A newly hired charge nurse assesses the staff nurses as competent individually but ineffective and nonproductive as a team. In addressing her concern, the charge nurse should understand that the usual reason for such a situation is:

Correct Answer: B

Rationale: Team ineffectiveness despite individual competence often stems from poor group dynamics, with unexpected feelings and emotions among staff (Choice B) being the usual culprit. Emotions like mistrust, resentment, or unresolved conflict disrupt communication and collaboratione.g., a nurse feeling undervalued might withhold input. Unhappiness about leadership change (Choice A) could contribute but isn't universal; new leaders can inspire if communication is strong. Fatigue from overwork (Choice C) reduces productivity but typically affects individuals uniformly, not just teamwork. Failure to involve staff in decisions (Choice D) is a factor, but emotions underlie its impacte.g., feeling ignored breeds frustration. Research (e.g., Tuckman's group development) shows emotional undercurrents derail forming cohesive teams. Addressing feelings via open forums or team-building restores function, making Choice B the correct and most common reason.

Correct Answer: C

Rationale: Nicotine withdrawal disrupts sleep due to its stimulant loss, but this resolves. 'Sleep problems from stopping smoking are temporary' is correct; insomnia peaks 1-3 weeks post-cessatione.g., nicotine's absence drops arousal, yet cravings wake patientsbut normalizes within months, per sleep research. Choice A, 'decide what's more important,' dismisses the patient's struggle, lacking empathy. Choice B, 'it might be better to smoke,' undermines cessation's health benefits (e.g., reduced cancer risk) and contradicts nursing ethics. Choice D, 'this will always be a problem,' is false; chronic insomnia isn't inevitable post-smokinge.g., most ex-smokers sleep normally by 6 months. A nurse, per Taylor, reassures with evidencee.g., 'Your brain's adjusting, it'll pass'promoting resilience. Choice C is the supportive, accurate response.

Correct Answer: A

Rationale: CPAP (continuous positive airway pressure) treats sleep apnea, typically obstructive (OSA). 'Positive air pressure holds the airway open' is the rationale; it splints the pharynxe.g., 10 cmH2O pressure prevents collapse during inhalation, per AASM guidelines. Choice B, 'negative air pressure holds the airway closed,' is opposite and nonsensicale.g., worsening obstruction. Choice C, 'delivery of oxygen facilitates respiratory effort,' aids hypoxemia but isn't CPAP's mechanism; it's pressure, not O2, per se. Choice D, 'alternating waves of air,' fits BiPAP, not CPAP's constant flowe.g., no 'waves' in standard use. A nurse might adjust CPAP for a patient with 30 apneas/hour, per Taylor's respiratory care, ensuring patency. Choice A is the correct, mechanistic answer.

Correct Answer: C

Rationale: Effective sleep plans yield measurable rest gains. 'Identifies factors that interfere with normal sleep pattern' shows success; awarenesse.g., 'Caffeine at 8 p.m. keeps me up'enables change, per Taylor's outcome criteria. Choice A, 'inability to sleep without medications,' signals failuree.g., dependence, not independence. Choice B, 'continues to read in bed for hours,' persists poor hygienee.g., delaying sleep to 1 a.m. Choice D, 'minimal improvement,' admits partial gaine.g., 6 vs. 5 hoursbut not optimal. Identifying barriers (e.g., noise, stress) empowers patients, making Choice C the correct, effective outcome.

Correct Answer: D

Rationale: Pain inside a cast stems from physical forces. 'Mechanical' is correct; pressure or frictione.g., a tight cast compressing tissue or rubbing skincauses this, per Taylor's pain classification. Thermal pain requires heat/colde.g., a burn, not cast-related. Chemical pain involves irritantse.g., acid exposure, not typical here. Electrical pain needs currente.g., a shock, irrelevant to casts. A cast too snug might pinch nerves or musclese.g., swelling post-fracture increases pressureproducing sharp or aching mechanical pain. Nurses assess for compartment syndrome or fit issues, adjusting or bivalving the cast. This contrasts with chemical pain from inflammation (e.g., prostaglandins) or thermal from external sources. The physical interaction of cast and limb drives this scenario, making Choice D the most likely type.