End of Chapter Question P.2

4. When delegating input and output (I&O) measurement to nursing assistive personnel, a nurse instructs them to record what information for ice chips? 1. The total volume 2. Two-thirds of the volume 3. One-half of the volume 4. One-quarter of the volume

4. Answer: 3. When ice chips melt, their water volume is one-half the volume of the ice chips. The water volume should be recorded as intake.

14. Which assessment does a nurse use as a clinical marker of vascular volume in a patient at high risk of extracellular fluid volume (ECV) deficit? 1. Dryness of mucous membranes 2. Presence or absence of edema 3. Fullness of neck veins when supine 4. Fullness of neck veins when upright

14. Answer: 3. ECV deficit involves decreased vascular and interstitial volume. One way to assess vascular volume is to examine the fullness of neck veins when an individual is supine. With normal ECV neck veins are full when the individual is supine. With ECV deficit they are flat.

1. An intravenous (IV) fluid is infusing more slowly than ordered. The infusion pump is set correctly. Which factors could cause this slowing? (Select all that apply.) 1. Infiltration at vascular access device (VAD) site 2. Patient lying on tubing 3. Roller clamp wide open 4. Tubing kinked in bedrails 5. Circulatory overload

1. Answer: 1, 2, 4. Factors that could slow an IV infusion even if the infusion pump is set correctly include increased pressure at the outflow site (e.g., infiltration) and compression of the tubing lumen (e.g., patient lying on the tubing or tubing kinked in bedrails).

1. When working with an older adult who is hearing-impaired, the use of which techniques would improve communication? (Select all that apply.) 1. Check for needed adaptive equipment. 2. Exaggerate lip movements to help the patient lip read. 3. Give the patient time to respond to questions. 4. Keep communication short and to the point. 5. Communicate only through written information.

1. Answer: 1, 3, 4. Communication techniques such as assessing the need for adaptive equipment, keeping communication short and direct, and giving the patient time to respond, assist the nurse in providing clear effective communication. Patients may have difficulty with rapid or lengthy explanations. Exaggerated lip reading may be difficult or demeaning to individuals with hearing deficits.

1. Which of the following signs or symptoms in a patient who is opioid-naïve is of greatest concern to the nurse when assessing the patient 1 hour after administering an opioid? 1. Oxygen saturation of 95% 2. Difficulty arousing the patient 3. Respiratory rate of 10 breaths/min 4. Pain intensity rating of 5 on a scale of 0 to 10

1. Answer: 2. Sedation is a concern because it may indicate that the patient is experiencing opioid-related side effects. Advancing sedation may indicate that the patient may progress to respiratory depression.

1. A nurse researcher studies the effectiveness of a new program designed to educate parents to promote the immunization of children. The nurse divides the parents randomly into two groups. One group receives the typical educational program and the other group receives the new program. This is an example of which type of study? 1. Historical 2. Qualitative 3. Correlational 4. Experimental

1. Answer: 4. Experimental; in experimental studies, the subjects are randomly assigned into groups with one group receiving the standard treatment and the other group receiving the intervention.

1. A manager is reviewing the nursing documentation entered by a staff nurse in a patient's electronic medical record and finds the following entry, "Patient is difficult to care for, refuses suggestion for improving appetite." Which of the following statements is most appropriate for the manager to make to the staff nurse who entered this information? 1. "Avoid rushing when documenting an entry in the medical record." 2. "Use correction fluid to remove the entry." 3. "Draw a single line through the statement and initial it." 4. Enter only objective and factual information about a patient in the medical record.

1. Answer: 4. Nurses should enter only objective and factual information about patients. Opinions have no place in the medical record. Because the information has already been entered and is not incorrect, it should be left on the record. Never use correction fluid in a written medical record.

10. The nurse is supervising a beginning nursing student and allowing the student to complete documentation of care under direct observation. Which of the following actions are not appropriate and would require intervention? The nursing student: (Select all that apply.) 1. Documents a medication given by another nursing student. 2. Includes the date and time of the entry into the medical record. 3. Enters assessment data into the electronic medical record using the computer mounted on the wall in the patient's room. 4. Leaves a slip of paper with her user name and password in the patient's room. 5. Starts to enter "Docusate sodium 100 mg ordered at 08:00 held. Patient declined to take dose stating, "I had several loose stools yesterday, and I'm afraid if I take this dose the problem will get worse," as a narrative comment.

10. Answer: 1, 4. Nurses only document the care they provide; entries in the chart need to be dated, timed, and signed. Personal passwords used to access an electronic medical record need to be kept secure to provide for safety and confidentiality of patient information. All of the other actions are appropriate for documentation.

10. A nurse has been gathering physical assessment data on a patient and is now listening to the patient's concerns. The nurse sets a goal of care that incorporates the patient's desire to make treatment decisions. This is an example of the nurse engaged in which phase of the nurse-patient relationship? 1. Working phase 2. Preinteraction phase 3. Termination phase 4. Orientation phase

10. Answer: 1. The nurse assists the patient in the identification of goals and expression of feelings during the working phase of the helping relationship.

10. A group of nurses on the research council of a local hospital are measuring nursing-sensitive outcomes. Which of the following is a nursing-sensitive outcome that the nurses need to consider measuring? (Select all that apply.) 64 1. Frequency of low blood sugar episodes in children at a local school 2. Number of patients who develop a urinary tract infection from a Foley catheter 3. Number of patients who fall and experience subsequent injury on the evening shift 4. Number of sexually active adolescent girls who attend the community-based clinic for birth control 5. Patient-reported quality of life following coronary artery bypass graft surgery and cardiac rehabilitation

10. Answer: 2, 3. Nurse sensitive indicators are outcomes that are sensitive to nursing practice; these outcomes will improve if the quantity or quantity of nursing care improves.

10. A patient is prescribed morphine patient-controlled analgesia (PCA). Arrange the following steps for administering PCA in the correct order. 1. Program computerized PCA pump to deliver prescribed medication dose and lockout interval. 2. Check label of medication 3 times: when removed from storage, when brought to bedside, when preparing for assembly. 1051 3. Administer loading dose of analgesia as prescribed. 4. Attach drug reservoir to infusion device, prime tubing, and attach needleless adapter to end of tubing. 5. Identify patient using two identifiers. 6. Insert and secure needleless adapter into injection port nearest patient.

10. Answer: 2, 5, 1, 4, 6, 3.

12. A nurse is reading a research article. The nurse just finished reading a brief summary of the research study that included the purpose of the study and its implications for nursing practice. Which part of the article did the nurse just read? 1. Abstract 2. Analysis 3. Discussion 4. Literature review

12. Answer: 1. An abstract is a brief summary that summarizes the purpose of the article. It also includes the major themes or findings and the implications for nursing practice.

10. Place the following steps for discontinuing intravenous (IV) access in the correct order: 1. Perform hand hygiene and apply gloves. 2. Explain procedure to patient. 3. Remove IV site dressing and tape. 4. Use two identifiers to ensure correct patient. 5. Stop the infusion and clamp the tubing. 6. Carefully check the health care provider's order. 7. Clean the site, withdraw the catheter, and apply pressure.

10. Answer: 6, 4, 2, 1, 5, 3, 7. A health care provider's order is necessary before discontinuing IV access, unless there is a complication such as infiltration or phlebitis. Identifying the patient and explaining the procedure are performed before hand hygiene and glove application to maintain clean gloves. Stopping the infusion prevents IV fluid from spilling on the patient once the catheter is removed. Removing the site dressing frees the catheter so it can be withdrawn.

11. A patient has severe hypercalcemia. What are the priority nursing interventions? (Select all that apply.) 1. Fall prevention interventions 2. Teaching regarding sodium restriction 3. Encouraging increased fluid intake 4. Monitoring for constipation 5. Explaining how to take daily weights

11. Answer: 1, 3, 4. Severe hypercalcemia causes lethargy, which creates a risk for falling and constipation. Increased fluid intake is important to prevent renal calculi during hypercalcemia.

11. Which of the following statements about evidence-based practice (EBP) made by a nursing student would require the nursing professor to correct the student's understanding? 1. "In evidence-based practice the patients are the subjects." 2. "It is important to talk with experts and patients when making an evidence-based decision." 3. "A nurse wanting to investigate the evidence to solve a problem starts by forming a PICOT question." 4. "It is important to ask a librarian for help when searching for literature to help you answer your PICOT question."

11. Answer: 1. Multiple research studies, expert opinion, personal experience, and patient preferences create the data source for evidence-based practice. Patients are not the subjects of EBP; they are typically the subjects in a research study.

11. A group of nurses is discussing the advantages of using computerized provider order entry (CPOE). Which of the following statements indicates that the nurses understand the major advantage of using CPOE? 1. "CPOE reduces transcription errors." 2. "CPOE reduces the time needed for health care providers to write orders." 3. "CPOE eliminates verbal and telephone orders from health care providers." 4. "CPOE reduces the time nurses use to communicate with health care providers."

11. Answer: 1. CPOE eliminates the need for someone to transcribe the orders because it allows the provider to enter the order directly, thus eliminating the need to transcribe orders. There is no evidence that CPOE reduces the time needed for providers to write orders for their patients, or the time nurses must spend communicating with providers. Nurses use CPOE systems under certain circumstances to enter orders given by a provider in person, or over the phone.

11. A patient rates his pain as a 6 on a scale of 0 to 10, with 0 being no pain and 10 being the worst pain. The patient's wife says that he can't be in that much pain since he has been sleeping for 30 minutes. Which is the most accurate resource for assessing the pain? 1. Patient's self-report 2. Behaviors 3. Surrogate (wife) report 4. Vital sign changes

11. Answer: 1. Patient's self-report of pain. Sleep is not an indicator of pain intensity. Unless a patient is stimulated, it is difficult to distinguish sleep from sedation, which may occur as a side effect of the opioid. Patients in pain sometimes sleep from exhaustion.

11. A patient is evaluated in the emergency department after causing an automobile accident while being under the influence of alcohol. While assessing the patient, which statement would be the most therapeutic? 1. "Why did you drive after you had been drinking?" 2. "We have multiple patients to see tonight as a result of this accident." 3. "Tell me what happened before, during, and after the automobile accident tonight." 4. "It will be okay. No one was seriously hurt in the accident."

11. Answer: 3. Focusing gives direction which enables the nurse to obtain more clear information without probing. Asking why questions can convey judgment on the part of the nurse. Giving false reassurance is not a therapeutic communication technique.

12. When using ice massage for pain relief, which of the following is correct? (Select all that apply.) 1. Apply ice using firm pressure over skin. 2. Apply ice for 5 minutes or until numbness occurs. 3. Apply ice no more than 3 times a day. 4. Limit application of ice to no longer than 10 minutes. 5. Use a slow, circular steady massage.

12. Answer: 1, 2, 5. Apply the ice with firm pressure over the skin; then use a slow, steady circular massage. Apply ice for 5 minutes or until the patient feels numbness. It is acceptable to apply ice 2 to 5 times a day.

12. A patient has hypokalemia with stable cardiac function. What are the priority nursing interventions? (Select all that apply.) 1. Fall prevention interventions 2. Teaching regarding sodium restriction 3. Encouraging increased fluid intake 4. Monitoring for constipation 5. Explaining how to take daily weights

12. Answer: 1, 4. Hypokalemia causes bilateral skeletal muscle weakness, especially in the quadriceps, which creates a risk for falling. It also causes gastrointestinal smooth muscle weakness, which produces constipation.

12. The nurse is working the evening shift at a hospital that uses military time for documentation. The nurse administered morphine 2 mg intravenously (IV) for pain at 3:45 PM, changed the dressing over the patient's abdominal incision at 5:34 PM, and administered Ancef 1 g IV at 8:00 PM. Using correct military time, label the documentation for each task with the time that it was completed. 1. ______ Morphine 2 mg IV given for pain rating of 8/10 2. ______ Dressing changed over midline abdominal incision using aseptic technique 3. ______ Ancef 1 g given IVPB over 30 minutes.

12. Answer: 1-15:45, 2-17:34, 3-20:00. Military time is essentially the same as civilian time for the hours between 1 a.m. and 12 noon, with the exception that you add a leading "0" to times before 10:00 a.m. (ex: 08:00 instead of 8:00 a.m.). To convert military time to civilian time: For a military time that's 13:00 or larger, simply subtract 12:00 to get the standard time (ex: If someone says "Meet me in room 202 at 15:45, subtract 12:00 from 15:45 to get 3:45 pm). To convert standard time to military time: add 12:00 to any time from 1:00 p.m. to 11:00 p.m. (ex: If you want to say 6:30 p.m. in military time, add 12:00 to 6:30 to get 18:30).

12. A nursing student is reviewing a process recording with the instructor. The student engaged the patient in a discussion about availability of family members to provide support at home once the patient is discharged. The student reviews with the instructor whether the comments used encouraged openness and allowed the patient to "tell his story." This is an example of which step of the nursing process? 1. Planning 2. Assessment 3. Intervention 4. Evaluation

12. Answer: 4. By reviewing a conversation with a patient and determining whether the student encouraged openness and allowed the patient to "tell his story," expressing both thoughts and feelings - involves evaluation.

13. A researcher is studying the effectiveness of an individualized evidence-based teaching plan on young women's intention to wear sunscreen to prevent skin cancer. In this study which of the following research terms best describes the individualized evidence-based teaching plan? 1. Sample 2. Intervention 3. Survey 4. Results

13. Answer 2. An intervention is an action or treatment performed by a researcher on a sample.

13. Which strategies should a nurse use to facilitate a safe transition of care during a patient's transfer from the hospital to a skilled nursing facility? (Select all that apply.) 1. Collaboration between staff members from sending and receiving departments 2. Requiring that the patient visit the facility before a transfer is arranged 3. Using a standardized transfer policy and transfer tool 4. Arranging all patient transfers during the same time each day 5. Relying on family members to share information with the new facility

13. Answer: 1, 3. Providing a standardized process, policy and tool can assist in a predictable, safe transfer of important patient information between healthcare facilities. Communication and collaboration between the sender and receiver of information enables the staff to validate the information was received and understood. Requiring a patient visit is not always necessary and relying on family member to share information does note release staff from their responsibilities.

13. The nurse is caring for a patient with a nasogastric feeding tube who is receiving a continuous tube feeding at a rate of 45 mL per hour. The nurse enters the patient assessment data and information that the head of the patient's bed is elevated to 20 degrees. An alert appears on the computer screen warning that this patient is at a high risk for aspiration because the head of the bed is not elevated enough. This warning is known as which type of system? 1. Electronic health record 2. Clinical documentation 3. Clinical decision support system 4. Computerized physician order entry

13. Answer: 3. A clinical decision support system is based on rules that are triggered by data entry. When certain rules are not met, alerts, warnings, or other information may be provided to the user.

13. A patient is admitted to the hospital with severe dyspnea and wheezing. Arterial blood gas levels on admission are pH 7.26; PaCO2, 55 mm Hg; PaO2, 68 mm Hg; and image, 24. The nurse interprets these laboratory values to indicate: 1. Metabolic acidosis. 2. Metabolic alkalosis. 3. Respiratory acidosis. 4. Respiratory alkalosis.

13. Answer: 3. The pH is abnormally low, which indicates acidosis. The PaCO2 is high, which indicates respiratory acidosis. The HCO3 − is in the normal range, which indicates an acute respiratory acidosis that has not had time for renal compensation. The low PaO2 and severe dyspnea and wheezing are consistent with this interpretation.

13. When teaching a patient about transcutaneous electrical nerve stimulation (TENS), which information do you include? 1. TENS works by causing distraction. 2. TENS therapy does not require a health care provider's order. 3. TENS requires an electrical source for use. 4. TENS electrodes are applied near or directly on the site of pain.

13. Answer: 4. TENS units act on both the central and peripheral nervous systems. The peripheral effect occurs through activation of the neuroreceptors at or near the source of pain; therefore the electrodes should be placed near the site.

14. While caring for a patient with cancer pain, the nurse knows that a multimodal analgesia plan includes: (Select all that apply.) 1. Using analgesics such as nonsteroidal antiinflammatory drugs (NSAIDs) along with opioids. 2. Stopping acetaminophen when the pain becomes very severe. 3. Avoiding polypharmacy by limiting the use of medication to one agent at a time. 4. Avoiding total sedation, regardless of the severity of the pain. 5. The use of adjuvants (co-analgesics) such as gabapentin (Neurontin) to manage neuropathic type pain.

14. Answer: 1, 5. Multimodal analgesia involves the use of a combination of drugs with at least two different mechanisms of action so pain control can be optimized. The use of acetaminophen, NSAIDs, gabapentin, and opioids represents a multimodal analgesic plan because each agent relies on a different mechanism of action to reduce pain, with the benefit of reducing the amount of opioid that is needed to control pain. This differs from polypharmacy because the combination of drugs is intentional and based on understanding of the action of each product on the pain pathway.

14. A nurse researcher wants to conduct historical research. Which of the following ideas for a study could the nurses conduct? (Select all that apply.) 1. Determining the effect of unemployment on emergency room usage 2. Understanding how Clara Barton shaped nursing in America 3. Evaluating the effect of the Vietnam War on nursing leadership and practice 4. Analyzing the evolution of nursing and patient care during recent disasters 5. Investigating barriers to exercise in women who have become mothers in the past year

14. Answer: 2, 3, 4. Historical studies are designed to establish facts and relationships concerning past events.

14. While reviewing the pulmonary assessment entered by a nurse in a patient's electronic medical record (EMR), a physician notices that the only information documented in that section is "WDL" (within defined limits). The physician also is not able to find a narrative description of the patient's respiratory status in the nurse's progress notes. What is the most likely reason for this? 1. The nurse caring for the patient forgot to document on the pulmonary system. 2. The EMR uses a charting-by-exception format. 3. The computer shut down unexpectedly when the nurse was documenting the assessment. 4. Because of HIPAA regulations, physicians are not authorized to view the nursing assessment.

14. Answer: 2. Given that the initial assessment indicated that the pulmonary system was within normal limits, the facility is most likely documenting by exception. There is no need for further documentation unless the pulmonary assessment changes and is no longer within normal limits.

14. A nurse is explaining to a patient how to follow infection control practices at home. During the discussion the nurse touches the patient on the shoulder. Explain which zone of touch the nurse should be practicing and what problems the action might cause.

14. Answer: Normally patient education occurs in a personal zone (18 inches to 4 feet) and not in the intimate zone where direct touch has occurred. The nurse must be respectful of this patient. Touch is something that might make the patient uncomfortable. The nurse needs to learn to be sensitive to others' reactions to touch and use it wisely. It should be as gentle or as firm as needed and delivered in a comforting, nonthreatening manner The nurse should confirm that touching the patient is acceptable.

15. A postoperative patient currently is asleep. Therefore the nurse knows that: 1. The sedative administered may have helped him sleep, but it is still necessary to assess pain. 2. The intravenous (IV) pain medication given in recovery is relieving his pain effectively. 3. Pain assessment is not necessary. 4. The patient can be switched to the same amount of medication by the oral route.

15. Answer: 1. A pain assessment is still needed because sleep in a postoperative patient cannot be used as an assessment of a patient's pain level. Sleep may result from sedating effects of medication, but analgesia may not be present. It is important to wake and assess the patient to ensure that the pain is controlled and the patient is not overly sedated from the medication (a sign of impending respiratory depression).

15. The nurse uses silence as a therapeutic communication technique. What is the purpose of the nurse's silence? (Select all that apply.) 1. Prevent the nurse from saying the wrong thing 2. Prompt the patient to talk when he or she is ready 3. Allow the patient time to think and gain insight 4. Allow time for the patient to drift off to sleep 5. Determine if the patient would prefer to talk with another staff member

15. Answer: 2, 3. Silence can provide that patient an opportunity to think and gain insight. Often the patient feels compelled to break the silence and is prompted to talk.

15. A nurse researcher is collecting data following approval from the institutional review board (IRB). In which part of the research process is this nurse? 1. Analyzing the data 2. Designing the study 3. Conducting the study 4. Identifying the problem

15. Answer: 3. Conducting the study includes tasks such as obtaining necessary approvals and implementing the study protocol to guide data collection.

15. What is the appropriate way for a nurse to dispose of information printed out from a patient's electronic health record? 1. Rip the papers up into small pieces and place the pieces into a standard trash can 2. Place all papers in the flip-top binder designated for that patient that is located in the nurse's station on the patient care unit 3. Place papers with patient information in a secure canister marked for shredding 4. Burn documents with patient information in the steel sink located within the dirty supply room on the patient care unit

15. Answer: 3. Confidential patient information should be shredded. It is generally collected in large secure containers and shredded at scheduled times.

15. A patient is hyperventilating from acute pain and hypoxia. Interventions to manage his pain and oxygenation will decrease his risk of which acid-base imbalance? 1. Metabolic acidosis 2. Metabolic alkalosis 3. Respiratory acidosis 4. Respiratory alkalosis

15. Answer: 4. Hyperventilation causes excessive excretion of carbonic acid, putting the patient at risk for developing respiratory alkalosis. Interventions to decrease the pain and hypoxia that are causing his hyperventilation will decrease his risk of respiratory alkalosis.

2. A health care provider writes the following order for a patient who is opioid-naïve who returned from the operating room following a total hip replacement: "Fentanyl patch 100 mcg, change every 3 days." On the basis of this order, the nurse takes the following action: 1. Calls the health care provider and questions the order 2. Applies the patch the third postoperative day 3. Applies the patch as soon as the patient reports pain 4. Places the patch as close to the hip dressing as possible

2. Answer: 1. The nurse needs to call the health care provider about the order because Fentanyl patches are not indicated for acute pain. They are indicated for patients with chronic pain who are opioid tolerant.

2. Nurses must communicate effectively with the health care team for which of the following reasons? (Select all that apply.) 1. Improve the nurse's status with the health team members 2. Reduce the risk of errors to the patient 3. Provide optimum level of patient care 4. Improve patient outcomes 5. Prevent issues that need to be reported to outside agencies

2. Answer: 2, 3, 4. Effective communication in healthcare has been linked to a decrease in medical errors, and an improvement in quality of care and patient outcomes. The status and of the nurse or reportable issues are not the focus of communication with patients.

2. Which patients does a nurse plan to teach regarding water restriction? 1. A 23-year-old with extracellular fluid volume (ECV) deficit 2. A 34-year-old with hyponatremia 3. A 47-year-old with hypercalcemia 4. A 69-year-old with metabolic acidosis

2. Answer: 2. Hyponatremia involves excessive water for the amount of sodium in the blood; the body fluids are too dilute. Therefore water restriction is the most common therapy for hyponatremia.

4. The nurse is reviewing the Health Insurance Portability and Accountability Act (HIPAA) regulations with the patient during the admission process. The patient states, "I'm not familiar with these HIPAA regulations. How will they affect my care?" Which of the following is the best response? 1. HIPAA allows all hospital staff access to your medical record. 2. HIPAA limits the information that is documented in your medical record. 3. HIPAA provides you with greater protection of your personal health information. 4. HIPAA enables health care institutions to release all of your personal information to improve continuity of care.

4. Answer: 3. HIPAA provides patients with control over who receives and accesses their medical records. It does not allow uncontrolled access to the medical records. HIPAA also does not dictate what must be documented in the patient's medical record.

2. A preceptor observes a new graduate nurse discussing changes in a patient's condition with a physician over the phone. The new graduate nurse accepts telephone orders for a new medication and for some laboratory tests from the physician at the end of the conversation. During the conversation the new graduate writes the orders down on a piece of paper to enter them into the electronic medical record when a computer terminal is available. At this hospital new medication orders entered into the electronic medical record can be viewed immediately by hospital pharmacists, and hospital policy states that all new medications must be reviewed by a pharmacist before being administered to patients. Which of the following actions requires the preceptor to intervene? The new nurse: 1. Reads the orders back to the health care provider to verify accuracy of transcribing the orders after receiving them over the phone. 2. Documents the date and time of the phone conversation, the name of the physician, and the topics discussed in the electronic record. 3. Gives a newly ordered medication before entering the order in the patient's medical record. 4. Asks the preceptor to listen in on the phone conversation.

2. Answer: 3. When provider orders for new medication(s) are entered into an electronic medical record, the new orders are available to pharmacists using the same electronic system within the hospital. To improve patient safety, many hospitals have a policy that new medications are not to be administered (unless in an emergency) until a pharmacist reviews the new order(s), and verifies that there is no document allergies to the medications, the ordered dose(s) are appropriate, and that there are no potential medication interactions with medications already ordered for a patient. Nurses enter orders into the computer or write them on the order sheet as they are being given to allow the read-back process to occur.

2. A nurse who works on a pediatric unit asks, "I wonder if children who interact with therapy dogs have reduced anxiety when they are in the hospital." In this example of a PICOT question, which of the following is the O? 1. Children 2. Therapy dogs 3. The pediatric unit 4. Anxiety

2. Answer: 4. O stands for outcome; in this PICOT question, the outcome the nurse is concerned about is anxiety.

3. A new nurse complains to her preceptor that she has no time for therapeutic communication with her patients. Which of the following is the best strategy to help the nurse find more time for this communication? 1. Include communication while performing tasks such as changing dressings and checking vital signs. 2. Ask the patient if you can talk during the last few minutes of visiting hours. 3. Ask Pastoral care to come back a little later in the day. 4. Remind the nurse to complete all her tasks and then set up remaining time for communication.

3. Answer: 1. It is important for the nurse to take the opportunity to provide communication opportunities while providing routine patient care.

3. A patient is being discharged home on an around-the-clock (ATC) opioid for chronic back pain. Because of this order, the nurse anticipates an order for which class of medication? 1. Opioid antagonists 2. Antiemetics 3. Stool softeners 4. Muscle relaxants

3. Answer: 3. Constipation is a common opioid-related side effect, and patients do not become tolerant to it.

3. A nurse researcher wants to know which factors are associated with a person's decision to exercise. The nurse distributes a survey to people who recently joined an exercise wellness program and analyzes the data to determine which factors and characteristics are most significantly linked to the decision to start exercising. Which type of a research study is this? 1. Qualitative 2. Descriptive 3. Correlational 4. Randomized controlled trial

3. Answer: 3. Correlational: in this study the nurse researcher is correlating characteristics or factors with the decision to start exercising.

3. A nurse assesses pain and redness at a vascular access device (VAD) site. Which action is taken first? 1. Apply a warm, moist compress 2. Monitor the patient's blood pressure 990 3. Aspirate the infusing fluid from the VAD 4. Stop the infusion and discontinue the intravenous infusion

3. Answer: 4. Pain and redness at a VAD site are indicators of phlebitis. When phlebitis occurs, the infusion must be stopped, and the VAD removed as the highest priority.

3. As the nurse enters a patient's room, the nurse notices that the patient is anxious. The patient quickly states, "I don't know what's going on; I can't get an explanation from my doctor about my test results. I want something done about this." Which of the following is the most appropriate way for the nurse to document this observation of the patient? 1. "The patient has a defiant attitude and is demanding test results." 2. "The patient appears to be upset with the nurse because he wants his test results immediately." 3. "The patient is demanding and is complaining about the doctor." 4. "The patient stated feelings of frustration from the lack of information received regarding test results."

3. Answer: 4. This is a nonjudgmental statement regarding the nurse's observations about the patient. Documenting that the patient has a defiant attitude or is demanding is judgmental, and information in the medical record should be factual and nonjudgmental. Noting that the patient appeared upset with the nurse needs to be more specific; it does not provide enough information regarding the reason for the patient's concern.

4. Motivational interviewing (MI) is a technique that applies understanding a patient's values and goals in helping the patient make behavior changes. What are other benefits of using MI techniques? (Select all that apply.) 1. Gaining an understanding of patient's motivations 2. Focusing on opportunities to avoid poor health choices 3. Recognizing patient's strengths and supporting their efforts 4. Providing assessment data that can be shared with families to promote change 5. Identifying differences in patient's health goals and current behaviors

4. Answer: 1, 3, 5. Motivational interviewing is a technique used to promote an understanding of patients' motivation, health goals, and current behaviors in a non-judgmental environment while focusing on the patient's strengths and efforts. The nurse provides a supportive approach to assist the patient in establishing and promoting positive healthcare changes.

4. A new medical resident writes an order for oxycodone CR (Oxy Contin) 10 mg PO q2h prn. Which part of the order does the nurse question? 1. The drug 2. The time interval 3. The dose 4. The route

4. Answer: 2. Long-acting or sustained-release opioids are dosed on a scheduled basis, not prn, to provide a base of continuous opioid analgesia.

4. A group of nurses have identified that the elderly patients on their unit have a high incidence of pressure ulcers after they have a stroke. During a unit meeting they discuss different interventions that they think may reduce the development of pressure ulcers. What is the nurses' next step to investigate this clinical problem further? 1. Conduct a literature review 2. Share the findings with others 3. Conduct a statistical analysis 4. Create a well-defined PICOT question

4. Answer: 4. In this case, the nurses need to develop a PICOT question next to search for appropriate evidence that might offer answers to this clinical problem.

5. A nurse assesses four patients. Which patient has greatest risk for hypomagnesemia? 1. A 72-year-old with chronic alcoholism 2. A 79-year-old with bone cancer 3. A 41-year-old with hypernatremia 4. A 46-year-old with respiratory acidosis

5. Answer: 1. Patients who have chronic alcoholism are at high risk for hypomagnesemia because of decreased magnesium intake and absorption and increased magnesium excretion.

5. A nurse is talking with a young-adult patient about the purpose of a new medication. The nurse says, "I want to be clear. Can you tell me in your words the purpose of this medicine?" This exchange 334is an example of which element of the transactional communication process? 1. Message 2. Obtaining feedback 3. Channel 4. Referent

5. Answer: 2. In this example, the nurse's question is a way to obtain feedback. Feedback is the message a receiver receives from the sender. It indicates whether the receiver, in this case the patient, understood the meaning of the sender's message.

5. A patient states, "I would like to see what is written in my medical record." What is the nurse's best response? 1. "Only your family can read your medical record." 2. "You have the right to read your record." 3. "Patients are not allowed to read their records." 4. "Only health care workers have access to patient records."

5. Answer: 2. Patients have the right to read their medical records, but the nurse should always know the facility policy regarding personal access to medical records because some require a nurse manager or other official to be present to answer questions about what is in the record. Families may read the records only when the patient has given permission.

5. Arrange the following steps of evidence-based practice (EBP) in the appropriate order. 1. Integrate the evidence. 2. Ask the burning clinical question. 3. Create a spirit of inquiry. 4. Evaluate the practice decision or change. 5. Share the results with others. 6. Critically evaluate the evidence you gather. 7. Collect the most relevant and best evidence.

5. Answer: 3, 2, 7, 6, 1, 4, 5.

5. The nurse reviews a patient's medical administration record (MAR) and finds that the patient has received oxycodone/acetaminophen (Percocet) (5/325), two tablets PO every 3 hours for the past 3 days. What concerns the nurse the most? 1. The patient's level of pain 2. The potential for addiction 3. The amount of daily acetaminophen 4. The risk for gastrointestinal bleeding

5. Answer: 3. The Food and Drug Administration (FDA) recommends a maximum daily dose of 4 g of acetaminophen, and many authorities believe that the maximum daily dose should be lower (3000 to 3200 mg/day) in the outpatient setting to reduce the risk of hepatotoxicity.

6. A patient who is Spanish-speaking does not appear to understand the nurse's information on wound care. Which action should the nurse take? 1. Arrange for a Spanish-speaking social worker to explain the procedure 2. Ask a fellow Spanish-speaking patient to help explain the procedure 3. Use a professional interpreter to provide wound care education in Spanish 4. Ask the patient to write down questions that he or she has for the nurse

6. Answer: 3. Professional certified interpreters can assist with simple or complex healthcare communications such as teaching instructions, test results, or education related to surgical consent. Other healthcare workers who are not certified interpreters cannot be relied on to provide clear and effective communication of healthcare information or teaching.

6. When recruiting subjects to participate in a study about the effects of an educational program to help patients at home take their medications as ordered, the researcher tells the subjects that their names will not be used and no one but the research team will have access to their information and responses. This is an example of: 1. Bias. 2. Anonymity. 3. Confidentiality. 4. Informed consent.

6. Answer: 3. Confidentiality - Confidentiality guarantees that any information a subject provides will not be reported in any manner that identifies the subject and will not be accessible to people outside the research team.

6. A patient with chronic low back pain who took an opioid around-the-clock (ATC) for the past year decided to abruptly stop the medication for fear of addiction. He is now experiencing shaking chills, abdominal cramps, and joint pain. The nurse recognizes that this patient is experiencing symptoms of: 1. Opioid toxicity. 2. Opioid tolerance. 3. Opioid addiction. 4. Opioid withdrawal.

6. Answer: 4. The common symptoms of opioid withdrawal that are associated with physical dependence may develop when an opioid is withdrawn rapidly. Symptoms include shaking chills, abdominal cramps, and joint pain.

6. Which assessment does a nurse interpret as a transfusion reaction? 1. Crackles in dependent lobes of lungs 2. High fever, severe hypotension 3. Anxiety, itching, confusion 4. Chills, tachycardia, and flushing

6. Answer: 4. A transfusion reaction occurs when the immune system reacts against the blood that is being transfused. Chills, tachycardia, and flushing are common manifestations.

6. Which of the following documentation entries is most accurate? 1. "Patient walked up and down hallway with assistance, tolerated well." 2. "Patient up, out of bed, walked down hallway and back to room, tolerated well." 3. "Patient up, walked 50 feet and back down hallway with assistance from nurse. Spouse also accompanied patient during the walk." 4. "Patient walked 50 feet and back down hallway with assistance from nurse; HR 88 and regular before exercise, HR 94 and regular following exercise."

6. Answer: 4. This provides the most accurate, objective information for the chart.

7. A patient has returned from the operating room, recovering from repair of a fractured elbow, and states that her pain level is 6 on a 0-to-10 pain scale. She received a dose of hydromorphone just 15 minutes ago. Which interventions may be beneficial for this patient at this time? (Select all that apply.) 1. Transcutaneous electrical nerve stimulation (TENS) 2. Administer naloxone (Narcan) 2 mg intravenously 3. Provide back massage 4. Reposition the patient 5. Withhold any pain medication and tell the patient that she is at risk for addiction

7. Answer: 1, 3, 4. Non-pharmacological therapies may provide comfort for the patient. It is much too early to consider possible addiction. Naloxone is not appropriate at this time because the patient does not show signs of over sedation or respiratory depression.

7. What assessment does a nurse make before hanging an intravenous (IV) fluid that contains potassium? 1. Urine output 2. Arterial blood gases 3. Fullness of neck veins 4. Level of consciousness

7. Answer: 1. Increased potassium intake when potassium output is decreased is a major risk for hyperkalemia. Before increasing IV potassium intake, check to see that urine output is normal.

7. Label each line of documentation with the appropriate SOAP category (Subjective [S], Objective [O], Assessment [A], Plan [P]). 1. ______ Repositioned patient on right side. Encouraged patient to use patient-controlled analgesia (PCA) device. 2. ______ "The pain increases every time I try to turn on my left side." 3. ______ Acute pain related to tissue injury from surgical incision. 4. ______ Left lower abdominal surgical incision, 3 inches in length, closed, sutures intact, no drainage. Pain noted on mild palpation.

7. Answer: 1= P (Plan): Repositioned patient on right side. Encouraged patient to use PCA device. 2= S (Subjective): "The pain increases every time I try to turn on my left side." 3= A (Assessment): Acute pain related to tissue injury from surgical incision. 4= O (Objective): Left lower abdominal surgical incision, 3 inches in length, closed, sutures intact, no drainage. Pain noted on mild palpation.

7. Nurses in a community clinic have seen an increase in the numbers of obese children. The nurses who care for children are discussing ways to reduce childhood obesity. One nurse asks a colleague, "I wonder what the most effective ways are to help school-age children maintain a healthy weight?" This question is an example of a/an: 1. Hypothesis. 2. PICOT question. 3. Problem-focused trigger. 4. Knowledge-focused trigger.

7. Answer: 3. A problem-focused trigger is a clinical problem you face while caring for patients; the nurses in this question have identified a clinical problem which they desire to investigate further.

7. A nurse prepares to contact a patient's physician about a change in the patient's condition. Put the following statements in the correct order using SBAR (Situation, Background, Assessment, and Recommendation) communication. 1. "She is a 53-year-old female who was admitted 2 days ago with pneumonia and was started on Levaquin at 5 PM yesterday. She complains of a poor appetite." 2. "The patient reported feeling very nauseated after her dose of Levaquin an hour ago." 3. "Would you like to make a change in antibiotics, or could we give her a nutritional supplement before her medication?" 4. "The patient started complaining of nausea yesterday evening and has vomited several times during the night."

7. Answer: 4S, 1B, 2A, 3R. The nurse describes the patient's complaint of nausea and vomiting to the physician (Situation). Specific patient demographic information and reason for admission with current symptomology is provided (Background). The physician is informed of the patient's complaint of nausea after receiving levaquin (Assessment). Physician is asked if they would like to make a change in the antibiotic or provide a nutritional supplement prior to medication administration (Recommendation).

8. Which of the following instructions is crucial for the nurse to give to both family members and the patient who is about to be started on a patient-controlled analgesia (PCA) of morphine? (Select all that apply.) 1. Only the patient should push the button. 2. Do not use the PCA until the pain is severe. 3. The PCA system can set limits to prevent overdoses from occurring. 4. Notify the nurse when the button is pushed. 5. Do not push the button to go to sleep.

8. Answer: 1, 3, 5. The safety of PCA is based on the fact that it requires an awake patient to activate the button. The safety is compromised when someone else pushes the button for the patient. A limit on the number of doses per hour or 4-hour intervals may be set. Opioids (morphine PCA) are intended to provide analgesia; drowsiness is an undesirable potential side effect of opioids, and the PCA should only be used for analgesia.

8. The health care provider's order is 500 mL 0.9% NaCl intravenously over 4 hours. Which rate does a nurse program into the infusion pump? 1. 125 mL/hr 2. 167 mL/hr 3. 200 mL/hr 4. 1000 mL/hr

8. Answer: 1. To infuse 500 mL in 4 hours, set the rate at 125 mL/ hr (500 ÷ by 4 = 125).

8. The nurses on a medical unit have seen an increase in the number of medication errors on their unit. They decide to evaluate the medication administration process on the basis of data gained from chart reviews and direct observation of nurses administering medications. Which process are the nurses using? 1. Evidence-based practice 2. Research 3. Quality improvement 4. Problem identification

8. Answer: 3. Quality improvement studies evaluate how processes work in an organization. The nurses in this example are evaluating the medication administration process.

8. A nurse is assigned to care for a patient for the first time and states, "I don't know a lot about your culture and want to learn how to better meet your health care needs." Which therapeutic communication technique did the nurse use in this situation? 1. Validation 2. Empathy 3. Sarcasm 4. Humility

8. Answer: 4. Humility is admitting to limitations in knowledge and skill. This enables the nurse to admit a knowledge deficit, so that guidance is sought from the patient. Humility helps improve the therapeutic relationship, and enables a nurse to provide safe and effective care.

8. Fill in the Blank. While working on a unit within a hospital, the nurse was able to access a patient's medical record and review the education that other nurses provided during an initial hospitalization and three subsequent clinic visits that occurred in different provider's offices over the past 6 months. This type of feature is most common in a(n) __________________________.

8. Electronic Health Record. This is an example of an electronic health record. The electronic health record is an electronic record of patient health information generated whenever a patient accesses medical care in any health care delivery setting. In this question you are able to access information about the patient from the current hospitalization and from four previous times when the patient accessed care.

9. The nurse is transferring a patient to a long-term, skilled care facility and has just given a telephone report to a registered nurse (RN) who works at that facility and who will be receiving the patient. In documenting this call, the nurse begins by writing the date and time the report was given and the name of the RN taking the report. Which of the following pieces of information does the nurse include in the documentation of this telephone call? (Select all that apply.) 1. The patient's name, age, and admitting diagnoses 2. The discussion of any allergies to food and medications that the patient has 3. That the nurse receiving the report was advised that the patient is "needy" and "on the call light all the time" 4. That the patient's pain rating went from 8 to 2 on a scale of 1 to 10 after receiving 650 mg of Tylenol 5. Description of any unresolved problems and current interventions in place

9. Answer: 1, 2, 4, 5. During transfer to another institution, include essential background information such as the patient's name, age, diagnosis, and allergies. Also include response to treatments such as response to pain-relieving measures. Information about how much the patient ate for breakfast is not necessary. This information is in the chart if the nurse really needs to know. Do not include critical comments about your patients.

9. A nursing student is preparing to read the methods section of a research article. Which type of information will the student expect to find in this section? (Select all that apply.) 1. How the researcher conducted the study 2. A description about how to use the findings of the study 3. The number and type of subjects who participated in the study 4. Summaries of other research articles that support the need for this study 5. Implications for future research studies

9. Answer: 1, 3. The methods section explains how a research study was organized and conducted to answer the research question or test the hypothesis as well as how many subjects or people participated in the study.

9. A patient with a 3-day history of a stroke that left her confused and unable to communicate returns from interventional radiology following placement of a gastrostomy tube. The patient has been taking hydrocodone/APAP 5/325 up to four tablets/day before her stroke for arthritic pain. The health care provider's order reads as follows: "Hydrocodone/APAP 5/325 1 tab, per gastrostomy tube, q4h, prn." Which action by the nurse is most appropriate? 1. No action is required by the nurse because the order is appropriate. 2. Request to have the order changed to around the clock (ATC) for the first 48 hours. 3. Ask for a change of medication to meperidine (Demerol) 50 mg IVP, q3 hours, prn. 4. Begin the hydrocodone/APAP when the patient shows nonverbal symptoms of pain.

9. Answer: 2. The patient can be expected to have acute pain related to the G-tube insertion; in addition, she has a history of chronic pain. Her pain should be treated with ATC medication to match the timing of her pain.

9. An older-adult patient is receiving intravenous (IV) 0.9% NaCl. A nurse detects new onset of crackles in the lung bases. What is the priority action? 1. Notify a health care provider 2. Record in medical record 3. Decrease the IV flow rate 4. Discontinue the IV site

9. Answer: 3. When an IV fluid is infusing, monitor for excess infusion. Crackles in the lung bases are an indication of extracellular fluid volume excess. For patient safety the IV flow rate must be decreased immediately, then contact the health care provider.

9. A new nurse is experiencing lateral violence at work. Which steps could the nurse take to address this problem? 1. Challenge the nurses in a public forum to embarrass them and change their behavior 2. Talk with the department secretary and ask if this has been a problem for other nurses 3. Talk with the preceptor or manager and ask for assistance in handling this issue 4. Say nothing and hope things get better

9. Answer: 3. Talking with a preceptor, manager, or mentor, notifies others of the problem, provides support for the nurse, and helps the nurse learn skills in addressing lateral violence.