unit 5 exam

The nurse is caring for a client with a diagnosis of end-stage renal disease. The client tells the nurse that a lawyer has prepared a living will and will be visiting the client today so that the will can be reviewed. The client also tells the nurse that the lawyer has asked for a witness to sign the will and requests that the nurse act as a witness. Which is the most appropriate nursing response to the client?

"A nurse caring for a client cannot serve as a witness to a living will."

The preceptor is explaining to the preceptee the proper way to handle conflict resolution with other staff members. What is the best comment the preceptor could make?

"Conflict resolution encourages both conflicting parties involved to get together to solve problems."

The nurse manager asks a licensed practical nurse to work on her day off because of a short-staffing problem. The licensed practical nurse has already made plans and does not want to work on the day scheduled to be off. Which response by the licensed practical nurse to the nurse manager is assertive?

"I have planned to take the day off and will not be able to work on that day."

The nurse has instructed an unlicensed assistive personnel (UAP) in the procedure for collecting a 24-hour urine specimen from a client. The nurse determines that the UAP understands the directions if the UAP makes which statement?

"I need to ask the client to void, discard the specimen, and note the start time."

The nurse manager is meeting with two nurses who are having problems working together. What statement by the nurse manager would be most beneficial to ensure a productive outcome?

"I want you both to go into the empty office and discuss your problem together."

The manager is conducting an interview with a long-term staff nurse who has had several clients submit complaints about this particular nurse. What is the most appropriate comment the manager could make to address this issue with the nurse?

"I would like you to tell me first what you think about these complaints."

At the before-shift conference, the nurse manager needs to tell the staff that they are short-staffed for the day. What is the best comment the nurse manager could make to the staff?

"I'll be on the unit all day so let me know how I can help you."

A client with metastatic bladder cancer is admitted to the hospital for chemotherapy. During data collection, the client tells the nurse that a living will was prepared 2 years ago and asks the nurse if this document is still effective. Which is the most appropriate nursing response?

"Yes, it is effective but you may want to discuss any changes you desire with your primary health care provider."

The nurse planning the client assignments for the day has a licensed practical nurse (LPN) and an unlicensed assistive person (UAP) on the nursing team. Which client should the nurse most appropriately assign to the LPN?

A client who had a myocardial infarction 4 days ago who becomes dyspneic on exertion

Several clients are awaiting treatment in an outpatient mental health crisis treatment center. Which client should be treated first?

A client who says that voices sponsored by the FBI are telling him to stab his roommates

A client who has been diagnosed with terminal cancer states wanting no further treatment and also informs the physician of not wanting any resuscitative action taken if the client experiences a cardiac or respiratory arrest. What type of order does the nurse anticipate the physician will write?

A do-not-resuscitate order

The nurse is told in intershift report that a client has been appointed a legal guardian. The nurse looks for what evidence that supports this information?

A judicial decision in a court of law

The emergency department (ED) nurse manager is conducting the daily preshift meeting with staff. Which piece of information would be most important for the manager to discuss with staff at this meeting?

A new client flow policy that is being tried that day

A client who has end-stage chronic obstructive pulmonary disease (COPD) asks the nurse, "Am I going to be getting better? Is there a cure?" What is the best response by the nurse that demonstrates the professional value, veracity?

Although there is no cure for this disease, we will keep you as comfortable as possible."

The nurse who works in a cardiac unit reports to work and is told that she needs to float to the neurological nursing unit because of a short-staffing problem on that unit. The nurse reports to the unit and receives a client assignment for the day from the nurse manager. The nurse is angry with the assignment because of a belief that the assignment is more difficult than the assignment delegated to other nurses on the unit. The nurse should carry out which action?

Ask the nurse manager of the neurological unit to discuss the assignment.

The nurse tells an unlicensed assistive personnel (UAP) that a client recovering from a myocardial infarction requires a complete bed bath. During the bath, the nurse should intervene if the nurse observed the UAP performing which action?

Asking the client to wash his legs

The LPN is assigning clients on a rehabilitation unit. Which of the following nursing actions should the LPN complete prior to assigning any delegated task?

Assess the clients

The nurse discovers that one of her assigned clients is bleeding excessively from an abdominal incision. The nurse gives specific prescriptions to an unlicensed assistive personnel (UAP) to attend to the other clients and tells another nurse to call the primary health care provider immediately. In this situation, the nurse is implementing which leadership style?

Autocratic

The nurse is caring for a client who is receiving intramuscular antibiotics. The nurse enters the client's room to administer the prescribed antibiotic, and the client tells the nurse that the medication burns and that he does not want the medication to be given. The nurse tells the client that the medication is necessary and administers the medication. With which crime can the client legally charge the nurse as a result of the nursing action?

Battery

A client requires a partial bed bath. The nurse gives instructions to an unlicensed assistive personnel (UAP) about the partial bed bath and should tell the UAP to perform which action?

Be sure to bathe the client's body parts that would cause discomfort or odor if left unbathed.

The nurse is caring for a client who has been intubated and on a mechanical ventilator and has been restrained with soft wrist restraints. The client no longer requires the restraints, so the nurse removes them. What type of ethical decision making does the nurse display?

Beneficence

A nurse provides patient care within a philosophy of ethical decision making and professional expectations. What is the nurse using as a framework for practice?

Code of Ethics

The nurse is planning care for the day for a client with multiple diagnoses. Which of the following criteria should the nurse consider first when setting priorities for the care of the client?

Consider the priority of maintaining vital signs.

Which type of law concerns offenses that violate the public's welfare?

Criminal law

The nurse is caring for pediatric clients on an oncology unit. The unit is experiencing a renovation, and the nurse manager is requesting suggestions for placement of the nurse's station with the goal of close pediatric client access. Which type of leadership style is the nurse manager employing?

Democratic leadership style

Which of the following is a component of the nurse practice acts of various states?

Determining the grounds for disciplinary action

A client with chronic obstructive pulmonary disease (COPD) asks the nurse for assistance with preparing a living will. The client tells the nurse that she has not discussed the living will with the family and wanted to make some decisions before discussing the will with the family. Which initial step in preparing this document should the nurse inform the client to do?

Discuss the request with the primary health care provider.

A nurse states to the client she will keep her pain free. However, her family wishes to try a treatment to prolong her life which may necessitate withholding pain medication. This factor will cause an ethical dilemma for the nurse in relation to which ethical principle?

Fidelity

The nurse witnesses an automobile accident and provides care at the scene of the accident to an open wound on a young child. The family is extremely grateful and insists that the nurse accept monetary compensation for the care provided to the child. Because of the family's insistence, the nurse accepts the compensation to avoid offending the family. The child develops an infection and sepsis and is hospitalized. The family files suit against the nurse who provided care to the child at the scene of the accident. The nurse understands that which is accurate regarding immunity from this suit?

Good Samaritan laws will not provide immunity from suit if the nurse accepted compensation for the care provided.

A staff nurse has scheduled a meeting with the nurse manager to ask for a pay increase. At the beginning of the meeting, after greetings, what question by the nurse manager would be most helpful in facilitating an acceptable outcome?

How have you been?

The nurse administers a fatal dose of morphine sulfate to a client. During the subsequent investigation of error, it is determined that the nurse did not check the client's respiratory rate before administering the medication. Failure to adequately assess the client is addressed under which function of the nurse practice act?

Identifying the process for disciplinary action if standards of care are not met

A nurse manager has accepted a new nurse management position at another hospital. What action would be most helpful as she begins her new job?

Introduce self to staff and observe unit activities for at least 3 months before making changes.

The nurse notes that an unlicensed assistive personnel (UAP) dons clean gloves but has not washed their hands before taking an oral temperature on a client. The nurse implements a teaching session for UAPs and should incorporate which principle?

Learning involves a change of behavior.

What is the first, and very important, step in effective time management?

Make time to plan and establish priorities.

The LPN has the responsibility to take the vital signs for a client who had a surgical procedure earlier that day. The blood pressure results were 78/42 mm Hg from a previous 132/74 mm Hg. The LPN documented the results without reporting them to the RN in charge. The client developed shock and died 3 hours later. What type of unintentional tort may the nurse be sued for?

Malpractice

The nurse administers medications to the wrong client. During the investigation of the incident, it was determined that the nurse failed to check the client's identification bracelet before administering the medications. The nursing supervisor evaluates the situation and determines that the nurse can be guilty of negligence because negligence is correctly characterized by which statement?

Negligence is defined as the failure to meet established standards of care.

Prior to delegating a task to a UAP, the LPN knows that the five rights of delegation are similar to what other operation commonly used in caring for clients?

Nursing process

Emergency surgery is scheduled for a client with a bowel obstruction. The licensed practical nurse (LPN) tells the registered nurse (RN) that she is unable to obtain informed consent from the client because the client has received opioid analgesics and is sedated. The LPN understands that which action should be implemented?

Obtaining a telephone consent from a family member and ensuring that the oral consent is witnessed by two persons

The nurse is observing an unlicensed assistive personnel (UAP) measuring the blood pressure (BP) of a client. The nurse should intervene if which action was observed that would interfere with accurate measurement of the BP?

Palpates the carotid artery and then places the cuff of the sphygmomanometer 1 inch (2.5 cm) above the brachial artery

The nurse manager is discussing financial penalties for readmissions to the hospital. Which nursing action, when caring for a client, is most helpful in decreasing hospital readmission?

Sanitize hands upon entering a client room

The nurse is assisting in caring for a client with a head injury who is restless and is pulling at the intravenous (IV) line. The client's primary health care provider does not want to sedate the client, and the family has requested that the client not be restrained. The nurse should implement which action?

Stay with the client and consult with the nurse manager about the situation.

The nurse is observing an unlicensed assistive personnel (UAP) communicating with a client who is deaf. The nurse should intervene if which behavior is observed?

The UAP stresses words by over enunciating them when speaking.

The nursing instructor is explaining to the clinical students the different roles and responsibilities of nurse leaders. Which comment is most correct?

The first responsibility the leader has is to the clients.

A client is brought to the Emergency Department in an unconscious state with a head injury. The client requires surgery to remove a blood clot. What would be the appropriate nursing intervention in keeping with the policy of informed consent prior to a surgical procedure?

The nurse ensures that the client's family signs the consent form.

During which client-nurse interaction would the nurse most appropriately use the authoritarian leadership style?

The nurse is assisting the client to the bathroom when wound dehiscence occurs.

While working in an institution that uses computer documentation, the nurse understands the need to log out of the computer if it is not in use. Following this procedure is necessary because of what ethical problem in nursing?

The right of confidentiality is essential to protect each client's private information.

The nurse is assisting in working with disaster relief following a tornado. The nurse's goal with the overall community is to prevent as much injury and death as possible from the uncontrollable event. Finding safe housing for survivors, providing support to families, organizing counseling sessions, and securing physical care when needed are examples of which type of prevention?

The tertiary level of prevention

A new graduate from an LPN/LVN program has accepted a position as an office manager in a family practice clinic and knows that leaders and managers share which qualities?

They are experts in both written and oral communication.

A nursing instructor asks a nursing student to describe the standards of care formulated by the American Nurses Association. Which statement by the student indicates an inaccurate description of these statements?

They are specific guidelines.

Which of the following is a true statement with regard to laws?

They are written rules for conduct and actions.

Which nursing management duties would the LPN identify as the primary goal of directing nursing care in the role of the team leader on a nursing unit?

To maintain the efficient flow of client care on the nursing unit

The charge nurse is observing a new nursing graduate insert a nasal trumpet airway to provide a route for suctioning the client. The nurse should intervene if the new nursing graduate performs which action?

Uses a nasal trumpet that is slightly larger than the nares

The nurse has a client who is confused and disrupting the unit by screaming obscenities and making a lot of noise. The client has been medicated as prescribed but is not responding to the sedation. The other clients on the unit are reporting agitation. The nurse makes the decision to move the client to a location further down the hall where there are fewer clients. What theory of ethics is the nurse demonstrating?

Utilitarianism

Which of the following is stated in a living will?

Wishes regarding healthcare if terminally ill

The nurse preceptor is trying to explain to her preceptee the legal points of delegation. Which one of the comments would be most important in describing this process?

You must know the agency's definition of the specific role and job description of the delegatee

A patient tells the nurse that he does not want to have a painful procedure. By respecting and supporting the patient's right to make decisions, what is the nurse demonstrating?

advocacy

A nurse using the principle-based approach to patient care seeks to avoid causing harm to patients in all situations. This principle is known as:

nonmaleficence

Nurse Practice Acts are examples of which type of laws?

• Statutory law

After receiving the report from the previous shift, which client should the nurse assess first?

• The client with a 5-pound (2.3 kg) weight gain since yesterday who reports increased dyspnea

The nurse is delegating a task to an unlicensed assistive personnel (UAP). Which question would be most helpful for the nurse to ask the UAP?

"Have you ever performed this task before?"

The nurse is reviewing the preprocedure care for a client scheduled to have an echocardiogram after a myocardial infarction. The nurse determines that the student nurse understands the preprocedure instructions if the student nurse made which statement?

"The procedure is painless and takes 30 to 60 minutes to complete."

An Emergency Department had a chaotic shift with multiple MVAs, a couple of suicide attempts, and three MIs. The clients underwent many tests, labs, radiographs, etc. and it was important for nursing staff keep client information and treatments organized. Of what benefit is an anecdotal record?

refreshes the nurse's memory

A nurse administers all assigned clients' medications as ordered and on schedule. The nurse's actions are an example of:

responsibility

Federal and state governments carefully regulate the treatment given in licensed healthcare facilities, particularly long-term care facilities, because of clients

vulnerability.

The LPN is working in a perioperative setting, and formalin is being used in an unvented room that could result in a health hazard to the other staff as well as clients. The nurse is aware that the Occupational Safety and Health Administration (OSHA) is an agency that will fine the hospital for this type of infraction. What type of law does the LPN understand empowers OSHA to regulate for the health, welfare, and safety of federal and state citizens?

Administrative law

Staff in both the intensive care unit (ICU) and emergency department (ED) are complaining to their respective managers that they are having conflicts with the other unit's staff when clients are being transferred from the ED to the ICU. Which strategy would be most helpful for the managers to help resolve these conflicts?

Arrange for staff of both units to meet and discuss the issue

The nurse has received a 7 am change of shift report on four clients. Which client should the nurse check first?

• A client admitted early this morning with right lower quadrant abdominal pain and an elevated leukocyte count

A client was involuntarily admitted to the psychiatric unit because of episodes of extremely violent behavior. The client is demanding to be discharged from the hospital. The licensed practical nurse (LPN) reports the information to the registered nurse (RN), and the RN does not allow the client to leave. The LPN understands that which represents the legal ramifications associated with the RN's behavior?

No charge will be made against the RN because the RN's actions are reasonable.

A physician is being sued for malpractice in a case involving a birth accident. What circumstance determines whether the suit is a negligence or malpractice suit?

None of the options is correct.

An emergency department nurse is caring for a 2-year-old, semiconscious child with numerous fractures and evidence of cigarette burns. The nurse and healthcare team suspect child abuse. The nurse reports the family to the child abuse hotline. The nurse is following which ethical principle?

Nonmaleficence

The nurse accidentally left a confidential lab report on a table in one of the exam rooms. The nurse is attending to another client in that room and realizes the mistake when the client says, "I didn't know that my neighbor was one of your patients. I must have just missed her!" The nurse plans to tell her supervisor about the mistake immediately upon finishing with this client. This is an example of:

accountability.

Which of the following best describes the utilitarian theory of ethics?

• The consequences of an action determine if it is right or wrong.

A client who has undergone resection of the intestine is on a liquid diet with a nasogastric tube in place. He refuses the food tray with regular food that comes to his room and insists that a physician be called. The nurse insists that it is the right food and makes the client take it. The client develops complications and has to be re-operated upon. How is negligence determined in this situation?

• The nurse did not realize the importance of the tube.

What is a distinguishing trait of integrated leader-managers? Select all that apply.

• They influence others beyond their own group. • They emphasize vision, values, and motivation.

Allowing unauthorized people to observe a client during treatment is an example of which of the following?

invasion of privacy

A nurse manager is getting ready to delegate tasks. Place in order the steps that the nurse should use from first to last.

• Know the client's needs, the skills of the UAPs, and the priorities. • Match the UAPs' skills with the tasks to be completed. • Identify the UAPs who will best handle the delegated tasks. • Communicate expectations clearly to UAPs, including what they need to do, what to watch for, and potential problems. • Ensure that tasks are completed according to standards.

The home care nurse observes that an older male client is confined to his room by his daughter-in-law. When the nurse suggests that he walk to the den and join the family, he says, "I'm in everyone's way, and my son needs me to stay here." Which is the best nursing intervention for this situation

• Suggest appropriate resources such as respite care and a senior citizens' center to the client and daughter-in-law.

The nurse goes to the nurse manager complaining about one of the primary health care providers who is harassing them. What would be the best question the nurse manager could ask the nurse?

"Have you ever taken this primary health care provider aside and asked him/her to discuss this problem with you?"

A nurse is caring for a client with stage IV colon cancer and multiple-stage two wounds on the coccyx area. The client confides feeling very weak and wanting to discontinue further aggressive treatment. Which nursing action best demonstrates the nurse in the role of the client advocate?

The nurse offers to be present to support the client at a family meeting.

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

Nonmaleficence

The unlicensed assistive personnel (UAP) who has been employed in a long-term care facility for 8 weeks is consistently 10 to 20 minutes late for work. The UAPs lateness has caused unrest with other staff members in the nursing unit. The UAP is due to receive a 3-month probation evaluation in 1 month. Which is the most appropriate action by the nurse in charge of the nursing unit when dealing with this situation?

• Confronting the UAP to discuss the lateness and initiate problem-solving measures

The supervisor invests a good deal of time and energy in talking with staff to gather data for departmental goals, promoting teamwork, and encouraging open communication. Although these are important aspects of her job, what is her primary function as department manager

accountability for the accomplishment of tasks

A physician's methods and outcomes are frequently the topic of conversation among the nursing staff. Often, staff will second-guess the physician's diagnoses and treatments. What tort is being committed each time staff members criticize the physician's perceived abilities in public?

defamation

A nurse has often had the opportunity to share personal prescriptions with family members when they were in need of pain medication or antibiotics. Which area of rules should govern the nurse's moral decision?

ethics

The wound care/stoma nurse at the hospital has an amazing rapport with both colleagues and clients. People seem to hang on every bit of education the nurse offers and to be extremely grateful for encouragement from this nurse during stressful times. Which type of power does this nurse wield?

expert power

Which of the following clinical events is addressed by the provisions of the Health Insurance Portability and Accountability Act (HIPAA)?

• A patient believes that the healthcare team is withholding information about her diagnosis and wishes to read her medical chart.

A client had a colon resection. A Salem tube was in place when a regular diet was brought into the client's room. The client did not want to eat solid food and asked that the primary health care provider be called. The nurse persisted in the belief that the solid food was the correct diet. The client ate two meals and subsequently had additional surgery due to complications. The nurse understands that the determination of negligence in this situation is based on what?

• A duty existed and it was breached

The nurse is assisting in reviewing the critical paths of the clients on the nursing unit. In performing a variance analysis, which indicates the need for further action and analysis?

• A postoperative client who develops a cough and a fever

The nurse working on the pediatric unit has just received a report on four clients. Which client should the nurse care for first

• A toddler who is admitted for acute epiglottitis with stridor and is becoming increasingly agitated

The parent of a 10-year-old client, newly diagnosed with diabetes, expresses concern that the child will not follow through with the diabetic regimen. The nurse suggests developing a calendar of daily requirements with a weekly prize for completion. Which type of power is the nurse suggesting the parent use?

• Reward power

A client with a headache arrives in the emergency department and is staggering, confused, smells of alcohol, and is verbally abusive. The nurse explains to the client that the primary health care provider will need to perform an assessment before the administration of medication. When the client becomes verbally abusive, the nurse threatens to place the client in restraints. With what can the client legally charge the nurse as a result of this nursing action?

• Assault

A student nurse has received the client assignment for the day and is organizing the required tasks. The nursing instructor reviews the plan for time management with the student and determines that the student needs assistance with the plan if the student indicated that which activity should be part of it?

• Documenting task completion at the end of the day

The nurse asks the registered nurse to call the primary health care provider (PHCP) of a client scheduled for a cardiac catheterization because the client has numerous questions regarding the procedure and has requested to speak to the PHCP. The PHCP is very upset and arrives at the unit to visit the client after prompting by the nurse. The nurse is outside the client's room and hears the PHCP tell the client in a derogatory manner that the nurse "doesn't know anything." The nurse plans to address the PHCP's remark, understanding that the PHCP has violated which legal tort?

• Slander

An unresponsive client with a terminal illness in the hospital has no advanced directive. What are the steps the nurse will follow to practice ethical decision making? Select all that apply.

• Assess the ethical/moral situations of the problem. • Convene an ethics panel. • List the alternatives. • Decide and evaluate the decision.

Which of the following would the nurse manager recognize as disadvantages of a laissez-faire approach? Select all that apply.

• Employees receive little direction or guidance. • Staff members do not receive feedback regarding their performance.

The nurse understands that laws and ethics are made in order to maintain order and harmony within society. What is the difference between laws and ethics?

• Laws are written rules for conduct and actions, and ethics are moral principles and values that guide our behavior.

A client reports having had two bowel movements this morning and refuses a dose of docusate sodium. After appropriately charting in the medication administration record, which action should the nurse take?

• Make a notation regarding the client's refusal in the nurse's notes.

A nurse is responsible for the following duties with a client. Place the tasks in the order of priority for the nurse to address them, from highest to lowest

• Assessing neurologic stability. • Administering antidiarrheal medication. • Assisting the client to complete menu card for next meal. • Placing an extra pillow behind the client's back.

The LPN/LVN who is seeking to become a team manager understands that leadership is slightly different than management and requires which qualities? Select all that apply.

• Emphasizes interpersonal relationships • Has the ability to organize events and inspires individuals to follow their leadership • Obtains power through influence

A client about to undergo gastric bypass surgery calls the nurse into the room. The client whispers to the nurse a concern that friends will learn about the upcoming surgery and pleads with the nurse to keep the surgery a secret. What response by the nurse is best?

"I am not at liberty to discuss your case with anyone except those directly involved in your care unless you authorize me to do so."