A nurse manager is reviewing the steps of the progressive discipline process prior to counseling a staff member who exhibits unprofessional behavior. Identify the sequence of steps the nurse manager should plan to take in response to the staff member's conduct. (Move the steps into the box on the right, placing them in order of performance. Use all the steps.)

Verbally remind the staff member of the expected behaviour changes.

Suspend the staff member from work for several days.

Give the staff member a written warning about the behavior.

Dismiss the staff member from employment at the facility.

Set up a meeting to speak with the staff member about the behavior.

Answer and Explanation

The Correct Answer is E,A,C,B,D

Rationale:

A. Verbally remind the staff member of the expected behaviour changes: After the initial meeting, a verbal reminder reinforces expectations and gives the staff member an opportunity to improve without formal penalties.

B. Suspend the staff member from work for several days: Suspension is used when prior interventions have not resulted in improvement. It serves as a serious consequence, giving time for reflection before returning to work.

C. Give the staff member a written warning about the behavior: A written warning follows a verbal reminder if the unprofessional behavior continues. It creates a formal record and communicates the seriousness of the issue.

D. Dismiss the staff member from employment at the facility: Termination is the final step when all other corrective measures have failed and the behavior persists, ensuring workplace standards and safety are maintained.

E. Set up a meeting to speak with the staff member about the behavior: The first action is to meet privately to discuss the observed behavior, clarify expectations, and begin the progressive discipline process in a constructive manner.

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Free Nursing Study Resources

Correct Answer is C

Explanation

A. Apply lidocaine gel around the incision: Topical lidocaine is generally used for localized superficial pain, not for deep postoperative pain following major joint surgery. Its effectiveness for a knee arthroplasty incision is limited.

B. Attach a transcutaneous electrical nerve stimulation unit around the incision: TENS units can help with some types of pain but are more effective for chronic musculoskeletal pain rather than acute postoperative pain.

C. Place a cold pack over the incision: Cold therapy reduces inflammation, swelling, and pain in the immediate postoperative period. It is a safe and effective nonpharmacological intervention for mild to moderate pain following knee arthroplasty.

D. Assist the client for a walk in the hallway: Early ambulation is important for preventing complications and promoting recovery, but it may initially increase pain when the client is only 4 hours post-surgery. Cold therapy is more appropriate for immediate pain relief.

A. Temperature 38.2° C (100.8° F) B. Heart rate 104/min C. Respiratory rate 18/min D. BP 108/70 mm Hg E. SaO2 97% on room air F. Client reports feeling unwell. G. Client states breasts feel firm, heavy, and warm with moderate nipple discomfort while breastfeeding. H. Fundus boggy but firmed with massage. I. Moderate amount of dark brown, foul-smelling lochia noted. J. Surgical incision well approximated with slight edema present no redness or drainage noted. K. No bowel movement since birth, hypoactive bowel sounds. L. WBC count 33,000/mm3 (5,000 to 10,000/mm3)

Correct Answer is ["A","B","F","H","I","L"]

Explanation

Rationale for correct choices:

Temperature 38.2° C (100.8° F): An elevated temperature in the postpartum period may indicate infection, particularly given the prolonged rupture of membranes and cesarean birth. Early recognition is essential to prevent progression to sepsis.
Heart rate 104/min: Tachycardia can be an early sign of infection or postpartum hemorrhage. In combination with fever and elevated WBC, this warrants prompt evaluation.
Client reports feeling unwell: The client’s report of illness is the first indicator of an ongoing disease process which warrants further evaluation, coupled by other findings, this indicates that there is something wrong.
WBC count 33,000/mm³: This is markedly elevated beyond the normal postpartum range and indicates a possible systemic infection. This finding requires immediate intervention and notification of the provider.
Fundus boggy but firmed with massage: A boggy uterus suggests uterine atony, which increases the risk of postpartum hemorrhage. Continuous monitoring is needed to prevent excessive blood loss.
Moderate amount of dark brown, foul-smelling lochia: Foul-smelling lochia is a sign of endometritis or uterine infection. Early identification and treatment reduce the risk of sepsis and further complications.

Rationale for incorrect choices:

Vital Signs Respiratory rate 18/min, BP 108/70 mm Hg, SaO₂ 97% on room air: This is within normal limits and does not indicate respiratory compromise at this time. Blood pressure is within normal postpartum range; no immediate intervention is needed. Oxygen saturation is adequate and does not require urgent follow-up.
Breast firmness with moderate nipple discomfort: These findings are consistent with normal lactation and engorgement, and do not indicate an immediate complication.
Surgical incision well-approximated with slight edema: Mild edema without redness or drainage is expected postoperatively and does not require immediate intervention.
No bowel movement since birth, hypoactive bowel sounds: While monitoring is necessary for constipation, this is a common postpartum finding, especially after surgery and opioid use, and does not require urgent intervention.

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Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who is 4 hr postoperative following a total knee arthroplasty. The client reports a pain level of 3 on a scale from 0 to 10. Which of the following nonpharmacological pain management therapies should the nurse recommend?

Correct Answer is C

Explanation

Correct Answer is ["A","B","F","H","I","L"]

Explanation

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