Nursing Management and Leadership: what the audit rejected

A nurse is reviewing the electronic health record (EHR) and notices that a colleague has documented the administration of a pain medication and a reassessment for a time that is 2 hours in the future.

1. ADelete the pre-charted entries to prevent false documentation.
2. BAsk the colleague to correct the documentation error.
3. CReport the finding to the charge nurse or nurse manager.Keyed by the writer
4. DAssess the patient for any adverse effects of the medication.

During a planned electronic health record (EHR) downtime, a nurse needs to administer a scheduled oral antihypertensive to a patient. What is the most appropriate action to ensure safe and legal documentation?

1. AAdminister the medication and document it on the approved downtime form, then enter the data into the EHR upon system restoration using the late entry protocol.Keyed by the writer
2. BAdminister the medication and wait until the EHR is back online to document the administration.
3. CAsk the pharmacy to hold all scheduled medications until the EHR system is fully functional again.
4. DDocument the administration in a personal notebook and later transcribe the information into the EHR.

A nurse is preparing to administer medications to a patient using a barcode medication administration (BCMA) system. When attempting to scan the patient's identification wristband, the barcode is unreadable. Which action should the nurse take first?

1. AManually enter the patient's medical record number to proceed with administration.
2. BVerify the patient's identity using two identifiers, such as name and date of birth.Keyed by the writer
3. CScan the barcode on another patient's wristband and then override the alert.
4. DAdminister the medication without scanning and document the omission later.

A nurse is using barcode medication administration to give a patient their scheduled dose of metoprolol. After scanning the patient's wristband and the medication barcode, the electronic health record displays an alert: 'Medication not found in active orders.' The nurse confirms the metoprolol order is active and the medication matches the order details, but the alert persists. What should the nurse do first?

1. AOverride the alert and administer the medication as ordered.
2. BAsk a second nurse to verify the medication and then administer it.
3. CWithhold the medication and contact the pharmacy to resolve the alert.Keyed by the writer
4. DDocument the medication as given and then review the alert details.

A nurse is preparing to administer morning medications using a barcode medication administration (BCMA) system. The patient's identification wristband barcode is smudged and will not scan. Which of the following actions should the nurse take first?

1. AManually enter the patient's identification number into the BCMA system after confirming two identifiers.
2. BReplace the patient's wristband using the unit's printer and then scan the new barcode before administration.Keyed by the writer
3. CAdminister the medications after visually verifying the patient's name and date of birth, then document the barcode failure.
4. DOverride the barcode requirement in the system and proceed with administration, noting the reason in the chart.

During morning medication administration, a staff nurse and a clinical pharmacist disagree about a new oral medication. The nurse states it should be given with meals to reduce gastrointestinal upset, while the pharmacist insists it must be taken on an empty stomach for proper absorption. The patient is waiting for the dose. The nurse manager should:

1. AInstruct the nurse to follow the pharmacist's recommendation, as the pharmacist has specialized knowledge of drug absorption.
2. BInstruct the nurse and pharmacist to consult the drug reference together to determine the correct administration timing.Keyed by the writer
3. CInstruct the pharmacist to consider the nurse's practical experience and allow administration with a small snack.
4. DInstruct the nurse and pharmacist to compromise by giving the medication with a small amount of food.

A nurse manager on a medical-surgical unit observes that communication between nurses and physicians during patient rounds is often fragmented, leading to delayed care decisions and staff frustration. Which action should the manager take first to improve interprofessional collaboration?

1. ASend an email to all staff emphasizing the importance of clear communication.
2. BConvene a meeting with nursing and physician representatives to identify communication barriers.Keyed by the writer
3. CDiscipline individual staff members who fail to communicate effectively.
4. DDistribute a survey to all staff to collect anonymous feedback on communication barriers.

A nurse manager is forming an interprofessional team to reduce patient falls on a medical-surgical unit. The team includes nurses, a pharmacist, a physical therapist, and a quality improvement specialist. During the first meeting, team members express confusion about how to begin their collaborative work.

1. AAssign each member specific tasks that align with their professional expertise.
2. BFacilitate a discussion to define roles and establish a collaborative plan.Keyed by the writer
3. CRequest that the quality improvement specialist develop a detailed project timeline.
4. DAllow team members to self-select their roles based on personal interests.

A nurse manager on a medical-surgical unit notices an increase in medication errors related to miscommunication during telephone clarifications between nurses and pharmacists. During a staff meeting, nurses express frustration that pharmacists often question orders without understanding the clinical context. Which of the following actions should the nurse manager take first to improve interprofessional collaboration?

1. AInstruct nurses to use a structured communication tool, such as SBAR, when calling pharmacists for order clarification.
2. BFacilitate joint training for nurses and pharmacists on using a validated structured communication tool, such as SBAR.Keyed by the writer
3. CRequest that the pharmacy director provide a list of common order clarification issues to the nursing staff.
4. DImplement a policy requiring pharmacists to review the patient's electronic health record before questioning an order.

A nurse leader is forming a new interprofessional team to reduce hospital readmissions. The team includes nurses, a pharmacist, a social worker, and a physical therapist. During the first meeting, team members express uncertainty about how to divide tasks given their overlapping scopes of practice. What should the nurse leader do first?

1. AAsk each member to describe their discipline's typical role in similar projects.
2. BFacilitate a discussion to clarify each member's role and responsibilities.Keyed by the writer
3. CDelegate the task of defining roles to the most experienced team member.
4. DProvide each member with a job description from their professional organization.

During a daily discharge planning huddle, a staff nurse and a physical therapist become visibly frustrated and raise their voices while disagreeing about a patient's readiness for discharge. The nurse insists the patient needs more education, while the therapist argues the patient is safe to go home. The discussion is escalating. What should the nurse manager do first?

1. AAsk the physical therapist to present evidence supporting the patient's safe discharge.
2. BSuggest that the team postpone the discussion until the next scheduled meeting.
3. CAcknowledge the disagreement and invite each party to share their perspective.Keyed by the writer
4. DRecommend that the patient be discharged with a home health referral to address education needs.

A nurse on a medical-surgical unit observes a colleague almost administer a wrong medication to a patient. The colleague catches the error before the medication is given, and the patient is not harmed. The colleague acknowledges the near miss but appears reluctant to report it. What is the most appropriate initial action for the nurse to take?

1. AReport the incident to the nurse manager only if the patient had been harmed.
2. BSubmit an incident report about the near miss without informing the colleague.
3. CDocument the near miss in the patient's medical record and continue to monitor.
4. DEncourage the colleague to self-report the near miss through the incident reporting system.Keyed by the writer

A nurse is preparing to call the attending physician about a patient who experienced a sudden drop in blood pressure. The nurse uses the SBAR communication tool. Which of the following statements represents the 'Situation' component?

1. A"The patient has a history of hypertension and was admitted yesterday with pneumonia."
2. B"I am calling about Mr. Johnson, who is now hypotensive at 80/50 mmHg and reporting dizziness."Keyed by the writer
3. C"I am concerned the patient may be bleeding internally and recommend a stat hemoglobin and type and crossmatch."
4. D"The patient's vital signs are blood pressure 80/50, heart rate 110, respiratory rate 22, and temperature 36.8°C."

A circulating nurse is preparing a patient for an elective left inguinal hernia repair. The patient has received preoperative sedation and is unable to reliably confirm the surgical site. The surgical consent form indicates a left inguinal hernia repair, but the surgeon has marked the right inguinal area. The nurse brings this discrepancy to the surgeon's attention, but the surgeon insists the marking is correct and wants to proceed. What should the nurse do next?

1. ADocument the discrepancy and assist with the procedure as planned.
2. BHalt the procedure and notify the charge nurse to resolve the discrepancy.Keyed by the writer
3. CAsk the surgeon to mark the left side and then proceed.
4. DProceed with the surgery on the right side as marked.

A nurse on a medical-surgical unit realizes that she inadvertently administered a double dose of a prescribed antihypertensive to a patient. After assessing the patient, the nurse finds a blood pressure of 100/60 mm Hg; the patient is asymptomatic and stable. The patient's family is at the bedside. What is the nurse's most appropriate initial action?

1. AInform the patient and family about the error, offer an apology, and explain the situation.
2. BNotify the healthcare provider of the error and the patient's current status.Keyed by the writer
3. CDocument the double dose administered and the patient's current vital signs in the medical record.
4. DComplete an incident report and notify the charge nurse of the error.

A patient on a medical-surgical unit sustains a fall while attempting to reach the bathroom unassisted. The nurse manager wants to identify the underlying system failures that contributed to this event, rather than focusing on individual blame. Which action should the manager take first?

1. AFile an incident report to document the fall and initiate a system-level review.
2. BConduct a post-fall huddle with the staff involved to identify immediate system factors.Keyed by the writer
3. CImplement a just culture framework to balance system accountability and individual responsibility.
4. DRequire staff to use two patient identifiers before assisting with ambulation.

A nurse researcher is designing a study to evaluate a new non-pharmacological intervention for agitation in patients with moderate Alzheimer's disease. Which of the following ethical considerations is most important to address when designing this study?

1. AEnsuring that all participant data are kept confidential and stored securely.
2. BAssessing the patient's decision-making capacity and obtaining informed consent or assent.Keyed by the writer
3. CSubmitting the study protocol for approval by the institutional review board.
4. DMinimizing any potential physical or psychological risks associated with the intervention.

A charge nurse on a medical-surgical unit is coordinating bed assignments. One patient has severe neutropenia with an absolute neutrophil count of 400 cells/mm³. Which of the following actions should the nurse take?

1. APlace the neutropenic patient in a room with a patient who has a draining abdominal wound colonized with MRSA.
2. BPlace the neutropenic patient in a room with no roommate.Keyed by the writer
3. CPlace the neutropenic patient in a room with a patient who has community-acquired pneumonia and productive cough.
4. DPlace the neutropenic patient in a room with a patient receiving a heparin infusion for deep vein thrombosis.

A nurse is planning discharge for a patient who underwent a colostomy creation two days ago. The patient expresses anxiety about managing the stoma at home. Which referral is most important to include in the discharge plan?

1. AHome health aide for assistance with activities of daily living
2. BOutpatient wound, ostomy, and continence (WOC) nurse clinic for specialized educationKeyed by the writer
3. CPhysical therapist to improve mobility and strength
4. DSocial worker to address financial concerns and emotional support

A nurse is caring for a 78-year-old patient who was admitted for pneumonia and is now medically stable for discharge. During the morning assessment, the patient reports feeling unsteady when walking to the bathroom and expresses fear of falling at home. The patient lives alone and has two steps to enter the house. Which resource should the nurse consult to best support this patient's safe transition home?

1. ARequest a physical therapy consultation for a home safety assessment.Keyed by the writer
2. BConsult a social worker to coordinate home safety and mobility services.
3. CAsk the dietitian to provide education on nutrition to improve strength.
4. DConsult the respiratory therapist to assess oxygen saturation with exertion.