NUR 205 Final Exam

A nurse is admitting a client to a geriatric medicine unit following the client's recent diagnosis of acute renal failure. Which of the following nursing actions is most likely to reduce the client's chance of experiencing a fall while on the unit? A) Orient the client to the room and environment thoroughly upon admission. B) Provide the client with a bedpan to reduce the need to transfer to a commode or washroom. C) Administer pain medications sparingly in order to minimize cognitive or musculoskeletal side effects. D) Place the client in a shared room with a client who is stable and oriented.

A A person who is familiar with his or her surroundings is less likely to experience an accidental injury. As part of the hospital admission routine, it is important to orient the client to the safety features and equipment in the room. A bedpan should not be used for the sole reason of reducing the risk of falls, and pain medication should be provided in doses sufficient to treat the client's pain. A client should never be charged with supervising the safety of another client.

A girl age 4 years has been admitted to the emergency department after accidently ingesting a cleaning product. Which of the following treatments is most likely appropriate in the immediate treatment of the girl's poisoning? A) Administration of activated charcoal B) Inducing vomiting C) Gastric lavage D) Intravenous rehydration

A Activated charcoal is the most common treatment for many poisonings and is more effective and safe than induced vomiting or gastric lavage. Rehydration is likely necessary, but this does not actively treat the girl's poisoning.

A nursing faculty member is teaching a class of second-degree students who have an average age of 32. What is important to remember when teaching adult learners? A) A focus on the immediate application of new material B) A need for support to reduce anxiety about new learning C) Older students may feel inferior in terms of new learning D) All students, regardless of age, learn the same

A Adults need to be taught differently. Andragogy, the study of teaching adults, is based on several principles. One of those is that most adults' orientation to learning is that new material should be immediately applicable.

A client with diabetes has impaired sensation in her lower extremities. What education would be necessary to reduce her risk of injury? A) "Always test the temperature of bath water before stepping in." B) "Take your insulin twice a day as we have discussed." C) "Remember to follow your diet so you lose weight this month." D) "Rub lotion on the skin of your legs and feet twice a day."

A Alterations in sensory perception can have a serious effect on safety. A client whose tactile sense is impaired may not perceive temperature extremes that are a threat to safety. Although all the other statements may be necessary, they do not promote safety.

After a client falls out of bed, the nurse completes which of the following? A) Safety event report (incident report) B) Telephone call to hospital's attorney C) Progress note stating event report was completed D) Malpractice report

A An accident or incident that compromises safety in a health care agency requires the completion of a safety event report. This is a confidential document, formerly referred to as an incident report. The safety event report is not a part of the medical record and should not be mentioned in the documentation.

The nurse has been working with a client for several days during the client's recovery from a femoral head fracture. How should a nurse best evaluate whether client education regarding the prevention of falls in the home has been effective? A) "What changes will you make around your house to reduce the chance of future falls?" B) "Do you have any questions about the fall prevention measures that we've talked about?" C) "In light of what we've talked about, why is it important that you remove the throw rugs in your house?" D) "Do you think that the safety measures I taught you are clear and realistic?"

A An open-ended question that requires the client to apply the information that has been taught is often the most accurate way to evaluate the effectiveness of client education. Yes/no questions are much less effective ("Do you have any questions?"; "Do you think that the safety measures I taught you are clear and realistic?"). Asking the client about the importance of preventing falls does not directly assess what the client will actually do to prevent falls.

A client arrives at the emergency department with nausea, hematemesis, fever, abdominal pain, and severe diarrhea. There is a suspicion the client has been exposed to the anthrax bacillus. What category of medications will be administered? A) Antimicrobials B) Narcotics C) Antihistamines D) Antacids

A Anthrax is a potentially fatal bacterial infection. The recommended treatment for exposure to, as well as symptoms of, an anthrax infection is with rapid administration of antimicrobial therapy. Narcotics are administered to manage pain. Antihistamines are prescribed to manage allergy conditions. Antacids are prescribed to manage gastrointestinal disorders.

Which of the following strategies might a nurse use to increase compliance with education? A) Include the client and family as partners. B) Use short, simple sentences for all ages. C) Provide verbal instruction at all times. D) Maintain clear role as the authority.

A Compliance is facilitated by including the client and family in the education-learning process. Other strategies include making sure instructions are understandable, using interactive education methods, and having a strong interpersonal relationship with clients and their families.

The clinical nurse educator at a long-term care facility is responsible for organizing and carrying out staff education sessions. Which of the following topics for staff education is most likely to benefit the greatest number of residents? A) Educating nurses on how to prevent falls B) Reviewing safe medication administration C) Educating nurses on how to prevent wandering by confused residents D) Reviewing resuscitation for cardiac and respiratory arrest

A Falls remain the leading cause of death among older adult Americans. Education that aims to reduce the incidence of falls is likely to be of more benefit than measures that address medication administration, prevention of wandering, or resuscitation procedures, even though such topics may be of importance.

A nurse is using motivational interviewing to find out why a client refuses to participate in the recommended rehabilitation program. Which of the following is an example of using the skill of reflective listening to help motivate this client? A) So, you feel that you are not ready to start a program this week...? B) Why do you feel that you are not ready to start rehabilitation? C) I understand that you are afraid to start rehabilitation; where do you see yourself in a week? D) Remember we discussed what needs to be done to get you back on your feet...How do you feel about getting started?

A Four skills have proved effective in motivational interviewing. These include: (answer A) reflective listening (restates the client's response back to him or her), (answer B) asking open questions (encourages discussion of the reason for making desired changes), (answer C) affirming (supports the client's efforts and encourages further exploration), and (answer D) summarizing (links and reinforces material that has been discussed).

A client has a private insurance policy that pays for most health care costs and services. Why is this plan called a third-party payer? A) The insurance company pays all or most of the costs. B) The family of the client is required to pay costs. C) The client gets the bill and pays out-of-pocket costs. D) Medicare and Medicaid will pay most of the costs.

A Insurance for health care may be financed through private insurance, in which members pay a monthly premium. These plans are called third-party payers, because the insurance company pays all or most of the cost of care.

After many years of advanced practice nursing, a nurse has recently enrolled in a nurse practitioner program. This nurse has been attracted to the program by the potential to provide primary care for clients after graduation, an opportunity that is most likely to exist in which of the following settings? A) A rural health center B) A long-term care facility C) A university hospital D) A community hospital

A Many rural health centers employ few health care providers, and primary care is often provided by a nurse practitioner (NP). A nurse practitioner may provide care in a long-term care facility or hospital, but in these settings, the NP is less likely to be the provider of primary care to clients.

What age group is most vulnerable to toxic fumes or asphyxiation? A) Young children B) Adolescents C) Toung adults D) Middle adults

A Most exposure to toxic fumes, such as carbon monoxide, occurs in the home. Young children and older adults are more vulnerable to toxic fumes. Suffocation, or asphyxiation, can occur at any age, but the incidence is greater in children.

Which of the following clients is the most appropriate candidate for receiving outpatient care? A) A client whose complaints of irregular bowel movements have necessitated a colonoscopy B) A woman who has previously borne two children and is entering the second stage of labor C) A man who is receiving treatment for sepsis after his blood cultures came back positive D) A client with a history of depression who is currently expressing suicidal ideation

A Outpatient services are appropriate for clients who are medically stable but who require diagnostic testing, such as a colonoscopy. Clients in active labor and clients who are actively septic or suicidal require close monitoring and frequent interventions, which can only be safely provided on an inpatient basis.

Who provides physicians with the authority to admit and provide care to clients requiring hospitalization? A) The health care institution itself B) Board of Healing Arts C) American Medical Association D) State Board of Nursing

A Physicians are granted the authority to admit clients to a health care agency or institution, and to provide care in that setting by the health care agency or institution itself. They are licensed to practice medicine by a state medical board, not a state board of nursing or a board of healing arts.

Which of the following measures should nurses implement in a hospital setting in order to identify intimate partner violence (IPV)? A) Routine screening of newly admitted clients B) Focused physical assessment for IPV for all new clients C) Involvement of a social worker in the admission assessment of all new female clients D) Review of the definition and legal repercussions of IPV with all new female clients

A Practices related to the identification of IPV vary, but it is generally agreed that a simple screening tool can be an effective strategy. A focused physical assessment and the involvement of social work are not warranted for all clients. A review of the definition and repercussions of IPV is likely not as effective as a simple and direct screening tool.

In light of the failure of alternatives, a nurse has been forced to physically restrain an agitated client. Which of the following actions should the nurse perform when applying and maintaining the restraints? A) Tie the client's hand restraint to the bed frame rather than the side rail. B) Obtain a physician's order for the restraints within 24 hours. C) Ensure the client is under continuous surveillance while restrained. D) Choose a restraint device that best minimizes the client's mobility.

A Restraints should be tied to the frame of the bed rather than to the side rails. A physician's order is needed for restraints, except in emergencies when an order must be obtained within one hour of application. Frequent assessment of the client is needed, but continuous surveillance is not necessarily required. The least restrictive type of device that allows the greatest mobility, while still ensuring safety, is chosen.

A diabetes nurse educator is teaching a client, newly diagnosed with diabetes, about his disease process, diet, exercise, and medications. What is the goal of this education? A) To help the client develop self-care abilities B) To ensure the client will return for follow-up care C) To facilitate complete recovery from the disease D) To implement ordered teaching and counseling

A The basic purpose of educating and counseling is to help clients and families develop the self-care abilities (knowledge, attitude, skills) needed to maintain and improve health.

One of the newest concepts in providing long-term care is called aging in place. What is the best description of this type of care? A) provided within the health care community where they live. B) Clients move into the nursing home, and access more and more services as required in the same facility. A long-term-care facility, associated with a hospital, that provides acute care services as needed so the client can return C) Clients move to an independent living apartment or home, then have access to increasing health care services as needed, to long term care. D) Clients are maintained in their own homes with home health care.

A The best description of "aging in place" is the type of care where the client moves into an independent living space, and then has access to more services, such as assisted living and/or skilled care, that are part of the health care community in which they live.

A male client age 61 years has been admitted to a medical unit with a diagnosis of pancreatitis secondary to alcohol use. Which of the client's following statements suggests that nurses' education has resulted in affective learning? A) "I'm starting to see how my lifestyle has caused me to end up here." B) "I understand why they're not letting me eat anything for the time being." C) "My intravenous drip will keep me from getting dehydrated right now." D) "I can see how things could have been much worse if I hadn't gotten to the hospital when I did."

A The client's understanding of his contribution to his problem demonstrates a shift in attitude and feelings that is characteristic of affective learning. Understanding the treatment, course, and prognosis of his illness are aspects of cognitive learning.

Nurses work with various members of the health team. The nurse understands that the role of the hospitalist is best described as: A) the doctor who admits the patient, assumes the management of the patient's care, and maintains communication with the primary physician while the patient is hospitalized. B) the physician who manages the patient's care in emergency and intensive care units only. C) the doctor who notifies the primary physician that their patient has been admitted to the hospital, and transfers care to a referral specialist. D) the specialist who admits the patient to hospital, and returns care to the primary physician for all other referrals and services.

A The hospitalist is a physician who provides care to the patient in the emergency room and after admission to the hospital. The hospitalist communicates with the patient's primary doctor, but manages the hospital care.

At completion of the health education for a client, the nurse documents the details of the health education in the client's medical record. What can be determined by this documentation? A) Proof of compliance with education standards B) Client's response to the health education C) Self-administration of medications D) Dietary instructions for the client

A The information about who was taught, what was taught, the education method, and the evidence of learning is the best proof of compliance with education standards. These are entered in the client's medical record. The client's response to the health education cannot be determined by this document. Self-administration of medications and dietary instructions for the client are not implied from who was taught, what was taught, the education method, and the evidence of learning.

The nurse is caring for a client who has prescribed extremity restraints. The nurse is required to document which of the following? A) Alternative measures attempted before applying the restraints B) A verbal order for renewal of the restraints every 48 hours C) Detailed description of the restraint application process D) Type of personal protective equipment (PPE) used by the nurse during restraint application

A This is not typically documented.

Which of the following clients is most likely to face an increased risk of falls due to his or her medication regimen? A) A female client age 77 years who has received a benzodiazepine to minimize her anxiety B) A male client age 79 years whose recent high blood pressure has required a PRN dose of an angiotensin-converting enzyme (ACE) inhibitor C) A woman age 81 years who has required a blood transfusion to treat a gastrointestinal bleed D) A man 90 years of age whose venous ulcer has required the administration of intravenous antibiotics

A While all drugs carry some risk of adverse effects, the use of benzodiazepines and antiepileptics are more predicative of falls than are other drug families.

A nurse is writing learning outcomes for a client recovering from severe burns. Which of the following verbs would be good choices to use when preparing outcomes related to learning how to change dressings? Select all that apply. A) Assembles B) Demonstrates C) Gives examples D) Identifies E) Chooses

A,B Changing dressings falls into the psychomotor domain. "Assembles" and "demonstrates" are appropriate verbs for outcomes. "Gives examples" and "identifies" are verbs best used for the cognitive domain. "Chooses" and "values" relate to the affective domain.

A nurse is educating an elderly client with diabetes and his family members about the importance of a nutritious diet. The nurse knows that client education promotes which of the following purposes? Select all that apply. A) Helps the nurse to restore optimal health in the client B) Helps the client to cope with alterations in health status C) Helps the nurse to be more aware of the client's health D) Helps the nurse to diagnose the client's illness early E) Helps the nurse to be well-informed about the client's care

A,B Nurses are involved in client education to promote wellness (primary prevention), prevent or diagnose illness early (secondary prevention), restore optimal health and function if illness has occurred (tertiary prevention), and assist clients and families to cope with alterations in health status. Simply being knowledgeable about the client's health status and care is not enough. Nurses must know the education and learning process and know how best to include the client's family in the process.

According to Rosenstock, which of the following are health beliefs critical for client motivation? Select all that apply. A) Clients view themselves as susceptible to the disease in question. B) Clients view the disease as a serious threat. C) Clients believe there are actions they can take to reduce the probability of contracting the disease. D) Clients believe the threat of taking these actions is greater than the disease itself. E) Patients view themselves as victims of the disease in question.

A,B,C A client's health beliefs can have great influence on motivation. The health belief model identifies several health beliefs as critical for client motivation (Rosenstock, 1974). Motivation is enhanced when clients view themselves as susceptible to the disease in question; when clients view the disease as a serious threat; when clients believe there are actions they can take to reduce the probability of contracting the disease; when clients believe the threat of taking these actions is not as great as the disease itself.

The nurse working in the hospital understands the changes that have resulted in shorter hospital stays, with a focus on acute care needs of the client. Which of the following factors influence shorter hospital stays? Select all that apply. A) Federal regulations for health care reimbursement policies. B) Increased emphasis on preventive care. C) Improvement in treatment of illness. D) Patients realize that longer stays result in infections and other problems.

A,B,C Shorter hospital stays direct the focus on the acute care needs of the client and have resulted from improved treatment of disease, increases in preventive care, and federal regulations and other health care reimbursement policies. Longer hospital stays are often the result of infection, as this factor is not related to shorter hospital stays.

The Public Health Service (PHS) is a federal agency of the U.S. Department of Health and Human Services. The professional nurse is aware that the services provided by the PHS include which of the following? Select all that apply. A) Care to migrant workers B) Care in federal prisons C) Veterans Administration (VA) hospitals D) Indian Health Services

A,B,D The Public Health Services provides all of these services and others, except the Veterans Administration Hospitals. VA hospitals are supported by government-operated health care, not the PHS.

Health care is constantly changing and becoming more complex. Select the answers that describe clients as health care consumers today. Select all that apply. A) They often have health information obtained from the Internet. B) They prefer to control the decisions made about their own health care. C) Most are less concerned about health care costs as long as they receive good care. D) They express concern regarding access to care and the quality of service. E) They have helped develop clients' rights and cost-containment measures.

A,B,D,E Health care consumers are increasingly more knowledgeable about health, and prefer to control the decisions about their care. They express concern about access to services, and the cost and quality of care. They question duplication of services, and are actively engaged. They have helped to develop client rights and cost-containment measures as protections for clients in health care settings. Today clients are surveyed regarding their experiences with doctors and nurses in hospitals.

Which of the following populations, based on their development stage, would benefit from strategies to prevent falls? Select all that apply. A) Newborns B) Toddlers C) Adolescents D) Adults E) Older Adults

A,B,E Educate parents never to leave newborns alone on a changing table, and also teach parents of toddlers to childproof the home. Parents of preschoolers should make sure their children wear proper safety equipment when riding bicycles or scooters. Adolescents and adults are not at high risk for falls. Older adults, however, are at risk for falls due to the effects of aging on the body systems.

Medicare reimburses in-hospital costs based on a set payment for a diagnostic related group (DRG). This means the hospital is reimbursed for a fixed amount based on the diagnosis and projected cost for care. As a result of this system the hospital can make a profit or a loss. Select the responses that describe when a profit for care of the client can be achieved. A) All of the hospitalization charges are less than projected. B) The client receives incompatible blood so the hospital does not get charged for it. C) The client is discharged before the approved discharge date. D) The nursing care results in the client reaching outcomes for recovery, without complication, after the projected timetable

A,C The hospital will make a profit when cost of hospitalization is less than the reimbursement assigned for the severity of illness and projected care costs. If the client is discharged earlier than projected the hospital keeps the total reimbursed. Incompatible blood is a preventable error, for which the hospital is not reimbursed. Reaching outcomes after the approved time results in additional cost to the hospital.

Long-term care is often needed for the elderly client. Select all the services that may be provided to the resident in a long-term care facility. A) Assistance with activities of daily living B) Immediate post-op care C) Mental disability services D) Nonmedical care for chronic illness E) Day care meals and services

A,C,D Acute/immediate post-op care is a specific need/care immediately following surgery/procedures and is completed at the facility. Day care meals and services are separate services and are not provided to residents in a long-term-care facility. All the others are part of what a long-term care facility provides.

A nurse is making a visit to a client in the home. As a home health care nurse you may be expected to accomplish which of the following? A) Complete an assessment on each visit. B) Provide support to the client and family. C) Administer treatments and medications. D) Document actions regarding patient, activities, and progress. E) Communicate and collaborate with other members of the health team.

All All of the above. Home health care nurses may provide all of these activities in the home setting.

What safety device for children is mandated by law in all 50 states? A) Bumper pads in baby cribs B) Infant car seats and carriers C) Automatic hot water heater controls D) Parental controls for Internet access

B All 50 states mandate the use of infant car seats and carriers when transporting a child in a motor vehicle.

A grade school nurse is addressing parents at a PTA meeting regarding car safety. Which of the following is a recommended safety guideline for this age group? A) All school-age children need to be secured in safety seats. B) Booster seats should be used for children until they are 4 feet 9 inches tall or at least 8 years of age. C) Children under 8 years old should ride in the back seat. D) All school-age children need to be secured in lap seat belts.

B All school-age children need to be secured in safety seats, belt-positioning booster seats, or shoulder lap belts for their size. The National Highway Traffic Safety Administration recommends booster seats for children until they are 4 feet 9 inches tall or at least 8 years of age, and all children 12 and under should ride in the back seat to eliminate the risk of injury from airbag deployment (National Highway Traffic Safety Administration [NHTSA], 2008).

An adolescent has recently had a ring inserted into her navel. Which of the following is the greatest risk facing the adolescent as a result of this activity? A) A scar over the navel B) A local and/or systemic infection C) A greater acceptance by peers D) A strained relationship with parents

B Body piercing is a quick procedure that does not require anesthesia, but the risk for infection is great. This risk includes local infection, hepatitis B virus, and HIV.

A nurse and a client are discussing managed care. The nurse explains that the managed care model was designed for which of the following reasons? A) Increasing client satisfaction B) Controlling costs while maintaining quality of care C) Providing a distinct area of care D) Providing an all-RN staff

B Case management is used in such situations to ensure optimum, high-quality care in the most efficient and economic manner. It is done by controlling costs while maintaining quality of care.

A nurse instructs a client to tell her about the side effects of a medication. What learning domain is the nurse evaluating? A) Affective B) Cognitive C) Psychomotor D) Emotional

B Cognitive learning involves storing and recalling new knowledge in the brain. Cognitive learning may be evaluated through oral questioning.

Which of the following phrases best describes hospitals today? A) Focus on chronic illnesses B) Focus on acute care needs C) Primary care centers D) Voluntary agencies

B Hospitals have become acute care providers for people who are too ill to care for themselves at home, who are severely injured, who require surgery or complicated treatment, or who are having babies. Hospitals rarely focus on chronic illnesses, and they are not primary care centers. Hospitals are not classified as voluntary agencies.

After a stroke, a client is having difficulty swallowing. The nurse may make a referral to what member of the health care team? A) Physical therapist B) Speech therapist C) Social worker D) Respiratory therapist

B In addition to providing services to improve oral communication, a speech therapist may also diagnose and treat swallowing problems in clients who have had a head injury or stroke. A physical therapist assists with musculoskeletal and neurological impairments, a social worker is educated to help clients with economic and social issues, and a respiratory therapist provides treatments to improve breathing.

A nurse has been hired to work as an occupational health nurse. In this position as a registered nurse, what will this nurse provide? A) Occupational therapy to schoolchildren. B) Education and safety programs in industrial settings. C) Assessment and motivation services to the unemployed. D) Activities to assist patients with ADLs in homeless shelters.

B Industrial settings is the best answer to define/describe occupational health nursing, which focuses on employee safety and health-promotion programs. The other options do not address health needs in an employment setting.

When is the best time to evaluate one's own teaching effectiveness? A) During the education session B) Immediately after an education session C) 1 week after the education session D) 1 month after the education session

B It is best to evaluate one's own teaching effectiveness immediately after an education session by quickly reviewing how one feels the plan was implemented; noting both strengths and weaknesses helps plan for subsequent sessions.

Which of the following health care insurance programs is most suitable for a client 68 years of age? A) Medicaid B) Medicare C) Capitation D) AmeriCare

B Medicare is a federal program that finances health care costs of persons 65 years and older, permanently disabled workers of any age and their dependents, and those with end-stage renal disease. The system is funded primarily through withholdings from an employed person's income. Capitation is a reimbursement strategy in managed care organizations. AmeriCare is a type of private insurance. Capitation and AmeriCare are not the preferred providers for the client, considering the client's old age. Medicaid is a federal program that is operated by the states, and each state decides who is eligible and the scope of health services offered. In Medicaid, eligibility may be decided by the state, which is not the case in Medicare.

Developing an education plan is comparable to what other nursing activity? A) Documenting in the nurse's notes B) Formulating a nursing care plan C) Performing a complex technical skill D) Using a standardized form or format

B Planning for learning involves the development of an education plan. Both education plans and nursing care plans follow the steps of the nursing process.

A person receiving health care insurance from his employer knows that he should check the approved list of contracted health care providers before seeking services, in order to receive them at a lower cost. What type of insurance is most likely involved? A) Medicaid B) Preferred provider organization C) Health maintenance organization D) Long-term care insurance

B Preferred provider organizations (PPOs) allow a third-party payer (agencies that pay health care providers for services provided to individuals, such as a health insurance company) to contract with a group of health care providers to provide services at a lower fee in return for prompt payment and a guaranteed volume of clients and services. Although clients are encouraged to use specific providers, they may also seek care outside the panel without referral by paying additional out-of-pocket expenses.

A physician orders restraints for a confused client who is at risk for injury by pulling out tubes necessary to sustain her life. Which of the following statements describes an accurate action to take when applying these restraints? A) Apply restraints to the hands or wrists, never to the ankles. B) Ensure that two fingers can be inserted between the restraint and the client's extremity. C) Use a quick-release knot to tie the restraint to the side rail. D) Remove the restraint at least every four hours, or according to agency policy.

B Restraints should be sufficiently loose for two fingers to be inserted between the restraint and the extremity. Restraints can be placed on ankles; quick-release knots should be tied to the bed frame, not the side rail. Restraints should be removed every two hours.

When caring for a client, the nurse gives day-to-day examples to explain certain points of the health education. The nurse also notes the client's concentration level and educates when the client is active. Which category does the client fall into? A) Motivation B) Attention and concentration C) Learning readiness D) Learning needs

B The client's attention and concentration affect the duration, delivery, and education methods employed. It is helpful to observe the client and implement health education when he or she is most alert and comfortable. This also means involving the client in an active way by providing examples of day-to-day activities. Learning is optimal when a person has a purpose for acquiring new information. The client needs to be motivated to learn new things. Readiness refers to the client's physical and psychological well-being. The best education and learning take place when both are individualized. To be most efficient and personalized, the nurse must gather pertinent information from the client and determine the client's needs when learning.

What is one of the most significant trends in health care today? A) Increased length of hospital stays B) Shift from hospitals to community-based care C) Emphasis on disease management D) Narrowing of the areas for nursing practice

B The shift to community-based care is related to the public's desire to participate more actively in health care decisions, issues, and choices.

Health care costs are increasing as technology and related services increase. Patients interact with many health care providers, such as RNs, LPNs, physicians, physical therapists, medical technologists, radiation technologists, specialists, and others employed in health care. As a result of the complexity of care and multiple providers, health care is becoming fragmented. What are the major results of fragmented care? A) Less confusion for clients regarding treatment. B) Increased medication errors. C) Clients receive more specialized care. D) Lack of continuity of care.

B,C,D Fragmented care increases health care costs and the number of providers/specialists seeing the client. A lack of continuity of care often results, increasing the client's confusion, and medication errors may increase. Although clients often receive specialized care and services, there may be conflicting care plans.

The National Patient Safety Foundation recently collaborated with the Partnership for Clear Health Communication (2007) to create awareness of the need for improved health literacy and developed the Ask Me 3 tool. Which of the following is an Ask Me 3 question? Select all that apply. A) Who will be my health care provider? B) What is my main problem? C) What do I need to do? D) Where will I get help? E) Why is it important for me to do this?

B,C,E Ask Me 3 questions are: What is my main problem? What do I need to do? Why is it important for me to do this?

A nurse in a neighborhood clinic is conducting educational sessions on weight loss. What aim of nursing is met by these educational programs? A) Practicing advocacy B) Preventing illness C) Restoring health D) Facilitating coping E) Maintaining and promoting health

B,C,E If this education is directed toward those who are healthy, weight loss information can help maintain health and prevent illness. If this education is used in those already ill (hypertension, diabetes), weight loss can restore health. The nurse is not practicing advocacy or facilitating coping by providing weight loss education.

A nurse educating a new mother on how to bathe her infant uses the acronym TEACH to maximize the effectiveness of the education plan. Which of the following are guidelines based on this acronym? Select all that apply. A) Tune out the individual client. B) Edit client information. C) Act on every teaching moment. D) Always refer a client to counseling. E) Clarify often.

B,C,E To maximize the effectiveness of patient education, the nurse should use the acronym TEACH — T: tune into the client, E: edit client information, A: act on every teaching moment, C: clarify often, H: honor the client as a partner in the education process.

A young mother asks the nurse in a pediatric office for information about safety, diet, and immunizations for her baby. Which nursing diagnosis would be appropriate for this client? A) Knowledge Deficit: Infant care B) Impaired Health Maintenance C) Readiness for Enhanced Parenting D) Readiness for Enhanced Coping

C A client who requests information is demonstrating motivation and readiness to learn. The appropriate nursing diagnosis would be Readiness for Enhanced Parenting.

Hospice nurses provide care in a variety of settings, including clients' homes, long-term-care facilities, and hospice residences. After the client dies, what happens next? A) The hospice services are provided to the families of the former residence clients only. B) The hospice services continue for family and friends during the bereavement period, up to one month after the death. C) The hospice nurse continues to care for the client's family for up to one year. D) Nurses assist the family to work through their grief during the period of mourning.

C After the death of the patient, the hospice nurse continues to care for the client's family during the bereavement period for up to one year. Nurses help the family to work through their loss.

A nurse makes a medication error and fills out an incident report. What will the nurse do with the incident report once it is filled out? A) Place it in the client's medical record. B) Take it home and keep it locked up. C) Maintain it according to agency policy. D) Include it with documentation of the error.

C An accident in a health care agency requires filling out an incident report, a confidential document that objectively describes the circumstances of the accident. The incident report is not a part of the medical record and should not be mentioned in the documentation. The report is maintained by the agency.

Bioterrorism has become a commonly used term. What is the definition of bioterrorism? A) A verbal threat by those wishing to harm specific individuals B) A written threat calculated to produce terror in a family C) The deliberate spread of pathogens into a community D) A worldwide plan to produce illness and injury

C Bioterrorism involves the deliberate spread of pathogenic organisms into a community.

The facility risk management team is preparing an in-service to nursing staff members. The presentation will highlight risk factor increase related directly to the type of clientele on a nursing unit. The presenter will correctly explain that which of the following risks is increased for female nurses who work on an oncology care unit? A) Back injuries B) Bloodborne pathogens C) Adverse reproduction D) Neurologic disorders

C Common risks in health care facilities are exposure to bloodborne pathogens from stick injuries via used needles, back injuries caused by heavy lifting, and potential adverse reproductive outcomes as a result of overexposure to antineoplastic medications. On oncology divisions, the nurse is continually exposed to antineoplastic agents.

What population do hospice nurses provide with care? A) Those requiring care to improve health B) Children with chronic illnesses C) Dying persons and their loved ones D) Older adults requiring long-term care

C Hospice is a program of palliative and supportive services providing physical, psychological, social, and spiritual care for dying persons, their families, and other loved ones. Hospice nurses do not implement care to improve health, focus on children with chronic illnesses, or care for older adults in long-term care.

What is the primary focus of health care today? A) Care of acute illnesses B) Care of chronic illnesses C) Health promotion D) Health restoration

C In the past, health care focused on the treatment of illnesses rather than prevention through health promotion, because preventive strategies were not covered by health insurance. Health awareness and the desire to be involved in one's own health care have strongly influenced the delivery of health care services in our society.

When educating parents of preschoolers, what is most important to include in your presentation? A) Use wrist guards with rollerblades B) Teach preschoolers to tread water C) Keep chemicals in a locked cabinet D) Strict discipline with potty training

C Increasing mobility, lack of life experience and judgment, and immature musculoskeletal and neurologic systems lead to potentially hazardous encounters for toddlers and preschoolers.

Which of the following is an essential component of the definition of learning? A) Increases self-esteem B) Decreases stress C) Can be measured D) Cannot be measured

C Learning is the process by which a person acquires or increases knowledge, or changes behavior in a measurable way, as a result of an experience.

Which of the following is true of long-term care facilities? A) They provide care only to older adults. B) They provide care for homeless adults. C) They provide care to people of any age. D) They provide care only for people with dementia.

C Long-term care facilities provide health care, and help with the activities of daily living, for people of any age who are physically or mentally unable to care for themselves independently. They do not provide care only to older adults or those with dementia, although they do care for those populations as well as others. They do not provide care to homeless persons.

When the newly diagnosed, insulin-dependent diabetic client tells the nurse that he has never received instruction on the administration of injections, an appropriately stated nursing diagnosis for the client is what? A) Self-care deficit related to lack of knowledge about injections B) Knowledge deficit related to lack of knowledge about injections C) Deficient knowledge of injection administration as verbalized by the client, related to the lack of instruction and experience D) Ineffective health care maintenance related to diabetic instructions

C Many factors can contribute to deficient knowledge, such as a lack of exposure, lack of recall, information misinterpretation, cognitive limitations, lack of interest in learning, and unfamiliarity with information resources.

Medicare uses a prospective payment plan based on diagnosis-related groups (DRGs). What are DRGs? A) Locally supported health care financing, usually by donations B) A public assistance program for low-income individuals C) Predetermined payment for services based on medical diagnoses D) A private insurance plan for subscribers who pay a copayment

C Medicare, based on DRGs, pays a hospital a fixed amount that is predetermined by the medical diagnosis or specific treatment rather than by the actual cost of hospitalization and care. This plan was put into effect in an effort to control rising health care costs. It is not supported by donations; it is not a public assistance program or a private insurance plan.

A nurse in a walk-in health care setting provides technical services (e.g., administering medications), determines the priority of care needs, and provides client teaching on all aspects of care. Which of the following terms best describes this type of health care setting? A) Hospital B) Physician's office C) Ambulatory center D) Long-term care

C Nurses in ambulatory care centers (walk-in clinics) provide technical services (e.g., administering medications), determine the priority of care needs, and provide teaching about all aspects of care. Nurses employed in hospitals have many roles, including manager of other members of the health care team providing client care, administrator, nurse practitioner, clinical nurse specialist, patient educator, in-service educator, and researcher. In physician's offices, advanced practice registered nurses (APRNs), nurse practitioners, midwives, or clinical nurse specialists work independently or collaboratively with physicians to make assessments and care for clients who require health maintenance or health promotion activities. Long-term care provides medical and nonmedical care for people with chronic illnesses or disabilities.

What statement by a client would indicate that a nurse had successfully implemented a educating/learning strategy to prevent injury in the home? A) "I will turn off the outside lights and lock the doors every night." B) "Do you think it would be best for me to buy a gun?" C) "I am going to remove all those throw rugs on the floor." D) "Well, I always let the boys play in the bathtub; they love it."

C Nurses must evaluate the effectiveness of their interventions to promote safety and prevent injury. If the expected client outcomes have been met and evaluative criteria satisfied, the client should be able to correctly identify real and potential unsafe environmental situations, and implement safety measures in the environment.

An older adult client is very stressed about who will care for his pets while he is hospitalized for a fall that caused a fractured hip. What type of counseling would the nurse conduct? A) None B) Long-term C) Short-term D) Motivational

C Short-term counseling focuses on an immediate problem or concern of the client or family. Even if it is a relatively minor concern, it needs immediate attention.

A client 36 years of age is able to understand the health education when she is given the opportunity to put the education into practice. The nurse helps the client to self-administer the medication dosage before the client is discharged from the health care facility. Which domain correctly identifies the client's learning style? A) Cognitive domain B) Affective domain C) Psychomotor domain D) Interpersonal domain

C The client's learning style falls into the psychomotor domain, which is a style of processing that focuses on learning by performing what has been learned. The cognitive domain is a style of processing information by listening or reading facts and descriptions. The affective domain is a style of processing, which appeals to a person's feelings, beliefs, or values. The interpersonal domain is a style of processing that focuses on learning through social relationships.

A nurse enters a client's room and finds that the client has fallen on her way to the bathroom. Which of the following is a prudent nursing intervention for this client? A) Briefly leave the client in order to call the primary physician to assess the client's condition. B) Order x-rays or CT scans for the client, as needed. C) Document the incident, assessment, and interventions in the client's medical record. D) Do not file an event report unless the client is seriously injured in the fall.

C The nurse is responsible for documenting the incident in the client's record. Assess the patient immediately and provide appropriate care and interventions based on client status, and ensure prompt follow-through for any physician orders for diagnostic tests. An event report should be filed in the case of a fall, as per facility policy.

Nurses who assist clients to deal holistically with their health care needs at the end of their lives work primarily in which health care delivery system? A) Acute care B) Primary care C) Hospice D) Rehabilitation

C The opportunity to help people maintain their ability to remain at home and deal holistically with their health and family needs at the end of their lives is home health hospice care.

A nurse is caring for a stable toddler diagnosed with accidental poisoning, due to the ingestion of cleaning solution. What must be included in educating parents about how to protect a toddler from accidental poisoning? A) Closely monitor the toddler's activity. B) Label poisonous solutions. C) Keep cleaning solutions locked up. D) Do not leave the toddler alone.

C The parents should keep cleaning solutions locked up to protect the toddler from accidental poisoning. Accidental poisonings usually occur among toddlers and commonly involve substances located in bathrooms or kitchens. Labeling poisonous substances may not help as toddlers are unable to read. Not leaving the child alone and closely monitoring the child are important, but not feasible all the time.

When providing client education it is essential for the nurse to incorporate what action so that learning can be optimized? A) Have the clients read material after client education B) Be sure that clients are formally engaged C) Include educational strategies that encourage clients to be active participants D) Administer tests to evaluate learning

C The teaching-learning relationship is a dynamic, interactive process that involves active participation from the nurse and client.

What is one way in which nurses can help shape health care reform? A) Do their job and do it well B) Refuse to participate in organizations C) Support legislation to improve care D) Become a member of a support group

C There are many ways in which nurses can help shape health care reform, including supporting legislation to improve care. Nurses are expected to do their job well. Refusing to participate in organizations and/or becoming a member of a support group will not help shape health care reform.

A mother of a toddler wants to learn how to do CPR. What education strategy would be most effective in helping her learn? A) Lecture B) Discussion C) Demonstration D) Discovery

C When a client wants to learn a specific skill, such as CPR, demonstration is an effective strategy. The client's learning can be evaluated by return demonstration. Lecture, discussion, and discovery are not as effective in teaching a skill.

What client characteristic is important to assess when using the health belief model as the framework for teaching? A) Developmental level B) Source of information C) Motivation to learn D) Family support

C When assessing a client's learning readiness, it is important to consider his or her motivation. Motivation is influenced by an individual's health beliefs and plays a key role in the health belief model. Motivation encourages the client to adopt health promotion and disease prevention actions.

What word or phrase best describes an effective counselor? A) Technically skilled B) Knowledgeable C) Practical D) Caring

D An effective counselor needs to be a caring individual with the interpersonal skills of warmth, friendliness, openness, and empathy.

The parents of an infant suffering from apnea need to be educated on the apnea monitor and cardiopulmonary resuscitation. What should the nurse assess first regarding the parents? A) Educational levels B) Home environment C) Infant bonding D) Baseline knowledge of these concepts

D Before educating parents on the apnea monitor and cardiopulmonary resuscitation, the nurse should determine the parents' baseline knowledge so that the nurse knows where to begin. Educational level would be the next assessment in order to plan the appropriate teaching delivery method.

Which of the following people has the greatest risk for accidental injury? A) An infant just learning to crawl B) An older adult who walks two miles a day C) An athlete who exercises on a regular basis D) A worker who operates industrial machines

D Certain occupations, lifestyles, and environments place people in more hazardous situations. A worker who operates industrial machines is at greater risk for accidental injury as well as for hearing loss.

A doctor orders restraints for an older adult client who is disoriented from the pain medication she is taking. Which of the following is an appropriate guideline for applying these restraints? A) Chemical restraints should be tried before using physical restraints. B) The restraints can be ordered by the nursing supervisor in emergency situations. C) The client's vital signs must be assessed every hour. D) Adults must be reassessed within 4 hours; children age 9 to 17 years within two hours; and children under 9 years within one hour.

D Client with restraints must be monitored and reassessed as described in answer D. Restraints must be ordered by a physician, and client vital signs must be assessed every two hours.

What is the most critical element of documentation of education? A) A summary of the education plan B) The implementation of the education plan C) the client's need for learning D) Evidence that learning has occurred

D Documentation of the education-learning process includes a summary of the learning need, the plan, the implementation of the plan, and the evaluation results. The evaluative statement is crucial and must show concrete evidence that demonstrates that learning has occurred. If the desired learning has not occurred, the notes should indicate how the problem was resolved. It is insufficient to document only what was taught; the charting must show evidence that the client or significant other has actually learned the material taught.

The nurse knows that a health care facility should determine its disaster-preparedness plan for delivering care in the event of an emergency or disaster? A) As soon as the disaster is announced publicly B) When officially informed that a disaster has occurred C) After the first disaster has been experienced D) In advance of a possible emergency or disaster

D Each health care facility should determine in advance how to deliver care, if an emergency or disaster occurs. This involves collaboration with internal committees and external agencies.

A man is scheduled for hospital outpatient surgery. He tells the nurse, "I don't know what that word,outpatient, means." How would the nurse respond? A) "It means you will have surgery in the hospital and stay for 2 days." B) "It means the surgeon will come to your home to do the surgery." C) "Why would you ask such a question? Don't worry about it." D) "You will have surgery and go home that same day."

D In addition to providing acute care, hospitals have many services for outpatients (those who require health care but do not need to stay in the facility). Clients who have outpatient surgery have the procedure, return to their hospital room for recovery, and then are discharged home on the same day.

In what situation would the use of side rails not be considered a restraint? A) The nurse keeps them raised at all times. B) The institution's policies mandate using side rails. C) A visitor requests their use. D) A client requests they be up at night.

D It is now recognized that side rails can pose serious risks for some clients. However, side rails are not considered restraints if the client requests they be put up at night to increase feelings of security while asleep. Agency policies help nurses determine when to apply restraints and what type to use.

Nurses provide many interventions to prevent falls in health care settings. Which of the following would be an appropriate intervention to prevent falls? A) Keep bed in the high position. B) Keep side rails up at all times. C) Apply restraints to all confused clients. D) Lock wheels on beds and wheelchairs.

D Locking wheels on beds and wheelchairs prevents them from rolling and precipitating a fall. Beds should be kept in low positions with the side rails down in most situations; restraints should be applied only as a last resort.

A nurse is working with an older adult client, educating the client on how to ambulate with the aid of a walker. The nurse notes that the client appears to lack the motivation to learn how to use device. The client states, "I'm just too old to learn." Which of the following would be most appropriate for the nurse to do to motivate this client? A) Tell the client how to move the walker as he ambulates. B) Explain how the walker supports the client's lower extremities C) Fully discuss the rationale for using the walker. D) Describe how the walker can improve the client's quality of life.

D Motivating the older adult client can be done by showing the client how the new knowledge will improve his quality of life, regardless of how long that may be. It will also demonstrate how the new knowledge could improve the client's level of independence. Although demonstrating the use of the walker and explaining how the walker assists with ambulation (and the rationale for its use) can be used to educate the client, these actions would not promote motivation for the client to learn.

A male client age 42 years recovering from a MI is having difficulty following the care plan to stop smoking and exercise. What is the nurse's best response to this client? A) Praise him for trying. B) Tell him that he will have another MI and it will be his own fault. C) Tell him that his cigarettes will be taken away if he smokes again. D) Ignore the behavior and recommend a behavior modification program.

D Negative reinforcement (criticism or punishment) is generally ineffective; undesirable behavior is usually best ignored. Behavior modification programs that reward desired behaviors and ignore undesired behaviors might be best for this client.

A student is developing an education plan for her assigned client. The student wants to educate the client on what symptoms to report after chemotherapy. What would the student need to do first? A) Ask other students what should be included in content. B) Ask the client what he or she wants to know. C) Tell the instructor that this topic hasn't been covered yet. D) Review information available in writing and on the Internet.

D New nurses (and students) usually need to research the subject to be taught to determine what information exists on the topic. Books, journals, manuals, and Web-based sources may be used to find information.

A nurse refers a client with a new colostomy to a support group. This nurse is practicing which of the following aims of nursing? A) Promoting health B) Preventing illness C) Restoring health D) Facilitating coping

D Not all clients fully recover from their illness or injury; many clients will need to learn to cope with permanent health alterations.

An emergency room nurse is assessing a toddler with multiple bruises and burns. The nurse suspects the toddler has been abused. What is legally required of the nurse? A) Nothing; the nurse has no control over the toddler's home. B) Refer the caregivers of the toddler to a home health nurse. C) Verbally confront the caregivers about the suspicions. D) Report suspicions about the abuse to proper authorities.

D Nurses are both legally and ethically obligated to report abuse, either suspected or confirmed. In many states, the failure to report actual or suspected abuse is a crime. The role of the nurse does not include confrontation.

In providing nursing care, it is most important to perform which of the following actions? A) Administration of prescribed medication B) Implementation of physician's orders C) Evaluation of client's responses D) Coordination of care with the health care team

D Nurses have moved from simply observing and giving prescribed medications to coordinating clinical information for the entire health care team.

A nurse is caring for clients at an ambulatory care facility. Which care intervention is least likely to be provided by the nurse in this setting? A) Patient education B) Treatment of minor trauma C) Medication administration D) Crisis management

D Nurses in ambulatory care centers and clinics provide technical services (e.g., administering medications), determine the priority of care needs, and provide teaching about all aspects of care. The urgent care center is a special type of ambulatory care center that provides walk-in care for illnesses and minor trauma. Crisis management or intervention is typical of mental health centers and not of ambulatory care settings.

Nurses who are employed in home care have a variety of responsibilities. Which of the following is one of those responsibilities? A) Provide all care and services B) Maintain a clean home environment C) Advise clients on financial matters D) Collaborate with other care providers

D Nurses who provide care in the home make assessments, provide physical care, administer medications, teach, and support family members. They also collaborate with other health care providers in providing care and services. Home care nurses do not provide all care and services, maintain a clean home environment, or advise clients on financial matters.

The U.S. system of health care is based on an ability to pay for care, which leaves millions of people uninsured or underinsured, with inadequate access to health care. Nurses are often presented with ethical dilemmas when caring for patients and families. Which of the following is an example of an ethical dilemma? Select all that apply. A) All clients are entitled to care, whether they can pay or not, because health care is a right. B) You may have to pay higher insurance premiums to cover the cost of care because you smoke. C) There are free clinics and health programs to serve the poor; they should receive health care there. D) Should the uninsured person, who cannot pay for health care, receive the same care and services as someone who works and pays for insurance?

D Only answer D suggests an ethical dilemma for which there is no easy answer. Answer A is an assumption that many have about health care. Answer B is a fact, as some health insurance programs charge more for those who smoke. Answer C is an opinion, as although there are some clinics for the poor, health care access is limited.

A grade school is preparing a series of classes on the dangers of smoking. Who would be most likely to teach the classes? A) A community health nurse B) An outside consultant C) A teacher D) The school nurse

D School nurses provide many different services, including maintaining immunization records, providing emergency care, administering prescribed medications, conducting routine screenings, conducting health assessments, and teaching for health promotion (e.g., the dangers of smoking). Although any of the other choices may provide teaching, it is the nurse who primarily provides health-related teaching.

A client is very anxious and states, "I am so stressed." Why do these factors affect the client's safety? A) Stress increases retention of information B) Stress affects interpersonal relationships C) Stress increases concern about hazards D) Stress tends to narrow the attention span

D Stressful situations tend to narrow a person's attention span and make him or her more prone to accidents. Stress does not increase retention of information or concern about hazards. Although stress may affect interpersonal relationships, that is not the same as safety.

To meet accreditation standards regarding client care, a health care facility must show evidence of what? A) Employee satisfaction surveys B) Financial accounts and statements C) Documentation of indigent care D) Client education documentation

D The Joint Commission also has established standards for client education that health care agencies must meet to receive accreditation.

An elderly woman has total care of her husband, who suffers from debilitative rheumatoid arthritis. The couple voices concern over the pain and stress associated with the condition. What type of care might the nurse suggest to help the couple? A) Primary care B) Respite care C) Bereavement care D) Palliative care

D The goal of palliative care is relief from the symptoms, pain, and stress of a serious illness, and to improve the quality of life for both the client and the family. The main purpose of respite care is to give the primary caregiver some time away from the responsibilities of day-to-day care. Primary care is found in acute care settings and physicians' offices. Bereavement care is provided to families following the death of a family member.

A nurse notices that a toddler is constantly snatching toys from the hands of other preschool children at the health care facility, placing the toddler and other children at risk for injury. Which of the following would be a most effective method for teaching the toddler not to snatch toys? A) Ask the children to play another game. B) Tell the toddler that God punishes children who snatch. C) Give the toddler another toy with which to play. D) Enlist the aid of the toddler's parents in education.

D The nurse should inform the toddler's parents as to his or her behavior. Since toddlers and preschoolers are accustomed to learning from and communicating with their parents, the parents are usually the most effective teachers. Children learn through play, so using dolls or toys as models can enhance learning. Giving another toy to the toddler or asking the children to play another game may not solve the problem, as the toddler would still want someone else's toys. Telling the toddler that God punishes children who snatch is not correct because the nurse is indirectly trying to scare and threaten the toddler.

A nurse is designing a teaching program for individuals who have recently immigrated to the United States from Iraq. Which of the following considerations is necessary for culturally competent client teaching? A) Use materials developed previously for U.S. citizens. B) Use all visual materials when teaching content. C) Use a lecture format to teach content with few questions. D) Develop written materials in the client's native language.

D With changes in society, nurses are faced with the challenge of teaching clients from different cultural and ethnic backgrounds. One of the strategies is to develop written materials in the native language of the client.