Which critical factors would the nurse say are associated with situational contingency theory quizlet?

1, 4, 5

The Synergy Model describes eight nurse competencies, which include collaboration, clinical judgment, advocacy and moral agency, caring practices, facilitation of learning, systems thinking, response to diversity (cultural competency), and clinical inquiry.

Care planning and communication are skills that every nurse should demonstrate regardless of the care delivery system being implemented.

3

The SBAR (Situation-Background-Assessment-Recommendation) provides a framework for communicating information about a change in client status to the health care provider (HCP). It includes the following information:
S = Situation - what prompted the communication
B = Background - pertinent information, relevant history, vital signs
A = Assessment - the nurse's assessment of the situation
R = Recommendation - request for prescription or action from the HCP

The report given by the nurse in Option 3 contains the most appropriate and complete information. The nurse includes pertinent data related to history, admission, and present treatment (background); indicates when and what changes occurred (situation, assessment); and requests a prescription from the HCP (recommendation).

(Option 1) This report does not include any information indicating a time frame for admission or when the change in condition occurred.

(Option 2) This report does not include any information related to the admission time frame, current diagnosis, or pertinent data assessed by the nurse giving the report.

(Option 4) This report does not include any information related to the admission time frame or pertinent data assessed by the nurse giving the report.

Educational objective: Nurses commonly use the SBAR framework to report changes in client status to the health care provider, communicating the current situation, client background, nurse's assessment, and a recommendation for prescription or action.

1

Critical laboratory results (eg, positive blood cultures, severe electrolyte derangements) require immediate intervention for client safety. The nurse receiving a critical laboratory result should notify the health care provider (HCP) as soon as possible. Hospital organizations have individual policies regarding the time frame for notification of the HCP and HCP response, usually ≤60 minutes. Bacteremia requires timely treatment to prevent further complications (eg, septic shock) (Option 1).

(Option 2) The critical laboratory result should be documented in the client's medical record, but only after immediate communication with the HCP.

(Option 3) The nurse must make direct contact, either via telephone or in person, when reporting a critical result. A telephone message may not be received promptly, and a critical value requires immediate intervention.

(Option 4) Even if the HCP usually makes rounds early in the morning, a critical value requires immediate, real-time notification to prevent delay of potentially urgent intervention.

Educational objective: Critical laboratory results, such as positive blood cultures, require immediate communication with the health care provider (HCP) and timely intervention for client safety. The nurse must contact the HCP directly as soon as possible to avoid life-threatening complications (eg, septic shock).

1

When clients are hospitalized, they lose control of many things, including their medication management. This loss of control can be frightening for the client, especially one who has had control of medications for many years.

This client, who has a decade of experience taking methadone for chronic pain, is afraid that suddenly stopping this medication may precipitate withdrawal. The client is trying to regain control and avoid this problem by leaving the hospital against medical advice. However, the client remains at risk of life-threatening arrhythmias. Therefore, the nurse should promote negotiation between the client and HCP to develop a plan of care that will address the concerns of each. The plan should advocate for the client to ensure that the concerns are addressed.

Care planning should be a collaborative, shared process informed by the knowledge and preferences of the client and evidence-based recommendations by the HCP that are appropriate to the situation.

(Option 2) This response is based on the idea of the nurse and HCP being in control, but it fails to include the client in the decision-making team.

(Option 3) This statement provides a rationale for the client to remain in the hospital, but it does not address the client's concerns about going into withdrawal.

(Option 4) This response is based on the idea of client autonomy, but it does not propose a solution to the problem.

Educational objective: A plan of care should be developed collaboratively, informed by the client's knowledge, beliefs, and preferences, and the expertise and evidence-based recommendations of HCPs.

4

The best initial result is to assess and validate the charge nurse's perception. Doing the test and comparing results randomly/intermittently will give data to prove/disprove this concern.

(Option 1) It could cause concern to involve a client when there may be an issue about inadequate provider care. The nurse should handle it independently.

(Option 2) It is good to reinforce policies in general announcements to the entire staff, especially if wide-spread compliance is a concern. However, there is only one person that is suspected of not adhering in this case. Speaking out is often a general step taken, but the intended individuals usually don't hear the information. In addition, this is information that the staff has known/heard before.

(Option 3) The normal discipline process is a verbal warning, a written warning, suspension, and termination. To initiate the process, there has to be evidence of wrong doing. However, it is only a suspicion at this point.

Educational objective: When deliberate inaccurate documentation is suspected, gather evidence before confronting the staff member. One way of doing this is by checking the data personally and comparing it to what has been documented.

1, 4, 5

The Joint Commission (2004) and Institute for Safe Medication Practices prohibit error-prone or "dangerous" abbreviations, descriptions of symptoms, and dose designations in medical documentation.

"Cm" (centimeters) and "II" (2) (eg, decubitus staging) are acceptable abbreviations/notations (Option 1).

The abbreviations "ac" (before meals), "pc" (after meals), and "c/o" (complains of) are acceptable (Option 4).

"QID" (4 times a day) is acceptable. Abbreviations that are not acceptable include "qd" (daily) and "q1d" (daily), which can be mistaken for "qid" (4 times a day), and "qod" (every other day), which can be mistaken for "qd" (daily) (Option 5).

(Option 2) A trailing zero after the decimal point is not acceptable as it could be interpreted as 40 instead of 4 if the decimal point is not noted. The use of "u" for unit is not acceptable as it can be mistaken for the number 0 or 4 (eg, 4u seen as 40). "SSRI" (sliding-scale regular insulin) is not acceptable to indicate insulin as it can be mistaken for selective serotonin reuptake inhibitor. "Mg" for milligrams is acceptable.

(Option 3) A zero must precede the decimal dose. If the decimal point is missed, ".5" could be mistaken for 5 mg.

Educational objective: Acceptable abbreviations include "ac," "pc," "QID," and "cm." Unacceptable abbreviations include "qd," "q1d," and "qod"; "SSRI" for insulin; and "u" for units. There must be a zero before a decimal dose and no trailing zero after a decimal point.

1, 2, 4, 5

Clients receiving IV heparin should maintain therapeutic clotting times, avoid developing embolic events, and remain free from signs of heparin-induced thrombocytopenia (eg, petechiae, purpura) (Option 1).

Clients having undergone a carotid endarterectomy, a surgical procedure removing plaque from carotid arteries, would be expected to show no evidence of hemorrhage (eg, hypotension, tachycardia) or neurological impairment (eg, decreased level of consciousness, altered mental status) (Option 2).

Clients receiving IV furosemide, a loop diuretic, should maintain adequate blood pressure and avoid developing symptoms of electrolyte imbalance (eg, muscle weakness, cramps, cardiac arrhythmia) (Option 4).

A femoral-popliteal angioplasty is a surgical procedure to restore perfusion to the legs of clients with peripheral arterial disease. After the procedure, the client should be able to ambulate without evidence of extremity ischemia (eg, leg pain) (Option 5).

(Option 3) A percutaneous coronary intervention (PCI) is a procedure used to restore coronary perfusion to prevent or treat ischemia or infarction. Clients having undergone a PCI would be expected to have no chest pain at rest. Chest pain at rest indicates myocardial ischemia.

Educational objective: Clients receiving heparin should remain free from heparin-induced thrombocytopenia. After carotid endarterectomy, clients should remain free from hemorrhage and neurological impairment. Those receiving loop diuretics should maintain electrolytes within normal limits. After a femoral-popliteal angioplasty, clients should be able to ambulate without leg pain. They should have no chest pain at rest after a percutaneous coronary intervention.

3

Surgical debridement of an unstageable pressure injury involves using a scalpel to remove necrotic (eschar) or infected tissue from the wound to promote healing. The most appropriate room assignment for this client is Room C, as the client with a gastrointestinal bleed and nasogastric tube is the least susceptible to infection compared with the clients in Rooms A and B (Option 3).

(Option 1) Multiple myeloma is a cancer that involves proliferation of malignant plasma cells (monoclonal antibodies), which are ineffective in providing protection against infection and suppress normal bone marrow cell production (eg, erythrocytes, platelets, leukocytes). This client in Room A is especially vulnerable to infection due to immunosuppression related to the disease process and to drug therapy with corticosteroids.

(Option 2) The postoperative client should not be assigned to Room B with a client who has osteomyelitis, an infection of bone.

(Option 4) The client with influenza requires droplet precautions and would likely require a private room (Room D). Clients with severe disease (ie, requiring hospitalization) should receive antiviral medication (eg, zanamivir, oseltamivir) as they are at high risk for complications.

Educational objective: A client undergoing an extensive surgical debridement for an infected pressure injury should not be assigned to a room with a client who is vulnerable to infection (eg, immunocompromised) or who has an active infection.

3

Anticipatory guidance prepares clients and caregivers for future health needs and is useful throughout life, from pediatric growth and development to anticipated changes related to disease processes. This type of education promotes health and helps to reduce client/caregiver stress and anxiety, which heighten with unexpected cognitive, physical, and emotional changes. Anticipatory guidance educational goals should be client-oriented, realistic, objective, measurable, and focused on preparing for future needs specific to the client.

The client with Alzheimer disease and osteoarthritis is at high risk for falls with disease progression. In the early stage, the client can make changes in the home to promote safety in the future (Option 3).

(Option 1) Memory aids (eg, pill organizers, alarms) should be used now, while the client has only mild cognition changes. As the disease progresses, a caregiver should take over medication management.

(Option 2) Support groups are an appropriate intervention for current psychosocial needs (eg, depression).

(Option 4) Clients with osteoarthritis are at risk for nutritional deficits due to functional decline (eg, inability to open jars), and clients with Alzheimer disease can forget to eat. The nurse should address this current need by teaching simple meal planning.

Educational objective: Anticipatory guidance addresses expected changes related to growth and development or disease progression. Educational goals should be client-oriented, realistic, objective, measurable, and focused on preparing for future needs specific to the client.

1, 3, 5

Lateral violence (also known as horizontal violence) can be defined as acts of aggression carried out by a co-worker against another co-worker and designed to control, diminish, or devalue a colleague. These behaviors usually take the form of verbal abuse such as name-calling, unwarranted criticism, intimidation, and blaming. However, other acts, such as refusing to help someone, sabotage, exclusion, and unfair assignments, also fall under the category of lateral violence.

Violence in the workplace should not be tolerated or ignored by either staff or management. Actions that staff members can take if they become victims of lateral violence include:
- Documenting and keeping a file of all incidents (Option 1)
- Reporting the incidents to the immediate supervisor
- Letting the bully know that the behavior will not be tolerated (Option 5)
- Observing interactions between the bully and other colleagues (may validate the victim's experiences and serve as a source of support) (Option 3)
- Seek support from within the facility or from an external source

(Option 2) Ignoring acts of lateral violence will perpetuate the bullying.

(Option 4) The chain of command should be followed when reporting incidents of lateral violence. If the immediate supervisor takes no action, the employee can move up the chain.

Educational objective: Lateral violence in the workplace (acts of aggression by an employee toward another employee) should not be tolerated or ignored. Victims can take action against bullying, including documenting and reporting incidents, standing up to the bully in a professional way, and seeking support.

4

Disaster triage is based on the principle of providing the greatest good for the greatest number of people. Clients are triaged rapidly using a color-coded system to categorize them from highest medical priority (emergent) to lowest (expectant).

The client with flail chest (ie, paradoxical chest movement during respiration) from multiple fractured ribs is at risk for respiratory failure from impaired ventilation. In addition, mobile fractured ribs may puncture the pleura or vessels, causing hemothorax and/or pneumothorax at any time. Therefore, this client would be classified as emergent due to airway compromise, which requires immediate treatment (Option 4).

(Option 1) Spotting at 8 weeks gestation may indicate complications of pregnancy (eg, miscarriage, ectopic pregnancy, hydatidiform mole). With stable vital signs, this client would be classified as nonurgent as the fetus is not at the age of viability and there is no evidence of risk to the mother's life.

(Option 2) The client with a compound fracture and oozing laceration would be classified as urgent and require care within 2 hours to prevent life-threatening complications (eg, hemorrhagic shock).

(Option 3) Absent respirations and fixed pupils indicate severe neurologic damage or death. Therefore, this client would be classified as expectant.

Educational objective: During mass casualty events, the goal is the greatest good for the greatest number of people. Clients are triaged rapidly using a color-coded system that categorizes them from highest medical priority to lowest: red (emergent), yellow (urgent), green (nonurgent), and black (expectant).

2, 3, 4, 5

The RN is required to report suspected abuse of vulnerable clients (eg, underage, elderly, mentally ill) to appropriate authorities, regardless of what other practitioners think. A proper investigation, rather than conflicting opinions, will determine whether abuse has occurred (Option 3). The RN should report suspected abuse of vulnerable clients even if the client denies it because other factors (eg, dependence on the abuser, dementia) could be the reason for denial (Option 4). Sexually transmitted infection (STI) in a child is sexual abuse and must be reported and investigated (Option 5).

The greater good of society outweighs an individual's right to confidentiality. Gonorrhea is an STI; the client should be informed that public health will be notified and partners will be contacted to receive treatment (Option 2).

(Option 1) Cupping is a recognized alternative medicine practice in which a circular object is typically used to create suction underneath a cup. The tension pulls the skin upward and promotes release of muscle tension and scar tissue. After the process, the circular marks remain for a certain period. The location, organized rows, and history help validate the cause of the marks.

Educational objective: An RN is required to report suspected abuse of vulnerable clients even if other practitioners do not agree or the clients deny it. An STI in a child is considered sexual abuse and requires reporting. Reportable conditions by law are not protected from reporting under the confidentiality of personal health care information in HIPAA.

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