ear packing and a bulky dressing, which is removed on approximately the sixth postoperative day.

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 (71-75)