HESI Case Studies–Management-Management of a Skilled Care Unit (Martha Kosky)

1. An LPN reports that Mr. and Mrs. Greene have engaged in sexual intercourse in their room. What action should Ms. Kosky take?
Explain to the LPN that intimacy is important throughout the lifespan
2. A female UAP tells Ms. Kosky that a male employee has been “talking dirty” and asking personal questions. What action should Ms. Kosky take first?
Ask the UAP if she told the male employee to stop
3. The UAP reports that she observed a custodian stealing jewelry from a resident’s room. What action should Ms. Kosky take first?
Ask the resident to determine if any jewelry is missing
4. Ms. Kosky encounters several residents while walking through the skilled care unit. Which situation requires the most immediate action?
A resident with incontinence has urinated on the floor while ambulating from his room toward the dining room
5. Upon entering the dining hall, Ms. Kosky observes several staff-resident interactions. Which situation requires her most immediate intervention?
A UAP is demonstrating verbally abusive behaviors toward a resident with dementia who is confused and disoriented

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6. Ms. Kosky hears the UAP say, “You stupid old woman, if you can’t drink that milk without spilling it you won’t get any more.” In observing the verbally abusive behavior of the UAP, what action should the nurse manager implement first?
Instruct the UAP to leave the dining room area immediately
7. The UAP states, “That old woman is so confused she doesn’t know what anyone says to her. Why is everyone so upset?” How should Ms. Kosky respond?
Disrespect of others is never considered acceptable behavior
8. Ms. Kosky overhears two LPNs discussing the situation in the employee break room. What action should Ms. Kosky take in response to the conversation?
Request that the two LPNs refrain from talking about the situation while at work or in any public place
9. A resident with Alzheimer’s disease is wandering in the enclosed garden and keeps repeating “Sit, sit, sit today.” Ms. Kosky remembers that the resident likes to sit in the garden and watch birds. Which interdisciplinary team member is best to assign to assist the resident?
Unlicensed assistive personnel (UAP)
10. Another resident, who experienced a CVA 2 weeks ago, tells Ms. Kosky that she is ready to learn how to use an assistive device for self-feeding. Who should Ms. Kosky contact to assist the resident with this skill?
The occupational therapist
11. Ms. Kosky is called to the room of a female resident who fell while attempting to transfer to the bedside commode without calling for assistance. In responding to the situation, which task(s) can be delegated to the UAP? (Select all)
-Place covers around the resident for warmth, if needed
-Obtain non-skid socks from the supply room and apply them to the client
12. The daughter states, “It is no surprise to me that she fell. My mother told me that no one ever answered her call light and she often wet herself waiting for help.” How should the nurse manager respond?
“I understand you distress about this situation. I plan to investigate the circumstances thoroughly.”
13. After arrangements are made to transport the resident to a local hospital, Ms. Kosky meets with the LPN responsible for the resident’s care. In discussing the situation with the LPN, how should Ms. Kosky begin?
Tell me exactly what events occurred that led up to the fall
14. The UAP responds that she does not want to take care of the resident because she was told the resident has hepatitis. How should the nurse manager respond?
Are you afraid you will get hepatitis from the resident?
15. While discussing the assignment with the UAP, Ms. Kosky overhears an LPN and several UAPs discussing their fear of caring for the same resident because of his hepatitis. Which action should Ms. Kosky implement?
Schedule an in-service program on the care of a person with hepatitis C
16. Although UAPs generally assist resident to the dining hall, Ms. Kosky identifies which resident(s) as needing the assistance of an LPN rather than a UAP? (Select all)
-A client with type I diabetes who reports feeling sweaty and tired
-An elderly woman who has experienced pneumonia and deep vein thrombosis and who has been on bed rest for 2 weeks
17. What action should the nurse manager take?
Assess the status of the dyspneic resident with the assistance of the UAP who is already in the room
18. The resident is experiencing fluid volume overload. Ms. Kosky asks the UAP to place the resident in a semi-Fowler’s position and then obtain a pulse oximeter from the nurse’s station. The UAP leaves the room immediately without changing the resident’s position. What action should the nurse manager take first?
Elevate the head of the bed to a semi-Fowler’s postition
19. Upon returning to the room with the pulse oximeter, the UAP states, “I have never used one of these before.” How should Ms. Kosky respond?
“Let me show you how to apply the oximeter on the resident’s finger.”
20. Which action should be delegated to the LPN working with the RN?
Monitor the pulse oximeter for changes in oxygen saturation
21. How should the care of this resident be managed while awaiting transfer tot he acute care facility?
The RN can assess breath sounds and reorient the resident while the LPN obtains vital signs
22. The LPN tells ms. Kosky that the physical therapist gave instructions for the nursing staff to remove the wound vacuum in 3 days. What action should Ms. Kosky take?
Review the prescription for wound care written by the healthcare provider
23. A new LPN expresses confusion about how to determine what skills can be performed as a staff LPN on the skilled care unit. To what resource should the nurse manager refer the LPN?
The policy and procedure manual
24. Which action should Ms. Kosky take after receiving the message about the LPN calling in the 6th time in 2 months stating that her car broke down again?
Begin the process of terminating the employment of the LPN
25. Ms. Kosky’s action is based on what ethical principle?
Fidelity
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