A nurse manager hears a staff nurse on the unit speak openly about her dislike of a recent policy change regarding client care. When discussing the issue with the nurse, which of the following statements by the nurse manager is appropriate?

You should support this policy change because it was based on evidence-based practice.

Why didn’t you voice your concerns before the new policy was implemented?

Let’s talk about your concerns about the new policy.

Being open to change is an expectation of the nurses who work on this unit.

Answer and Explanation

The Correct Answer is C

Choice A reason: This statement is prescriptive and dismissive of the nurse’s feelings, implying compliance without exploration. While evidence-based practice is the foundation for policy, invoking it as a directive shuts down dialogue and can contribute to moral distress. It bypasses therapeutic communication, fails to acknowledge the nurse’s perspective, and risks escalating resistance. An effective leader creates psychological safety by fostering open discussion, not enforcing acceptance. This approach also misses an opportunity to identify unintended consequences or implementation barriers that the staff nurse may be experiencing.

Choice B reason: This response is retrospective and accusatory, focusing on what the nurse “should have done” rather than addressing present concerns constructively. It can provoke defensiveness and erode trust, discouraging future feedback. In leadership communication, the goal is to understand current issues, validate the nurse’s experience, and engage in problem-solving. Asking why the nurse didn’t speak up earlier implies blame and may ignore systemic factors—such as time pressure, unclear channels for feedback, or fear of reprisal—that can inhibit staff input.

Choice C reason: This is an open, collaborative invitation that centers the nurse’s perspective and promotes psychological safety. It uses therapeutic communication by acknowledging concerns and encouraging dialogue to understand specifics—such as workflow impacts, patient outcomes, or staffing implications. This stance helps the manager gather actionable information, promotes engagement, and supports shared governance. It respects the nurse’s professional judgment while aligning with continuous improvement, making it the most appropriate and effective statement.

Choice D reason: While setting expectations can be part of culture-building, stating it in this manner is general and potentially dismissive of legitimate concerns. It frames the situation as a compliance issue rather than an opportunity to learn from frontline experience. Staff may hear this as “just adapt,” which undermines buy-in and the identification of real barriers. Effective change management emphasizes listening, iterative feedback, and support; a blanket expectation statement does not achieve those aims in the moment of concern.

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Correct Answer is C

Explanation

Choice A reason: Asking the client to describe the bugs reinforces the hallucination and validates the false perception. This can worsen the client’s anxiety and delusion rather than providing reassurance. It is not therapeutic because it does not orient the client to reality.

Choice B reason: Telling the client directly that this is part of withdrawal may be factually correct, but it lacks empathy and does not address the client’s fear. It can come across as dismissive and may increase distress. Therapeutic communication requires acknowledging the client’s feelings while gently reorienting them.

Choice C reason: This response acknowledges the client’s fear without reinforcing the hallucination. It provides empathy by recognizing the emotional state and gently reorients the client to reality by clarifying that the nurse does not see bugs. This balances reassurance with therapeutic communication, making it the most appropriate response.

Choice D reason: Saying the bugs will not harm the client still validates the hallucination, which is not therapeutic. It fails to reorient the client to reality and may perpetuate the delusion.

A. An adolescent who has sickle cell disease, reports pain as 7 on a scale of 0 to 10, and requests pain medication. B. A toddler who has asthma and has a pulse oximetry reading of 95% while receiving oxygen at 2 L/min. C. A toddler who has otitis media, a temperature of 39.2 °C (102 °F), and purulent ear discharge. D. A school-age child who has acute epiglottitis, is drooling, and has an absence of spontaneous cough.

Correct Answer is D

Explanation

Choice A reason: This adolescent is experiencing significant pain due to sickle cell disease, which is a priority for pain management. However, pain, even when severe, is not immediately life-threatening compared to airway obstruction. The adolescent is stable in terms of airway, breathing, and circulation, so while pain control is important, this client does not require the provider first.

Choice B reason: The toddler with asthma has a pulse oximetry reading of 95% while on oxygen. This is slightly below the normal range but still acceptable and not immediately life-threatening. The child is oxygenating adequately, and there is no indication of severe respiratory distress such as retractions, cyanosis, or inability to speak. Therefore, this client does not require immediate provider intervention compared to airway obstruction.

Choice C reason: The toddler with otitis media has fever and purulent ear discharge, which indicates infection. While this requires treatment, it is not an emergency. The child is not in respiratory distress, and the condition is not immediately life-threatening. This client can safely wait for provider care after more urgent cases are addressed.

Choice D reason: The school-age child with acute epiglottitis who is drooling and has no spontaneous cough is in a critical airway emergency. Epiglottitis can rapidly progress to complete airway obstruction. Drooling and absence of cough indicate inability to handle secretions and impending airway compromise. This is a life-threatening emergency that requires immediate provider intervention to secure the airway. This client must be cared for first.

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A nurse manager hears a staff nurse on the unit speak openly about her dislike of a recent policy change regarding client care. When discussing the issue with the nurse, which of the following statements by the nurse manager is appropriate?

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Naxlex Comprehensive Predictor Exams

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Correct Answer is C

Explanation

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Correct Answer is D

Explanation

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A nurse manager hears a staff nurse on the unit speak openly about her dislike of a recent policy change regarding client care. When discussing the issue with the nurse, which of the following statements by the nurse manager is appropriate?