Why is the assessment of staffing needs a crucial management skill?
It enables the manager to avoid staffing crisis
Key points for management to help with this
-Know the source of their nursing pool
-Local nursing school numbers
-Normal length of employment for new hires
-Peak resignation periods in the year
-When patient
What is the process of actively seeking out or
attracting applicants
for existing positions called?
Recruitment
Important to note it should be an ongoing process
What are the to characteristics that help an organization to be considered on a list of "best places" to work?
-"Financially secure/fit"
-"Leadership keeping the ball rolling to keep revenue and patient satisfaction going upward
What are some factors that positively affect recruitment?
-Competitive salaries
-Desirable location of company
-Financial resources
-Adequate nursing pool
-Reputation of company
-Status of national/local economy
What is the term used to describe a verbal interaction between individuals for a particular hiring purpose, in which the company is looking to see if you are a good fit, and also if they are
a good fit for you
?
An interview
What is the most
commonly used method
for employee selection used by managers?
Interviewing as a selection tool
-Also the most
time consuming
method and
most costly
What is something that can cause the
reliability and validity
of an interview as a selection tool to be questioned?
The interviewer uses judgements, biases, and values to make a decision based on a short interaction with the applicant.
What are some ways to overcome interview limitations?
-Use a team approach
-Use of scenarios to test decision making ability
-Use/develop a structured interview format for each job description.
-Conduct multiple interviews
-Provide training to management in effective interviewing techniques
What is the next step after applicants have been recruited, applied, and completed an interview?
The selection process
1. You are caring for a patient with esophageal cancer. Which task could be delegated to a UAP?
1. Assisting the patient with oral hygiene
2. Observing the patient's response to feedings
3. Facilitating expression of grief or anxiety
4. Initiating daily w
Answer: 1
-Oral hygiene is w/in the scope of duties of the UAP. It is the responsibility of the RN to observe response to treatments and to help the patient deal with loss/anxiety. The UAP can be directed to weight the patient but should not be expected t
A 56-year-old patient comes to the walk-in clinic reporting scant rectal bleeding and intermittent diarrhea and constipation for the past several months. There is a history of polyps and a family history of colorectal cancer. While you are trying to teach
4
The patient's physical condition is currently stable, but emotional needs are affecting his or her ability to receive the information required to make an informed decision. The other diagnoses are relevant, but if the patient leaves the clinic the inter
Which patient is at greatest risk for pancreatic cancer?
1. An elderly African-American man who smokes
2. A young white obese woman with gallbladder disease
3. A young African-American man with type 1 diabetes
4. An elderly white woman who has pancreatiti
1
Pancreatic cancer is more common in African-Americans, males, and smokers. Other associated factors include alcohol use, diabetes, obesity, history of pancreatitis, exposure to organic chemicals, consumption of a high-fat diet, and previous abdominal ir
Patients receiving chemotherapy are at risk for thrombocytopenia related to chemotherapy or disease processes. Which actions are needed for patients who must be placed on bleeding precautions? (Select all that apply.)
1. Provide mouthwash with alcohol for
Ans: 2, 3, 5, 6, 7 Mouthwash should not include alcohol, because it has a drying action that leaves mucous membranes more vulnerable. Insertion of suppositories, probes, or tampons into the rectal or vaginal cavity is not recommended. All other options ar
When care assignments are being made for patients with alterations related to gastrointestinal (GI) cancer, which patient would be the most appropriate to assign to an LPN/LVN under the supervision of a team leader RN?
1. A patient with severe anemia seco
Ans: 2 Administering enemas and antibiotics is within the scope of practice of LPNs/LVNs. Although some states an facilities may allow the LPN/LVN to administer blood, in general, administering blood, providing preoperative teaching, and assisting with ce
6. A community health center is preparing a presentation on the prevention and detection of cancer. Which health care professional (RN, LPN/LVN, nurse practitioner, nutritionist) should be assigned responsibility for the following tasks?
1. Explain screen
Ans: 1. Nurse practitioner, 2. Nutritionist, 3. LPN/LVN, 4. Nurse practitioner, 5. RN The nurse practitioner is often the provider who performs the physical examinations and recommends diagnostic testing. The nutritionist can give information about diet.
The physician tells the patient with cancer that there will be an initial course of treatment with continued maintenance treatments and ongoing observation for signs and symptoms over a prolonged period of time. Which patient statement would concern you t
Ans: 3 Further assess what the patient means by having "control over my own life and death." This could be an indirect statement of suicidal intent. A patient who believes he will be cured should also be assessed for misunderstanding what the physician sa
For a patient who is experiencing side effects of radiation therapy, which task would be the most appropriate to delegate to the UAP?
1. Helping the patient to identify patterns of fatigue
2. Recommending participation in a walking program
3. Reporting th
Ans: 3 The UAP can observe the amount that the patient eats (or what is gone from the tray) and report to the nurse. Assessing patterns of fatigue and skin reaction is the responsibility of the RN. The initial recommendation for exercise should come from
For a patient receiving the chemotherapeutic drug vincristine (Oncovin), which side effects should be reported to the physician?
1. Fatigue
2. Nausea and vomiting
3. Paresthesia
4. Anorexia
Ans: 3 Paresthesia is a side effect associated with some chemotherapy drugs such as vincristine. The physician can modify the dosage or discontinue the drug. Fatigue, nausea, vomiting, and anorexia are common side effects of many chemotherapy medications.
For a patient who is receiving chemotherapy, which laboratory result is of particular importance?
1. White blood cell (WBC) count
2. Prothrombin time and partial thromboplastin time
3. Electrolyte levels
4. Blood urea nitrogen level
Ans: 1 WBC count is especially important, because chemotherapy can cause decreases in WBCs, particularly neutrophils (known as neutropenia), which leave the patient vulnerable to infection. The other tests are important in the total management but are les
For care of a patient who has oral cancer, which task would be appropriate to delegate to an LPN/LVN?
1. Assisting the patient to brush and floss
2. Explaining when brushing and flossing are contraindicated
3. Giving antacids and sucralfate suspension as
Ans: 3 Giving medications is within the scope of practice of the LPN/LVN. Assisting the patient in brushing and flossing should be delegated to the UAP. Explaining contraindications is the responsibility of the RN. Recommendations for saliva substitutes s
When staff assignments are made for the care of patients who are receiving chemotherapy, what is the major consideration regarding chemotherapeutic drugs?
1. During preparation, drugs may be absorbed through the skin or inhaled.
2. Many chemotherapeutic d
Ans: 1 Chemotherapy drugs should be given by nurses who have received additional training in how to safely prepare and deliver the drugs and protect themselves and others from exposure. The other options express concerns, but the general principles of dru
You have just received the morning report from the night shift nurse. List the order of priority for assessing and caring for the following patients.
1. A patient who developed tumor lysis syndrome around 5:00 AM
2. A patient with frequent reports of brea
Ans: 1, 3, 2, 4 Tumor lysis syndrome is an emergency involving electrolyte imbalances and potential renal failure. A patient scheduled for surgery should be assessed and prepared for surgery. A patient with breakthrough pain needs assessment, and the phys
You are monitoring your patient who is at risk for spinal cord compression related to tumor growth. Which patient statement is most likely to suggest an early manifestation?
1. "Last night my back really hurt, and I had trouble sleeping."
2. "My leg has b
Ans: 1 Back pain is an early sign of spinal cord compression occurring in 95% of patients. The other symptoms are later signs. Focus: Prioritization
You are caring for an older woman with hepatic cancer. The UAP informs you that the patient's level of consciousness is diminished compared to earlier in the shift. Prioritize the steps of assessment and intervention related to this patient's change of me
Ans: 2, 7, 1, 3, 6, 4, 5 Determine level of consciousness and responsiveness, and changes from baseline. Oxygen should be administered immediately in the presence of respiratory distress or risk for decreased oxygenation and perfusion. Pulse oximetry can
Which members of the health care team (APN, MD, RN, LPN/LVN) should perform the tasks related to care of patients who are at risk for breast cancer? (There may be more than one professional who could complete the task.)
1. Perform the clinical breast exam
Ans: 1. Advanced practice nurse, MD, 2. Advanced practice nurse, MD, RN, 3. Advanced practice nurse, RN, 4. Advanced practice nurse, MD, RN, 5. Advanced practice nurse, MD, RN, LPN/LVN, 6. MD Advanced practice nurses could do any of the tasks; however, ex
For a patient with osteogenic sarcoma, which laboratory value causes you the most concern?
1. Sodium level of 135 mEq/L
2. Calcium level of 13 mg/dL
3. Potassium level of 4.9 mEq/L
4. Hematocrit of 40%
Ans: 2 Potentially life-threatening hypercalcemia can occur in cancers with destruction of bone. Other laboratory values are pertinent for overall patient management but are less specific to bone cancers. Focus: Prioritization
Which two cancer patients could potentially be placed together as roommates? (Select all that apply)
1. A patient with a neutrophil count of 1000/mm3
2. A patient who underwent debulking of a tumor to relieve pressure
3. A patient who just underwent a bon
Ans: 2, 4 Debulking of tumor and laminectomy are palliative procedures. These patients can be placed in the same room. The patient with a low neutrophil count and the patient who has had a bone marrow transplantation need protective isolation. Focus: Assi
An athletic young man was recently diagnosed with Ewing sarcoma. He has pain, low-grade fever, and anemia. The surgeon recommends amputation of the right lower leg for an operable tumor. The patient tells you he is leaving the hospital to go on a long hik
Ans: 3 The patient is not coping with the recent diagnosis of cancer and prospect of losing his leg. His decision to go hiking may be a form of denial, or possibly a veiled suicide threat. It is also possible that he has decided not to have any treatment;
Following chemotherapy, a patient is being closely monitored for tumor lysis syndrome. Which laboratory value requires particular attention?
1. Platelet count
2. Electrolyte levels
3. Hemoglobin level
4. Hematocrit
Ans: 2 Tumor lysis syndrome can result in severe electrolyte imbalances and potential kidney failure. The other laboratory values are important to monitor to identify general chemotherapy side effects but are less pertinent to tumor lysis syndrome. Focus:
People at risk are the target populations for cancer screening programs. Which of these asymptomatic patients need extra encouragement to participate in cancer screening? (Select all that apply.)
1. A 21-year-old white American woman who is sexually inact
Ans: 1, 3, 4, 5 Women age 21 or over should have annual Pap smears, regardless of sexual activity. African-American men should begin prostate-specific antigen testing at age 45. Colonoscopy and annual fecal occult blood testing are recommended for those w
A patient with lung cancer develops syndrome of inappropriate antidiuretic hormone secretion (SIADH). After reporting symptoms of weight gain, weakness, and nausea and vomiting to the physician, you would anticipate which initial order for the treatment o
Ans: 2 Hyponatremia is a concern; therefore, fluid restrictions would be ordered. Urinalysis is less pertinent; however, the nurse should monitor for changes in urine specific gravity. The diet may need to include sodium supplements. Fluid bolus is unlike
In the care of a patient with neutropenia, what tasks can be delegated to a UAP? (Select all that apply.)
1. Taking vital signs every 4 hours
2. Reporting temperature of more than 100.4� F (38� C)
3. Assessing for sore throat, cough, or burning with urina
Ans: 1, 2, 4, 6 Measuring vital signs and reporting on specific parameters, practicing good hand washing, and gathering equipment are within the scope of duties for a UAP. Assessing for symptoms of infections and superinfections is the responsibility of t
A primary nursing responsibility is the prevention of lung cancer by assisting patients in cessation of smoking or other tobacco use. Which task would be appropriate to delegate to an LPN/LVN?
1. Development of a "quit plan"
2. Explanation of how to apply
Ans: 2 An LPN/LVN is versed in medication administration and able to teach patients standardized information. The other options require more in-depth assessment, planning, and teaching, which should be performed by the RN. Helping patients with smoking ce
You are providing end-of-life-care for a patient with terminal liver cancer. The patient is weak and restless. Her skin is cool and mottled. Dyspnea develops and the patient appears anxious and frightened. What should you do?
1. Obtain an order for morphi
Ans: 1 Morphine elixir is the therapy of choice because it is thought to reduce anxiety and the subjective sensation of air hunger. It also increases venous capacitance. End-of-life-care should not include aggressive measures such as intubation or resusci
You are asked to float to a different nursing unit. During report, you are told that the patient is receiving IV administration of vincristine (Oncovin) that should be completed within the next 15 minutes. The IV site is intact, and the patient is not hav
Ans: 3 Explain that you are not chemotherapy certified so that the charge nurse can quickly rearrange the patient assignments. You can assess the patient, site, and infusion; however, you do not have the expertise to recognize the side effects of the medi
You are caring for a patient with uterine cancer who is being treated with intracavitary radiation therapy. The UAP reports that the patient insisted on ambulating to the bathroom and now "something feels like it is coming out." What is the priority actio
Ans: 2 If the radiation implant has obviously been expelled (i.e., is on the bed linens), use a pair of forceps to place the radiation source in a lead container. The other options would be appropriate after safety of the patient and personnel are ensured
You are the charge nurse. Two hours into the shift you discover that two nurses have switched patients because Nurse A does "not like to take care of patients with prostate cancer." Which action should you take first?
1. Insist that they switch back to th
Ans: 3 You must try to find out what Nurse A is thinking and feeling. If you can discover the underlying issue, there is a better chance that you can help her (e.g., referral to counseling or in-service training). You should try to avoid being too draconi
You are initiating a nursing care plan for a patient with osteoporosis. All of these nursing interventions apply to the nursing diagnosis Risk for Falls. Which intervention should you delegate to the UAP?
1. Identifying environmental factors that increase
Ans: 4 Assisting with activities of daily living (ADLs) is within the scope of the UAP's practice. The other three interventions require additional educational preparation and are within the scope of practice of licensed nurses. Focus: Delegation, supervi
You are preparing to teach a patient with a new diagnosis of osteoporosis about strategies to prevent falls. Which teaching points will you be sure to include? (Select all that apply.)
1. Wear a hip protector when ambulating.
2. Remove throw rugs and othe
Ans: 1, 2, 3, 5 The purpose of the teaching is to help the patient prevent falls. The hip protector can prevent hip fractures if the patient falls. Throw rugs and obstacles in the home increase the risk of falls. Patients who are tired are also more likel
Your assessment reveals all of these data when you are admitting a patient with Paget disease. Which finding should you notify the physician about first?
1. There is a bowing of both legs and the knees are asymmetrical.
2. The base of the skull is invagin
Ans: 2 Platybasia (basilar skull invagination) causes brainstem manifestations that threaten life. Patients with Paget disease are usually short and often have bowing of the long bones that results in asymmetrical knees or elbow deformities. The skull is
The charge nurse observes an LPN/LVN providing all of these interventions for a patient with Paget disease. Which action requires that the charge nurse intervene?
1. Administering 600 mg of ibuprofen (Advil) to the patient
2. Encouraging the patient to pe
Ans: 3 Applying heat, not ice, is the appropriate measure to help reduce the patient's pain. Ibuprofen is useful to manage mild to moderate pain. Exercise prescribed by the PT would be non impact in nature and provide strengthening for the patient. A diet
As charge nurse, you are making assignments for the day shift. Which patient would you assign to the nurse who was floated from the postanesthesia care unit (PACU) for the day?
1. 35-year-old with osteomyelitis who needs teaching before hyperbaric oxygen
Ans: 4 The PACU nurse is very familiar with the assessment skills necessary to monitor a patient who just underwent surgery. For the other patients, nurses familiar with musculoskeletal system-related nursing care are needed to provide teaching and assess
You delegate the measurement of vital signs to an experienced UAP. Osteomyelitis has been diagnosed in a patient. Which vital sign value would you instruct the UAP to report immediately?
1. Temperature of 101� F (38.3� C)
2. Blood pressure of 136/80 mm Hg
Ans: 1 An elevated temperature indicates infection and inflammation. This patient needs IV antibiotic therapy. The other vital sign values are normal or high normal. Focus: Delegation, supervision
You are working with a UAP to provide care for six patients. At the beginning of the shift, you carefully tell the UAP what patient interventions and tasks she is expected to perform. To be sure that your communication is appropriate, you refer to the "Fo
Ans: Clear, Concise, Correct, Complete Implementing the Four Cs of communication helps the nurse ensure that the UAP understands what is being said; that the UAP does not confuse the nurse's directions; that the directions comply with policies, procedures
You are caring for a patient with carpal tunnel syndrome (CTS) who has been admitted for surgery. Which intervention should you delegate to the UAP?
1. Initiating placement of a splint for immobilization during the day
2. Assessing the patient's wrist and
Ans: 3 Helping with ADLs is within the scope of practice of UAPs. Placing a splint for the first time is appropriate to the scope of practice of PTs. Assessing and testing for paresthesia are not within the scope of practice of UAPs. Focus: Delegation, su
You observe a UAP performing all of these interventions for a patient with CTS. Which action requires that you intervene immediately?
1. Arranging the patient's lunch tray and cutting his meat
2. Providing warm water and assisting the patient with his bat
Ans: 3 When a patient with CTS has a splint to immobilize the wrist, the wrist is placed either in the neutral position or in slight extension. The other interventions are correct and are within the scope of practice of a UAP. UAPs may remind patients abo
A patient is scheduled for endoscopic carpal tunnel release surgery in the morning. What would you be sure to teach the patient?
1. Pain and numbness will be experienced for several days to weeks.
2. Immediately after surgery, the patient will no longer n
Ans: 1 Postoperative pain and numbness occur for a longer period of time with endoscopic carpal tunnel release than with an open procedure. Patients often need assistance postoperatively, even after they are discharged. The dressing from the endoscopic pr
As charge nurse, you assign the nursing care of a patient who has just returned from open carpal tunnel release surgery to an experienced LPN/LVN, who will perform under the supervision of an RN. Which instructions would you provide for the LPN/LVN? (Sele
Ans: 1, 2, 3, 5 Postoperatively, patients undergoing open carpal tunnel release surgery experience pain and numbness, and their discomfort may last for weeks to months. All of the other directions are appropriate for the postoperative care of this patient
You are preparing the patient who had carpal tunnel release surgery for discharge. Which information is important to provide to this patient?
1. The surgical procedure is a cure for CTS.
2. Hand movements will be restricted for 4 to 6 weeks after surgery.
Ans: 2 Hand movements, including heavy lifting, may be restricted for 4 to 6 weeks after surgery. Patients experience discomfort for weeks to months after surgery. The surgery is not always a cure; in some cases, CTS may recur months to years after surger
When receiving discharge instructions, a patient with osteoporosis makes all of these statements. Which statement indicates to you that the patient needs additional teaching?
1. "I take my ibuprofen every morning as soon as I get up."
2. "My daughter remo
Ans: 1 Ibuprofen can cause abdominal discomfort or pain and ulceration of the gastrointestinal tract. In such cases, it should be taken with meals or milk. Removal of throw rugs helps prevent falls. Range-of-motion exercises and rest are important strateg
A patient has a fractured femur. Which finding would you instruct the UAP to report immediately?
1. The patient reports pain.
2. The patient appears confused.
3. The patient's blood pressure is 136/88 mm Hg.
4. The patient voided using the bedpan.
Ans: 2 Fat embolism syndrome is a serious complication that often results from fractures of long bones. Its earliest manifestation is altered mental status caused by a low arterial oxygen level. The nurse would want to know about and treat the pain, but i
After you receive the change-of-shift report, which patient should you assess first?
1. 42-year-old with CTS who reports pain
2. 64-year-old with osteoporosis awaiting discharge
3. 28-year-old with a fracture who reports that the cast is tight
4. 56-year-
Ans: 3 The patient with the tight cast is at risk for circulation impairment and peripheral nerve damage. Although all of the other patients' concerns are important and the nurse will want to see them as soon as possible, none of their complaints is urgen
A patient with a fractured fibula is receiving skeletal traction and has skeletal pins in place. What would you instruct the UAP to report immediately?
1. The patient wants to change position in bed.
2. There is a small amount of clear fluid at the pin si
Ans: 3 When the weights are resting on the floor, they are not exerting pulling force to provide reduction and alignment or to prevent muscle spasm. The weights should always hang freely. Attending to the weights may reduce the patient's pain and spasm. W
The nursing diagnosis for a patient with a fracture of the right ankle is Impaired Physical Mobility. As charge nurse, you observe a newly-graduated RN perform all of these interventions. For which action should you intervene?
1. Encouraging the patient t
Ans: 1 Moving from a lying position first to a sitting position and then to a standing position allows the patient to establish balance before standing. Administering pain medication before the patient begins exercising decreases pain with exercise. Expla
The charge nurse is assigning the nursing care of a patient who had a left below-the-knee amputation 1 day ago to an experienced LPN/LVN, who will function under your supervision. What will you tell the LPN/LVN is the major focus for the patient's care to
Ans: 2 Monitoring for sufficient tissue perfusion is the priority at this time. Phantom pain is a concern but is more common in patients with above-the-knee amputations. Early ambulation is a goal, but at this time the patient is more likely to be engaged
A patient with a right above-the-knee amputation asks you why he has phantom limb pain. What is your best response?
1. "Phantom limb pain is not explained or predicted by any one theory."
2. "Phantom limb pain occurs because your body thinks your leg is s
Ans: 1 Three theories are being researched with regard to phantom limb pain. The peripheral nervous system theory holds that sensations remain as a result of the severing of peripheral nerves during the amputation. The central nervous system theory states
During morning care, a patient with a below-the-knee amputation asks the UAP about prostheses. How will you instruct the UAP to respond?
1. "You should get a prosthesis so that you can walk again."
2. "Wait and ask your doctor that question the next time
Ans: 4 The patient is indicating an interest in learning about prostheses. The experienced nurse can initiate discussion and begin educating the patient. Certainly the health care provider can also discuss prostheses with the patient, but the patient's wi
During assessment of a patient with fractures of the medial ulna and radius, you find all of these datas. Which assessment finding should you report to the health care provider immediately?
1. The patient reports pressure and pain.
2. The cast is in place
Ans: 1 Pressure and pain may be due to increased compartment pressure and can indicate the serious complication of acute compartment syndrome. This situation is an emergency. If it is not treated, cyanosis, tingling, numbness, paresis, and severe pain can
A patient who underwent a right above-the-knee amputation 4 days ago also has a diagnosis of depression. Which order would you clarify with the health care provider?
1. Give fluoxetine (Prozac) 40 mg once a day.
2. Administer acetaminophen with codeine (T
Ans: 1 Doses of fluoxetine, a drug used to treat depression, that are greater than 20 mg should be given in two divided doses, not once a day. The other three orders are appropriate for a patient who underwent amputation 4 days earlier. Focus: Prioritizat