Prep U's - Chapter 1 - Professional Nursing Practice

The nurse is preparing to organize a community prescription drop-off program. Anticipating the need for heavy security, the nurse alerts the local police to drop-off locations and the schedule. Which critical thinking traits described by Alfaro-LeFevre (2013) is the nurse demonstrating? A. Proactiveness B. Flexibility C. Fair-mindedness D. Open-mindedness

Answer: A Rationale: Alfaro-LeFevre (2013) identified critical thinkers as individuals with the following characteristics: active thinker, fair-minded, open-minded, persistent, empathic, independent in thought, good communicators, honest, organized and systematic, proactive, flexible, realistic, humble, cognizant of rules of logic, curious and insightful, and creative and committed to excellence. By planning ahead for the need for increased security related to the prescription drug drop-off program, the nurse is being proactive.

The physician has ordered cimetidine for a client with gastric ulcers, and the nurse administers the first dose. The nurse's actions are noted in the medical record. This notation is an example of which aspect of implementing the plan of care? A. documentation B. monitoring C. intervention D. assessment

Answer: A Rationale: An important element of implementation is documentation. By law, nurses must document all nursing actions, observations, and client responses in a permanent record.

Using the concept of the wellness-illness continuum, what would the nurse include in the development of a nursing care plan for a chronically ill patient? A. Encourage positive health characteristics within the limits of the specific illness. B. Educate the patient about every possible complication associated with the specific illness. C. Limit all activities because of the progressive deterioration associated with all chronic illnesses. D. Recommend activity beyond the scope of tolerance to prevent early deterioration.

Answer: A Rationale: By viewing health and illness on a continuum, it is possible to consider a person as being neither completely healthy nor completely ill. Instead, a person's state of health is ever-changing and has the potential to range from high-level wellness to extremely poor health and imminent death. The use of the health-illness continuum makes it possible to regard a person as simultaneously possessing degrees of both health and illness. On the health-illness continuum, even people with a chronic illness or disability may attain a high level of wellness if they are successful in meeting their health potential within the limits of their chronic illness or disability (Manderscheid, Ryff, Freeman, et al., 2010).

The basic difference between nursing diagnoses and collaborative problems is that: A. nurses manage collaborative problems using physician-prescribed interventions. B. nursing diagnoses incorporate physician-prescribed interventions. C. nursing diagnoses incorporate physiologic complications that nurses monitor to detect change in status. D. collaborative problems can be managed by independent nursing interventions.

Answer: A Rationale: Collaborative problems are physiologic complications that nurses monitor to detect onset of changes in patient status and manage through the use of physician-prescribed and nursing-prescribed interventions to minimize the complications of events. Collaborative problems require both nursing and physician-prescribed interventions. Nursing diagnoses can be managed by independent nursing interventions. Nursing diagnoses refer to actual or potential health problems that can be managed by independent nursing interventions.

A nurse is unsure how best to respond to a client's vague complaint of "feeling off." The nurse is attempting to apply the principles of critical thinking, including metacognition. How can the nurse best foster metacognition? A. By examining the way that she thinks and applies reason. B. By thinking about the way that an "ideal" nurse would respond in this situation. C. By evaluating her responses to similar situations in the past. D. By eliciting input from a variety of trusted colleagues.

Answer: A Rationale: Critical thinking includes metacognition, the examination of one's own reasoning or thought processes, to help refine thinking skills. Metacognition is not characterized by eliciting input from others or evaluating previous responses.

The LPN is collaborating with the RN in developing a plan of care for a new client. Which description of nursing roles best describes the LPN's contribution to the plan? A. Data gathering, identification of client strengths, and assurance of client safety during the assessment phase. B. Establishment of priorities during the planning phase. C. Identification of problems and risks that require nursing management during the nursing diagnosis phase. D. Providing referrals and delegating and managing client care during the implementation phase.

Answer: A Rationale: Establishment of priorities, identification of problems and risks, and delegation and management of client care are all roles of the registered nurse during the nursing process. Data gathering, identification of client strengths, performance of assessments and assurance of client safety are role of the LPN when using the nursing process to develop the client plan of care.

A client reports postoperative pain near the incision site on his abdomen. He describes the pain as constantly burning and rates it at an 8/10 using the pain scale. The nurse administers morphine sulfate 2 mg IVP as ordered. Ten minutes later the nurse documents that the client now rates his pain at a 3/10 using the pain scale. The nurse's documentation is an example of which part of the nursing process? A. Evaluation B. Assessment C. Analysis D. Data collection

Answer: A Rationale: Evaluation, the final step of the nursing process, allows the nurse to determine the client's response to the nursing interventions and the extent to which the objectives have been achieved. The other answers are incorrect because they are not the correct phase of the nursing process.

The nurse is caring for a client who is withdrawing from heavy alcohol use and who is consequently combative and confused, despite the administration of benzodiazepines. The client has a fractured hip that he suffered in a traumatic accident and is trying to get out of bed. What is the most appropriate action for the nurse to take? A. Obtain a physician's order to restrain the client. B. Read the facility's policy on restraints. C. Order soft restraints from the storeroom. D. Leave the client and get help.

Answer: A Rationale: It is mandatory in most settings to have a physician's order before restraining a client. Before restraints are used, other strategies, such as asking family members to sit with the client, or utilizing a specially trained sitter, should be tried. A client should never be left alone while the nurse summons assistance.

Which is an important role for a nurse in the health care delivery system? A. Identifying patient needs and working with patients to address them. B. Participating in treatment decisions regarding health restoration. C. Balancing work with leisure activities. D. Participating in the diagnosis and treatment of disease.

Answer: A Rationale: Nurses work in various settings, requiring them to adhere to facility policies and state nurse practice acts. Among the nurse's important functions in health care delivery are identifying a patient's immediate, ongoing, and long-term needs and working in concert with the patient to address them. Balancing work with leisure activities is not the function of a nurse in the health care delivery system. A nurse does not diagnose and treat diseases and does not participate in treatment decisions regarding health restoration.

An older adult client has a diagnosis of rheumatoid arthritis (RA) and has been achieving only modest relief with the use of nonsteroidal anti-inflammatory drugs (NSAIDs). When creating this client's plan of care, which nursing diagnosis would most likely be appropriate? A. Self-care deficit related to fatigue and joint stiffness. B. Risk for hopelessness related to body image disturbance. C. Anxiety related to chronic joint pain. D. Ineffective airway clearance related to chronic pain.

Answer: A Rationale: Nursing diagnoses are actual or potential problems that can be managed by independent nursing actions. Self-care deficit would be the most likely consequence of rheumatoid arthritis. Anxiety and hopelessness are plausible consequences of a chronic illness such as RA, but challenges with self-care are more likely. Ineffective airway clearance is unlikely.

When an ethical decision is made based on the reasoning of the "greatest good for the greatest number," what theory is the nurse following? A. Utilitarian theory B. Deontological theory C. Formalist theory D. Moral-justification theory

Answer: A Rationale: One classic theory in ethics is teleologic theory or consequentialism, which focuses on the ends or consequences of actions. The best-known form of this theory, utilitarianism, is based on the concept of "the greatest good for the greatest number." Another theory in ethics is the deontological or formalist theory, which argues that ethical standards or principles exist independently of the ends or consequences.

According to Maslow, which category of needs represents the most basic on the hierarchy? A. Physiologic needs B. Self-actualization C. Sense of belonging D. Safety and security

Answer: A Rationale: Physiologic needs must be met before an individual is able to move toward psychological health and well-being. Self-actualization is the highest level of need. Safety and security, while a lower level of need, are not essential to physiologic survival. A sense of belonging and affection needs are not essential to physiologic survival.

The nurse is assisting with the development of a program to administer flu shots to a group of senior citizens. What type of prevention does this program reflect? A. Primary prevention B. Secondary prevention C. Prevalence D. Tertiary prevention

Answer: A Rationale: Primary prevention is prevention of the development of disease in a susceptible or potentially susceptible population and includes health promotion and immunization. Secondary prevention is the early diagnosis and treatment to shorten duration and severity of an illness, reduce contagion, and limit complications. Tertiary prevention is healthcare to limit the degree of disability or promote rehabilitation in chronic, irreversible diseases. Prevalence is the number of cases of a disease in a specific population during a specific period.

Which therapeutic communication technique may occur during the planning stage, when the client is presented with alternative ideas for consideration relative to problem solving? A. Suggesting B. Reflection C. Focusing D. Clarification

Answer: A Rationale: Suggesting is the presentation of alternative ideas for the client's consideration relative to problem solving. Clarification is asking the client to explain what he or she means or attempting to help verbalize the client's vague ideas or unclear thoughts to enhance the nurse's understanding. Focusing includes questions or statements to help the client develop or expand an idea.

Which type of nursing diagnosis is a clinical judgment of a client's motivation and behavior to increase his or her well-being? A. health promotion B. risk C. actual D. syndrome

Answer: A Rationale: The health promotion diagnosis is a judgment of a client's motivation and behavior to increase well-being and enhance health-seeking behaviors. The risk diagnosis identifies potential problems for which the client is at risk. The syndrome diagnosis describes specific diagnoses that occur as a group. The actual diagnosis identifies an existing problem such as Urinary Retention or Acute Anxiety.

Which type of nursing diagnosis identifies an existing condition that the client is experiencing? A. problem-focused B. syndrome C. risk D. health promotion

Answer: A Rationale: The problem-focused diagnosis identifies an existing problem such as Urinary Retention or Acute Anxiety. The health promotion diagnosis is a judgment of a client's motivation and behavior to increase well-being. The risk diagnosis identifies potential problems for which the client is at risk. The syndrome diagnosis describes specific diagnoses that occur as a group.

A group of students are reviewing various evidence-based practice (EBP) tools used for planning client care. The students demonstrate understanding when they identify which of the following as the most detailed type? A. Algorithms B. Multidisciplinary action plan C. Clinical guidelines D. Care map

Answer: B Rationale: Care maps, multidisciplinary action plans, clinical guidelines, and algorithms are evidence-based practice (EBP) tools for planning client care. Of these, multidisciplinary action plans are the most detailed.

To address the needs of a chronically ill patient and promote the concept of wellness, a nursing care plan should outline steps to: A. Encourage positive health characteristics within the limits of the disease. B. Restrict most activities to protect the patient from additional deterioration. C. Encourage activity, beyond the scope of tolerance, to prevent progressive deterioration. D. Inform the patient about all the possible complications of the disease process.

Answer: A Rationale: Those with chronic illnesses do have the potential to attain a high-level of wellness within the limits of their disability or illness. The focus of nursing care should be to emphasize a positive approach to coping with the illness. Therefore, the best approach for nursing care is to encourage appropriate health behaviors, promote a sense of hopefulness, and help the patient recognize when his or her limits have been reached. Discussing possible negative complications is not relevant. Also, promoting unnecessary restrictions or activities beyond a patient's ability is not necessary.

How should the registered nurse be responsive to the changing health care needs of society? A. Place increasing emphasis on wellness, health promotion, and self-care, because the majority of Americans today suffer from chronic debilitative illness. B. Learn how to delegate discharge planning to ancillary personnel so that registered nurses can spend their time managing the "high-tech" equipment needed for patient care. C. Stress the curative aspects of illness, especially the acute, infectious disease processes. D. Focus care on the traditional disease-oriented approach to patient care, because hospitalized patients today are more acutely ill than they were 10 years ago.

Answer: A Rationale: Today, increasing emphasis is placed on health, health promotion, wellness, and self-care. Health is seen as resulting from a lifestyle oriented toward wellness. The result has been the evolution of a wide range of health promotion strategies, including multiphasic screening, genetic testing, lifetime health monitoring, environmental and mental health programs, risk reduction, and nutrition and health education. A growing interest in self-care skills is reflected by the many health-related publications, conferences, and workshops designed for the lay public.

A nurse saw a coworker steal drugs from a locked cabinet. The supervisor notices the missing drugs and has a good idea who is responsible for the theft. The supervisor asks if the nurse saw anything out of the ordinary. Which professional value reflects a nurse's duty to tell the truth? A. veracity B. nonmaleficence C. beneficence D. autonomy

Answer: A Rationale: Veracity is the nurse's duty to tell the truth in all professional situations. Autonomy refers to a client's right to self-determination. Beneficence is the duty to do good for the clients assigned to the nurse's care. Nonmaleficence is the duty to do no harm to the client.

During review of a plan of care for a client, the nurse determines that the outcomes have not been achieved. The nurse believes an error may have been made during the planning phase of the nursing process. Based on this belief, what will the nurse consider during this evaluation step? Select all that apply. A. Do the nursing interventions need revision? B. Have new problems evolved requiring different interventions? C. Were the appropriate nursing diagnosis chosen? D. What factors led to the achievement of the outcomes? E. Were the time frames appropriate to achieve the expected outcomes?

Answer: A, B, C, D, E Rationale: Evaluation is the final step in the nursing process. Here the nurse determines if the expected outcome has been achieved. The nurse needs to examine the steps of the nursing process to identify areas like diagnosis, new problems, and interventions that may need revision in order to achieve the expected outcome. In this case, the planning phase, time frames, and factors need to be questioned and reviewed.

When applying Maslow's hierarchy of needs to patient care, the nurse determines that the patient has reached the ultimate goal indicating integrated human functioning and health when which level is met? A. Esteem and self-respect B. Self-actualization C. Safety and security D. Belongingness and affection

Answer: B Rationale: According to Maslow's hierarchy of needs, a person moves from fulfillment of basic needs to higher level needs, the highest being self-actualization, indicating that the ultimate goal of integrated human functioning and health has been achieved. Lower-level needs always remain, but a person's ability to pursue high-level needs indicates movement toward psychological health and well-being.

The physician asks the nurse not to disclose a client's diagnosis of end-stage cancer with the client until the client's family can be available to provide support. During the nurse's shift, the client asks the nurse, "What is wrong with me? Everyone is treating me like I am dying." Which of the following replies by the nurse allows the nurse to maintain integrity while providing care for the patient? A. "Test results indicate that you are in the end-stages of your disease process." B. "You feel like people are treating you like you are dying?" C. "I will call the chaplain to talk to you about your concerns." D. "You are fine; I hear your family will be in town soon."

Answer: B Rationale: By using the therapeutic communication technique of restating, the nurse demonstrates listening and validates the client's concerns, allowing the nurse to maintain integrity. Calling the chaplain defers care of the client to the clergy. Telling clients they are fine does not provide accurate information to them. Lying to the patient jeopardizes the nurse's integrity and ability to develop a trusting relationship with the client. Although information provided at the client's request protects the client's autonomy, it does not provide respect for others in this situation. Disclosure of sensitive information without compassion and caring may increase the impact and distress related to a poor diagnosis.

After teaching nursing students about the health-illness continuum, the instructor determines that teaching was successful when the students state which of the following? A. "A patient with a disease typically falls on the far end of the continuum." B. "A person can be both healthy and ill at the same time." C. "A patient's care must be focused on treating the disease." D. "A patient with a chronic illness is considered ill."

Answer: B Rationale: By viewing health and illness on a continuum, it is possible to consider a person as being neither completely healthy nor completely ill. Instead, a person's state of health is ever-changing and has the potential to range from high-level wellness to extremely poor health and imminent death. Use of the health-illness continuum makes it possible to regard a person as simultaneously possessing degrees of both health and illness. Patient care should not focus just on the treatment of disease; people do have varying degrees of illness, and care should focus on the patient's response to all aspects of nursing care. A patient with a chronic illness or disability may attain a high level of wellness if he or she is successful in meeting health needs within the limits of his or her illness or disability.

While working in an institution that uses computer documentation, the nurse understands the need to log out of the computer if it is not in use. Following this procedure is necessary because of what ethical problem in nursing? A. Maintaining trust between client and nurse is necessary for proper client care. B. The right of confidentiality is essential to protect each client's private information. C. Nonmaleficence is the duty not to inflict harm on a client. D. Respect for clients ensures that nurses treat them in such a way that enables clients to make choices.

Answer: B Rationale: Confidentiality is essential to protect the rights of clients. The Health Insurance Portability and Accountability Act (HIPPA) is federal legislation to protect client privacy. Violation of this act could result in criminal or civil litigation. Logging off the computer ensures no one readily has access to client information.

Analyzing information for patterns, maintaining a flexible attitude, and making decisions reflecting creativity are all what type of components necessary for nurses? A. Moral thinking B. Critical thinking C. Utilitarianism D. Rationalism

Answer: B Rationale: Critical thinking requires going beyond basic problem-solving and results in comprehensive plans of care.

Which of the following is a cognitive or mental activity that nurses use in critical thinking? A. Using bias to achieve goals. B. Drawing on past clinical experiences and knowledge to explain what is happening. C. Setting priorities with broad time constraints. D. Determining nurse-specific outcomes.

Answer: B Rationale: Intellectual skills used in critical thinking include drawing on past clinical experiences and knowledge to explain what is happening, priority setting with timely decision making, and determining client-specific outcomes. Bias is not used to achieve goals.

A student nurse has been assigned to provide basic care for a 58-year-old man with a diagnosis of AIDS-related pneumonia. The student tells the instructor that she is unwilling to care for this client. What key component of critical thinking is most likely missing from this student's practice? A. Respect for authority B. Withholding judgment C. Compliance with direction D. Analyzing information and situations.

Answer: B Rationale: Key components of critical thinking behavior are withholding judgment and being open to options and explanations from one client to another in similar circumstances. The other listed options are incorrect because they are not the essence of this nurse's unjustifiable refusal.

A client was discharged from the hospital 3 weeks ago following surgery and has now been contacted to complete the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. This survey will primarily address the client's: A. experiences with community health nurses following discharge. B. satisfaction with the care he or she received in the hospital. C. health status at the current time. D. recovery and rehabilitation following discharge.

Answer: B Rationale: Most items on the HCAHPS survey measure patients' satisfaction with the quality of the nursing care they receive in the hospital, not their health status or care postdischarge.

The nurse is to administer a potassium supplement to the client. The nurse does not check the potassium level prior to administering the medication and later finds that the potassium level was at a critical high. What principle has this nurse violated? A. Autonomy B. Nonmaleficence C. Fidelity D. Beneficence

Answer: B Rationale: Nonmaleficence is the duty to do no harm to the client. For instance, if a nurse fails to check a prescription for an unusually high dose of insulin and administers it, the nurse has violated the principle of nonmaleficence. Beneficence is the duty to do good for the clients assigned to the nurse's care. The nurse has a duty to remove wrist restraints whenever possible (removing a harm) and to help the client regain independence (promoting and doing good). Fidelity is the duty to maintain commitments of professional obligations and responsibilities. Autonomy refers to a client's right to self-determination or the freedom to make choices without opposition.

A hospital board of directors decides to close a pediatric burn treatment center (BTC) that annually admits 50 patients and to open a treatment center for terminally ill AIDS patients (with an expected annual admission of 200). This decision means that the nearest BTC for children is now 300 miles away. What example of ethical reasoning is this decision consistent with? A. Obligation or duty B. Utilitarianism C. "The means justifies the end" D. A formalist approach

Answer: B Rationale: One classic theory in ethics is teleologic theory or consequentialism, which focuses on the ends or consequences of actions. The best-known form of this theory, utilitarianism, is based on the concept of "the greatest good for the greatest number." Another theory in ethics is the deontological or formalist theory, which argues that ethical standards or principles exist independently of the ends or consequences. Beneficence is the obligation or duty to do good and the active promotion of benevolent acts (e.g., goodness, kindness, charity).

The nurse admits a client to an oncology unit that is a site for a study on the efficacy of a new chemotherapeutic drug. The client knows that placebos are going to be used for some participants in the study but does not know that he is receiving a placebo. When is it ethically acceptable to use placebos? A. When the client is unaware of it and it is deemed unlikely that it would cause harm. B. When the client knows placebos are being used and is involved in the decision-making process. C. Whenever the placebo replaces an active drug. D. Whenever the potential benefits of a study are applicable to the larger population.

Answer: B Rationale: Placebos may be used in experimental research in which a client is involved in the decision-making process and is aware that placebos are being used in the treatment regimen. Placebos may not ethically be used solely when there is a potential benefit, when the client is unaware, or when a placebo replaces an active drug.

Which is a goal of case management? A. Attainment of fixed price reimbursement. B. Appropriateness of services. C. Utilization of the nursing process. D. Prescriptive authority.

Answer: B Rationale: The goals of care management are to ensure the quality, appropriateness, and timeliness of services as well as to reduce costs. Case managers do not have prescriptive authority. Fixed price reimbursement is a feature of managed care. Case managers do not utilize the nursing process.

The nurse is preparing a client for a colonoscopy at the hospital. Who does the nurse understand is responsible for obtaining the informed consent from this client? A. The nurse manager B. The primary care provider C. The health care provider's office nurse D. The nurse

Answer: B Rationale: The primary care provider obtains the informed consent and must inform the client of the description of the procedure, potential benefits, material risk involved, acceptable alternatives available, expected outcome, and consequences if the procedure is not done.

A client has been diagnosed with small cell lung cancer. The client has met with the oncologist and is now weighing the relative risks and benefits of chemotherapy and radiotherapy. This client is demonstrating which ethical principle in making a final decision? A. Justice B. Beneficence C. Autonomy D. Confidentiality

Answer: C Rationale: Autonomy entails the ability to make a choice free from external constraints. Beneficence is the duty to do good and the active promotion of benevolent acts. Confidentiality relates to the concept of privacy. Justice states that cases should be treated equitably.

Which of the following is a true statement about critical thinking according to Alfaro-LeFevre (2010)? A. It is based on the medical model. B. It considers only the client's needs. C. It is guided by professional standards and codes of ethics. D. It makes judgments based on conjecture.

Answer: C Rationale: Critical thinking is guided by professional standards and codes of ethics. It is based on principles of the nursing process and scientific methods. Critical thinking makes judgments based on evidence rather than conjecture. It considers client, family, and community needs.

A nurse has been using the nursing process as a framework for planning and providing client care. What action would the nurse do during the evaluation phase of the nursing process? A. Remove a client's surgical staples on the scheduled postoperative day. B. Provide information on a follow-up appointment for a postoperative client. C. Document a client's improved air entry with incentive spirometry use. D. Have a client provide input on the quality of care received.

Answer: C Rationale: During the evaluation phase of the nursing process, the nurse determines the client's response to nursing interventions. An example of this is when the nurse documents whether the client's spirometry use has improved the condition. A client does not do the evaluation. Removing staples and providing information on follow-up appointments are interventions, not evaluations.

An occupational nurse is working with patients at a construction site. According to Maslow's Hierarchy of Needs, what dimension of care should the nurse make the highest priority in working with these clients? A. Safety B. Spiritual C. Physiologic D. Esteem

Answer: C Rationale: Maslow ranked human needs as follows: physiologic needs; safety and security; sense of belonging and affection; esteem and self-respect; and self-actualization, which includes self-fulfillment, desire to know and understand, and aesthetic needs. Such a hierarchy is a useful framework that can be applied to the various nursing models for assessment of a client's strengths, limitations, and need for nursing interventions. The other answers are incorrect because they are not of primary importance when caring for clients at a worksite.

The nurse moves a confused, disruptive patient to a private room at the end of the hall so that other patients can rest, even though the confused patient becomes more agitated. The nurse's intervention is consistent with what moral theory? A. "Veracity," in which the nurse has an obligation to tell the truth. B. "Duty of obligation," by which an action, regardless of its results, is justified if the decision making was based on moral principles. C. "Consequentialism," by which good consequences for the greatest number are maximized. D. "Paternalism," in which the action limits the patient's autonomy.

Answer: C Rationale: One classic theory in ethics is teleologic theory or consequentialism, which focuses on the ends or consequences of actions. The best-known form of this theory, utilitarianism, is based on the concept of "the greatest good for the greatest number." The choice of action is clear under this theory, because the action that maximizes good over bad is the correct one. The theory poses difficulty when one must judge intrinsic values and determine whose good is the greatest. In addition, it is important to ask whether good consequences can justify any amoral actions that might be used to achieve them.

A client has a nursing diagnosis of "Feeding self-care deficit related to right-sided weakness. Which of the following would be the most appropriate expected outcome for this client? A. The client will have a staff member open all packages prior to all meals. B. The client will demonstrate an interest in eating during the evening snack. C. The client will demonstrate an ability to feed himself with a spoon at the morning meal. D. The client will not lose any weight throughout the hospital stay.

Answer: C Rationale: Outcomes are expressed in terms of client behavior and have a time period in which they are to be achieved. The outcome is associated with the nursing diagnosis. In this case, the diagnosis reflects a self-feeding problem caused by weakness. Therefore, being able to feed oneself would be a client behavior the nurse would expect to see achieved.

The nurse is attending a client with chronic renal failure. The client is experiencing a loss of appetite and reports feeling like everyday situations have become more stressful. The client reports feeling disappointed and frustrated with the condition, and says the family is not getting any help. What is the most important nursing intervention that the nurse needs to carry out at this point? A. schedule a family meeting B. administer immunosuppressant. C. coordinate with resources for client support D. offer nutritional counseling.

Answer: C Rationale: Promotion of psychological comfort is one of the most important aspects of the care of a client with chronic renal failure. Coordination of resources for client support is an appropriate nursing intervention in this situation. Scheduling a family meeting is a start, but more resources for the client may be needed. Nutritional counseling and administration of immunosuppressant drugs are medical management tasks.

Which of the following delineates actions that are legally permitted for a particular profession based on specific educational qualifications? A. Occupational Health and Safety Administration (OSHA) B. Job description C. Scope of practice D. Code of ethics

Answer: C Rationale: Scope of practice is used to delineate actions that are legally permitted for a particular profession, based on specific educational qualifications. The job description represents qualifications and duty of employment. The Code of Ethics represents ethical standards. The code is an ideal framework for nurses to use in ethical decision-making. Under the Occupational Safety and Health Act of 1970, employers are responsible for providing a safe and healthy workplace for their employees.

A nurse in a hospice facility cares for clients with terminal illnesses and witnesses a great deal of pain and emotional distress. Which factor that affects healthcare ethics determines how the nurse must respond when a client asks for help in ending his or her suffering? A. advances in scientific research B. advances in technology C. legislative and judicial decisions D. healthcare reform

Answer: C Rationale: Society's struggles with ethical issues result in legislative and judicial decisions that affect ethical decisions. Nurse practice acts prohibit nurses from assisting clients to die. The other options are factors that do not affect the nurse's ethical position.

A nursing student is preparing for a class presentation addressing the collaborative practice model. Which of the following would the student expect to include? A. A discussion of a centralized organizational structure. B. Nurses and physicians playing major roles in clinical decisions. C. Participation in decision making that is shared by all involved. D. Accountability that is primarily attributed to the patient.

Answer: C Rationale: The collaborative practice model involves all care providers, including nurses, physicians, and ancillary health personnel as well as the patient functioning within a decentralized organizational structure to collaboratively make clinical decisions. The collaborative model promotes shared participation, responsibility, and accountability in a health care environment that strives to meet the complex health care needs of the public.

Which of the following patient age groups is currently one of the fastest growing age groups in the population? A. children under 5 years of age B. children 5 to 18 years of age C. adults 65 years of age and over D. adults 18 to 45 years of age

Answer: C Rationale: The decline in birth rate and the increase in lifespan have resulted in proportionately fewer school-age children and more senior citizens. Both the number and proportion of Americans 65 years of age and older have grown substantially in the past century. In 2013, an estimated 44.7 million older adults resided in the United States; this number is expected to grow to 79.7 million by 2040.

According to Maslow's hierarchy of needs, which of the following is the lowest-level need? A. Sense of belonging and affection B. Safety and security C. Physiological needs D. Esteem and self-respect

Answer: C Rationale: The lowest-level need according to Maslow is physiological needs. Maslow ranked human needs as physiological needs, safety and security, sense of belonging and affection, esteem and self-respect, and self-actualization.

The following nursing diagnoses are formulated with a client: constipation, acute pain, and caregiver role strain. During the planning phase of the nursing process, the nurse will prioritize the diagnoses in what order? A. Caregiver role strain, constipation, acute pain B. Constipation, acute pain, caregiver role strain C. Acute pain, constipation, caregiver role strain D. Caregiver role strain, acute pain, constipation

Answer: C Rationale: Using critical thinking skills involves a sound knowledge base that leads to the formulation of outcome-oriented activities and identification of client needs. Critical thinking enables accurate prioritization of care. In this case, easing the client's pain is the most important priority, followed by alleviating the constipation, and then addressing the caregiver issues.

In determining goals for clients, the expected outcomes need to: A. be derived from nursing diagnoses. B. include time estimate for achievement of short- and long-term outcomes. C. All of the responses are correct. D. include measurable goals.

Answer: C Rationale: When writing expected outcomes, the nurse should relate them directly to the nursing diagnoses; make them clear, specific, and measurable and include the appropriate timeframe for completion.

According to the American Nurses Association (1995), the advanced practice registered nurse is distinguished from other registered nurses according to scope of practice. Select the activity that would distinguish the advanced practice nurse from other RNs. A. Reports abnormal test results. B. Develops nursing care plans. C. Interprets health care provider orders. D. Prescribes medications.

Answer: D Rationale: All registered nurses are responsible for interpreting health care provider orders, developing nursing care plans and reporting abnormal diagnostic test results. Only RNs with a master's or doctoral degree and credentialed by the American Nurses Credentialing Center or a Specialties National Certification Body can function as advanced practice nurses and prescribe medications.

A client has just returned to the unit following abdominal surgery and is in significant pain. According to the nursing process, how frequently will the nurse perform assessments on this client? A. once upon arrival and 1 hour later. B. twice per shift. C. once upon arrival and every 2 hours afterward. D. as often as needed.

Answer: D Rationale: Assessment is an important, recurring nursing activity that continues as long as a need for healthcare exists. During assessment, the nurse methodically obtains data about the client's health, illness, and change in condition.

Which written medical instruction explicitly states that no action should be taken to revive a client if he or she experiences cardiac arrest? A. living will B. durable power of attorney C. advance directive D. do-not-resuscitate order.

Answer: D Rationale: Do-not-resuscitate (DNR) orders involve a written medical order for end-of-life instructions. If a DNR order is written, the client wishes to have no resuscitative action taken if he or she experiences a cardiac arrest. An advance directive provides the means for clients to communicate their wishes regarding life-sustaining treatment and other medical care, so that their significant others will know what decisions the clients desire. It is not a medical order. A living will is a type of advance directive; it is not a medical order. A durable power of attorney is a legal document that appoints a person to act as an agent for another person. A DPOA for healthcare appoints a person to make medical decisions for a client who is incapacitated and unable to make decisions for himself or herself.

Healthcare providers use a problem-solving approach for ethical dilemmas. Which is the last step of the ethical decision-making model? A. Follow through on the decision that has been made. B. Keep detailed documentation of the entire decision-making process. C. Survey other healthcare professionals to see if they agree with the decision. D. Evaluate the decision in terms of effects and results.

Answer: D Rationale: Evaluating the decision is the very important last step. Making the decision and following through on it are important, but they are not the last step. Surveying other healthcare professionals is not part of the ethical decision-making model. Detailed documentation is important in regard to many professional duties, but it is not the last step of the ethical decision-making model.

Nurses in acute care settings must work with other health care team members to maintain quality care while facing pressures to care for clients who are hospitalized for shorter periods of time than in the past. To ensure positive health outcomes when clients return to their homes, what action should the nurse prioritize? A. Close communication with primary providers. B. Participation in continuing education initiatives. C. Promotion of health literacy during hospitalization. D. Thorough and evidence-based discharge planning.

Answer: D Rationale: Following discharges that occur after increasingly short hospital stays, nurses in the community care for clients who need high-technology acute care services as well as long-term care in the home. This is dependent on effective discharge planning to a greater degree than continuing education, communication with health care providers, or promotion of health literacy.

Patient health education provided by the nurse: A. must be approved by the physician. B. requires a physician's order. C. must focus on wellness issues. D. is an independent function of nursing practice.

Answer: D Rationale: Health education is an independent function of nursing practice and is included in all state nurse practice acts. Teaching, as a function of nursing, is also included in all state nurse practice acts. Health education is a primary responsibility of the nursing profession. Health education by the nurse focuses on promoting, maintaining, and restoring health; preventing illness; and assisting people to adapt to the residual effects of illness.

A nurse is planning a medical client's care with consideration of Maslow hierarchy of needs. Within this framework of understanding, what should the nurse prioritize? A. Teaching the client to self-administer insulin safely. B. Ambulating the client in the hallway. C. Allowing the family to see a newly admitted client. D. Administering pain medication.

Answer: D Rationale: In Maslow hierarchy of needs, pain relief addresses the client's basic physiologic need. Activity, such as ambulation, is a higher-level need above the physiologic need. Allowing the client to see family addresses a higher-level need related to love and belonging. Teaching the client is also a higher-level need related to the desire to know and understand and is not appropriate at this time, as the basic physiologic need of pain control must be addressed before the client can address these higher-level needs.

Which statement by the nurse shows an understanding of the focus of the quality assurance programs developed in the 1980s? A. "The quality assurance programs focus on individual incidents or errors and minimal expectations." B. "The quality assurance programs focus on coordinating care for patients." C. "The quality assurance programs focus on decreasing the cost of health care for the consumer." D. "The quality assurance programs focus on processes used to provide care and improving those processes."

Answer: D Rationale: In the 1980s, hospitals and other health care agencies implemented ongoing quality assurance programs that provided the foundation for the establishment of continuous quality improvement (CQI) programs in the 1990s. Despite these efforts to ensure the provision of quality health care, the IOM (2000) reported an alarming breakdown in quality control in the American health care system. The IOM report To Err Is Human: Building a Safer Health System (2000) noted that nearly 100,000 Americans died annually from preventable errors in hospitals, and many more suffered nonfatal injuries from errors. A subsequent IOM report, Crossing the Quality Chasm: A New Health System for the 21st Century (2001), envisioned a reformed health care system that is evidence based and systems oriented. Its proposed six aims for improvement included ensuring that patient care is safe, effective, patient centered, timely, efficient, and equitable (IOM, 2001).

One classic theory in ethics is teleologic theory or consequentialism, which focuses on the ends or consequences of actions. The nurse knows that the best known form of this theory is: A. Formalist theory B. Beneficence C. Double effect D. Utilitarianism

Answer: D Rationale: One classic theory in ethics is teleologic theory or consequentialism, which focuses on the ends or consequences of actions. The best-known form of this theory, utilitarianism, is based on the concept of "the greatest good for the greatest number." Beneficence and double effect are examples of common ethical principles. The formalist theory is another theory in ethics which argues that ethical standards or principles exist independently of the ends or consequences.

A client has been admitted in the emergency care unit with conditions of respiratory distress and pneumonia. The client's condition worsens and requires mechanical ventilation. While visiting this client in the hospital, the family observes members of the health care team washing their hands upon entering and leaving the room. By implementing recommended hand hygiene measures, which organization's goals is the health care team supporting? A. Institute of Medicine (IOM) B. The National Council of State Boards of Nursing (NCSBN) C. Agency for Healthcare Research and Quality (AHRQ) D. The Joint Commission

Answer: D Rationale: One of The Joint Commission National Patient Safety Goals (NPSGs) prioritizes the reduction of health care-associated infections. The NCSBN prioritizes matters related to public health, safety, and welfare, including the development of licensing examinations in nursing. The IOM emphasis relates to ensuring that patient care is safe, effective, patient centered, timely, efficient, and equitable. The AHRQ highlights patients' satisfaction with care.

A client, 50 years old, is admitted for treatment of a gastric tumor. The client asks the nurse, "Do you think I have cancer?" Which response by the nurse would be most therapeutic? A. "Most women your age has some kind of cancer." B. "Your physician can tell you more about it." C. "We don't know for sure until you undergo more tests." D. "You sound concerned about what the physicians will tell you."

Answer: D Rationale: Reflection is a therapeutic communication tool that validates the nurse's understanding of what the client is saying and signifies empathy, interest, and respect for the client.

This organization is responsible for the classification of client outcomes sensitive to nursing interventions. A. ANA B. NLN C. NANDA D. NOC

Answer: D Rationale: The Nursing-Sensitive Outcomes Classification (NOC) is a classification of client outcomes sensitive to nursing interventions. NANDA International is the official organization responsible for developing the taxonomy of nursing diagnoses and formulating nursing diagnoses acceptable for study. The ANA and NLN are not charged with the task of developing the taxonomy of nursing diagnoses.

Nursing continues to recognize and participate in collaboration with other health care disciplines to meet the complex needs of the client. Which of the following is the best example of a collaborative practice model? A. The nurse accompanying the physician on rounds. B. The nurse making a referral on behalf of the client. C. The nurse attending an appointment with the client. D. The nurse and the physician jointly making clinical decisions.

Answer: D Rationale: The collaborative model, or a variation of it, promotes shared participation, responsibility, and accountability in a health care environment that is striving to meet the complex health care needs of the public. Collaborative practice goes beyond a nurse simply accompanying a physician. Making referrals and accompanying a client do not demonstrate interprofessional collaboration because they are independent nursing actions.

The nurse is caring for a terminally ill client in the intensive care unit that is on life support measures. The family members are opposed in their decision to take the client off of life support. What option does the nurse discuss with the nurse manager? A. Have the health care provider inform the family that they are not responsible for the decision. B. Take the client off of life support when the family is not present. C. Ask the family to go out of the unit and make a decision that is final. D. Contact the ethics committee for their input.

Answer: D Rationale: The ethics committee may be called on to act as an advocate for clients who no longer are mentally capable of making their own decisions. Ethics committees are a valuable resource for reviewing difficult cases and helping ensure a careful and unbiased decision. The nurse is not practicing within the scope of practice by taking the client off of life support. The nurse does not mandate to the health care provider decisions that should be made. It is nontherapeutic for the nurse to ask the family to go out and make a decision.

The client has become confused and attempts to climb out of bed. What interventions will the nurse provide prior to applying restraints? A. Place all four side rails of the bed in the upright position. B. Call the health care provider to prescribe sedation for the patient. C. Place the client in a chair at the nurses' station with a sheet tied around the client's waist. D. Arrange a schedule for staff to sit with the client.

Answer: D Rationale: The nurse should arrange a schedule for the staff to sit with the client. Calling for sedation is not the first step with caring for a client with confusion. The chair with a sheet and the side rails are restraints. The use of restraints (including physical and pharmacologic measures) is another issue with ethical overtones because of the limits on a person's autonomy when restraints are used. It is important to weigh carefully the risks of limiting autonomy and increasing the risks of injury by using restraints against the risks of injury if not using restraints, which have been documented as resulting in physical harm and death. The ANA advocates that restraints only be used when no other viable option is available. The Joint Commission and the Centers for Medicare and Medicaid Services (CMS) have designated standards for the use of restraints.

The nurse and patient establish a goal to stand at the bedside for 5 minutes prior to the end of her shift at 2300. Earlier that day the patient had a total knee replacement. This is an example of which type of goal? A. Intermediate goal B. Independent goal C. Long-term goal D. Immediate goal

Answer: D Rationale: The patient and family are included in establishing goals for the nursing actions. Immediate goals are those that can be attained within a short period. Intermediate and long-term goals require a longer time to be achieved and usually involve preventing complications and other health problems and promoting self-care and rehabilitation.

A Jewish patient, who adheres to the dietary laws of his faith, is in traction and confined to bed. He needs assistance with his evening meal of chicken, rice, beans, a roll, and a carton of milk. Choose the nursing approach that is most representative of promoting wellness. The nurse: A. Removes items from the over-bed table, sets up the dinner tray, and leaves the patient so he can enjoy time with his family. B. Pushes the over-bed table toward the bed so that it will be within the patient's reach when the dinner tray arrives. C. Asks a family member to assist the patient with the tray and the over-bed table while the nurse straightens the surrounding area in an attempt to provide a pleasant atmosphere for eating. D. Prepares the environment and the over-bed table and inspects the contents of the dinner tray. The nurse asks the patient whether he would like to make any substitutions in the foods and fluids he has received.

Answer: D Rationale: The patient has religious beliefs that may influence his food choices. Therefore, in addition to preparing the environment, the nurse needs to make sure the patient can eat the foods that have been prepared.

A nursing instructor is describing to a class the various roles that nurses assume. The instructor determines that teaching has been effective when the students identify which of the following as the focus of the nursing researcher role? A. Promotion of health through screening and early detection. B. Achievement of patient outcomes through direct intervention. C. Provision of cost-effective, high-quality nursing care. D. Establishment of a scientific basis for action.

Answer: D Rationale: The primary task of nursing research is to contribute to the scientific basis of nursing practice. While achievement of patient outcomes through direct intervention can be affected by information gained through nursing research, this is not the focus of nursing research. Cost-effective, high-quality nursing care is the goal of continuous quality improvement (CQI). Health promotion through screening and early detection is a component of the practitioner role.

A nurse is leading a community health clinic. What should the nurse emphasize in order to promote disease prevention? A. It is best achieved by being an active participant in the community. B. It is best achieved through attending self-help groups. C. It is best achieved by reducing psychological stress. D. It is best achieved by exhibiting behaviors that promote health.

Answer: D Rationale: Today, increasing emphasis is placed on health, health promotion, wellness, and self-care. Health is seen as resulting from a lifestyle oriented toward wellness. Nurses in community health clinics do not teach that disease prevention is best achieved through attending self-help groups, by reducing stress, or by being an active participant in the community, though each of these activities is consistent with a healthy lifestyle.

A nurse is leading a community health clinic. What should the nurse emphasize in order to promote disease prevention? A. It is best achieved by reducing psychological stress. B. It is best achieved by being an active participant in the community. C. It is best achieved through attending self-help groups. D. It is best achieved by exhibiting behaviors that promote health.

Answer: D Rationale: Today, increasing emphasis is placed on health, health promotion, wellness, and self-care. Health is seen as resulting from a lifestyle oriented toward wellness. Nurses in community health clinics do not teach that disease prevention is best achieved through attending self-help groups, by reducing stress, or by being an active participant in the community, though each of these activities is consistent with a healthy lifestyle.

A client has been admitted to the hospital with a large sacral pressure ulcer. The physician prescribes the wound care protocol to be performed twice a day. What would be a statement on the plan of care that would address the implementation phase of the nursing process for this client? A. A 6 cm x 4 cm wound with malodorous, yellow exudate. B. The client's wound will heal by 1 cm by the end of 5 days. C. The client's wound has healed by 0.5 cm on day 3 of wound care. D. Turn the client every 2 hours.

Answer: D Rationale: Turning the client every 2 hours is implementing care to allow the pressure ulcer to heal and prevent another formation of a wound. Recording the description of the wound would occur during the assessment phase of the nursing process. The prediction of how much and how soon the client's wound will heal would be made during the planning phase, while noting the amount the wound has healed on a given day is an example of a statement that would be made during the evaluation phase.

The Healthy People initiatives have targeted the improvement of health for all. In addition to eliminating health disparities, what are the broad goals of the Healthy People initiatives? A. Reducing expenditures on end-of-life care. B. Applying a systematic approach to health improvement. C. Increasing technological innovation in treatment of disorders. D. Increasing the quality and length of a healthy life.

Answer: D Rationale: Two broad goals of the Healthy People initiative are to increase the quality and years of healthy life and to eliminate health disparities. Healthy People puts forward a number of health objectives but does not propose a systematic approach to health improvement. Healthy People addresses technology in relation to electronic health information, but does not directly promote technological innovations in treatment. While Healthy People has a number of objectives specific to older adults and objectives around making health care more affordable and accessible, it does not seek to reduce expenses on end-of-life care.

Using Maslow's hierarchy of needs, place the following problems in their order of priority. A. Failure to achieve potential. B. Low self-concept C. Fear D. Loneliness E. Constipation

Answer: E, C, D, B, A Rationale: Applying Maslow's hierarchy, the needs would be prioritized as constipation (physiologic), fear (safety and security), loneliness (belongingness and affection), low self-concept (esteem and self-respect), and failure to achieve potential (self-actualization).