A new unit nurse manager is holding her first staff meeting. The manager provides a plan that she developed and a list of tasks and activities for which each staff member must volunteer to perform.
In addition, she instructs staff members to report any problems directly to her. What type of leader and manager approach do the new manager's characteristics suggest?

Choice A rationale

Inspecting the mouth is an important aspect of overall hygiene and monitoring for oral candidiasis or dryness related to oxygen therapy, but it does not address the most immediate physical risk of the nasal cannula apparatus itself. While the mouth should be assessed regularly, every 24 hours is a generic interval that might miss early signs of mucosal irritation or other complications in a client with chronic obstructive respiratory disease.

Choice B rationale

Nasal cannulas exert constant pressure and friction on the sensitive skin of the nares and behind the ears. For clients with chronic respiratory issues, skin integrity is a priority because breakdown can lead to infection and discomfort, potentially decreasing compliance with oxygen therapy. Assessing the nares every 8 hours allows for early detection of redness or pressure ulcers, which is standard nursing practice for maintaining skin integrity in patients using external medical devices.

Choice C rationale

Checking oxygen flow and pulse oximetry every 48 hours is dangerously infrequent for a client with a chronic obstructive respiratory disease. These clients require frequent monitoring to ensure they are maintaining adequate saturation, typically between 88.

Choice D rationale

Checking the patency of the cannula only once every 24 hours is insufficient for ensuring continuous and effective oxygen delivery. Cannulas can easily become dislodged, kinked, or clogged with nasal secretions, leading to a sudden drop in the fraction of inspired oxygen. Frequent checks of the equipment are necessary to ensure the client receives the prescribed flow rate, especially since these clients rely on supplemental oxygen to maintain baseline metabolic functions and prevent exacerbations.

Choice A rationale

Avoiding choices altogether can diminish a client's sense of autonomy and dignity, even when cognitive impairment is present. While providing too many choices can be overwhelming, offering two clear options can help a client feel involved in their care. Total restriction of choice can lead to frustration or agitation. The goal of communication is to simplify the decision-making process rather than completely removing the client's ability to express personal preferences.

Choice B rationale

Using short, simple, and concrete sentences is the gold standard for communicating with cognitively impaired individuals. This approach reduces the cognitive load required to process and retain information. Clients with conditions like dementia often struggle with abstract concepts and complex syntax. By using direct language and focusing on one idea at a time, the nurse ensures the message is understood, thereby reducing anxiety and improving the quality of the interaction.

Choice C rationale

Providing lengthy and detailed explanations is ineffective because clients with cognitive impairment often have limited short-term memory and reduced attention spans. Complex information can lead to sensory overload, causing the client to become confused, withdrawn, or combative. Explanations should be limited to the immediate task or situation to avoid taxing the client's diminished neurological resources. Effective nursing care requires adapting communication to the specific functional level of the individual.

Choice D rationale

Asking multiple questions at once is overwhelming for someone with cognitive deficits. Each question requires the brain to retrieve data, formulate a response, and execute speech, which are processes often slowed by neurological decline. When multiple queries are presented, the client may lose track of the conversation or provide inaccurate answers. Nurses should ask one question at a time and allow ample time for the client to process and respond before moving on.