Management of Care — Questions and Answers
Question 1: A charge nurse has a unit with four clients needing care. Which client should be assessed first?
- A client with stable COPD requesting assistance to ambulate to the bathroom
- A postoperative client who reports incisional pain of 4 out of 10
- A client with chest pain radiating to the left arm who is diaphoretic (Correct answer)
- A client awaiting discharge instructions after an appendectomy yesterday
Correct answer: A client with chest pain radiating to the left arm who is diaphoretic
Chest pain radiating to the left arm with diaphoresis suggests acute myocardial infarction — a life-threatening emergency that requires immediate assessment and intervention. Prioritization follows the ABCs (Airway, Breathing, Circulation) and Maslow's hierarchy.
Question 2: A registered nurse (RN) is delegating tasks to a licensed practical nurse (LPN) and an unlicensed assistive personnel (UAP). Which task is most appropriate to delegate to the UAP?
- Administer oral medications to a stable post-surgical client
- Perform a focused assessment on a newly admitted client
- Measure and record vital signs for a client 4 hours post-surgery (Correct answer)
- Teach a diabetic client about insulin self-injection technique
Correct answer: Measure and record vital signs for a client 4 hours post-surgery
Measuring and recording vital signs for a stable postoperative client is within the UAP's scope of practice and does not require clinical judgment. Assessment, medication administration, and client education require RN or LPN licensure and may not be delegated to UAPs.
Question 3: A nurse suspects that a colleague is diverting controlled substances. The nurse's most appropriate first action is to:
- Confront the colleague directly and ask for an explanation
- Monitor the situation for several more weeks before taking action
- Report the suspicion to the nurse manager or through the facility's chain of command (Correct answer)
- Ask other staff members if they have noticed anything unusual
Correct answer: Report the suspicion to the nurse manager or through the facility's chain of command
Drug diversion is a patient safety and legal issue. The nurse has a professional and ethical obligation to report the suspicion through the proper chain of command (charge nurse, nurse manager, or risk management). Confronting the colleague or delaying reporting is inappropriate.
Question 4: A client with terminal cancer has a valid do-not-resuscitate (DNR) order. The client's adult child insists the nurse 'do everything possible' if the client stops breathing. The nurse should:
- Follow the family's wishes, as they are the client's next of kin
- Initiate CPR to avoid conflict with the family
- Honor the client's DNR order and explain it reflects the client's own wishes (Correct answer)
- Contact the physician to rescind the DNR order based on family request
Correct answer: Honor the client's DNR order and explain it reflects the client's own wishes
A legally executed DNR order reflects the autonomous decision of a competent client and must be honored. Family members cannot override a valid advance directive. The nurse should communicate compassionately with the family while upholding the client's rights.
Question 5: A nurse is completing an incident report after a client received the wrong dose of a medication. The report should include:
- The nurse's personal opinion about why the error occurred
- Objective facts: what happened, when, who was involved, and what actions were taken (Correct answer)
- Speculation about which staff member was primarily responsible
- The incident report number documented in the client's medical record
Correct answer: Objective facts: what happened, when, who was involved, and what actions were taken
Incident reports are objective factual accounts used for quality improvement, not punitive assignment of blame. They should describe what happened, when it occurred, who was involved, and what interventions followed. The incident report itself is never referenced in the medical record.
Question 6: A nurse manager notices that several nurses on the unit consistently bypass the two-patient identifier protocol before administering medications. The most effective management intervention is to:
- Write up each nurse individually and place the documentation in their personnel files
- Post a reminder memo on the medication room door
- Conduct a staff education session and implement unit-level audits to monitor compliance (Correct answer)
- Assign the charge nurse to watch every medication administration on the floor
Correct answer: Conduct a staff education session and implement unit-level audits to monitor compliance
Sustained safety behavior change requires both education and accountability. A targeted education session addresses knowledge gaps, while audits create objective data to monitor compliance and identify persistent issues. This systems-level approach is more effective than individual punitive action.
Management of Care
A charge nurse has a unit with four clients needing care.
Which client should be assessed first?