Test 4 Practice Questions GOOD LUCK EVERYONE! WE GOT THIS :)

Complaint?

"First step of legal action"

In case management, it is unlikely that any single professional has the expertise, knowledge, or skills required to achieve success. The synergy produced by all involved parties (client, providers, payers, family/significant others, and community organizations) can result in successful outcomes. This statement relates to the sequential process of: A. Collaboration B. Communication C. Cooperation D. Negotiation

A. Collaboration

A nurse forgets to administer a client's diuretic and the client experiences an episode of pulmonary edema. The charge nurse would consider the medication error to constitute negligence b/c the situation contains which element? 1. purposeful failure to perform a healthcare procedure 2. unintentional failure to perform a healthcare procedure 3. Act of substituting a different med for the one ordered 4. failure to follow a direct order by a physician

2.

7. Penders health promotion model would benefit which of the following clients? (Select all that apply) 1. An active 21- year old who does not smoke or drink alcohol 2. A 50- year old client who exercises four times a week 3. A 32-year old who has yearly breast exams and other routine health screenings 4. An overweight 29-year old who engages in risky behaviors

1, 2, & 3 All are engaging in health promotion activities

The HCP orders a med in a dose that is considered toxic. The nurse administers the med to the client, who later suffers a cardiac arrest and dies. What consequence can the nurse expect from this situation. Select all that apply. 1. the HCP can be chrgd w/ negligence, being the person who ordered the dose 2. as the employing agency, only the hospital can be charged w/ negligence 3. the nurse and the physician may be terminated from employment to prevent a charge of negligence to the hospital 4. negligence will not be charged, as this event could have happened to any reasonable person 5. The nurse can be charged with negligence for administering the toxic dose

1, 5

A new nurse is *NOT* performing dressing changes satisfactorily. What is the best approach for the nurse-manager to use first? 1. ask the new nurse how she perceives her performance 2. tell her there are deficiencies that must be rectified by the stated deadline 3. document the inadequacies in writing and have the new nurse sign the paper 4. tell the unit's nurse educator to schedule a class for the unit on the topic

1.

An individual has a seizure while walking down the street. During the seizure, a nurse from a physician's office is noticed driving past without stopping to assist. The individual sues the nurse for negligence but fails to win a judgement for which reason? 1. The nurse had no duty to the individual 2. The nurse did what most nurse's do in the same circumstance 3. the nurse did not cause the client's injuries 4. The nurse was off duty

1.

A nurse-manager appropriately behaves as an autocrat in which situation? 1. planning vacation time for staff 2. directing staff activities if a client has a cardiac arrest 3. evaluating a new medication administration process 4. identifying the strengths and weaknesses of a client education video

2.

Migrant workers and their families who reside in a specific mobile home park during the summer months would best be classified as a: A. Community B. Group C. Setting of practice D. Target population

A. Community

The nurse-manager meets with a staff nurse to evaluate performance after a 6-month probationary period. As part of the evaluation process, the nurse-manager would ask the staff nurse to: 1. accept the nurse-manager's evaluation by signing in agreement 2. contribute a self-evaluation and suggested areas for future growth 3. have peers vouch for his or her performance 4. giver her perception of how the manager is performing

2.

There has been a large disaster, and nurses have been floated to help with the lrg influx of clients. Which client is most appropriate to assign to the nurse floated from the mother-baby unit? 1. 1 day postop hemicolectomy male with foley cath 2. women in pelvic traction who is 3 mo. pregnant 3. elderly woman who has herpes zoster 4. male admitted for hearing command voices to kill himself

1. gv floated nurse clients with whom they can use the skills they would ordinarily use. 1 is similar to client with c-section; OB nurses do not handle traction (woman dsnt hv issues r/t pregnancy; OB nurse shouldnt take care of infectious clients to avoid inadvertent transmission; OB nurses are nor experienced in managing suicidal clients

The nurse is triaging clients from a large disaster. Which client should receive care first? 1. client w/ lrg shard of glass piercing chest wall, RR 32 2. client w/ forearm disfigured w/ protruding bone, finger cap refill 2 seconds 3. child w/ 3-in. oozing laceration on leg 4. woman who is 2 months pregnant, partial-thickness burn on forearm

1. the integrity of the chest wall has been compromised and is becoming a "breathing" problem. The others can wait up to two hours

9. The client is attending Alcoholics Anonymous meetings for support to assist in remaining sober. It is anticipated that the client will remain in this group for several years. What stage of health behavior is the client experiencing? 1. Maintenance 2. Action 3. Preparation 4. Termination

1. Maintenance- when person is striving to prevent relapse by integrating newly adopted behaviors into lifestyle

4. The nurse is providing health education about injury and poisoning prevention to a group of young mother's at a health fair. What type of prevention is the nurse conducting? 1. Primary prevention 2. Secondary prevention 3. Tertiary prevention 4. Limited prevention

1. Primary prevention- generalized health promotion and specific protection against diseases or specific accidents targeted to a specific group. This intervention precedes disease or dysfunction and is applied to generally health group

6. A school nurse is teaching a group of seniors about self- examination techniques for the breast and testicular cancer in their health class. What type of health care prevention is the school nurse teaching? 1. Primary 2. Secondary 3. Tertiary 4. Limited

1. Primary- generalized health promotion and specific accidents targeted to a specific group. This intervention precedes disease or dysfunction and is applied to generally healthy individuals or group

A nurse in community health seeks a low-cost evaluation method to learn the perspectives of the largest number of persons regarding a proposed local safe haven program for unwanted infants. The best evaluation method to meet the criteria would be: A. Community forums B. Focus groups C. Key informants D. Surveys

A. Community forums

The major sources of information for program evaluation are (select all that apply): A. Community indicators B. Media reports C. Program clients D. Program providers E. Program records

A. Community indicators C. Program clients E. Program records

Which is the best instructional guidance for the nurse-manager to include for the staff nurses when delegating the responsibility to revise the unit's educational policies? 1. "Let me know if you need anything" 2. "Complete the tasks in six weeks" 3. "Give your suggestions and I'll decide" 4. "Tell me what you think after looking at everything"

2. Delegation must be done clearly and precisely. The nurse-manager must assign responsibility, identify the task to be accomplished, explain what outcomes are needed, and identify the time frame for completing the work.

What is the most important aspect to determine when deciding which nursing care delivery system should be used? 1. staff preference 2. staff licensure 3. number of staff 4. experience of staff

2. determining who has responsibility for making decisions regarding client care is an essential element of all client care delivery systems

A nurse and teacher are discussing legal issues r/t the practice of their professions. The teacher asks what the functions are of the Nurse Practice Act (NPA) in that state. The nurse would include which thoughts in response? Select all that apply. 1. accredit schools of nursing 2. enforce ethical standards of behavior 3. protect the public 4. define the scope of nursing practice 5. determine liability insurance rates

3, 4 The state's *NPA* serves to protect the public by setting minimum qualifications for nursing in relation to skills and competencies. One way it fulfills responsibility to protect the public is by defining the scope of practice in that state. The *state board of nursing* approves schools to operate but does not accredit them. The state board of nursing does not enforce ethical standards. A state NPA has no role in in setting liability insurance.

The nurse working in an acute care environment would utilize which strategies to reduce the risk of malpractice litigation? Select all that apply. 1. discuss any errors with the client and family in detail 2. keep incident reports on file 3. maintain expertise in practice 4. offer opinions to clients when the situation warrants 5. report unsafe staffing levels to supervisor

3, 5

The ED staff report not receiving enough info from the long-term care (LTC) facility that are transferring clients. What is the best approach? 1. tell ED staff to handle it with the LTC staff by calling for what is needed 2. realize that the behavior of others cannot be controlled 3. organize a meeting b/w the facilities to develop a satisfactory process 4. call the director of the LTC facility and ask that nursing be more complete

3.

The nurse on the hospital quality improvement team has been asked to evaluate nursing care on the nurse's assigned unit. After deciding to ask the nursing staff for assistance in this effort, what would be most appropriate for the nurse to initially ask the staff to do? 1. track the number of supplies used by the clients on the unit 2. document the time spent on direct client care 3. administer a client and family satisfaction survey 4. assess clients and report acuity daily

3.

The nurse-manager implements new processes to decreased the incidence of central IV line infection. What is the best indicator that the measures have resulted in improved outcomes? 1. a survey of the unit's nurses indicates perceived improvement in results 2. a total decrease in the number of central line IV line infections on the unit has been identified 3. retrospective chart audits for infection rate show improvement in clients with central line IV lines 4. comparison of total number of IV ABX used b/w the two time periods has shown a decreased in ABX use

3.

The nurse-manager notes an unacceptable rate of falls on the unit. Hourly rounds by nursing staff are initiated. What is the best method to determine that the change has made a difference? 1. Scores on client satisfaction surveys 2. surveys on staff's perception of the effectiveness 3. comparing fall rates after the rounds are initiated 4. documentation that the rounds are completed as scheduled

3.

The nursing team consists of one RN, one LPN, and one UAP. What is the most appropriate assignment for the RN to delegate to the LPN? 1. pass the dinner trays 2. empty the Foley cath 3. admin morning daily meds 4.suction client who is one day postop after tracheostomy

3.

A client is referred to a surgeon by the general practitioner. After meeting the surgeon, the client decides to find a different surgeon to continue treatment. The nurse supports the client's action, utilizing which ethical principle? 1. beneficence 2. veracity 3. autonomy 4. privacy

3. *Autonomy* is the right of individuals to take action for themselves. *Beneficence* is an ethical principle to do good and applies when the nurse has a duty to help others by doing what is best for them. *Veracity* refers to truthfullness. *Privacy* is the nondisclosure of information by the health care team.

A client with cancer has decided to discontinue further tx. Although the nurse would like the client to continue tx, the nurse recognizes the client is competent and supports the client's decision using which ethical principle? 1. Justice 2. Fidelity 3. Autonomy 4. Confidentiality

3. *Autonomy* refers to the right to make one's own decisions, which is the principle supported in this situation. *Justice* refers to fairness. *Fidelity* refers to trust and loyalty. *Confidentiality* refers to privacy of personal health information

A government agency is conducting an audit of all active clients in the local hospice program to ensure that hospice criteria for care are being applied appropriately. The type of tool being used in this specific approach to quality assurance is: A. Concurrent audit B. Outcome audit C. Retrospective audit D. Peer review

A. Concurrent audit

A nurse in community health integrates new slides into a presentation that will be given to a local community group regarding the techniques of proper handwashing. The new slides will repeat essential points during the presentation. This demonstrates the nurse's understanding of what principle? A. Continuity B. Integration C. Participation D. Sequencing

A. Continuity

On a busy med-surg unit, a winter storm has prevented most of the staff members from getting to work. One RN, two LPNs, and three UAPs have been able to get to work. What nursing care delivery system should be implemented in this situation? 1. team nursing 2. primary nursing 3. functional nursing 4. case management

3. *Functional nursing* best uses the skills of all staff in a timely manner during this crisis. This delivery system requires the lest staff and delegates tasks to those who can best perform them. *Team nursing* doesn't allow for the best use of a limited number of staff who must care for a large number of clients. *Primary nursing* and *case management* require more RNs than are currently available

Which is an example of a staff nurse functioning in the role of an informal leader? 1. verifying adequate staff coverage for a shift 2. filling out a discipline form on a nursing assistant 3. encouraging a peer to join a committee 4. attending a hospital-wide policy meeting

3. A *leader* doesn't always have formal power and authority but influences the success of a unit by being an excellent role model and by guiding, encouraging, and facilitating professional growth and development. A *manager* has formal power and authority from the status within the organization, and such a power and authority are detailed in the the manager's job description

The team leader notices at the beginning of the shift that all of the IV ABX for a client are still in the medication room. Which action should the team leader take first? 1. ask client if client received the meds on previous shift 2. return meds to pharmacy so client does not get billed 3. ask nurse who cared for the client about the medications 4. notify the nurse-manager of the unit

3. team leader should attempt to clarify with the involved staff first

5. A client had a surgery for gastrointestinal problems and required a colostomy from the surgery. What type of preventive care would this client need at this stage? 1. Primary 2. Secondary 3. Tertiary 4. Limited

3. Tertiary

3. The nurse refers a new below-the - knee (BKA) amputation client to a support group for amputees. This is an example of what type of prevention? 1. Primary 2. Secondary 3. Tertiary 4. Terminal

3. Tertiary - begins after an illness, when a disability is fixed, stabilized, or determined to be irreversible. The focus is to assist rehabilitation and restore clients to highest level of functioning

A staff nurse at the nurse's station answers the phone and is told there is a bomb in a client's room. What action should the nurse take? 1. put call on hold and obtain charge nurse 2. transfer call to security 3. ask caller for details about the bomb placement 4. signal to staff to close the clients door

3. with potential danger, it is important to determine as much information as possible

10. Who is responsible for developing health promotion plans? 1. Physician 2. Family 3. Client 4. Nurse

3.Client

A new graduate nurse is completing the scheduled 4-week orientation to a med-surg unit. Which self-recognized need should prompt the new graduate nurse to request some additional time or training before ending orientation? 1. uncomfortable if had to manage a cardiac arrest independently 2. unclear on staffing assignments are made on the unit 3. frequently unable to establish new IV access on the first attempt 4. unable to manage more than two clients at a time

4.

Staff from two different dept. are disagreeing over the transfer process b/w there respective dept. Which is the best process to handle this disagreement? 1. ask director of nursing to establish a policy 2. allow the staff to handle the issue on their own without authoritative interference 3. Arrange managers from the dept. to determine a solution 4. set up a meeting of staff from the departments to identify key issues

4.

A client asks why a dx test has been ordered and the nurse replies, "I'm unsure but I will find out for you." When the nurse later returns and provides an explanation, the nurse is acting under which principle? 1. Nonmaleficence 2. Veracity 3. Beneficence 4. Fidelity

4. *Fidelity* means being faithful to agreements and promises. This nurse is acting on the client's behalf to obtain needed information and report it back to the client. *Nonmaleficence* is the duty to do no harm. *Veracity* refers to telling the truth for example, not lying to a client about a serious prognosis. *Beneficence* means doing good, such as by implementing actions (e.g., keeping a salt shaker out of sight) that benefit a client (heart condition requiring sodium-restricted diet)

Which action can the nurse be legally liable for? 1. administering 2 mg hydromorphone (Dilaudid) when the client is prescribed 1 to 2 mg q 4hrs 2. withholding digoxin (Lanoxin) when the client's apical pulse is 56 bpm 3. withholding mononitrate (Imdur) when client's BP is 80/40 4. Administering cephalosporin when the client has an allergy to penicillin

4. (4)There is a cross-sensitivity b/w cephalosporin and penicillin, and the drug should not be given. (1)When a range is ordered, any dose in the range is acceptable. (2)Bradycardia is a sign of digoxin toxicity, and the drug should not ordinarily be given if the pulse is less than 60. (3)Nitrates cause vasodilation and should not be given when hypotension is present.

The nurse has recently been assigned to manage a pulmonary progressive unit at a large urban hospital. The nurse's leadership style is participative, with the belief that all staff members assist in decision making and the development of the unit's goals. The nurse is implementing which leadership style? a) democratic b) laissez faire c) auticratic d) situational

A - Democratic leadership is defined as participative with a focus on the belief that all members of the group have input into the decision making process. This leader acts as a resource person and facilitator. Laissez faire leaders assume a passive approach, with the decision making left to the group. Autocratic leadership dominates the group, with maintenance of strong control over the group. Situational leadership is based on the current events of the day.

A nurse is told that the nursing model used in the nursing facility is a functional nursing approach. The nurse understands that planning care delivery will be based on which characteristic of this type of nursing model of practice? a) a task approach methods is used to provide care to clients b) a single registered nurse (RN) is responsible for providing nursing care to a group of clients c) managed care concepts and tools are used in providing client care d) nursing personnel are led by a RN in providing care to a group of clients

A - In functional nursing, a task approach method is used to provide care to clients. Option B exemplifies primary nursing. Option C exemplifies a component of case management. Option D exemplifies team nursing.

A registered nurse assigns a new nursing graduate to care for a client with a diagnosis of active tuberculosis, and the registered nurse explains the use of a particulate respirator to the graduate. Which observation indicates that the new nursing graduate understands how the particulate respirator operates? a) the nosepiece is readjusted if air is detected escaping around the nose b) another particulate respirator is obtained if air is escaping around the nose c) the new nursing graduate states that a fit check is not needed d) the new nursing graduate states that a fit check is necessary only when putting on the respirator for the first time

A - Personal protective equipment, called particulate respirators, is required for all health care workers entering a tuberculosis isolation room. When fitted and used properly, these respirators filter droplet nuclei. It is important that no air escapes around the nose while wearing the respirator. The strap needs to be adjusted if air is escaping. It is important to exhale forcefully while placing both hands over the apparatus. It is necessary to perform a fit check each time the nurse uses the mask.

When a nurse manager makes a decisions regarding the management of the nursing unit without input from the staff, the type of leadership style that the nurse manager is demonstrating is: a) autocratic b) situational c) democratic d) laissez-faire

A - The autocratic style of leadership is task oriented and directive. The leader uses his or her power and position in an authoritarian manner to set and implement organizational goals. Decisions are made without input from the staff. Democratic styles best empower staff toward excellence because this style of leadership allows nurses to provide input regarding the decision-making process and an opportunity to grow professionally. The situational leadership style utilizes a style depending on the situation and events. The laissez-faire style allows staff to work without assistance, direction, or supervision

A registered nurse is observing a nursing student auscultate the breath sounds of a client. The registered nurse intervenes if the nursing student performs which incorrect action? a) use the bell of the stethoscope b) asks the client to sit straight up c) places the stethoscope directly on the client's skin d) has the client breathe slowly and deeply through the mouth

A - The bell of the stethoscope is not used to auscultate breath sounds. The client ideally should sit up and breathe slowly and deeply through the mouth. The diaphragm of the stethoscope, which is warmed before use, is placed directly on the client's skin, not over a gown or clothing.

A hospitalized client with a diagnosis of anorexia nervosa and in a state of starvation is in two-bed hospital room. A newly admitted client will be assigned to this client's room. Which client would be inappropriate to assign to this two-bed room? a) a client with pneumonia b) a client who can perform self-care c) a client with a fractured leg that is casted d) a client who is scheduled for a diagnostic test

A - The client in a state of starvation has a compromised immune system. Having a roommate with pneumonia would place the client at risk for infection. Options B, C, and D are appropriate roommates.

The nurse manager is planning to implement a change in the nursing unit from team nursing to primary nursing. The nurse anticipates that there will be resistance to the change during the change process. The primary technique that the nurse would use in implementing this change is which of the following? a) introduce the change gradually b) confront the individuals involved in the change process c) use coercion to implement the change d) manipulate the participants in the change process

A - The primary technique that can used to handle resistance to change during the change process is to introduce the change gradually. Confrontation is an important strategy used to meet resistance when it occurs. Coercion is another strategy that can be used to decrease resistance to change but is not always a successful technique for managing resistance. Manipulation usually involves a covert action, such as leaving out pieces of vital information that the participants might receive negatively. It is not the best method of implementing a change.

A registered nurse is mentoring a new nurse hired to work in the nursing unit. The registered nurse determines that the new nurse is competent to provide safe effective care for a client on a ventilator when the registered nurse notes that the new nurse: a) has the ventilator routinely assessed by the respiratory therapist b) realizes that the ventilator readings provide information without human error c) teaches family members how to reset controls during their visits if necessary d) establishes a rest pattern before morning care

A - Ventilators need to be assessed routinely by the respiratory therapist. Ventilators are machines, and machines can fail. Therefore, option B is not a reasonable option. Family members should not reset ventilator controls. Although option D is considered good nursing practice for the comfort of the client, it is not the priority option.

Remove all tubes and equipment (unless organ donation is to take place), clean the body, and position appropriately.

A client who had a "Do Not Resuscitate" order passed away. After verifying there is no pulse or respirations, the nurse should next:

The choices involved do not appear to be clearly right or wrong.

A health care issue often becomes an ethical dilemma because

When applying evidence-based practice (EBP), community-oriented nurses are primarily obligated to ensure that evidence applied to practice is: A. Acceptable to the community B. Contains cost and reduces legal liability C. Applied as a universal remedy D. Limited to research findings

A. Acceptable to the community

A nurse in community health is planning to begin a class to help mothers returning to work better cope with the stresses of multiple roles. The nurse would most likely use: A. An andragogical approach B. A behavioral approach C. An operational approach D. A pedagogical approach

A. An andragogical approach

Which of the following best supports the concept of community-oriented nursing practice? Select all that apply. A. Direct nursing care of individuals with tuberculosis (TB) B. Hospice home care for a terminally ill individual and family C. Nursing interventions to stop elder abuse D. Nutrition education programs for teenagers and their families E. Wound care for a homebound individual

A. Direct nursing care of individuals with tuberculosis (TB) C. Nursing interventions to stop elder abuse D. Nutrition education programs for teenagers and their families

There are many barriers that affect the actual implementation of evidence-based practice (EBP) in a nursing environment. The statement that reflects the most significant concern of nurses is: A. EBP will lead to a cookbook approach to nursing. B. EBP requires little support. C. EBP demands change. D. EBP questions long-standing nursing practice.

A. EBP will lead to a cookbook approach to nursing.

Which nursing actions could result in malpractice? Select all that apply 1. Learns about a new piece of equipment 2. Forgets to complete the assessment of a client 3. Does not follow up on client's complaints. 4. Charts client's drug allergies 5. Questions primary care provider about an illegible order

Answer: 2 and 3 Rationale: Standards of practice require a complete assessment. A nurse needs to be sure the client's needs have been met. They both can impact client safety and do not follow standards of care.

A Hispanic outreach program works with the nurse in community health to train Hispanic health care workers in providing basic services and education within the local Hispanic community. The concept basic to community-oriented nursing practice that is best described by this intervention is: A. Community B. Community client C. Community health D. Community partnerships

D. Community partnerships

Which of the following factors puts an older adult at risk for physical, emotional, and financial abuse? Select all that apply. Decrease in strength and mobility Increase in independence Isolation Declining mental ability

Decrease in strength and mobility Declining mental ability

Who Issued Patients Bill of Rights?

American Hospital Association

Patients Bill of Rights was developed by?

American Hospital Association 1972

Who developed the Code for Nurses, which defines the Nurses responsibility for upholding the clients rights?

American Nurses Association

A nurse discovers that a primary care provider has prescribed an unusually large dosage of a medication. Which is the most appropriate action? 1. Administer the medication 2. Notify the prescriber 3. Call the pharmacist. 4. Refuse to administer the medication.

Answer #2 Rationale: The nurse should call the person who wrote the order for clarification. Administering the medication is incorrect because knowing the dose is outside the normal range and not questioning it could lead to client harm and liability for the nurse.

The nurse has just been promoted to unit manager. Which advice, offered by a senior unit manager, will help this nurse become inspirational and motivational in this new role? 1. "If you make a mistake with your staff, admit it, apologize, and correct the error if possible." 2. "Don't be too soft on the staff. If they make a mistake, be certain to reprimand them immediately." 3. "Give your best nurses extra attention and rewards for their help." 4. "Never get into a disagreement with a staff member."

Answer: 1. "If you make a mistake with your staff, admit it, apologize, and correct the error if possible." Rationale: 1: Managers need to be honest and forthcoming with staff, which includes taking responsibility for one's own actions and errors. This also provides a positive role model for the staff. 2: When errors occur, the manager should use the opportunity for improvement, not punishment. 3: When staff feel some staff are given extra credit, staff will feel uncomfortable with the manager and resentment will build. 4: Staff need to feel that they can share their feedback, positive or negative, and not feel threatened when they disagree with the manager.

The patient who had a colonoscopy one hour ago suddenly experiences bright red rectal bleeding, becomes diaphoretic, and is short of breath. The nurse decides to implement standing emergency orders and initiates oxygen per mask and increases the patient's IV rate while a colleague contacts the patient's physician. Which critical element of nursing is this nurse demonstrating? Standard Text: Select all that apply. 1. Autonomy. 2. Responsibility. 3. Delegation. 4. Accountability. 5. Relevance.

Answer: 1. Autonomy. 2. Responsibility. 4. Accountability. Rationale 1: Autonomy in clinical decision making occurs whenever a nurse makes an independent judgment about the presence of a clinical issue and then provides the resolution. This nurse identified that the patient was experiencing distress and made the clinical judgment to use emergency orders. The nurse could have also made a clinical judgment not to use them. Rationale 2: This nurse was entrusted with a particular function, in this case, caring for a post-op patient. Rationale 3: There is no indication that the nurse delegated care of this patient to anyone. Rationale 4: Accountability is the acceptance of responsibility of the outcomes of care. Rationale 5: This term is not one of the critical elements of nursing.

The health care providers in an organization have chosen not to adopt the use of clinical pathways. What are reasons to justify this decision? Select all that apply. 1. Clinical pathways development and implementation takes time and can be costly. 2. The pathway content has to be evaluated each time it is used. 3. Some believe that clinical pathways result in excessive paperwork and redundant documentation. 4. There is fear that pathways will be used in evaluating staff performance. 5. The use of clinical pathways has not been proven to make a difference in patient care.

Answer: 1. Clinical pathways development and implementation takes time and can be costly. 2. The pathway content has to be evaluated each time it is used. 3. Some believe that clinical pathways result in excessive paperwork and redundant documentation. 4. There is fear that pathways will be used in evaluating staff performance. Rationale 1: These pathways are developed for each facility and can be costly to develop and implement. Rationale 2: Since the content contains the general care of the patient with a specific disease, the content must be reviewed and individualized to each patient each time it is used. Rationale 3: New forms and paperwork often cause health care providers to be concerned about new methods of providing care. Rationale 4: Some health care providers fear the interprofessional aspects of these tools. Others resent the requirement to follow the instructions of the critical pathway and fear they will be criticized if their general care does not match that required by the critical pathway. Rationale 5: These pathways do change patient care and can support interprofessional care.

Describe the primary focus of a manager in a knowledge work environment. 1. Developing the most effective teams. 2. Taking risks. 3. Routine work. 4. Understanding the history of the organization.

Answer: 1. Developing the most effective teams. Rationale: 1: The most important focus of this manager is on developing and supporting effective teams, utilizing the knowledge of many. 2: Risk taking is a part of knowledge work, but is not the most important of this manager's tasks. 3: Knowledge work is a combination of routine and non-routine work, so the manager will have focus on the routine. This is not the manager's most important focus. 4: Understanding the history of the organization is important as it will help the manager work within the organization, but it is not the most important focus.

The nurse who works for an insurance company has been asked to develop an initial set of disease management programs. What factors should this nurse consider when choosing the diseases? Select all that apply. 1. High cost problems. 2. Those with high numbers of hospitalizations. 3. Those with high risk for complications. 4. Long-term problems. 5. Those with a longer length of stay when hospitalization is required.

Answer: 1. High cost problems. 2. Those with high numbers of hospitalizations. 3. Those with high risk for complications. 4. Long-term problems. 5. Those with a longer length of stay when hospitalization is required. Rationale 1: High cost, high volume, high risk diseases are typically considered for management programs. Rationale 2: High cost, high volume, high risk diseases are typically considered for management programs. Rationale 3: High cost, high volume, high risk diseases are typically considered for management programs. Rationale 4: Long-term problems incur high costs. Rationale 5: Longer length of stay increases costs.

The staff nurse has been asked to assume leadership of a work team. Which strategies should this nurse use to increase the team members' trust? Select all that apply. 1. Keep promises that are made. 2. Give honest feedback. 3. Create a logical excuse for not keeping promises made. 4. Reward followers. 5. Ask followers to defer feedback until the end of the project.

Answer: 1. Keep promises that are made. 2. Give honest feedback. 4. Reward followers. Rationale 1: If the leader does not keep promises, trust is lost. Rationale 2: Feedback should be honest and formulated to help the follower do a better job. Rationale 3: The leader can explain why a promise was not kept, but should not "create" excuses. Rationale 4: Followers appreciate rewards when they are earned. Rationale 5: Followers should be encouraged to provide feedback to the leader throughout the project.

The nurse wishes to improve personal Emotional Intelligence (EI) in hopes of a promotion to nurse manager. Which skills are important for this nurse to improve? Select all that apply. 1. Self-confidence. 2. Knowledge base of nursing. 3. Proficiency in technical skills. 4. Empathy. 5. Ability to initiate change.

Answer: 1. Self-confidence. 4. Empathy. 5. Ability to initiate change. Rationale: 1: EI competencies are self-confidence, empathy, change catalyst, and visionary leadership. 2: While this is an important aspect of professional nursing, it is not a competency of EI. 3: While this is an important aspect of professional nursing, it is not a competency of EI. 4: EI competencies are self-confidence, empathy, change catalyst, and visionary leadership. 5: EI competencies are self-confidence, empathy, change catalyst, and visionary leadership.

What are the responsibilities of the nurse manager in most shared governance models? Standard Text: Select all that apply. 1. Staffing. 2. Direct patient care. 3. Program evaluation. 4. Allocation of resources. 5. Long-range planning.

Answer: 1. Staffing. 3. Program evaluation. 4. Allocation of resources. 5. Long-range planning. Rationale 1: This is a responsibility of the nurse manager in most shared governance models. Rationale 2: In most shared governance models, the nurse manager is not responsible for providing direct patient care. Rationale 3: This is a responsibility of the nurse manager in most shared governance models. Rationale 4: This is a responsibility of the nurse manager in most shared governance models. Rationale 5: This is a responsibility of the nurse manager in most shared governance models.

Differentiate between disease management programs and clinical guidelines by choosing the option that describes disease management programs. 1. The major goal is to prepare the patient to understand the disease and to increase self-management of the disease. 2. They establish standards that focus on health maintenance. 3. They have been adopted to control costs. 4. They are also called medical review criteria.

Answer: 1. The major goal is to prepare the patient to understand the disease and to increase self-management of the disease. Rationale 1: The purpose of disease management programs is to provide patients with education and preventive care that improves quality of life. Rationale 2: This is true of clinical guidelines. Rationale 3: This is true of clinical guidelines. Rationale 4: This is true of clinical guidelines.

What is a disadvantage of using the team approach for care delivery? 1. The team leader might not have the necessary leadership skills required to successfully lead the team. 2. There is a risk that care will be fragmented. 3. This approach often leads to greater staff dissatisfaction, with staff members feeling they are just grinding out tasks. 4. This approach may lead to decreased collaboration and redundancy in patient care.

Answer: 1. The team leader might not have the necessary leadership skills required to successfully lead the team. Rationale 1: Using the team approach requires that the team leader have the necessary leadership skills to coordinate and delegate patient care. Rationale 2: The team approach helps keep care from becoming fragmented. Rationale 3: In this approach, each team member can contribute his or her own special expertise or skill in caring for the patient. Rationale 4: There is generally a greater amount of collaboration and less redundancy or care.

The staff nurse has been asked to work on a committee whose task is to develop clinical pathways for the facility. What is the purpose of these pathways? 1. To provide quality health care with the efficient use of resources while controlling costs. 2. To provide practice guidelines for the general treatment of a specific diagnosis. 3. To reduce patient length of stay. 4. To justify alternative treatment methods.

Answer: 1. To provide quality health care with the efficient use of resources while controlling costs. Rationale 1: Clinical pathways were developed in response to the need to identify quality, cost-effective health care within a specific time frame. Rationale 2: Clinical pathways are specific and unique to the health care agency or managed care organization in which they are used. Rationale 3: One of the purposes for developing clinical pathways is to reduce the cost of health care. This can occur as a result of reduced length of stay, but reducing length of stay is not the primary goal. Rationale 4: Clinical pathways often are used to demonstrate compliance with standards of care, accreditation, and regulatory requirements.

The nursing student clinical group is attending the first clinical session of the semester. What nursing care delivery model can these students most usually expect to follow? 1. Total patient care model. 2. Functional nursing model. 3. Primary nursing model. 4. Care management model.

Answer: 1. Total patient care model. Rationale 1: Typically, student nurses follow the total patient care model and provide all of the care for a patient while in the clinical area. This model may be altered slightly to accommodate the student's progress in the nursing program or the policies of the facility. For example, the nursing student may provide all care except giving IV meds. Rationale 2: Functional nursing is a task-oriented approach where staff members are assigned to provide a specific task, such as wound care. Rationale 3: In primary nursing, the RN assumes 24-hour responsibility for planning, directing, and evaluating the patient's care, from admission to discharge. Rationale 4: The care management model, which is similar to case management, focuses on the needs of the integrated delivery system.

What is the oldest of the nursing care models? 1. Total patient care. 2. Functional nursing. 3. Team nursing. 4. Primary nursing.

Answer: 1. Total patient care. Rationale 1: This is the oldest of the models. Nurses have provided this type of care for generations. Rationale 2: This model is not as old as total patient care. Rationale 3: This model is not as old as total patient care. Rationale 4: This model is not as old as total patient care.

Which options are included in the six dimensions of shared governance? Standard Text: Select all that apply. 1. Informal authority base. 2. Access to information about the organization. 3. Delegation of care to others. 4. Ability to set goals and negotiate conflict. 5. Control over professional practice.

Answer: 2. Access to information about the organization. 4. Ability to set goals and negotiate conflict. 5. Control over professional practice. Rationale 1: Shared governance requires formal authority granted by the organization. Rationale 2: This is a part of shared governance. Rationale 3: This is not a part of shared governance though it occurs in a shared governance organization. Rationale 4: This is a part of shared governance. Rationale 5: This is a part of shared governance.

Typically the nurse manager of a unit uses a participatory style of leadership. Today a patient suffered a cardiac arrest; the manager took over the patient's care, issuing orders, and expecting staff to obey them immediately. Which type of leadership did this manager exhibit today? Select all that apply. 1. Bureaucratic. 2. Autocratic. 3. Permissive. 4. Directive. 5. Authoritarian.

Answer: 2. Autocratic. 4. Directive. 5. Authoritarian. Rationale: 1: This style is focused on organizational rules and policies. 2: Autocratic, directive, and authoritarian are all terms used to describe leadership in which the leader makes the decisions for the group, issues direct orders, and expects staff to immediately obey. This is an appropriate leadership style in emergencies such as a cardiac arrest. 3: This is a "hands-off" approach. 4: Autocratic, directive, and authoritarian are all terms used to describe leadership in which the leader makes the decisions for the group, issues direct orders, and expects staff to immediately obey. This is an appropriate leadership style in emergencies such as a cardiac arrest. 5: Autocratic, directive, and authoritarian are all terms used to describe leadership in which the leader makes the decisions for the group, issues direct orders, and expects staff to immediately obey. This is an appropriate leadership style in emergencies such as a cardiac arrest.

The nurse manager is making patient assignments for the shift. What should be the primary guiding factor in these assignments? 1. Number of staff available. 2. Skill mix of the staff. 3. Patient needs. 4. Physical layout of the unit.

Answer: 3. Patient needs. Rationale 1: This is an important determinant of staff assignments, but is not the most important factor. Rationale 2: This is an important determinant of staff assignments, but is not the most important factor. Rationale 3: The most important factor in any decision made by any health care provider should be patient needs. Rationale 4: This is an important determinant of staff assignments, but is not the most important factor.

The nurse is interviewing for a position in a newly opened hospital. Which observation would best indicate to this nurse that the organization follows a shared governance model? 1. Among the documents provided by the human resources department is an organizational chart of the nursing department, indicating that the director is the highest-ranking member. 2. Conversation with a staff nurse reveals that the nurse feels empowered in making patient care decisions. 3. The mission statement of the hospital describes centralized power. 4. A staff nurse mentions that each individual staff member has complete autonomy.

Answer: 2. Conversation with a staff nurse reveals that the nurse feels empowered in making patient care decisions. Rationale 1: This documents that the hospital follows the classical theory of organization. Rationale 2: Shared governance increases each nurse's influence over the organization, empowering staff. Rationale 3: This is a classical organizational model. Rationale 4: Although the shared governance model does provide some autonomy, there is also an understanding that staff are expected to collaborate and function cooperatively with both management and colleagues.

This morning, the RN is assigned to administer medications to all of the patients on the medical-surgical unit. From this assignment, the RN knows that this organization adheres to which type of patient care delivery model? 1. Total patient care model. 2. Functional nursing model. 3. Primary nursing model. 4. Care management model.

Answer: 2. Functional nursing model. Rationale 1: The staff working for an organization that uses the total patient care model are assigned to provide all of the care for a patient while in the clinical area. Rationale 2: Functional nursing is a task-oriented approach where staff members are assigned to provide a specific task, such as passing out medications for the unit. Rationale 3: IN primary nursing, the RN assumes 24-hour responsibility for planning, directing, and evaluating the patient's care, from admission to discharge. Rationale 4: The care management model, which is similar to case management, focuses on the needs of the integrated delivery system.

A very young nurse has been promoted to nurse manager of an inpatient surgical unit. The nurse is concerned that older nurses may not respect the manager's authority because of the age difference. How can this nurse manager best exercise authority? 1. Use critical thinking to solve problems on the unit. 2. Give assignments clearly, taking staff expertise into consideration. 3. Understand complex health care environments. 4. Maintain an autocratic approach to influence results.

Answer: 2. Give assignments clearly, taking staff expertise into consideration. Rationale: 1: Critical thinking is important for every RN, not just a manager 2: Giving clear assignments is a characteristic of authority. The young nurse who takes staff expertise into consideration when making assignments is likely to be more successful in leading the group. 3: Nurse managers do work in complex health care environments but must create an appropriate organizational environment as a way of exercising authority. 4: In autocratic leadership, one person has all of the power. This is not a good approach for a younger leader to adopt when working with a group of older, more experienced nurses.

The nurse manager has asked that all staff nurses develop effective leadership competencies. How should the staff nurses interpret this request? 1. This is an unrealistic expectation, because only managers are leaders. 2. If the nurses learn about and use relevant leadership and management theories and styles this is possible. 3. In order to become leaders, the staff nurses will have to emphasize control, competition, and getting the job done. 4. Unless the staff nurses possess the traits of a natural born leader, this is an unrealistic expectation.

Answer: 2. If the nurses learn about and use relevant leadership and management theories and styles this is possible. Rationale: 1: A nurse does not need to have a formal management position with a management title to be a leader; if nurses demonstrate leadership competencies, they are considered nurse leaders. 2: In today's health care environment, nurses must have knowledge of relevant leadership and management theories and styles. This knowledge helps nurses emerge as leaders. Nurses are also leaders of their own nursing practices. 3: Control, competition, and getting the job done are past theories and styles and are not as useful in today's environment. 4: Leadership is a skill that can be learned.

A nursing student prepares a treatment plan for a client that draws upon the student's understanding of pathophysiology and nursing practice theory learned in the student's coursework. This application of new information used in a different way demonstrates the educational principle of: A. Affective domain B. Cognitive domain C. Events of instruction D. Principles of effective education

B. Cognitive domain

What statement, made in the morning shift report, would help an effective manager develop trust on the nursing unit? 1. "I know I told you that you could have the weekend off, but I really need you to work." 2. "The others work many extra shifts, why can't you?" 3. "I'm sorry, but I do not have a nurse to spare today to help on your unit. I cannot make a change now, but we should talk further about schedules and needs." 4. "I can't believe you need help with such a simple task. Didn't you learn that in school?"

Answer: 3. "I'm sorry, but I do not have a nurse to spare today to help on your unit. I cannot make a change now, but we should talk further about schedules and needs." Rationale: 1: To develop trust, managers who make promises to staff must keep the promise. 2: This statement implies that the staff nurse is not a team player. It also sets up one nurse against the remainder of the staff. Effective managers must be fair and supportive with all staff. 3: This manager is standing up for staff by not allowing another unit to take a nurse today. 4: This statement is belittling to the staff nurse. This attitude does not demonstrate trust that staff performances will be effective.

Compare and contrast manager roles and leadership roles by choosing the options that are more aligned with the manager role. Select all that apply. 1. Focus is change. 2. Have the ability to influence others. 3. Control the environment. 4. Focus is on people. 5. Focus on efficiency.

Answer: 3. Control the environment. 5. Focus on efficiency. Rationale: 1: The manager accepts the status quo, while the leader challenges it. 2: The manager controls people, while the leader influences 3: The manager controls the environment, patient care, and the staff that deliver that care. 4: The leader focuses on people while the manager focuses on systems and structure. 5: Managers focus on efficiency, while leaders focus on effectiveness.

The manager has asked the staff to participate in the selection of new intravenous pumps for the unit. The manger has provided a list of choices and budget guidelines. This is an example of use of which management strategy? 1. Use of expert power. 2. Use of legitimate power. 3. Empowerment of staff. 4. Management persuasiveness.

Answer: 3. Empowerment of staff. Rationale 1: This manager has used expert opinion, not expert power. Rationale 2: Legitimate power is the type of power that is "awarded" with a position. Rationale 3: This action enables others to act and provides others with the opportunity to participate and influence decisions. Rationale 4: The manger would have used persuasiveness to convince the staff to adopt a particular kind of pump that the manager chose.

There have been several patient complaints that the staff members of the unit are disorganized and that "no one seems to know what to do or when to do it." The staff members concur that they don't have a real sense of direction and guidance from their leader. Which type of leadership is this unit experiencing? 1. Autocratic. 2. Bureaucratic. 3. Laissez-faire. 4. Authoritarian.

Answer: 3. Laissez-faire. Rationale: 1: Autocratic and authoritarian leaders make decisions for the group and assume people are incapable of making independent decisions. While this is not always a good leadership style, it is unlikely the complaints in this scenario would occur. 2: Bureaucratic leaders depend upon policy and rules. This is not always a good style of leadership, but it is unlikely the complaints in this scenario would occur. 3: This style of leadership can be so detached that there is no direction or real leadership. This will often be reflected in the work of the staff and the perceptions of the patients. 4: Autocratic and authoritarian leaders make decisions for the group and assume people are incapable of making independent decisions. While this is not always a good leadership style, it is likely the complaints in this scenario would occur.

A nurse in community health contacts three individuals who have had sexual encounters with an individual recently diagnosed with syphilis. The concept basic to community-oriented nursing practice that is best described by this intervention is: A. Community B. Community as client C. Individual as client D. Partnership

B. Community as client

Which behavior demonstrates the nurse's competency as an emotionally intelligent leader? 1. The nurse is proficient in technical skills. 2. The nurse relies on policies, not options. 3. The nurse supports team members. 4. Productivity is not a major concern.

Answer: 3. The nurse supports team members. Rationale: 1: While technical skill is important for all nurses, it is not a hallmark of a competent leader. 2: Chaos theory states that solutions are not always clear and policies might not always be applied easily; other options might need to be considered. 3: In Emotional Intelligent theory, team members support each other and feel supported by the team leader. 4: This statement reflects the country club leadership style.

What is the primary focus of disease management programs? 1. Curing the disease. 2. Reducing the need for medications. 3. The whole patient. 4. Learning more about the disease.

Answer: 3. The whole patient. Rationale 1: This can be a focus, depending upon the disease, but is not the primary focus. Rationale 2: This can be a focus, depending upon the disease, but is not the primary focus. Rationale 3: The primary focus is caring for the whole patient. Rationale 4: This can be a focus, but is not the primary focus.

The Governing Board of the hospital has completed an assessment of the organization's culture. Which findings would lead the Board to determine that the culture is healthy? Standard Text: Select all that apply. 1. There is wide variation in the expectations of individual employees and departments. 2. The decisions made about care are staff-centered. 3. There is evidence that the values of the organization and the health professionals working there are similar. 4. The organization is designed to serve its health professionals. 5. New people who come into the organization learn about the culture by connecting behaviors and consequences.

Answer: 3. There is evidence that the values of the organization and the health professionals working there are similar. 5. New people who come into the organization learn about the culture by connecting behaviors and consequences. Rationale 1: Separate approaches to expectations, caring, and values among departments would not be present. Rationale 2: The decisions should be patient-centered. Rationale 3: A hallmark of a healthy organization is a close match of values between the organization and its health professionals. Rationale 4: The organization should be designed to serve the patients. Rationale 5: This is the way new people learn the values of the organization.

Which statement is true regarding implementation of clinical pathways? 1. Pathways replace physician orders. 2. Pathways cannot be used for patients with more than one illness or condition. 3. Using pathways is the best way to assess length of stay (LOS). 4. Disclaimers may be used with clinical pathways to convey that treatment is standardized.

Answer: 3. Using pathways is the best way to assess length of stay (LOS). Rationale 1: Pathways do not replace physician orders. Rationale 2: Pathways can be used for patients with more than one illness or condition by developing co-paths. Rationale 3: Using pathways is the best way to assess the LOS, and their use helps to determine the best expected LOS. Rationale 4: Disclaimers are a way to indicate that care will be provided to meet the individual needs of the patient, which may require variance from a clinical pathway.

Which description of a clinical pathway provided by a nursing student would indicate the best understanding of the concept? 1. Clinical pathways are tools to measure patient outcomes. 2. Clinical pathways are the same as nursing care plans. 3. Clinical pathways are developed to use in acute care settings and guide the nursing care of patients as they are admitted, treated, and discharged. 4. Clinical pathways guide the patient and interprofessional team in managing patient care and recovery within a designated time frame.

Answer: 4. Clinical pathways guide the patient and interprofessional team in managing patient care and recovery within a designated time frame. Rationale 1: This statement only describes a portion of the use of clinical pathways. Rationale 2: While the clinical pathway does include nursing care, they are interprofesssional. Rationale 3: This option does not take into account the interprofessional nature of clinical pathways, nor does it take into account the fact that they are used in areas other than acute care. Rationale 4: This statement is the clearest and most complete description of a clinical pathway.

Peter Drucker's view of management stimulated the shift toward the realization of the importance of participatory organizations. Which option provides a scenario that is an example of a participatory organization? 1. The control of the organization is centralized, and decisions are made by upper-level management. 2. Staff nurses are expected to provide support and nurturing for management's decisions. 3. The organization's approach to leadership is autocratic and bureaucratic. 4. Staff nurses provide input into planning and changes for their own unit.

Answer: 4. Staff nurses provide input into planning and changes for their own unit. Rationale: 1: In participatory organizations, the control of the organization is decentralized and many decisions are made by those "on the front lines" of the organization. 2: The theory is that the staff should be nurtured to promote greater leadership competency. 3: According to Drucker, when staff participate in the core functions of management, the organization is more effective. 4: According to Drucker, when staff participate in the core functions of management such as planning and changes for their own units, the organization is more effective.

Which factor would least likely be included in the analysis of an organization? 1. Whether the organization's mission and vision match staff performance. 2. Results from a staff opinion survey regarding the organization's decision-making processes. 3. How the organization's communication patterns have affected the change process. 4. The turnover rate of nursing personnel in a given unit.

Answer: 4. The turnover rate of nursing personnel in a given unit. Rationale 1: The vision and mission statements are the driving forces behind all decision, and provide critical information about the organization's values and philosophy. Rationale 2: It is important to analyze how staff members believe decisions are made. Rationale 3: It is essential to analyze communication patterns because communication runs an organizations and its ability to function effectively. Rationale 4: Organizational analysis does take staffing issues into consideration. However, of the options provided, the turnover rate of a particular unit is least likely to be considered. Analysis would likely be focused on the turnover rate in the entire organization.

A nursing student is employed and working as an unlicensed assistive personnel (UAP) on a busy surgical unit. The nurses know that the UAP is enrolled in a nursing program and will be graduating soon. A nurse asks the UAP if he has performed a urinary catheterization on clients while in school. When the UAP says yes, the nurses asks him to help her by doing a urinary catheterization on a post surgical client. What is the best response by the UAP? 1. "Let me get permission from the client first." 2. "Sure, which client is it?" 3. "I can't do it unless you supervise me." 4. "I can't do it. is there something else I can help you with."

Answer: 4 Rationale: A sterile invasive procedure that places the client at significant risk for infection is generally outside the scope of practice of a UAP. Even though the UAP is a nursing student, the agency job description should be followed.

The registered nurse (RN), who is supervising a group of nurses at a health clinic, overhears a nurse telling a patient, "If you do not stop shouting, I am going to give you an injection." The RN immediately intervenes and tells the nurse this action can lead to which accusation? Delegation Breach of confidentiality Assault Respondeat superior

Assault Assault is a threat or an attempt to make bodily contact with another person without that person's consent. Breach of confidentiality is revealing health care information to those not involved with the care of the patient. Delegation involves giving someone else authority to act for another. Respondeat superior attributes the acts of the employees to their employer.

The nurse believes that all patients should be treated as individuals. The ethical principle that this belief reflects is?

Autonomy

A nurse informs the patient's health care provider that the patient is refusing potentially life saving surgery. In this situation, which ethical principle is the nurse using? Beneficence Nonmaleficence Autonomy Justice

Autonomy Using the principle of autonomy allows individuals to have the right to determine their own actions and make their own choices. Calling the health care provider to report the patient's refusal of surgery demonstrates the nurse's use of autonomy to guide practice. Beneficence is frequently described as "the doing of good." Nonmaleficence is the duty to do no harm. A description of justice includes patients with the same diagnosis and health care needs receiving the same care.

A client with active tuberculosis (TB) is to be admitted to a medical-surgical unit. When planning a bed assignment, the nurse: a) plans to transfer the client to the intensive care unit b) places the client in a private, well-ventilated room c) assigns the client to a double room because intravenous antibiotics will be administered d) assigns the client to a double room and places a "strict handwashing" sign outside the door

B - According to category-specific (respiratory) isolation precautions, a client with TB requires a private room. The room needs to be well-ventilated and should have at least six exchanges of fresh air per hour and should be ventilated to the outside if possible. Therefore, option 2 is the only correct option.

While conducting a community health assessment, a nurse in community health meets with local religious leaders to understand the values, norms, perceived needs, and influence structures within the community. This process of data collection can best be described as: A. Data gathering B. Data generation C. Data interpretation D. Problem identification

B. Data generation

Four months after the disaster of 9/11 at the Pentagon, a local EMS worker complained of extreme exhaustion. The veteran EMS worker also stated that the pace of work at the squad was too slow. The occupational health nurse that is assessing the EMS worker recognizes the symptoms of: A. Anger B. Delayed stress reaction C. Inability to concentrate D. Insomnia

B. Delayed stress reaction

When acting as a mediator, the nurse advocate would: A. Choose a new health plan for a client with limited funds B. Assist new parents in communicating with their health plan regarding well-baby coverage C. Provide health education to teens who need knowledge about sexually transmitted diseases D. Set up a doctor's appointment for an illiterate adult

B. Assist new parents in communicating with their health plan regarding well-baby coverage

When a community health nurse uses evidence-based practice (EBP) to evaluate effectiveness, accessibility, and quality of personal and population-based services, the nurse is addressing the core public health function of: A. Assessment B. Assurance C. Policy development D. Research

B. Assurance

One specific approach to quality assurance is the use of Total Quality Management (TQM). A district public health department uses this approach and gives much attention to ensuring that studies are used to improve processes, remove management by objectives, and promote self-improvement. The major TQM guideline that would summarize these efforts would be: A. Create, publish, and distribute aims and purposes B. Drive out fear and create trust C. Eliminate barriers to pride of work/performance D. Understand the purpose of inspection

B. Drive out fear and create trust

A nurse manager has implemented a change in the method of documenting nursing care. A licensed practical nurse (LPN) is resistant to the change and is not taking an active part in facilitating the process of change. Which of the following would be the best approach in dealing with the LPN? a) ignore the resistance b) tell the LPN that the registered nurse will do all of the documentation c) confront the LPN, and encourage verbalization of feelings regarding the change d) tell the LPN that she must comply with the change

C - Confrontation is an important strategy to meet resistance head-on. Face-to-face meetings to confront the subject at hand will allow verbalization of feelings, identification of problems and subjects, and development of strategies to solve the problem. Option A will not address the problem. Option B might provide a temporary solution to the resistance but will not specifically address the concern. Option D might produce additional resistance.

A new nursing graduate is attending an agency orientation regarding the nursing model of practice implemented in the health care facility. The nurse is told that the nursing model is a team nursing approach. The nurse understands that planning care delivery will be based on which characteristic of this type of nursing model of practice? a) a task approach method is used to provide care to clients b) managed care concepts and tools are used in providing client care c) an RN leads nursing personnel in providing care to a group of clients d) a single RN is responsible for providing nursing care to a group of clients

C - In team nursing, nursing personnel are led by a registered nurse leader in providing care to a group of clients. Option A identifies functional nursing. Option B identifies a component of case management. Option D identifies primary nursing.

A nurse notes that a postoperative client has not been obtaining relief from pain with the prescribed opioid analgesics when a particular licensed practical nurse (LPN) is assigned to the client. The appropriate action for the nurse to take is to: a) reassign the LPN to the care of clients not receiving opioids b) notify the physician that the client needs an increase in opioid dosage c) review the client's medication administration record immediately and discuss the observations with the nursing supervisor d) confront the LPN with the information about the client having pain control problems and ask if the LPN is using the opioids personally

C - In this situation, the nurse has noted an unusual occurrence, but before deciding what action to take next, the nurse needs more data than just suspicion. This can be obtained by reviewing the client's record. State and federal labor and opioid regulations, as well as institutional policies and procedures, must be followed. It is therefore most appropriate that the nurse discuss the situation with the nursing supervisor before taking further action. The client does not need an increase in opioids. To reassign the LPN to clients not receiving opioids ignores the issue. A confrontation is not the most advisable action because it could result in an argumentative situation.

A registered nurse suspects that a colleague is substance impaired and notes signs of alcohol intoxication in the colleague. The Nurse Practice Act requires the registered nurse do which of the following? a) talk with the colleague b) call the impaired nurse organization c) report the information to a nursing supervisor d) ask the colleague to go to the nurse's lounge to sleep for a while

C - Nurse Practice Acts require reporting the suspicion of impaired nurses. The Board of Nursing has jurisdiction over the practice of nursing and may develop plans for treatment and supervision. This suspicion needs to be reported to the nursing supervisor, who will then report to the Board of Nursing. Confronting the colleague may cause conflict. Asking the colleague to go to the nurses' lounge to sleep for awhile does not safeguard clients.

A nurse manager has identified a problem on the nursing unit and holds unit meetings for all shifts. The nurse manager presents an analysis of the problem and proposals for actions to team members and invites the team members to comment and provide input. Which style of leadership is the nurse manager specifically employing? a) situational b) laissez-faire c) participative d) authoritarian

C - Participative leadership demonstrates an "in-between" style, neither authoritarian nor democratic style. In participative leadership, the manager presents an analysis of problems and proposals for actions to team members, inviting critique and comments. The participative leader then analyzes the comments and makes the final decision. A laissez-faire leader abdicates leadership and responsibilities, allowing staff to work without assistance, direction, or supervision. The autocratic style of leadership is task oriented and directive. The situational leadership style utilizes a style depending on the situation and events.

A client is scheduled for bronchoscopy, and the registered nurse reviews the plan of care written by a nursing student. The registered nurse discusses revision of the plan with the nursing student if which incorrect intervention was documented? a) removing any dentures b) removing contact lenses c) letting the client eat or drink d) obtaining a signed informed consent

C - The client is not allowed to eat or drink for usually 6 to 8 hours (or as specified by the physician) before the procedure. The client must sign an informed consent, because the procedure is invasive. If the client has any contact lenses, dentures, or other prostheses, they are removed before sedation is administered to the client.

A nurse manager is planning to implement a change in the method of the documentation system for the nursing unit. Many problems have occurred as a result of the present documentation system, and the nurse manager determines that a change is required. The initial step in the process of change for the nurse manager is which of the following? a) plan strategies to implement the change b) set goals and priorities regarding the change process c) identify the inefficiency that needs improvement or correction d) identify potential solutions and strategies for the change process

C - When beginning the change process, the nurse should identify and define the problem that needs improvement or correction. This important first step can prevent many future problems, because, if the problem is not correctly identified, a plan for change may be aimed at the wrong problem. This is followed by goal setting, prioritizing, and identifying potential solutions and strategies to implement the change.

A charge nurse observes that a staff nurse is not able to meet client needs in a reasonable time frame, does not problem-solve situations, and does not prioritize nursing care. The charge nurse has the responsibility to: a) supervise the staff nurse more closely so that tasks are completed b) ask other staff members to help the staff nurse get the work done c) provide support and identify the underlying cause of the staff nurse's problem d) report the staff nurse to the supervisor so that something is done to resolve the problem

C Option C empowers the charge nurse to assist the staff nurse while trying to identify and reduce the behaviors that make it difficult for the staff nurse to function. Options A, B, and D are punitive actions, shift the burden to other workers, and do not solve the problem.

The nurse has just taught a client newly diagnosed with diabetes how to administer sliding-scale insulin. The most effective way to evaluate learning is to: A. Provide an online test module B. Ask whether there are any questions C. Ask for a return demonstration D. Give a short paper-and-pencil quiz

C. Ask for a return demonstration

A parent involved in conflict resolution with her teenager says, "I know that some of your friends stay out until midnight, but I think it is best if you are in at 10 o'clock." This statement, a behavior seen in conflict situations, is an example of: A. Negotiation B. Cooperation C. Assertiveness D. Aggressiveness

C. Assertiveness

Nurses agree to be advocates for their patients. Practice of advocacy calls for the nurse to: A. Seek out the nursing supervisor in conflicting situations B. Work to understand the law as it applies to the client's clinical condition. C. Assess the client's point of view and prepare to articulate this point of view. D. Document all clinical changes in the medical record in a timely manner.

C. Assess the client's point of view and prepare to articulate this point of view. Rationale: Nurses strengthen their ability to advocate for a client when nurses are able to identify personal values and then accurately identify the values of the client and articulate the client's point of view.

The charge nurse on the night shift reports that the narcotic count is incorrect. The nurse has spoken to the responsible staff nurse and believes that substance abuse by the nurse is the cause. If substance abuse proves to be the cause of the incorrect count, what is the most appropriate next step?

Complete and incidence report and report findings to the pharmacy and nursing administration. *if the staff nurse id founds to be using the substance, this finding must be reported to the state board of nursing*

Which of the following statements characterizes criminal law? Criminal law applies to conduct that violates a person's rights. Criminal law involves an offense against an individual. Criminal law applies to conduct that is detrimental to society. The purpose of criminal law is to restitute the victim.

Criminal law applies to conduct that is detrimental to society. Criminal law is concerned with offenses against society in general. Civil law deals with personal rights. The purpose of criminal law is to punish the crime and to deter and prevent further crimes. Civil law's purpose is to make the aggrieved person whole again. Civil law applies to conduct that is detrimental to an individual.

A charge nurse knows that drug and alcohol use by nurses is a reason for the increasing numbers of disciplinary cares by the Board of Nursing. The charge nurse understands that when dealing with a nurse with such an illness, it is most important to assess the impaired nurse to determine: a) the magnitude of drug diversion over time b) if falsification of clients records occurred c) the types of illegal activities related to the abuse d) the physiological impact of the illness on practice

D - A nurse must be able to function at a level that does not affect the ability to provide safe, quality care. The highest priority is to determine how the illness affects the nurse's ability to practice. The other options will be addressed if an investigation is carried out.

A clinical nurse manager conducts an inservice educational session for the staff nurses about case management. The clinical nurse manager determines that a review of the material needs to be done if a staff nurse stated that case management: a) manages client care by managing the client care environment b) maximizes hospital revenues while providing for optimal client care c) is designed to promote appropriate use of hospital personnel and material resources d) represents a primary health prevention focus managed by a single case manager

D - Case management represents an interdisciplinary health care delivery system to promote appropriate use of hospital personnel and material resources to maximize hospital revenues while providing for optimal client care. It manages client care by managing the client care environment.

The nurse manager has implemented a change in the method of the nursing delivery system from functional to team nursing. A nursing assistant is resistant to the change and is not taking an active part in facilitating the process of change. Which of the following is the best approach in dealing with the nursing assistant? a) ignore the resistance b) exert coercion with the nursing assistant c) provide a positive reward system for the nursing assistant d) confront the nursing assistant to encourage verbalization of feelings regarding the change

D - Confrontation is an important strategy to meet resistance head on. Face-to-face meetings to confront the issue at hand will allow verbalization of feelings, identification of problems and issues, and development of strategies to solve the problem. Option A will not address the problem. Option B may produce additional resistance. Option C may provide a temporary solution to the resistance but will not address the concern

A nursing student is developing a plan of care for a client with a chest tube that is attached to a Pleur-Evac drainage system. The nurse intervenes if the student writes which incorrect intervention in the plan? a) position the client in semi-fowler's position b) add water to the suction chamber as it evaporates c) tape the connection sites between the chest tube and the drainage system d) instruct the client to avoid coughing and deep breathing

D - It is important to encourage the client to cough and deep breathe when a chest tube drainage system is in place. This will assist in facilitating appropriate lung re-expansion. Water is added to the suction chamber as it evaporates to maintain the full suction level prescribed. Connections between the chest tube and the drainage system are taped to prevent accidental disconnection. The client is positioned in semi-Fowler's to facilitate ease in breathing.

During orientation, a graduate nurse learns that the nursing model of practice implemented in the facility is a primary nursing approach. When the nurse attends report on the medical unit, the nurse will verify with the staff which of the following characteristics of primary nursing? a) critical paths are used when providing client care b) the nurse manager assigns tasks to the staff members c) a registered nurse (RN) leads nursing staff in providing care to a group of clients d) a single RN is responsible for planning and providing individualized nursing care to clients

D - Primary nursing is concerned with keeping the nurse at the bedside actively involved in direct care while planning goal-directed, individualized client care. Option A identifies a component of case management. Option B identifies functional nursing. Option C identifies team nursing.

A registered nurse has instructed a new nursing graduate about the procedure for weaning a client from a ventilator by using a T-piece. The registered nurse determines that the new nursing graduate nurse states which of the following to be part of the procedure? a) removing the client from the mechanical ventilator for a short period b) connecting the T-piece to the client's artificial airway c) providing supplemental oxygen through the T-piece at an Flo2 that is 10% higher than the ventilator setting d) gradually decreasing the respiratory rate on the ventilator until the client takes over all of the work of breathing

D - The T-piece or Briggs device requires that the client is removed from the mechanical ventilation for a short time, usually beginning with a 5-minute period. The ventilator is disconnected and the T-piece is connected to the client's artificial airway. Supplemental oxygen is provided through the device, often at a FIo2 that is 10% higher than the ventilator setting. Option 4 describes the process of weaning via synchronized intermittent mandatory ventilation.

Based upon a request made by the client's spouse and children, a physician asks a nurse to discontinue the feeding tube in a client who is in chronic debilitated and comatose state. The nurse understands the legal basis for carrying out the order and first checks the client's record for documentation of: a) a court approval to discontinue the treatment b) approval by the institutional Ethics Committee c) a written order by the physician to remove the tube d) authorization by the family to discontinue the treatment

D - The family or a legal guardian can make treatment decisions for the client who is unable to do so. Once the decision is made, the physician writes the order. Generally, the family makes decisions in collaboration with physicians, other health care workers, and other trusted advisors. Although a written order by the physician is necessary, the nurse first checks for documentation of the family's request. Unless special circumstances exist, a court order is not necessary. Although some health care agencies may require reviewing such requests via the Ethics Committee, this is not the nurse's first action.

A registered nurse is preceptor for a new nursing graduate and is observing the new nursing graduate organize the client assignment and daily tasks. The registered nurse intervenes if the new nursing graduate does which of the following? a) provide time for unexpected tasks b) lists the supplies needed for a task c) prioritizes client needs and daily tasks d) plans to document task completion at the end of the day

D - The nurse should document task completion continuously throughout the day. Options A, B, and C identify accurate components of time management.

A 3-year smoking cessation program for teens has just concluded. The type of evaluation the staff will conduct is: A. A formative evaluation B. An informal evaluation C. An ongoing evaluation D. A summative evaluation

D. A summative evaluation

A case manager is concerned that some of the clients at the neighborhood clinic are getting fewer services because of their financial situations. The case manager is confronting the ethical principle of: A. Justice B. Veracity C. Deontology D. Beneficence

D. Beneficence

A nurse is preparing for change-of-shift rounds with the nurse who is assuming care for his patients. Which of the following statements or actions by the nurse are characteristics of ineffective handoff communication? This patient is anxious about his pain after surgery; you need to review the information I gave him about how to use a patient-controlled analgesia (PCA) pump this evening. The nurse refers to the electronic care plan in the electronic health record (EHR) to review interventions for the patient's care. During walking rounds the nurse talks about the problem the patient care technicians created by not ambulating the patient. The nurse gives her patient a pain medication before report so there is likely to be no interruption during rounding.

During walking rounds the nurse talks about the problem the patient care technicians created by not ambulating the patient Creating a culture of blame does not support questioning, which is needed for good handoff communication. Talking about the patient's anxiety during handoff is patient centered and thus appropriate, referring to the EHR to review interventions ensures that essential information is included, and administering a pain medication before the report allows the nurse to be organized and uninterrupted during rounds.

Secondary prevention

Emphasizes early detection of disease, prompt intervention, and health maintenance for individuals experiencing health problems

Once a nurse is licensed, he or she can apply to another state for licensure by: Applying to take the NCLEX® examination in that state Interstate compact Endorsement Following the nurse practice act

Endorsement A nurse can apply for a license in another state by endorsement if all licensing criteria have been met for that state.The NCLEX® examination is a national licensure exam. It is not necessary to take it again. Interstate compact is a legal agreement among certain states that allows multistate practice of nursing as long as the nurse has a license in his or her home state. The Nurse Practice Act lists a nurse's scope of practice for the different licensure.

American Nurses Association's (ANA's) Code of Ethics

Ethical principles for professional nursing practice in a clinical setting are guided by the principles of conduct that are written as the:

Another term for standards of care?

Evidence based Practice

A nurse is working in a neonatal intensive care unit (NICU) where a premature baby (26 weeks gestation) is facing respiratory disorders, numerous infections, and a brain hemorrhage. The parents want every measure to be taken to keep their baby alive, but several members of the health care team are advocating removal of life support. The nurse believes there are several ethical issues involved in this case. What step should the nurse take first when facing an ethical dilemma? Gather as much information as possible about the situation Identify the options available in this situation Act in a fair and equitable manner for all involved Evaluate the actions taken using ethical principles

Gather as much information as possible about the situation The nurse should clarify the ethical dilemma by gathering as much information as possible about the situation. This compares with the assessment phase of the nursing process and is the first step in the ethical decision making model. Most ethical dilemmas have multiple options, which should all be considered, but gathering additional data must be the first step. Making a decision and acting in a fair and equitable manner must take place, but gathering additional data is the first step. Evaluating the actions taken is the last step of the ethical decision making model.

The term for injury to a person or the person's property that gives rise to a basis for a legal action against the person who caused the damage is: Assault Harm Malpractice Negligence

Harm Assault is an intentional threat to cause bodily harm to another. It does not have to include actual bodily contact.Malpractice is the failure to meet a legal duty that results in harm to another. Negligence is the commission of an act or omission of an act that a reasonably prudent person would have done in a similar situation, leading to harm to another person.

A federal regulation that came into effect April 14, 2003 has impacted the health care field regarding privacy of a patient's health information. This regulation is the: Joint Commission on Accreditation of Healthcare Organizations Patient Self-Determination Act Patient's Bill of Rights Health Insurance Portability and Accountability Act

Health Insurance Portability and Accountability Act The Health Insurance Portability and Accountability Act of 1996 (HIPAA) came into effect on April 14, 2003 to safeguard a person's health information. It sets rules and limits on who can look at and receive health information. The Patient's Bill of Rights is the list of things that patients have the right to do or refuse to do. The Patient Self-Determination Act requires that institutions maintain written policies and procedures regarding advance directives, the right to accept or refuse treatment, and the right to participate fully in health care-related decisions. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) is an organization that accredits health care facilities.

A patient is admitted to the hospital with a sacral wound that has a foul odor, purulent drainage, and necrotic tissue in the center. It measures 4 cm in circumference by 2 cm deep. Select the most appropriate nursing diagnosis. Risk for infection Impaired skin integrity Chronic pain Impaired peripheral circulation

Impaired skin integrity The collected data all show that there is an impaired skin integrity.The data show that an infection is already present and so the diagnosis needs to be actual and not risk for. More data would need to be collected to know if the patient has pain. Impaired peripheral circulation -More assessment data would need to be collected, so it is not the most appropriate at this time.

The nurse is planning care of a patient with difficulty breathing due to a medical diagnosis of COPD. Which of the following should the nurse determine is the priority nursing diagnosis? Knowledge deficit regarding use of inhaler Sleep pattern disturbance Spiritual distress Ineffective airway clearance

Ineffective airway clearance Airway clearance is a high priority physiological need and should take priority over non-physiological, basic needs. Knowledge deficit, sleep pattern disturbance, and spiritual distress are all important needs, but physiological needs should be the priority of care.

The nurse is caring for a patient who is scheduled for surgery. Prior to going to surgery the nurse would make sure that the patient has been fully informed about the procedure to be done. What would the patient sign to acknowledge that he or she is making an intelligent decision? Patient's Bill of Rights Accountability statement Informed consent doctrine Confidentiality statement

Informed consent doctrine An informed consent doctrine is a person's agreement to allow a particular treatment based on full disclosure of the facts needed to make an intelligent decision. The patient's Bill of Rights is a list of rights of the patient that includes the right of an informed consent. Accountability is the responsibility of the nurse as part of the care to be given to the patient. Confidentiality is the responsibility of the nurse as part of the care to be given to the patient.

A nurse reports a medication error and monitors the patient, who suffers no ill effects. Which element is lacking to prove nursing malpractice? Duty of care Breach of duty Injury Standard of care

Injury Since there is no injury, then malpractice cannot be proven. Breach of duty, duty of care, and standard of care are not relevant elements in this case.

The nurse is providing patient education for a patient newly diagnosed with diabetes mellitus. When the nurse teaches the patient how to administer insulin, the nurse is demonstrating which phase of the nursing process? Diagnosis Planning Evaluation Interventions

Interventions A nurse providing patient education on self-administration of insulin is demonstrating the intervention phase of the nursing process. Teaching patients is not an example of diagnosis, planning, or evaluation.

On a medical unit, several patients are being treated for Hepatitis B infection. One of the patients contracted Hepatitis B through using infected needles associated with heroin use. Another of the patients contracted Hepatitis B through a blood transfusion following a car accident. Several of the employees on the unit treat the patient who used heroin rudely and delay their attention to the patient's requests. The nurse intervenes and reminds the staff to use which ethical principle? Justice Nonmaleficence Beneficence Autonomy

Justice Justice describes providing patients with the same diagnosis and health care needs the same care. By delaying attention to the patient's requests and treating the patient rudely, the staff is not using the principle of justice. Nonmaleficence is the duty to do no harm. Beneficence is frequently described as "the doing of good." Autonomy means that individuals have the right to determine their own actions and the freedom to make their own decisions.

When caring for patients, the nurse knows that part of the ethical principles include all patients having the same right to nursing interventions. This principle is: Autonomy Nonmaleficence Justice Beneficence

Justice Justice in nursing means that nurses must allocate time among all the assigned patients to meet their needs.Autonomy refers to personal freedom of choice, a right to be independent and make decisions freely. Nonmaleficence means to do no harm.Beneficence means doing what is good.

A recent graduate of a nursing program has accepted a position in a long term care unit. The nurse can use which strategy to reduce the risk of malpractice suits? Carry malpractice insurance Request supervision for all care Not sign his or her name in patient records Maintain good relationships with patients and families

Maintain good relationships with patients and families Maintaining good relationships with patients and families does reduce the risk of malpractice suits. Carrying malpractice insurance does not reduce the risk of a malpractice suit. Requesting supervision for all care provided is not feasible in many situations and does not reduce the risk of malpractice suits. Not signing patient records can actually increase the risk of lawsuits, as failure to document is considered a category of negligence that results in malpractice lawsuits.

The LPN/LVN knows that building the nurse-patient relationship is important in providing patient care, and a legal relationship is being formed. If there is a breach in this relationship and harm to the patient has occurred, which legal action can the nurse be charged with? Assault Negligence Slander Malpractice

Malpractice Malpractice in the failure to meet a legal duty that results in harm to another. Slander in malicious or untrue spoken words about another person or property.Negligence is the commission or omission of an act that a reasonably prudent person would have done in a similar situation that leads to harm to another person.Assault is an intentional threat to cause bodily harm to another.

Who developed rights for mentally ill clients?

Mental Health Systems Act

A nurse is providing patient teaching for a patient undergoing chemotherapy. The nurse is explaining that the chemotherapy will cause some unpleasant side effects, such as nausea and hair loss. In this situation, the nurse is using which ethical principle? Beneficence Nonmaleficence Autonomy Justice

Nonmaleficence Nonmaleficence involves the duty to do no harm. Although the patient will experience nausea and hair loss (harm), the treatment will eventually produce good for the patient. Beneficence is frequently defined as the "doing of good." Autonomy means that individuals have the right to determine their own actions and the freedom to make their own decisions. Justice means that the same care is provided to patients with similar diseases and health care needs.

Assess the client's point of view and prepare to articulate this point of view.

Nurses agree to be advocates for their patients. Practice of advocacy calls for the nurse to:

Following the gathering of subjective and objective data, performing a health history and a physical assessment, the nurse sets up a plan of care. The first step is to identify the problem with a(n): Medical diagnosis Nursing intervention Nursing diagnosis Evaluation

Nursing diagnosis The nursing diagnosis is the title or label given to an identified problem and is the first step is a patient's plan of care.A medical diagnosis is the problem identified by the physician upon admission.Nursing intervention is the action used to meet the goal of the plan of care.Evaluation is the last step in the plan of care to see if the interventions are working or need to be changed.

n experienced nurse would best demonstrate collegiality with a novice nurse by which of the following behaviors? Allowing the novice plenty of independence to "get his feet wet" Overlooking mistakes to avoid embarrassing the novice nurse Asking a nursing instructor on the unit to take students elsewhere so the novice nurse can complete assigned tasks. Offering to serve as a mentor to the novice with mutually agreed on goals.

Offering to serve as a mentor to the novice with mutually agreed on goals. A nurse would best demonstrate collegiality with a novice nurse by offering to serve as a mentor to the novice. Allowing the novice to "get his feet wet" does not display behavior that supports another nurse. Overlooking mistakes does not serve as a positive role model. Asking students to leave does not demonstrate welcoming behavior.

Action stage

Person actively implements changes needed to interrupt previous risky behavior

Preparation stage

Person intends to take action in the immediate future

Maintenance stage

Person is striving to prevent relapse by integrating newly adopted behaviors into lifestyle

A nurse is talking with a patient who is visiting a neighborhood health clinic. The patient came to the clinic for repeated symptoms of a sinus infection. During their discussion the nurse checks the patient's medical record and realizes that he is due for a tetanus shot. Administering the shot is an example of what type of preventive intervention? Tertiary Direct care Primary Secondary

Primary An immunization is an example of a primary prevention aimed at health promotion.

The nurse enters a patient's room, and the patient asks if he can get out of bed and transfer to a chair. The nurse takes precautions to use safe patient handling techniques and transfers the patient. This is an example of which physical care technique? Meeting the patient's expressed wishes Indirect care measure Protecting a patient from injury Staying organized when implementing a procedure

Protecting a patient from injury A common method for administering physical care techniques appropriately includes protecting you and your patients from injury, which involves safe patient handling. Transferring a patient is a direct care measure. Organization is an aspect of physical care but not an example of this nurse's action. Although meeting patient needs is important, it is not a physical care technique.

The nurse gets a report, puts his patient assignment notebook in his pocket, and goes on break. His notebook has very specific information about his patients and is missing from his pocket when he returns to the unit. The book is found later on the floor in the cafeteria by a visitor and is returned later to the information desk. The nurse:

has violated the Health Insurance Portability and Accountability Act (HIPPA) of 1996

The LVN is reviewing the patients medical record. The nurse notes the presence of an advance directive. The nurse recognizes that the purpose of this documentation is to?

help every person exercise the right to die with dignity

Current health standards should determine the acceptability of cultural practices.

When providing care to clients with varied cultural backgrounds, it is imperative for the nurse to recognize that:

Define legal relationship?

When the nurse assumes responsibility for the patients care- prudent care

The newly licensed nurse is assigned to a patient who needs catheterization. The nurse has not preformed the procedure before. What would be the best action for the nurse?

Review the agency procedure for male catheterization in the units resource area and ask another experienced nurse to supervise her during the procedure

A nurse is starting on the evening shift and is assigned to care for a patient with a diagnosis of impaired skin integrity related to pressure and moisture on the skin. The patient is 72 years old and had a stroke. The patient weighs 250 pounds and is difficult to turn. As the nurse makes decisions about how to implement skin care for the patient, which of the following actions does the nurse implement? (Select all that apply.) Review the set of all possible nursing interventions for the patient's problem Review all possible consequences associated with each possible nursing action Consider own level of competency Determine the probability of all possible consequences

Review the set of all possible nursing interventions for the patient's problem Review all possible consequences associated with each possible nursing action When making decisions about implementation, reviewing all possible interventions and consequences and determining the probability of consequences are necessary steps. The nurse is responsible for having the necessary knowledge and clinical competency to perform an intervention, but this is not part of the decision making involved.

In which of the following examples is a nurse applying critical thinking attitudes when preparing to insert an intravenous (IV) catheter? (Select all that apply.) Following the procedural guideline for IV insertion Seeking necessary knowledge about the steps of the procedure from a more experienced nurse Showing confidence in performing the correct IV insertion technique Being sure that the IV dressing covers the IV site completely

Seeking necessary knowledge about the steps of the procedure from a more experienced nurse Showing confidence in performing the correct IV insertion technique Seeking necessary knowledge about the steps of the procedure shows humility. The nurse recognizes that she needs clarification from a senior colleague. Another example of a critical thinking attitude is confidence. In this case confidently inserting an IV line allows the nurse to convey expertise and a sense of calm, leading the patient to trust the nurse. Following policy and procedure is an example of following standards of care, not of a critical thinking attitude. Making sure that the dressing is covered is a step in following good standards of IV care but is not a critical thinking attitude.

Which steps does the nurse follow when he or she is asked to perform an unfamiliar procedure? (Select all that apply.) Seeks necessary knowledge Reassesses the patient's condition Collects all necessary equipment Delegates the procedure to a more experienced staff member Considers all possible consequences of the procedure

Seeks necessary knowledge Considers all possible consequences of the procedure You require additional knowledge and skills in situations in which you are less experienced. When you are asked to administer a new procedure with which you are unfamiliar, follow the three choices: seek necessary knowledge, collect necessary equipment, and consider all possible consequences of the procedure. Collecting necessary equipment and considering potential consequences is needed for any procedure.

A nurse is orienting a new graduate nurse to the unit. The graduate nurse asks, "Why do we have standing orders for cases when patients develop life-threatening arrhythmias? Is not each patient's situation unique?" What is the nurse's best answer? Standing orders are used to meet our physician's preferences. Standing orders ensure that we are familiar with evidence-based guidelines for care of arrhythmias. Standing orders allow us to respond quickly and safely to a rapidly changing clinical situation. Standing orders minimize the documentation we have to provide.

Standing orders allow us to respond quickly and safely to a rapidly changing clinical situation. Standing orders are preprinted documents containing orders for the conduct of routine therapies, monitoring guidelines, and/or diagnostic procedures for specific patients with identified clinical problems. They are common in critical care settings and other specialized practice settings in which patients' needs change rapidly and require immediate attention.

As part of their right to refuse treatment, patients may prepare advance directives specifying what life-saving treatments they do or do not wish to receive. When determining the legality of an advance directive, the nurse should know the applicable _______ laws. Federal State County Local

State State laws vary on the legalities of the various forms of advance directives, so the nurse needs to know the applicable state laws.

Administration Laws?

State board of Nursing

Who developed policy and statements on the rights of mentally ill individuals?

The Joint Commission

LPN/LVNs need to know what they can and cannot do within their scope of practice. They would need to refer to: Interstate compact ANA The Nurse Practice Act of their licensing state Their employing institution

The Nurse Practice Act of their licensing state The state in which the nurse receives licensing has adopted a Nurse Practice Act that defines the scope of nursing practice for the LPN/LVN within that state. The interstate compact in a legal agreement that allows multistate practice of nursing.ANA is involved in developing standards of care for nursing practice. The employing institution may limit further the scope of practice for an LPN/LVN, but it is for that institution only.

The patient refused to take medication his doctor ordered for relief of pain. The LVN knows this is a patient right established by?

The Patient Self-Determination Act

Bio-cultural needs

Which factor is least significant during assessment when gathering information about cultural practices?

What is deposition?

a process where witnesses are required to undergo questioning by the attorneys

Civil

The client's right to refuse treatment is an example of _________ laws.

American Nursing Association

The code of ethics for nurses is composed and published by

A nurse manager is conducting an employee evaluation for a new employee. Which employee behavior best indicates that the nurse is providing patient-centered care? The nurse shares his or her own personal problems in order to obtain the patient's trust and to show empathy with the family. The nurse avoids raising the patient's anxiety by chatting about pleasant topics before unpleasant procedures. The nurse clarifies patients' reasons for refusing medications without becoming defensive. The nurse avoids upsetting patients by not bringing up health care issues that might upset the patient.

The nurse clarifies patients' reasons for refusing medications without becoming defensive. Providing patient-centered care involves clarifying patients' reasons for refusing medications. Refraining from discussing own concerns demonstrates a patient-centered approach. The nurse displays patient-centered care by attempting to talk the patient through anxiety-laden procedures. Avoiding discussing health issues does not display a patient- centered approach.

A charge nurse is evaluating the performance of a staff nurse. Which activity best demonstrates expert thinking, rather than novice thinking? The nurse focuses on own actions. The nurse follows clear-cut rules. The nurse considers options before acting. The nurse relies on step-by-step procedures.

The nurse considers options before acting. A nurse who assesses and considers different options for intervening before acting is demonstrating expert thinking. Novice thinking is characterized by focusing on one's own actions, following clear-cut rules, and relying on step-by-step procedures.

The patient has a central venous line. The registered nurse (RN) delegates changing the sterile dressing over the line to a nursing assistant. The nursing assistant does not understand sterile technique and contaminates the dressing. An infection develops in the patient. The nurse manager discusses the action of the RN. Which statement is correct regarding the nurse's action? The nursing assistant is guilty of malpractice. The nurse is responsible for the acts delegated. The hospital cannot be held responsible for the act of its employees. No harm came to the patient, so a malpractice suit cannot be claimed.

The nurse is responsible for the acts delegated. The registered nurse is responsible for delegating appropriately. It is not appropriate to delegate a skill requiring sterile technique and assessment of a central line site to a nursing assistant. It is not within the nursing assistant's scope of practice to perform central line dressing changes. The hospital is responsible for the acts of its employees under the concept of respondeat superior. Harm was caused by this act, since the patient did develop an infection, so a malpractice suit can be claimed.

Collecting all available information about the situation

The nurse is working with parents of a seriously ill newborn. Surgery has been proposed for the infant, but the chances of success are unclear. In helping the parents resolve this ethical conflict, the nurse knows that the first step is

The registered nurse, employed by the risk management department of a hospital is giving an inservice class on social media to nursing employees. Which one of these statements should be included in this class? Posts are private and accessible only to the intended recipient. Once content has been deleted, it is no longer accessible. No harm is done if patient information is disclosed only to the intended recipient. The nurse should not refer to a patient, even by nickname or room number.

The nurse should not refer to a patient, even by nickname or room number. The nurse should never refer to a patient on social media, even by nickname or room number. Social media posts are not considered private and are not always accessible only to the intended recipient. Even deleted content is accessible at times on social media. Disclosing any patient information is a harmful act, even if it is disclosed only to the intended recipient.

The nurse knows that all patients have the right to nursing interventions regardless of their race, religion, or gender. The ethical principal that best describes this concept is?

justice

The nurse is documenting several aspects of an assessment conducted on a patient newly admitted to the hospital with a suspected myocardial infarction. Which of the following is considered objective data? The patient states, "I feel like an elephant is standing on my chest." The patient is diaphoretic, pale, hypotensive, and tachycardic The patient states, "This is the worst pain I have had in my life." The patient states, "I have pain under the breastbone in my chest."

The patient is diaphoretic, pale, hypotensive, and tachycardic Objective data is the type of data that the nurse will collect through observation of the patient. It is measurable, and often called signs. The patient statements of a feeling of an elephant standing on the chest, severe pain, and pain under the breastbone are all examples of subjective data.

What is the significance of 1991?

The patient self Determination Act

The nurse is planning care for an 8-year-old patient who had undergone a tonsillectomy yesterday and is having difficulty increasing fluid intake postoperatively due to incisional pain. Which of the following is an appropriate patient goal? The patient will consume 1000 ml within 24 hours. Provide the patient with small sips of favorite liquids. Encourage the patient to take prescribed pain medications. Apply an ice collar to the patient's throat if desired.

The patient will consume 1000 ml within 24 hours. A goal is a statement of what is to be accomplished. It should be stated in terms of what the patient will do rather than what the nurse will do. The statement "the patient will consume 1000 ml of fluid within 24 hours" is a goal. The statements regarding providing sips of liquids, administering pain medications and ice collars are nursing interventions, not goals.

Relationships

The philosophy sometimes called the code of ethics of care suggests that ethical dilemmas can best be solved by attention to

True

True or False - The dominant value in American society of individual autonomy and self-determination may be in direct conflict with diverse groups.

False

True or False - The nurse practice acts are an example of civil law.

A nurse is on duty in the emergency room when the nurse is notified that a school bus has been struck by a train. Immediately the nurse reports to the triage area and begins the task of determining the severity of injuries, so that the most critical patients receive care first. Which ethical theory is the nurse putting into action? Utilitarianism Act deontology Rule deontology Virtue ethics

Utilitarianism Utilitarian ethics states that "what makes an action right or wrong is its utility, with useful actions bringing about the greatest good for the greatest number of people." By triaging the patients according to the severity of the injury, the nurse will be able to save the lives of more patients, thus doing the greatest good for the greatest number of people. Act deontologists determine the right thing to do by gathering all the facts and then making a decision. Rule deontologists emphasize that principles guide our actions. Virtue ethics are tendencies to act, feel, and judge that develop through appropriate training but come from natural tendencies.

The sequencing of stages of grief may occur in order, they may be skipped, or they may reoccur

When helping a person through grief work, the nurse knows

National Federation of LPN, Nurses code of Ethics:

know function within your scope of practice, maintain patient confidences, provide healthcare without discrimination

Civil Ligation?

lawsuit in a civil court, begins when the plaintiff contacts an attorney

What are some Negligent Acts?

medication errors, falls that occur without providing safety, failure to use sterile technique, failure to report changes in clients condition, failure to provide complete report to oncoming nursing staff

Ommission:

not doing an act

Define proximate cause:

occurrence of harm depended directly on the occurrence of the breach

Types of Special consent:

organ, photographing, use of restraints

Values?

personal beliefs about worth of an object, idea, custom, or an attitude

What is value clarification?

process of self evaluation that helps gain insight to personal values

What is Malpractice?

professional negligence

The LVN knows that one of the best defenses against a lawsuit is for a nurse to?

promote a positive nurse-patient relationship

Intervention Project for Nurses (IPN)

always report

Types of consent:

admissions agreement, research, blood transfusion, surgical

What is Interstate compact?

allows multi state practice of nursing

Good Samaritan Law?

provides immunity from liability in certain circumstances, encourages health care prof. to assist in emergencies without fear of being sued for care provided (except when gross negligence has occurred)

Define duty:

refers to established relationship between the patient and the nurse

What is the Doctrine of informed consent?

refers to full disclosure of facts that the patient needs to make informed decision before invasive treatment

What does the Board of Vocational Nursing and Psychatric Technicians do?

regulate what you can/cant do

What is an appeal?

requesting a review of the decision

What is Autonomy?

respect for an individuals right to self-determination

The patient admitted for surgery has a lump in her breast. The patients daughter asks the LVN if her mother should have surgery. Which issued might be considered before responding?

respect for people and personal autonomy

What is accountability?

being responsible for ones own actions

Contract Law?

between nurse and pt, employer, insurance or agency

The health care providers order read, "assist the patient with walking." The nurse allowed the patient to walk alone. The patient fell, fracturing the humerus. Which verdict is most likely occurrence?

the nurse will only be guilty of negligence

What is Non-Maleficence?

to do no harm

The nurse working in a nursing home correctly recognizes that the duties include patient advocacy. Which role is considered a primary duty of patient advocacy?

to safe guard the well being of every patient

Civil Battery?

unlawful touching of a person

Ethics?

values that influence a persons behavior and feelings about what is right and wrong

The nurse loves photography and brings his camera to work at the nursing home, He takes a picture of one of his coworkers walking a patient. What best describes the action taken by the nurse?

violated the patients right to privacy

What is Euthanasia?

with holding of life saving treatment

The client's right to refuse treatment is an example of _________ laws.

civil

An alert adult patient has refused an intramuscular injection. The nurse waits until the patient is asleep and gives the injection anyway. The nurse could be charged with?

civil battery

Plaintiff?

complaining party

What does a Summons do?

court order notifies defendant of legal actions

What is an Advance Directive?

written documentation by state law that provides directions concerning the provision of care when a client is unable to make his or her on decision. Ex: living wills and durable power of attorney

What is Deliberation?

deciding guilt or innocence of defendant

The newly licensed LVN/LPN has reviewed the Nurse Practice Act of the state of licensure. What is the purpose of this documentation?

define the scope of nursing practice

Common Laws?

developed in response to SPECIFIC LEGAL QUESTIONS brought before the court

How to avoid a lawsuit?

document everything, compassion/competent nursing care

Define harm:

does not have to be physical injury

Commission:

doing an act

Constitution?

due process, equal protection

Health care proxy?

durable power of attorney: a person to make decisions regarding medical treatment if the patient is unable to make them

What elements does the Malpractice concept contain?

duty, breach, harm, proximate cause

The nurses first job an as LVN is on a unit that cares for the terminally ill children. What action should be taken by the nurse before helping families cope with their childs illness?

evaluate her own personal mores and customs that may affect the practice of nursing in general

Define breach:

failure to preform the duty in a reasonable, prudent manner

Practitioner Assisted Suicide:

form of active euthanasia, practitioner taking an active role in helping to end a patients life

LVNs have a code of professional and personal ethics to follow. The purpose of a code of ethics is to?

give the nurse guidelines for ethical decision making

Customs?

habits, way of acting

2. Identify which of the following is the most basic type of health promotion activity ( select all that apply) 1. A billboard promoting abstinence to prevent sexually transmitted diseases and unplanned pregnancies 2. A wellness assessment program 3. An environment control program about pesticide use 4. A nurse who models healthy lifestyle behaviors 5. A school of nursing that holds a blood pressure fair

1 & 5 are correct Examples are billboards, posters, brochures, newspapers, books, and health fairs. It raises the level of awareness and knowledge of individuals and groups about healthy behaviors

As an advocate for the client, the nurse must make sure that "safe, effective care" is given in conformity with the A. Nurse Practice Act (NPA). B. American Nursing Association (ANA) C. National Council for Lisensure Examinations D. State Board of Licensure

A. Nurse Practice Act (NPA).

A registered nurse arrives at work and is told to "float" to the ICU for the day because the ICU is understaffed and needs an additional nurse to care for the clients. The nurse has never worked in the ICU. Which of the following is the most appropriate nursing action? A. refuse to float in the ICU B. call the hospital lawyer C. call the nursing supervisor D. report to the ICU and identify tasks that can be safely performed

Answer: D Rationale - floating is acceptable and legal practice. The nurse floated to a unit until will be given orientation; be assigned to care for stable patients or those with conditions similar to her training experience.

The nurse practice acts are an example of civil law. A. True B. False

Answer: False Rationale: Nurse practice acts fall under Statutory law

A general approach to quality improvement where a qualified agent designates formal recognition to individuals or institutions that have met minimum standards of performance is best described as: A. Accreditation B. Charter C. Credentialing D. Licensing

C. Credentialing

A nurse working with a Hispanic client explains the referral options available for the client to receive a mammogram. One option is free and has limited Spanish language resources. The other option has a nominal fee and comprehensive Spanish language resources. The nurse supports the client's decision to choose the provider that the client feels would best meet her needs. This advocacy role is best described as: A. Intercessor B. Mediator C. Obstructer D. Promoter

D. Promoter

A home health nurse receives a referral to educate an older adult client with diabetes in proper foot care. The nurse's assessment of the client determines that the client has poor eyesight that may affect the client's ability to learn and perform certain skills. Which educational principle is being examined? A. Cognitive domain B. Events of instruction C. Principles of effective instruction D. Psychomotor domain

D. Psychomotor domain

Disasters may be classified by type, level (response and relief costs), and scope. Disasters such as multifamily home fires are typically responded to by the fire/police department and the: A. Centers for Disease Control & Prevention (CDC) B. Federal Emergency Management Agency (FEMA) C. Public Health Service (PHS) D. Red Cross chapter

D. Red Cross chapter

8. A client has complete confidence that she has learned health behaviors that will enable her to maintain her current health status by exercising three to five times a week, monitoring her dietary intake , and by no longer engaging in risky behaviors. What stage of health behavior is this client experiencing? 1. Maintenance 2. Action 3. Preparation 4. Termination

4. Termination - when individual has complete confidence that problem is no longer a threat or temptation

1. A client reports that he believes he will "never lick the habit" of smoking because he has tried before and failed. Using the transtheoretical model (TTM), what stage of health behavior is the client functioning in? 1. Preparation stage 2. Contemplation stage 3. Termination stage 4. Action stage 5. Precontemplation stage 6. Maintenance stage

5. Precontemplation stage- the person does not change his/her behavior in the next 6 months. In this stage, the client tends to avoid reading, talking, and thinking about his/ her risky behavior

Finding resources to implement evidence-based practice (EBP) in community health will continue to be a challenge because of the emphasis on quality care, equal distribution of health care resources, and cost control. Which of the following would demonstrate a creative strategy to implementing EBP? Select all that apply. A. Adopting quality indicators for evaluating websites claiming to contain EBP B. Avoiding the issue of community politics C. Creating the role of a knowledge manager D. Making decisions on behalf of the community E. Providing all staff full access to the Internet

A. Adopting quality indicators for evaluating websites claiming to contain EBP & C. Creating the role of a knowledge manager

A nurse coordinating care for undocumented minority workers with a high incidence of tuberculosis (TB) conducts a presentation before the local community health board to focus attention on the magnitude of the problem and its potential impact on the local community. The presentation stimulates the community to explore innovative solutions to increase screening for and treatment of TB cases. This scenario is an example of the relationship between: A. Advocacy and case management B. Advocacy and continuity of care C. Care management and case management D. Care management and continuity of care

A. Advocacy and case management

The nurse in community health identifies an elder abuse problem because of caregiver stress among families in the local community due to lack of caregiver support services. The next step in the community-oriented nursing process would be to: A. Analyze the community problem B. Establish priorities C. Establish goals and objectives D. Identify intervention activities

A. Analyze the community problem

A neighborhood association group has asked the local nurse in community health for a class on environmental hazards. The nurse in community health has seen good information in the community health text and thinks about getting permission to copy some of the information. The most important thing the nurse should do before using copies of this material is to: A. Assess the literacy level of the group B. See how many plan to attend C. See whether the group is ready to learn D. Secure a good space for a group meeting

A. Assess the literacy level of the group

A nurse in community health in California has been working with a 6-year-old child that was rescued from a mudslide. The nurse will observe the child for which of the following stress effects? Select all that apply. A. Bed-wetting episodes B. Desire to return to school C. Fantasies of denial D. Increased playfulness with peers E. Thumb sucking

A. Bed-wetting episodes C. Fantasies of denial E. Thumb sucking

Identification of the discrepancies between the quality standards of the agency and the actual practice of the health care professionals is part of the interpretation component of quality assurance programs. Other factors addressed during this stage are (select all that apply): A. Choices of possible courses of action B. Follow-up evaluation C. Strengths and weaknesses D. Taking action

A. Choices of possible courses of action C. Strengths and weaknesses

The nurse engaging in formative program evaluation would most likely: A. Conduct medical record audits for quality assurance B. Make a home visit before a client is discharged from the program C. Participate in new client evaluation D. Write policy for risk management

A. Conduct medical record audits for quality assurance

Local officials have requested a program evaluation of a comprehensive teen sex education program offered in the local schools in preparation for potential budget discussions. A nurse in community health conducts a program evaluation and determines that the teen pregnancy rate has gradually declined over the years that the program has been in place. The community is measuring the program's: A. Efficiency B. Progress C. Relevance D. Sustainability

A. Efficiency

The nurse in community health defines goals and measurable objectives during the planning phase of a community health intervention. This also marks the beginning of the: A. Evaluation phase B. Implementation phase C. Needs assessment D. Problem analysis

A. Evaluation phase

The Omaha System is a client classification system developed by the Visiting Nurses Association of Omaha, Nebraska, that has the potential to improve the delivery of care by: A. Improving the description of care B. Minimizing the assessment required C. Predicting the outcome D. Decreasing the communication needs

A. Improving the description of care

A controlled study indicated that providing family caregiver training would assist informal caregivers in understanding the disease process of dementia, recognizing their own limits, and reducing adverse outcomes. This study is an example of: A. Practice-oriented research B. Continuous quality improvement C. Knowledge management D. Individual differences

A. Practice-oriented research

An example of using evidence-based practice (EBP) to improve practice is the EBP project for public health nursing interventions initiated in the 1990s, which describes the practice of the nurse at the community and systems level, as well as practice with individuals and families. This example of using evidence to improve practice is: A. The Minnesota Model B. The Cochrane Database of Systematic Review C. Healthy People 2010 D. The CDC's Community Guide

A. The Minnesota Model

Obtaining informed consent is the responsibility of A. The physician B. The RN manager C. The nurse D. The CNA

A. The physician Rationale: The physician is RESPONSIBLE for obtaining an informed consent.

Given recent vaccine shortages for the flu, the local nurses in community health form a group to evaluate the process of scheduling and operating flu vaccination clinics in the community and review the community's complaints from the previous season. The activity best represents the principle of: A. Total quality management (TQM) to achieve continuous quality improvement (CQI) B. Quality assurance (QA) to achieve continuous quality improvement (CQI) C. Risk management to achieve quality D. Continuous quality improvement (CQI) to achieve total quality management (TQM)

A. Total quality management (TQM) to achieve continuous quality improvement (CQI)

Although the client refused the procedure, the nurse insisted and inserted a nasogastric tube in the right nostril. The administrator of the hospital decides to settle the lawsuit because the nurse is most likely to be found guilty of which of the following? 1. An unintentional tort 2. Assault 3. Invasion of Privacy 4. Battery

Answer #4 Rationale: Battery is the willful touching of a person without permission. Another name for an unintentional tort is malpractice. This situation is an intentional tort because the nurse executed the act on purpose.

The primary care provider wrote a do-not-resuscitate (DNR) order. The nurse recognizes that which applies in the planning of nursing care for this client? 1. The client may no longer make decisions regarding his or her own health care. 2. The client and family know that the client will most likely die within the next 48 hours. 3. The nurses will continue to implement all treatments focused on comfort and symptom management. 4. A DNR order from a previous admission is valid for the current admission

Answer: #3 Rationale: A DNR order only controls CPR and similar life-saving treatments. All other care continues as previously ordered. Competent clients can still decide about their own care (including the DNR order.)

A primary care provider's orders indicated that a surgical consent form needs to be signed. Since the nurse was not present when the primary care provider discussed the surgical procedure, which statement "best" illustrates the nurse fulfilling the client advocate role? 1. "The doctor has asked that you sign the consent form." 2. "Do you have any questions about the procedure?" 3. "What were you told about the procedure you are going to have?" 4. "Remember that you can change your mind and cancel the procedure."

Answer: #3 Rationale: This is the best answer because the nurse is assessing the client's level of knowledge as a result of the discussion with the primary care provider. Based on this assessment, the nurse may initiate other actions (call the primary care provider if the client has any questions)

The nurse's partner/spouse undergoes exploratory surgery at the hospital where the nurse is employed. Which practice is most appropriate 1, Because the nurse is an employee, access to the chart is allowed. 2. The relationship with the client provides the nurse special access to the chart. 3. Access to the chart requires a signed release form 4. The nurse can ask the surgeon to discuss the outcome of the surgery.

Answer: #3 Rationale: The only person entitled to information without written consent is the client and those providing direct care. The nurse has open access to information regarding assigned clients only.

A primary care provider prescribes on tablet, but the nurse accidentally administers two. After notifying the primary care provider, the nurse monitors the client carefully for untoward effects of which there are none. Is the client likely to be successful in suing the nurse for malpractice? 1. No, the client was not harmed 2.No, the nurse notified the primary care provider 3. Yes, a breach of duty exists 4. Yes, foreseeability is present

Answer: 1 Rationale: All elements such as duty, foreseeability causation, harm/injury and damages must be present for malpractice to be proven.

The nurse notices that a colleague's behaviors have changed during the past month. Which behaviors could indicate signs of impairment? Select all that apply 1. Is increasingly absent from the nursing unit during the shift. 2. Interacts well with others 3. "Forgets" to sign out for administration of controlled substances. 4. Offers to administer prn opiates for other nurse's clients 5. Is able to say "no" to requests to work more shifts.

Answer: 1, 3, 4 Rationale: Interacting with others (versus isolating self from others) and setting limits on the number of hours working are positive behaviors and not indicative of possible impairment. The other options are warning signs for impairment

Following a motor vehicle crash, a nurse stops and offers assistance. Which of the following actions are most appropriate? Select all that apply 1. The nurse needs to know the Good Samaritan Act for the state. 2. The nurse is not held liable unless there is gross negligence 3. After assessing the situation, the nurse can leave to obtain help. 4. The nurse can expect compensation for helping. 5. The nurse offers to help but cannot insist on helping.

Answer: 1,2,5 Rationale: The nurse is subject to the limitations of state law and should be familiar with the Good Samaritan laws in the specific state. Gross negligence would be described by the individual state law. Unless there is another equally or more qualified person present, the nurse needs to stay until the injured person leaves. The nurse should ask someone else to call or go for additional help. The same client rights apply at the scene of an accident as well as those in the workplace.

A community health nurse is working with an uninsured family with two children. The nurse assists the parents in applying for SCHIP benefits and securing an appointment for the children with a community pediatrician that participates in SCHIP. The intervention can best be described as: A. Care management B. Case management C. Continuity of care D. Disease management

B. Case management

A nurse in community health is invited to work with a coalition of churches to address safety concerns for children in the local community. The nurse provides training in problem-solving skills, manages conflict, facilitates the process, and provides expertise in interpreting data. This nurse has chosen the implementation role of: A. Change agent B. Change partner C. Group leader D. Data collector

B. Change partner

The major evaluation source for a nurse to use to determine the effectiveness of a teen driver safety program is: A. Centers for Disease Control and Prevention (CDC) reports B. Community health indexes C. Recent census data D. Voter registration records

B. Community health indexes

Following the attacks of 9/11, a nurse practitioner in a family clinic used opportunities at the clinic staff meetings to speak about her own feelings of loss and guilt. This strategy indicates that the nurse was aware of what phenomenon related to disasters? A. Anxiety B. Effects of stress on individuals C. Sense of urgency D. Scapegoating and blaming

B. Effects of stress on individuals

A community-oriented nurse convenes a support group for teenage mothers. The nurse understands that this strategy will foster cohesiveness among members and allow the members to learn from one another. What other benefit specific to group teaching will be achieved? A. Cultural sensitivity B. Efficiency in client service C. Learning of new skills D. Distraction-free surroundings

B. Efficiency in client service

The nurse puts a restraint jacket on a client without the client's permission and without the physicians order. The nurse may be guilty of assault. A. True B. False

B. False Rationale: Battery is physical in nature. Assault is a threat.

A student nurse who is employed as a nursing assistant may perform any functions that she taught in school. A. True B. False

B. False Rationale: You may only perform functions that you are licensed to perform while on the job.

The recovery phase of a disaster can take a very long time. Nurses need to be aware that despite effective disaster preparedness and response efforts: A. Environmental hazards are minimal B. Individuals must ultimately recover on their own C. The government provides economic support D. Religious organization must bear the burden of the community

B. Individuals must ultimately recover on their own

Nurses often participate on field assessment teams (surveillance) during a disaster response. These assessments are crucial to best help: A. Encourage good intentions of those giving aid B. Match available resources to the population's emergency needs C. Separate casualties and allocate treatment D. Provide compassion and dignity

B. Match available resources to the population's emergency needs

A state health department wants to ensure that the local health departments are delivering quality client care and can demonstrate the degree of excellence attained. The principle that is best defined by this statement is: A. Continuous quality improvement (CQI) B. Quality assurance (QA) C. Risk management D. Total quality management (TQM)

B. Quality assurance (QA)

A nurse is conducting an in-service education session on the Centers for Disease Control and Prevention's (CDC's) updates for preventive services for a group of nurses in community health. The nurse would demonstrate the best understanding of the educational process by integrating which planning strategies? Select all that apply. A. Use of films B. Small group interaction C. Use of games D. Session timing E. Session space

B. Small group interaction C. Use of games D. Session timing &E. Session space

Tertiary prevention

Begins after illness, when a defect or disability is fixed, stabilized, or determined to be irreversible. Focuses on rehab and restoring to optimum level of functioning

A nurse educator who teaches at the local community college takes the time to read and understand her community's disaster plans and participates in community mock disasters as a leader of the triage team. The best description of the nurse's activities would be: A. ARC disaster training B. Community preparedness C. Personal preparedness D. Professional preparedness

D. Professional preparedness

One reason that nursing may be slow in developing evidence-based practice (EBP) for nursing may be the lack of understanding about the differences between EBP and: A. Evidence gathering B. Research design C. Research funding D. Research use

D. Research use

The nurse notes that an advance directive is in the client's medical record. Which of the following statements represents the best description of guidelines a nurse would follow in this case? A. A durable power of attorney for health care is invoked only when the client has a terminal condition or is in a persistent vegetative state B. A living will allows an appointed person to make health care decisions when the client is in an incapacitated state. C. A living will is invoked only when the client has a terminal condition or is in a persistent vegetative state. D. The client cannot make changes in the advance directive once the client is admitted into the hospital.

C. A living will is invoked only when the client has a terminal condition or is in a persistent vegetative state. Rationale: A living will directs the client's healthcare in the event of a terminal illness or condition. A durable power of attorney is invoked when the client is no longer able to make decisions on his or her own behalf. The client may change an advance directive at any time.

When working with communities, "best practices," the application of the best available evidence to improve practice, must also be: A. Accessible and diverse B. Competent and compliant C. Culturally and financially appropriate D. Reasonable and deliverable in a timely fashion

C. Culturally and financially appropriate

A nurse in community health has determined that there is a need for a program for teenage fathers who want to learn about childcare. The next step in the program management process would be to: A. Conduct a survey to determine how many children the fathers have B. Determine whether the fathers have benefited from this type of program before C. Meet with community members to form a planning body D. Provide the fathers with community resources

C. Meet with community members to form a planning body

A nurse in community health is participating on a community service board strategic team that is currently assessing the community's strengths, the local public mental health system, the community's mental health status, and other variables. This best describes what strategic program planning model used today in the public health arena? A. Assessment Protocol for Excellence in Public Health (APEXPH) B. Health Evaluation Data Information System (HEDIS) C. Mobilizing for Action Through Planning and Partnership (MAPP) D. Planning Approach to Community Health (PATCH)

C. Mobilizing for Action Through Planning and Partnership (MAPP)

A community health nurse involved in care management would most likely: A. Develop, conduct, and evaluate health teaching programs in primary care B. Manage the staff at a free clinic C. Monitor the health status, resources, and outcomes for an aggregate D. Provide immunizations to migrant workers

C. Monitor the health status, resources, and outcomes for an aggregate

Miss Magu, an 88-year old woman, believes that life should not be prolonged when hope is gone. She has decided that she does not want extraordinary measures taken when her life is at its end. Because she feels this way, she has talked with her daughter about her desires, completing a living will and left directions with her physician. This is an example of: A. Affirming a value B. Choosing a value C. Prizing a value D. Reflecting a value

C. Prizing a value

The general approach to quality improvement known as licensure that grants control over who can enter into and who exists in a profession can best be described as a contract between the: A. Consumers and the profession B. Legislature and the state board C. Profession and the state D. Public and the professional associations

C. Profession and the state

The gold standard of evidence gathering in evidence-based practice is: A. Clinical knowledge and judgment B. Expert opinions C. Randomized clinical trials D. Theories of practice

C. Randomized clinical trials

A nurse functioning in the role of a case manager decides to use a CareMap tool. The nurse also reviews the available scientific literature because: A. CareMaps always cite the source of their data B. CareMaps are often incorrect C. CareMaps only provide limited information D. CareMaps may not be evidence based

D. CareMaps may not be evidence based

A nurse performing home hospice case management notes the increasing number of hospice clients that lack caregivers in the home environment. The nurse identifies the potential need for a hospice house facility to meet the needs of these clients. The case management process frequently reveals such larger picture issues as (select all that apply): A. Community cost concerns B. Community conflict-resolution skills C. Community satisfaction D. Community weaknesses in quality of services E. Community weaknesses in quantity of services

D. Community weaknesses in quality of services E. Community weaknesses in quantity of services

The nurse in community health is meeting with staff to systematically plan for a new outreach program. Doing so helps them to: A. Assess the needs of potential outreach clients B. Recognize the special needs of vulnerable people in the area C. Identify how the problems of similar programs will not be repeated D. Identify the resources and activities that will help them meet their program objectives

D. Identify the resources and activities that will help them meet their program objectives

A multidisciplinary quality assurance team has reviewed an organization's stated philosophy and objectives and developed a conceptual model for appraisal that integrates peer review and client satisfaction. The quality assurance program component that should be addressed next would be: A. Action B. Process C. Structure D. Outcome

D. Outcome

Evidence-based practice (EBP) is defined as those interventions in health care that are based on the best available (preferably scientific) evidence. Another way of defining EBP is to state that EBP includes the evaluation of evidence and the application of acquired evidence to practice, making EBP both: A. Assessment and decision B. Policy and procedure C. Process and procedure D. Process and product

D. Process and product

The purpose of record keeping in public health agencies is to maintain complete information on clients served and the extent and quality of service provided to those clients. The records also provide information for education and research. Another important use of the records is to: A. Determine raises for personnel B. Explain cost overruns C. Foster independence in clinical practice D. Resolve legal issues in malpractice suits

D. Resolve legal issues in malpractice suits

The nurse in community health reviews the monthly and year-to-date health service use report for the local community to monitor trends as correlates of the community's health. The nurse is viewing community health through the dimension of: A. Partnership B. Process C. Status D. Structure

D. Structure

A nurse in community health becomes aware that a teen smoking cessation program offered at the health department is a demonstration project. In evaluating this program, the nurse would be concerned with the program's: A. Efficiency B. Impact C. Relevance D. Sustainability

D. Sustainability

The nurse is obligated to follow a physicians order unless: A. The order is a verbal order B. The order is illegible C. The order has not been transcribed D. The order is an error, violates hospital policy, or would be detrimental to the client

D. The order is an error, violates hospital policy, or would be detrimental to the client.

The major factor that has increased Florida's vulnerability to natural disasters in the recent decades has been: A. El Niño B. Geography C. Trade winds D. Urbanization

D. Urbanization

To maintain effective disaster preparedness, nurses working in the community can play a critical role in providing an updated record of: A. Immunizations B. Active tuberculosis (TB) cases C. WIC enrollees D. Vulnerable populations

D. Vulnerable populations

Two nurses in community health schedule a day to ride through a low-income community to better understand the community and its boundaries, trends, rhythm, stability, and changes that can affect the health of that community. This direct data collection method is often referred to as: A. Composite database B. Participant observation C. Secondary analysis D. Windshield survey

D. Windshield survey