Nursing Elites

1. When a client's postoperative pain seems to be getting worse due to grief over the recent death of their spouse, what should the nurse consider?

• A. calling the physician for an increased dosage of pain medication
• B. calling the physician for a sedative
• C. referring the client for a psychiatric consult
• D. developing interventions for grief and loss

Correct answer: D

Rationale: The correct answer is developing interventions for grief and loss. In this scenario, the client's pain is not solely sensory but also affective due to grieving over the death of their spouse. It is essential to address the emotional component of pain by providing support and interventions for grief and loss. Referring the client for a psychiatric consult may not be necessary as grieving is a normal response to such a significant loss. Calling the physician for an increased dosage of pain medication or a sedative solely focuses on the sensory aspect of pain and does not address the underlying emotional distress.

2. A nurse discusses staff empowerment with the nursing team. The nurse explains that staff empowerment has which function?

• A. Fosters the growth of others so that they are less dependent on the leader
• B. Means that the staff has the power to reprimand and punish any individual who is not meeting the standards of care delivery
• C. Indicates that the nurse leader will make decisions regarding the nursing unit and expects that the staff will comply with the changes
• D. Allows the staff to make every decision regarding employee scheduling

Correct answer: A

Rationale: Staff empowerment fosters the growth of others and facilitates their development so that they are less dependent on their leader. This empowerment is about enhancing skills and autonomy, not about reprimanding or punishing others (Choice B). Empowerment involves shared decision-making and autonomy, not unilateral decision-making by the leader (Choice C). Moreover, staff empowerment does not mean that staff should make every decision regarding operational aspects like employee scheduling (Choice D). It is primarily focused on developing individuals' capabilities and fostering independence within the team.

3. A health care provider repeatedly asks a nurse to write his verbal prescriptions in his clients' charts after he makes his rounds. The nurse is uncomfortable with writing the prescriptions and explains this to the health care provider, but the health care provider tells the nurse that she will be reported if she does not write the prescriptions. How should the nurse manage this conflict?

• A. Stating to the health care provider, 'I don't really care whether you report me. I am not writing your prescriptions.'
• B. Fulfilling the health care provider's request
• C. Discussing the situation with the nurse manager
• D. Reporting the health care provider to the chief of medicine at the hospital

Correct answer: C

Rationale: When a conflict arises, it is most appropriate to try resolving the conflict directly. In this situation, the nurse has tried to explain why she is uncomfortable with the health care provider's request but has been unable to resolve the conflict. The nurse would then most appropriately use organizational channels of communication and discuss the issue with the nurse manager, who would then proceed to resolve the conflict. The nurse manager may attempt to discuss the situation with the health care provider or seek assistance from the nursing supervisor. Fulfilling the health care provider's request and writing the prescriptions in the clients' charts ignores the issue. Reporting the health care provider to the chief of medicine is inappropriate because the nurse should use the appropriate organizational channels of communication to resolve the conflict. Stating 'I don't really care whether you report me. I am not writing your prescriptions.' is an inappropriate statement and will result in further conflict between the nurse and health care provider.

4. A director of nursing at a long-term care center has announced a change to computerized documentation of nursing care. A certified nursing assistant (CNA) on the team, resistant to the change, is not taking an active part in facilitating the implementation of the new procedure. Which strategy would be the best approach to dealing with the conflict?

• A. Meeting with the CNA and encouraging him to express his feelings regarding the change
• B. Ignoring the resistance
• C. Telling the CNA that a licensed practical nurse (LPN) will perform all computer documentation while he documents intake and output and vital signs
• D. Telling the CNA that noncompliance will be documented in the personnel record

Correct answer: A

Rationale: The best approach to dealing with resistance to change is through open communication and understanding. Meeting with the CNA and encouraging him to express his feelings regarding the change allows for a constructive dialogue where issues can be addressed, and alternative solutions can be explored. Ignoring the resistance does not help in resolving the conflict and may lead to further issues. Telling the CNA that a licensed practical nurse (LPN) will perform all computer documentation while he documents intake and output and vital signs does not address the underlying concerns of the CNA and may create more resistance. Threatening the CNA with noncompliance consequences may escalate the resistance and create a negative work environment.

5. Which of the following behaviors is least appropriate when dealing with fellow staff members?

• A. Provide positive feedback and constructive criticism
• B. Serve as a resource
• C. Only report conflicts that interfere with client care
• D. Provide input for performance evaluations

Correct answer: C

Rationale: The least appropriate behavior when dealing with fellow staff members is to only report conflicts that interfere with client care. This choice implies ignoring or neglecting other conflicts that may affect team dynamics and the work environment. It is crucial to address and report all conflicts, whether they impact client care directly or not, to maintain a harmonious and effective working relationship within the healthcare setting. Providing positive feedback, constructive criticism, serving as a resource, and offering input for performance evaluations are all important and appropriate behaviors that contribute to a supportive and professional work environment. By focusing solely on conflicts that interfere with client care, essential issues that influence teamwork and overall staff morale may be overlooked, potentially leading to a negative impact on the work environment.

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