NURS336 Exam 3 Collab change delegation conflict
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Free NURS336 Exam 3 Collab change delegation conflict Questions
A nurse is providing relief to victims from a small community of 150 people, who are in a shelter because their homes were destroyed by local flooding. The nurse recognizes this as which level of disaster?
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Level I, single-family disaster
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Level IV, local disaster
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Level V, state disaster
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Level II, major disaster
Explanation
Correct Answer: (B) Level IV, local disaster
A Level IV disaster involves a localized event affecting a small community that can be managed with local resources. Flooding that displaces 150 people from a small community requiring shelter reflects a local-level disaster that does not necessitate state or federal intervention, consistent with a Level IV classification.
Why Other Options are Incorrect:
A. Level I, single-family disaster — A Level I disaster involves a single family or very small group and does not apply to a community of 150 displaced individuals.
C. Level V, state disaster — A state disaster involves a widespread event that overwhelms local resources and requires state-level intervention, which is not described in this scenario.
D. Level II, major disaster — A major disaster involves a larger scale event affecting multiple communities or regions, which exceeds the scope of this local flooding scenario.
The community has been affected by a major disaster. In order to receive information on available shelters, the emergency department charge nurse realizes which hospital employee is in charge?
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Incident commander
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Staff nurse
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Emergency room physician
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Nurse Manager
Explanation
Correct Answer: (A) Incident commander
During a major disaster, the Hospital Incident Command System (HICS) is activated and the Incident Commander assumes overall authority and responsibility for managing the hospital's emergency response. The Incident Commander oversees all aspects of disaster management, including coordination with community resources such as available shelters. All departments and roles within the facility operate under the direction of the Incident Commander during an emergency.
Why Other Options are Incorrect:
B. Staff nurse Staff nurses carry out direct patient care during a disaster but do not hold command authority over organizational or community-level disaster coordination. They work within the scope defined by the incident command structure.
C. Emergency room physician The emergency room physician leads medical decision-making for patient care during a disaster but does not hold the overarching administrative and coordination authority that the Incident Commander holds. Clinical and operational leadership are separate roles within HICS.
D. Nurse Manager The Nurse Manager oversees the nursing staff on their unit during a disaster but operates within the broader incident command structure. They do not have the authority or responsibility to manage hospital-wide disaster response or community shelter coordination.
A nurse is helping to triage a group of clients at a mass casualty incident who were involved in an explosion at a local factory. Which of the following clients should the nurse tag to be the priority for care?
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A client who has a piece of wood punctured into the chest wall and has an audible hissing sound coming from the wound site
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A client who has a simple fracture of the femur, multiple scratches on both legs, and is crying hysterically
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A client who has severe head injuries, respiratory rate 6/min, and is unresponsive
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A female who is pregnant at 20 weeks of gestation, has multiple cuts and abrasions, and is walking around
Explanation
Correct Answer: (A) A client who has a piece of wood punctured into the chest wall and has an audible hissing sound coming from the wound site
This client has a penetrating chest wound with an audible hissing sound, which is a classic sign of an open pneumothorax (sucking chest wound). This is an immediately life-threatening condition that compromises breathing and oxygenation. In mass casualty triage using the START system, this client is tagged RED (immediate) because the injury is survivable with immediate intervention. Sealing the wound can prevent progression to tension pneumothorax and death.
Why Other Options are Incorrect:
B. A client who has a simple fracture of the femur, multiple scratches on both legs, and is crying hysterically This client would be tagged YELLOW (delayed). The injuries are significant but not immediately life-threatening. The fact that the client is crying indicates they are conscious, breathing, and able to vocalize, placing them in a lower priority category.
C. A client who has severe head injuries, respiratory rate 6/min, and is unresponsive This client would be tagged BLACK (expectant) in a mass casualty scenario. A respiratory rate of 6/min and unresponsiveness with severe head injuries indicates injuries that are likely unsurvivable even with intervention. In mass casualty triage, resources are directed toward those most likely to survive.
D. A female who is pregnant at 20 weeks of gestation, has multiple cuts and abrasions, and is walking around This client would be tagged GREEN (minor). She is ambulatory, which indicates she is stable and does not have immediately life-threatening injuries. She can wait for care without risk of deterioration.
A nurse is giving a shift report. Which information is most important to include?
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Nurse's personal impression of the patient's personality
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Patient's support or lack of from family
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Patient's current status and recent changes
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Exact details of the interventions provided during the shift
Explanation
Correct Answer: (C) Patient's current status and recent changes
The primary purpose of a shift report is to ensure continuity of care. The most critical information to communicate is the patient's current clinical status and any recent changes, as this directly impacts the incoming nurse's ability to prioritize and respond appropriately.
Why Other Options are Incorrect:
A. Nurse's personal impression of the patient's personality — Personal impressions are subjective and not clinically relevant to patient care continuity.
B. Patient's support or lack of from family — While family support is important, it is not the most critical piece of information in a shift report compared to clinical status.
D. Exact details of the interventions provided during the shift — While relevant, overly detailed intervention reporting is secondary to communicating the patient's current status and changes.
Prescribed: Begin Heparin infusion at 1,050 units/hr Available: Heparin 25,000 units/250 mL D5W How many mL/hr will the nurse set the infusion pump?
Explanation
Correct Answer: 10.5 mL/hr
Step 1 — Find the concentration: 25,000 units/250 mL = 100 units/mL
Step 2 — Calculate the rate: 1,050 units/hr ÷ 100 units/mL = 10.5 mL/hr
The nurse will set the infusion pump to 10.5 mL/hr.
A nurse manager demonstrates a passion for helping the staff, takes time to listen, and prefers to be a teacher rather than a leader. Which type of leader is this most characteristic of?
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Situational leader
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Democratic leader
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Charismatic leader
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Transformational leader
Explanation
Correct Answer: (D) Transformational leader
A transformational leader is characterized by a genuine passion for developing and empowering others, a preference for mentoring and teaching over directing, active listening, and inspiring staff to grow beyond their current capabilities. Transformational leaders focus on the personal and professional development of their team, building a culture of learning and shared purpose rather than simply managing tasks and processes.
Why Other Options are Incorrect:
A. Situational leader A situational leader adapts their leadership style based on the specific situation and the readiness level of their staff. While flexible, situational leadership is primarily task and context-driven rather than centered on mentorship and a passion for developing people.
B. Democratic leader A democratic leader involves staff in decision-making and values group input. While this style respects staff voices, it is primarily focused on participative decision-making rather than the teaching-oriented, growth-centered relationship that defines transformational leadership.
C. Charismatic leader A charismatic leader relies on personal charm, vision, and the ability to inspire through personality and enthusiasm. While charismatic leaders can be motivating, this style is more personality-driven than focused on the deliberate mentorship and teaching orientation described in this scenario.
A busy medical-surgical nursing unit is experiencing high census and seasonal staffing issues. Select the most effective strategy for the nurse manager to recommend to help nursing staff decrease physical stress.
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Nurturing oneself with comfort foods
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Increasing shift rotation
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Encouraging frequent use of personal time off
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Taking time for breaks and lunch
Explanation
Correct Answer: (D) Taking time for breaks and lunch
Taking regular breaks and lunch periods is a practical, evidence-based strategy for reducing physical stress during demanding shifts. It allows nurses to rest, rehydrate, eat, and recover physically, which is directly within the nurse manager's ability to encourage and enforce as a unit policy during periods of high census and staffing strain.
Why Other Options are Incorrect:
A. Nurturing oneself with comfort foods — While self-care is important, relying on comfort foods is not a healthy or effective stress management strategy and may contribute to long-term physical health issues.
B. Increasing shift rotation — Increasing shift rotation during staffing shortages and high census periods can worsen physical and mental fatigue by disrupting sleep patterns and increasing workload demands.
C. Encouraging frequent use of personal time off — While time off is beneficial, it is not a practical immediate strategy during periods of high census and staffing shortages, as increased absences would further strain the unit.
After receiving change of shift report, the nurse prepares to administer morning medications. Which medication should the nurse administer first?
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Stimulant laxative to a patient who has not had a bowel movement in 3 days.
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Intravenous (IV) proton-pump inhibitor medication to a patient who is nothing by mouth (NPO).
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Rapid acting insulin to a patient who has breakfast tray in the room.
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Loop diuretic to a patient with a potassium (K+) level of 3.2 mEq/L.
Explanation
Correct Answer: (C) Rapid acting insulin to a patient who has breakfast tray in the room
Rapid acting insulin must be administered immediately before or at the time of meal consumption. The patient already has their breakfast tray in the room, meaning they are about to eat. Delaying rapid acting insulin while the patient consumes food can result in dangerous postprandial hyperglycemia. Timely administration is critical for glycemic control and patient safety.
Why Other Options are Incorrect:
A. Stimulant laxative to a patient who has not had a bowel movement in 3 days While three days without a bowel movement is a concern, it is not an immediately life-threatening situation. This medication can safely be administered after the more time-sensitive insulin is given.
B. Intravenous proton-pump inhibitor medication to a patient who is NPO While IV medications for NPO patients are important, the proton-pump inhibitor does not carry the same immediate time-sensitive risk as rapid acting insulin given in the presence of an active meal. It can follow once the insulin is administered.
D. Loop diuretic to a patient with a potassium level of 3.2 mEq/L A potassium level of 3.2 mEq/L indicates hypokalemia, and administering a loop diuretic would further lower potassium levels, worsening the electrolyte imbalance. This finding should be reported to the provider before administering the diuretic, and it does not take priority over time-sensitive insulin administration.
The manager of the emergency department has an experienced nurse who has worked for 17 years consistently without difficulty. The manager now notices that the nurse has begun calling in for severe headaches. What type of behavior does this describe?
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Warning signs of overstress
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Compassion fatigue
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Ineffective coping
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Burnout
Explanation
Correct Answer: (D) Burnout
Burnout is characterized by a gradual decline in performance and engagement in a previously high-functioning employee. A nurse with 17 years of consistent, excellent performance who suddenly begins exhibiting physical symptoms such as frequent severe headaches and absenteeism is displaying classic signs of burnout, which develops over time from prolonged occupational stress.
Why Other Options are Incorrect:
A. Warning signs of overstress — While overstress can manifest physically, the pattern described here — a long-term high performer with a sudden behavioral change — is more consistent with burnout than acute overstress.
B. Compassion fatigue — Compassion fatigue typically presents as emotional exhaustion and reduced empathy specifically related to caring for patients, rather than a broader pattern of absenteeism and physical complaints.
C. Ineffective coping — Ineffective coping is a broader concept and does not specifically describe the pattern of gradual deterioration in a previously high-functioning professional seen here.
A staff nurse serves as a member of the hospital's disaster team. Every 3 months, the team tests its disaster plan by practicing for a mass casualty incident. Which role is this drill preparing the nurse for?
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Initiation of the employee call list
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Triage and first aid of victims
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Rescue and evacuation patients
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Coordination of patient supplies
Explanation
Correct Answer: (B) Triage and first aid of victims
Mass casualty incident drills are specifically designed to prepare nurses and other healthcare personnel for the rapid assessment and prioritization of victims based on the severity of their injuries. Triage and first aid are the core nursing functions practiced during such disaster simulations to ensure an organized and effective response when a real event occurs.
Why Other Options are Incorrect:
A. Initiation of the employee call list — This is an administrative function typically handled by management or designated personnel and is not the primary focus of a mass casualty drill for staff nurses.
C. Rescue and evacuation of patients — Rescue and evacuation are primarily the responsibility of emergency responders such as firefighters and security personnel, not bedside nurses.
D. Coordination of patient supplies — Supply coordination is a logistical role typically managed by supply chain or administrative staff, not the primary role practiced by a staff nurse in a mass casualty drill.
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