Question 1

A new LPN/LVN asks the LPN/LVN charge nurse what continuous quality improvement (CQI) is all about. The charge nurse should explain that the focus of CQI in a health care agency is

Accepted Answer

The focus of CQI is quality of care, as indicated by patient outcomes. CQI does not focus on saving time, agency profit, or stress reduction.

Question 2

The most fundamental requirement for assuming the practice role of LPN/LVN charge nurse is

Accepted Answer

The LPN/LVN practice role requires that the individual be licensed as an LPN/LVN in the state in which he or she is practicing. The other qualifications are important but are not the most basic.

Question 3

The plan of care for a resident in the rehabilitation unit requires the resident to receive teaching about how to monitor blood glucose as part of discharge teaching. The RN is working with a resident whose condition is deteriorating. The LPN/LVN charge nurse has performed blood glucose monitoring many times but is new and has not received facility certification. The nursing assistant assigned to the patient is a diabetic and monitors blood glucose several times a day. Who should perform the teaching?

Accepted Answer

The RN is required to initiate teaching. The LPN/LVN can follow up, review, and reinforce.

Question 4

In which situation would the LPN/LVN charge nurse be in violation of OBRA provisions?

Accepted Answer

OBRA regulations call for all nursing assistants to be certified. Permitting an uncertified employee to perform the duties of a CNA violates OBRA regulations. Allowing a son to feed his father is permissible. Scheduling a nursing assistant to attend a 2-hour in-service training session and notifying the RN supervisor that a nursing assistant needs additional training are appropriate.

Question 5

The LPN/LVN charge nurse has assigned tasks to the nursing assistant staff and the LPN/LVN orienting to the unit. On which statement about responsibility for outcomes should the LPN/LVN charge nurse base her or his actions?

Accepted Answer

The LPN/LVN charge nurse is responsible for ensuring that all assigned tasks and delegated duties have been performed and for noting the outcomes.

Question 6

A leadership style that focuses on both the task and the employee is the

Accepted Answer

Focusing on both the task and the employee is characteristic of the democratic style of leadership. A purely task-centered leadership style (autocratic style) thrives on power. It involves telling someone what to do, with little regard for the employee as a person who may have ideas about how to improve patient care or reach the goals of the employer. Situational leadership involves varying leadership style to meet the demands of the situation in the work environment. A purely people-oriented style (laissez-faire) focuses on people's feelings but ignores the task at hand. It allows employees to act without any direction.

Question 7

A people-oriented leadership style that focuses on people's feelings but ignores the task at hand and allows people to act without any direction is the

Accepted Answer

A purely task-centered leadership style (autocratic style) thrives on power. It involves telling someone what to do, with little regard for the employee as a person who may have ideas about how to improve patient care or reach the goals of the employer. Situational leadership involves varying leadership style to meet the demands of the situation in the work environment. Focusing on both the task and the employee is characteristic of the democratic style of leadership. A purely people-oriented style (laissez-faire) focuses on people's feelings but ignores the task at hand. It allows employees to act without any direction.

Question 8

Assuming all the following are staff members on the unit, to whom should the LPN/LVN charge nurse assign a newly admitted 65-year-old resident with left hemiplegia and a large sacral decubitus requiring a sterile dressing change?

Accepted Answer

The resident will require data collection by an experienced person to assist the RN with care planning. The assigned care giver will need to be able to implement relatively complex care, including use of surgical aseptic technique and nursing judgment. The care required might be more than the orientee can provide. A nursing assistant should not be assigned to care for a new resident requiring careful data collection and use of nursing judgment.

Question 9

When the Nurse Practice Act of the state permits delegation as part of the LPN/LVN charge nurse duties, which task could be delegated to experienced, unlicensed assistive personnel who have been trained to perform the task?

Accepted Answer

This duty is one that can be safely and appropriately delegated. The other options are duties that are reserved for charge nurses or higher level management. Duties that may be delegated to nursing assistants usually involve identified resident goals rather than goals relating to personnel management.

Question 10

The new nursing assistant arrived 1 hour late for duty on the second day of employment, giving the excuse of car trouble. The LPN/LVN charge nurse should

Accepted Answer

Documenting the incident in the charge nurse's personal file will allow the charge nurse to later determine whether a pattern develops. If no pattern develops, no harm has been done to the employee's work record. A first instance of tardiness does not require reprimand or termination but rather an explanation that the expectation for all employees is to be at work on time.

Question 11

The LPN/LVN charge nurse notices that a new nursing assistant has offensive body odor. The LPN/LVN charge nurse should

Accepted Answer

This action encourages the nursing assistant to take personal responsibility for her hygiene and appearance. The other actions do not permit the nursing assistant the opportunity to take personal responsibility.

Question 12

The 3 to 11 shift LPN/LVN charge nurse on a 20-bed nursing home unit is asked by the only other staff member on duty, a nursing assistant, "Will it be all right if I go home tonight while you are giving report to the night shift? My husband needs the car so he can go to work." The best response by the charge nurse is:

Accepted Answer

The LPN/LVN is not responsible for the problems the nursing assistant (NA) has at home and must uphold institutional policies. This response sets limits and explains the reason the NA is needed on the unit. Responding not to make a habit of it and stating that it is permissible because the residents will be sound asleep by 11 PM create an unsafe environment for residents. The remaining option does not explain the major reason the NA is needed on the unit.

Question 13

The long-term care agency has recently announced that it will soon lay off six LPN/LVNs and hire eight nursing assistants. Today, the RN charge nurse presents the LPN/LVN charge nurse with a certificate recognizing her ability to manage effectively despite short staffing. The LPN/LVN responds somewhat politely but seems more angry than pleased. In terms of the Howlett hierarchy of needs, which of the following is the best explanation for the employee's reaction?

Accepted Answer

Job security is a level 2 need, whereas recognition is a level 4 need. The level 2 need is threatened; therefore, the level 4 need seems less important. Data are not present to support that the LPN/LVN is responding to poor working conditions. The remaining options are either not accurate or not relevant to the scenario.

Question 14

During an emergency, the charge nurse tells the LPN/LVN, "I need you to place the patient on a non-rebreather mask now." The charge nurse has little regard for the LPN/LVN's input at this time. The charge nurse is displaying what leadership style?

Accepted Answer

A purely task-centered leadership style (autocratic style) thrives on power. It involves telling someone what to do, with little regard for the employee as a person who may have ideas about how to improve patient care or reach the goals of the employer. Situational leadership involves varying leadership style to meet the demands of the situation in the work environment. Focusing on both the task and the employee is characteristic of the democratic style of leadership. A purely people-oriented style (laissez-faire) focuses on people's feelings but ignores the task at hand. It allows employees to act without any direction.

Question 15

The priority step the LPN/LVN charge nurse should take before delegating one of the charges to another LPN/LVN on staff is to

Accepted Answer

Charge nurse duties are part of an expanded LPN/LVN role. The charge nurse can delegate duties that are part of the ordinary role of the LPN/LVN to another LPN/LVN but may not be able to delegate duties that are part of the expanded role unless specifically permitted to do so by the Nurse Practice Act of the state. Determining whether the other LPN/LVN is competent to perform the task to be delegated is relevant but not the priority step to take. Delegating both the task and the responsibility that goes with the task is not the priority step to take. Determining the directions that will be provided to the person to whom the task is delegated is relevant but not the priority step to take.

Question 16

When a resident's family complains that their mother is receiving inferior care in the extended care facility, which action should the LPN/LVN charge nurse initially take?

Accepted Answer

Data collection is necessary to clarify the problem needing to be resolved. The other options display various levels of defensiveness.

Question 17

The LPN/LVN charge nurse at the long-term care facility has assigned a newly licensed LPN/LVN to care for a resident needing a colostomy irrigation. The new LPN/LVN voices concern, because he has never performed a colostomy irrigation. What would be the best course of action for the LPN/LVN charge nurse?

Accepted Answer

This action provides the supervision the new employee needs, and the new LPN/LVN probably will be capable of performing the task independently in the future. Stating, "A colostomy irrigation is just like giving an enema. You'll be fine" does not recognize the need for supervision. Telling the new employee that the charge nurse will do the irrigation while the LPN/LVN cares for other assigned residents increases the workload of the charge nurse with no change in the employee's capabilities. Delegating the procedure to a willing nursing assistant would be inappropriate. The delegate should be competent, and the delegation should be acceptable according to state and agency policy.

Question 18

A resident has not voided in 6 hours. Which instruction to a nursing assistant would likely ensure getting the information needed by the LPN/LVN charge nurse?

Accepted Answer

This is an example of specific, complete communication. It should be followed by giving the nursing assistant an opportunity to repeat what is expected. The other instructions are vague and could leave the nursing assistant wondering what to do.

Question 19

When conducting an employee performance evaluation conference, the LPN/LVN charge nurse should understand that

Accepted Answer

Evaluation should be a joint interactive process rather than a one-way communication. Dialogue can clarify and enhance the process. Evaluation should focus on identification of strengths as well as behaviors to be modified. The statement "You're doing fine" does not exemplify measurable feedback. The tone should be nonthreatening and objective but does not require the evaluation to begin with positive feedback. An employee may develop his or her own plan, but the individual needs to include problem areas identified by the charge nurse as well as the employee's own goals.

Question 20

Which information can be omitted when the LPN/LVN charge nurse gives the change-of-shift report?

Accepted Answer

Routine care should not be included in the change-of-shift report. It is recorded on the resident's Kardex and care plan and documented in the medical record and flow sheets. The change-of-shift report should focus on new information about residents.

Quiz 17: Collaboration: Leading and Managing