n222 exam 4 coursepoint q's 8/9/10/19/20

The nurse is completing documentation after an education session with a client. Which statement best demonstrates detailed documentation of an effective teaching plan? Demonstrated cord care to mother, who stated understanding and performed return demonstration using correct technique. Spouse taught to flush feeding tube before and after medication. Denied further instruction needed. Discussed wet-to-dry dressing changes, and client stated understanding. Lecture provided about infection, and client stated understanding what infection is.

Demonstrated cord care to mother, who stated understanding and performed return demonstration using correct technique.

An informatics nurse specialist is working as part of a team that will be developing and implementing a new client assessment tool. During which phase of the system development lifecycle would the team be integrating information about workflow patterns, standard terminology, and recommendations for screen layout from supportive research? Train Design and build Analyze and plan Test

Design and build

An informatics nurse specialist is working on a team that is considering a new technological system for the facility. Which aspect would be most important for the team to do as the first step? Determine the need or problem to be solved Identify the use of standard terminology Conduct testing of the system Train those who will be using the system

Determine the need or problem to be solved

An informatics nurse is participating in an online continuing education course about nursing informatics. The nurse demonstrates successful comprehension of the course by identifying which individual as being considered the first informatics nurse? Virginia Henderson Dorothea Orem Hildegard Peplau Florence Nightingale

Florence Nightingale

As the nurse enters the room to teach the client about self-care at home, the client states, "I am glad you are here. I need some pain medicine. I can't stand it anymore." What is the best action of the nurse? Give written materials to the client and administer pain medication. Redirect the client to learning about self-care and begin education. Have the client rate pain level, and reschedule the teaching session. Assess the client's understanding of self-care and administer medication.

Have the client rate pain level, and reschedule the teaching session.

A nursing facility has recently implemented new policies regarding nurse-to-client ratios. The nursing staff seems very resistant to the change. How can the nurse manager help the staff accept the change? Institute the changes immediately and collectively to decrease anticipation anxiety. Use the laissez-faire leadership style to address staff concerns. Challenge staff's beliefs and values regarding providing quality client care. Hold a unit meeting to discuss how the changes will benefit staff.

Hold a unit meeting to discuss how the changes will benefit staff.

Which statement is not true regarding a medication administration record (MAR)? If the client declines the dose, the nurse does not have to document this on the MAR. After using an electronic MAR, the nurse should log off. The MAR distinguishes between routine and "as needed" medications. The MAR identifies routine times for medication administration.

If the client declines the dose, the nurse does not have to document this on the MAR.

The nurse is documenting a variance that has occurred during the shift. This report will be used for quality improvement to identify high-risk patterns and, potentially, to initiate in-service programs. This is an example of which type of report? Transfer report Nurse's shift report Telemedicine report Incident report

Incident report

The nurse is sharing information about a client at change of shift. The nurse is performing what nursing action? Documentation Verification Dialogue Reporting

Reporting

The nurse is caring for a client who requests to see a copy of the client's own health care records. What action by the nurse is most appropriate? Discuss how the hospital can be fined for allowing clients to view their health care records. Explain that only a paper copy of the health care record can be viewed by the client. Access the health care record at the bedside and show the client how to navigate the electronic health record. Review the hospital's process for allowing clients to view their health care records.

Review the hospital's process for allowing clients to view their health care records.

The nurse is conducting a community health promotion class and has developed scenarios that will involve active participation by the class attendees. What type of education strategy is the nurse incorporating into this class? Programmed instruction Role-playing Panel discussion Role modeling

Role-playing

The nurse is caring for a client who has an elevated temperature. When calling the health care provider, the nurse should use which communication tools to ensure that communication is clear and concise? MAR SOAP SBAR PIE

SBAR

A nurse manager best demonstrates effective leadership characteristic by which action? Sharing a vision for the unit and enlisting support Knowing all information about the unit processes Being very structured and rigid with the unit flow Indicating an interest in becoming a role model

Sharing a vision for the unit and enlisting support

A nurse may attempt to help a client solve a situational crisis during what type of counseling session? Professional counseling Motivational counseling Long-term counseling Short-term counseling

Short-term counseling

The charge nurse is reviewing SOAP format documentation with a newly hired nurse. What information should the charge nurse discuss? The plan includes interventions, evaluation, and response. Objective data are what the client states about the problem. Subjective data should be included when documenting. Abnormal laboratory values are common items that are documented.

Subjective data should be included when documenting.

A nurse has a two-way video communication with the specialist involved in the care of a client in a long-term care facility. This is an example of what nursing informatics technology? Data aggregation technology Population health management technology Client engagement technology Telemedicine and mobile technology

Telemedicine and mobile technology

A client is reluctant to learn to do finger sticks for home international normalized ratio (INR) monitoring. What is the best statement by the nurse? Are you worried about the pain? Tell me what you know about these tests. Why don't you want to do this? Most people are afraid of sticking themselves.

Tell me what you know about these tests.

A charge nurse on a medical-surgical unit is asked by the nurse manager to serve as a mentor to another staff nurse who is less experienced. Which of these would best describe this role? The staff nurse is orienting to the unit as a newly hired nurse. The charge nurse is being paid to supervise the staff nurse. The staff nurse is learning about all the hospital policies from the charge nurse. The charge nurse is providing support for the staff nurse in new responsibilities.

The charge nurse is providing support for the staff nurse in new responsibilities.

When establishing a teaching-learning relationship with a client, it is most important for the nurse to remember that effective learning can best be achieved through which concept? The nurse is the expert in the teaching-learning environment. The client and the nurse are equal participants. The nurse must be able to handle criticism during the process. Assimilation and application of psychomotor concepts is essential.

The client and the nurse are equal participants.

Which observation during the nursing assessment of a client supports the documentation of low health literacy? The client complies with the medication regimen despite financial difficulties. The client avoids health care screenings and seeks care in the local emergency department. The client is provides a coherent health history. The client's health forms are complete.

The client avoids health care screenings and seeks care in the local emergency department.

The nurse is educating a client regarding a new skill. When evaluating the client's knowledge about the topic covered, which best represents that the client has learned a new skill? The client verbalizes items needed and how to perform the skill. The client nods when asked about process and assists with cleanup. The client states understanding and passes a written test. The client organizes materials needed and gives return demonstration.

The client organizes materials needed and gives return demonstration.

The nurse is reassessing a client after pain medication has been administered to manage the pain from a bilateral knee replacement procedure. Which statement most accurately depicts proper documentation of pain assessment? The client appears to have a low tolerance for pain and frequently reports intense pain. The client is receiving sufficient relief from pain medication, stating no pain in either knee. The client reports that on a scale of 0 to 10, the current pain is a 3. The client appears comfortable and is resting adequately and appears to not be in acute distress.

The client reports that on a scale of 0 to 10, the current pain is a 3.

The following statement is documented in a client's health record: "Patient c/o severe H/A upon arising this morning." Which interpretation of this statement is most accurate? The client has symptoms in the morning associated with a heart attack. The client has a history of severe complaints in the morning. The client is coughing and experiencing severe heartburn in the morning. The client reports waking up this morning with a severe headache.

The client reports waking up this morning with a severe headache.

The nurse is providing instructions to a client about performance of breast self-examination. What learning outcome would be most appropriate regarding this education? The client will be able to perform proper breast self-examination for breast cancer detection and prevention. The client will demonstrate improved coping skills. The client will have restoration of breast function. The client will demonstrate self-efficacy and improved body image.

The client will be able to perform proper breast self-examination for breast cancer detection and prevention.

The case manager works in a facility that supports a participative leadership style. Which action should the nurse recognize as an example of democratic leadership style? The interdisciplinary health care team collectively developing plans of care for clients The dietitian completing a nutritional assessment for a registered nurse (RN) The unlicensed assistive personnel (UAP) taking vital signs for several nurses The nurse implementing the health care provider's written orders for client care

The interdisciplinary health care team collectively developing plans of care for clients

A nurse is writing learner objectives for a client who was recently diagnosed with type 2 diabetes. Which statement best describes the proper method for writing objectives? The nurse writes one or two broad objectives rather than several specific objectives. The nurse writes one long-term objective for each diagnosis, followed by several specific objectives. The nurse writes general statements for learner objectives that could be accomplished in any amount of time. The nurse plans learner objectives with another nurse before obtaining input from the client and family.

The nurse writes one long-term objective for each diagnosis, followed by several specific objectives.

Two new nurses are requesting the same preceptor for unit orientation. Both new nurses have been very vocal about being unhappy if they do not receive their choice of preceptor. Which illustrates the nurses using a compromise approach to conflict resolution? The nurses agree that one nurse will obtain the preceptor for orientation in exchange for that nurse working each weekend. The nurses ignore each other's request for the preceptor. The nurses agree to have the preceptor precept one nurse at the beginning of the orientation and the other at the end. The nurses agree to allow the preceptor to decide which nurse to precept.

The nurses agree to have the preceptor precept one nurse at the beginning of the orientation and the other at the end.

A parish nurse is preparing to provide a health promotion class to a group of adults in the parish. In preparing to meet the learning needs of this group, the nurse recognizes which as a characteristic of an adult learner? Peer group acceptance is a critical issue for this age group. Their readiness to learn is often related to a developmental task or social role. Previous experiences have little impact on learning. The material presented should focus on future application.

Their readiness to learn is often related to a developmental task or social role.

A nurse is caring for a client diagnosed with myocardial infarction. A person identifying himself as the client's friend asks the nurse for the client's records, but the nurse declines. The nurse's unwillingness to divulge the requested information is based on the understanding that which people would be entitled to access to the client's records? health care professionals of the facility close friends of the client those directly involved in the client's care any family member of the client

those directly involved in the client's care

The nurse is caring for a client who demonstrates a health literacy concern. The nurse adjusts client teaching in which way? uses medical terminology to help the client feel smarter gives instructions in multiple ways so the client will understand uses videos, diagrams, and pictures rather than focusing on verbal teaching provides general teaching instead of specificity regarding diagnosis

uses videos, diagrams, and pictures rather than focusing on verbal teaching

A nurse is trying to encourage a client with paraplegia who is depressed and not adhering to the treatment program to join a support group. Which statement by the nurse is most appropriate? "I am going to sign you up for a support group." "I am sure you would feel better if you joined a support group." "Support groups are for people like you who are depressed." "What do you know about support groups?"

"What do you know about support groups?"

The nurse is teaching an 80-year-old client how to instill eye drops for glaucoma. The client's daughter asks, "How do you know that my mother understands what to do?" What is the appropriate nursing response? "I will have you bring your mother back next week to see how things are going." "When 15 minutes have passed, I will ask your mother to show me how to instill the drops." "We can never be completely sure that your mother understands instructions." "After I demonstrate it once, your mother will be able to do it."

"When 15 minutes have passed, I will ask your mother to show me how to instill the drops."

The nursing student is discussing the benefits of electronic charting with a precepting nurse who is frustrated with computerized documentation. Which statement by the student requires intervention from the nursing instructor? "You save time because you don't have to look for the physical chart." "The computer reminds the nurse to enter information and inhibits omissions." "You don't have to worry about trying to read poor handwriting." "You can make extra money with overtime pay with end-of-shift charting."

"You can make extra money with overtime pay with end-of-shift charting."

Which attributes should be characteristic of a nurse mentor? Select all that apply.

- supportive - resourceful - demonstrates leadership abilities - is an experienced, licensed professional

A nurse is providing care to a 3-year-old child admitted with a diagnosis of infectious diarrhea. The nurse needs to insert an intravenous catheter in order to administer prescribed intravenous fluids. In an attempt to foster communication, the nurse should: A. involve the child's stuffed animal in the educational session. B. ask the child's parents to leave the room while the nurse and child talk. C. show the child the intravenous catheter and explain how it works. D. provide both verbal and written information to the child.

A. involve the child's stuffed animal in the educational session.

A nurse is caring for a client who presents with a skin infection. While obtaining the client's medical history, it is determined that the client is an intravenous drug user. To foster effective communication, the nurse should: A. remain honest, open, and frank. B. ask if the client realizes the infection is a direct result of the drug use. C. ask the client for a urine specimen for urine drug use screening. D. consult with the social worker regarding inpatient drug rehabilitation.

A. remain honest, open, and frank.

A nurse is interviewing a client for the establishment of long-term care insurance. During the interview, the nurse asks questions regarding the client's past medical history. In this case, the nurse plays the role in the process of communication of the: A. sender. B. decoder. C. receiver. D. target.

A. sender.

An informatics nurse specialist has completed the evaluation of an update to a current clinical information system used by the staff at the local hospital and has documented the results. Documentation reveals the need for an improvement in the screen display. Which action would be next? Train Implement Analyze and Plan Test

Analyze and Plan

A nurse is working with a 15-year-old client with sickle cell anemia. The client was started on a new pain management plan today, and the nurse is evaluating the effectiveness of the plan. Which is not appropriate to include in the nursing care? Including a note about who was taught this new information in the client's chart Asking only the client's parents to be present at the education session Assuring the client that the conversation is confidential except under extreme circumstances Answering questions openly and honestly

Asking only the client's parents to be present at the education session

Which is an open-ended question? A. "When was the last time you had your prescription refilled?" B. "Why did the health care provider prescribe this medication for you?" C. "How many tablets do you take at one time?" D. "Do you take this medication daily?"

B. "Why did the health care provider prescribe this medication for you?"

A nurse has been caring for a client who had a myocardial infarction 2 days ago. During the morning assessment, the nurse asks the client how the client feels. Which scenario warrants further investigation? A. The client looks at the nurse and states, "I am still not feeling my best." B. The client stares at the floor and states, "I feel fine." C. The client is sitting in a chair and states, "I feel a lot better than I did yesterday. D. The client smiles at the nurse and states, "I cannot wait to go home."

B. The client stares at the floor and states, "I feel fine."

The nurse has educated the client on the pathophysiology of osteoarthritis and degenerative joint disease. This type of teaching best illustrates which learning theory? Adaptive learning theory Developmental learning theory Cognitive learning theory Behavioral learning theory

Cognitive learning theory

The nurse is performing an admission interview with a new client diagnosed with acute coronary syndrome. For the nurse to obtain information and allow the client free verbalization, which question would elicit the most information? A. "I have had chest pain before, and it is really scary!" B. "Did you take any medication when you had the pain?" C. "Have you ever had chest pain prior to this admission?" D. "Could you tell me more about how you are feeling right now?"

D. "Could you tell me more about how you are feeling right now?"

A nurse is completing a health history on a client who has a hearing impairment. Which action should the nurse take first to enhance communication? A. Provide paper and pencil for written communication B. Use facial and hand gestures C. Contact a person skilled in sign language D. Assess how the client would like to communicate

D. Assess how the client would like to communicate

A family has lost a member who was treated for leukemia at a nursing unit. The nurse provides emotional support to the family and counsels them to cope with their loss. Which quality should the nurse use in this situation? A. Pity B. Indifference C. Sympathy D. Empathy

D. Empathy

The nurse has recently been promoted to nurse manager on a pediatric unit and has decided to accept input from staff regarding changes they would like to see on the unit. Which type of leadership style is the nurse embodying? Democratic Quantum Autocratic Laissez-faire

Democratic

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

Describe how the walker can improve the client's quality of life.

The health care provider is in a hurry to leave the unit and tells the nurse to give morphine 2 mg IV every 4 hours as needed for pain. What action by the nurse is appropriate? Write the order in the client's record. Inform the health care provider that a written order is needed. Call the pharmacy to have the order entered in the electronic record. Add the new order to the medication administration record.

Inform the health care provider that a written order is needed.

Which of these statements reflects the expected functioning at a hospital that has achieved Magnet status? Staff nurses are developing innovative solutions to problems. There is a decreased rate of retention among the nursing staff. Most client outcomes have improved but are not at target range. Nursing administration is in control of all decision-making.

Staff nurses are developing innovative solutions to problems.

A nurse is educating a client with a new diagnosis of diabetes. Which example demonstrates cognitive learning by the client? The client demonstrates proper technique for injecting insulin. The client expresses a desire to improve nutritional intake and lose weight. The client describes signs and symptoms of hypoglycemia. The client prepares the skin for the administration of an insulin injection.

The client describes signs and symptoms of hypoglycemia.

Which response from the client enables the nurse to determine the effectiveness of a recent medication teaching session for an older adult client who is diagnosed with tuberculosis (TB)? "I can't remember when I have to take my medications, so I have my son come and give me my pills." "I will be taking the TB medication for at least 6 months, because it takes a long time to kill the TB germs." "It is okay to skip some doses if I don't feel well or sick to my stomach." "If I stop coughing after 3 months, I can stop taking my TB medication because that means I no longer have the germ in my syste

"I will be taking the TB medication for at least 6 months, because it takes a long time to kill the TB germs."

The nurse calls the health care provider due to changes in the client's status. Using the SBAR, the nurse is about to address Recommendation. Which statement appropriately supports this part of the SBAR? "Will you prescribe a complete blood count to check the white blood cell count and a culture?" "The client's temperature has been 102°F (38.9°C) for the last 6 hours." "The client was admitted today with a urinary tract infection." "I am concerned that the client might be exhibiting sepsis."

"Will you prescribe a complete blood count to check the white blood cell count and a culture?"

The nurse is visiting a client who was released from inpatient rehabilitation 6 weeks ago after a 5-month recovery from a motor vehicle accident that left the client immobile. As the nurse enters the home, the client braces hands on the arms of a chair to rise and uses crutches to walk across the room. What is the best response by the nurse? "You have made an amazing recovery." "Those physical therapists work wonders. "Let me document that you can walk." "Are you supposed to be out of the wheelchair?"

"You have made an amazing recovery."

The health care provider notified the client and the spouse that the client's condition was terminal. The spouse has been crying since the interaction with the health care provider. The nurse is going to talk with the spouse about the spouse's feelings. What action(s) would the nurse do to promote a positive impression with the spouse? Select all that apply.

- Available resources - Learning style preferences - Literacy level

Which are appropriate actions for protecting clients' identities? Select all that apply.

- Document all personnel who have accessed a client's record. - Place light boxes for examining X-rays with the client's name in private areas. - Have conversations about clients in private places where they cannot be overheard.

A registered nurse checks the American Nurses Association (ANA) regulations prior to delegating tasks to unlicensed assistive personnel (UAP) on a burn unit. Which principles regarding the regulation, education, and use of UAP are recommended by the ANA? Select all that apply.

- It is the purpose of assistive personnel to work in a supportive role to the registered nurse. - It is the role of the assistive personnel to carry out tasks to enable the professional nurse to concentrate on nursing care for the client. - It is the registered nurse who is responsible and accountable for nursing practice.

The nurse is preparing discharge teaching for a client with diabetes. Which information should the nurse include? Select all that apply.

- Meal planning - Community resources - Appropriate use of a glucometer - Instructions to follow up with the health care provider

Which information should the nurse include in a client's plan of care? Select all that apply.

- The client's problems, goals, and nursing orders - Routine care, such as the client's bath and mouth care - The client's level of activity and current medical orders

A client is received into the emergency department after getting shot in the chest. The client is hemorrhaging profusely and is in hypovolemic shock. The nurse calls a code blue. What type of leadership style will be most effective during the management of the code? Laissez-faire leadership Autocratic leadership Democratic leadership Transactional leadership

Autocratic leadership

A nurse during orientation notices that the preceptor gives all subcutaneous injections on a 45-degree angle. When the new nurse asks the preceptor the rationale for the practice the preceptors states, "This is how I do it, and this is how you will do it." The new nurse recognizes this behavior to be: A. assertive. B. aggressive. C. nurturing. D. passive.

B. aggressive.

The nurse completes the admission process of a client to an acute care facility. Which statement by the nurse demonstrates the communication technique of focusing? A. "You are frustrated because you are too tired to perform normal activities." B. "You have been having a great deal of fatigue for the last 3 months." C. "You are unsure of what helps or prevents your fatigue." D. "You are hoping to figure out the cause of your extreme fatigue during this hospital stay."

D. "You are hoping to figure out the cause of your extreme fatigue during this hospital stay."

Which is a skill appropriate to use in therapeutic communication? A. Avoid the use of periods of silence. B. Be precise and inflexible regarding the intent of the conversation. C. Use cliches to enhance a client's understanding of information. D. Control the tone of the voice to avoid hidden messages.

D. Control the tone of the voice to avoid hidden messages.

A nurse is showing an older adult client with severe diabetes the correct method of self-administering an insulin injection. What comment(s) is acceptable if the client continues making mistakes when learning how to self-administer an insulin injection? Select all that apply.

- "First-time learners often have this same concern." - "You have just about figured out how to give yourself an injection." - "Try to angle the syringe a little more this way."

The client has Alzheimer disease and is a new admission to the nursing home. The client was transferred from the hospital. When first meeting the client, what technique(s) will the nurse use to facilitate communication with this client? Select all that apply.

- Approach the client from the front of the client. - Call the client by the client's preferred name. - Use simple words and short sentences when talking with the client.

A nurse is documenting care for clients in a hospital setting. Which documenting errors may potentially increase the nurse's risk for legal problems? Select all that apply.

- The content is not in accordance with professional standards. - There are lines between the entries. - Dates and times of entries are omitted.

A nurse is providing teaching to clients in a short-term rehabilitation facility. Which examples are common teaching mistakes made by health care professionals? Select all that apply.

- The nurse fails to accept that clients have the right to change their minds. - The nurse uses medical jargon frequently when discussing the teaching plan. - The nurse ignores the restrictions of the client's environment.

A nurse is communicating the plan of care to a client who is cognitively impaired. Which nursing actions facilitate this process? Select all that apply.

- The nurse maintains eye contact with the client. - The nurse shows patience with the client and gives the client time to respond. - The nurse keeps communication simple and concrete.

Besides being an instrument of continuous client care, the client's health care record also serves as a(an): incident report. Kardex. legal document. assessment tool.

legal document.

A client is scheduled for a CABG procedure. What information should the nurse provide to the client? "A coronary artery bypass graft will benefit your heart." "A complete ablation of the biliary growth will decrease liver inflammation." "The CABG procedure will help increase intestinal motility and prevent constipation."

"A coronary artery bypass graft will benefit your heart."

Which documentation example best reflects the complexity of client teaching by the nurse? "Taught client about peak flows; client verbalized understanding." "Client return demonstrated how to use glucometer." "Told client to take antibiotic as ordered." "Client and spouse taught how to use phone app to count carbohydrates; client return demonstrated carb counting for a hypothetical meal."

"Client and spouse taught how to use phone app to count carbohydrates; client return demonstrated carb counting for a hypothetical meal."

In a nursing unit, the RN delegates nursing tasks to the nursing assistant. Keeping in mind the delegation guidelines, which statement denotes the right communication for the nursing assistant? "Check the infusion rate." "Dispose of the disconnected IV set." "Discontinue the IV solution." "Inspect the site for thrombophlebitis."

"Dispose of the disconnected IV set."

An informatics nurse specialist is conducting an in-service program for a group of staff nurses about this specialty. One of the nurses asks, "What exactly is nursing informatics?" Which response by the informatics nurse specialist would be most appropriate? "It involves working primarily with computers and programming codes." "It is a specialty that deals with online client educational programs." "It combines nursing science with information management and analytical sciences." "It refers to the use of the electronic health record."

"It combines nursing science with information management and analytical sciences."

The nurse is collecting health data and avoids using closed-ended questions. Which are examples of closed-ended questions? Select all that apply.

- "Do you smoke cigarettes?" - "Is there any chance you might be pregnant?" - "Does it hurt when I touch you here?" - "Are you ready to get out of bed?"

The nurse is caring for a client who is a victim of sexual assault. Which action would the nurse take to develop a trusting rapport with the client? A. Approach the client with empathy and understanding and allow the client to share feelings without being judged. B. Use strategic pauses to allow the client to provide information that will be used to help officials in their investigation. C. Exhibit a professional demeanor while examining the client and obtaining specimens, asking questions that are not intrusive. D. Practice active listening by allowing the client to express fears and concerns then restating in the nurse's own words to demonstrate understanding.

A. Approach the client with empathy and understanding and allow the client to share feelings without being judged.

A client has cancer, but the significant other does not want the client to know the diagnosis. The nurse demonstrates sensitivity to the significant other and works with the couple to achieve desired outcomes. What kind of behavior is the nurse exhibiting? A. Empathy B. Curiosity C. Sympathy D. Humility

A. Empathy

The nurse is providing care to an older adult client who has visual and hearing deficits. What action by the nurse is appropriate to help with communication? A. Identify oneself by name and title with each entry into the client's room. B. Speak in a loud voice over the volume of the television set. C. Remove the COVID protection face mask while speaking with the client. D. Obtain the client's attention by calling out the client's first name.

A. Identify oneself by name and title with each entry into the client's room.

A nurse is caring for a client in a semi-private room. How will the nurse prepare a private environment to discuss the client's plan of treatment? A. Pull the curtain dividing the two beds. B. Bring the client into the hallway to discuss the treatment plan. C. Ask all visitors to leave the room. D. Direct the client in the other bed to walk in the hallway.

A. Pull the curtain dividing the two beds.

A nurse is obtaining a history from an adult female client. When the nurse asks how many times the client has been pregnant, the client answers, "I have four kids." Which statement, made by the nurse, seeks clarification of the original question? A. "All right, you have four children, is that correct?" B. "I understand you have four kids; how many times have you actually been pregnant?" C. "How old are your children?" D. "Were these term births?"

B. "I understand you have four kids; how many times have you actually been pregnant?"

During an admission intake assessment, a nurse uses open-ended questions to gather information. An example of an open-ended question is: A. "Can you tell me the medications you take on a daily basis?" B. "What did your health care provider tell you about your need to be admitted?" C. "Are you allergic to any medications?" D. "Do you have an advanced directive or a living will?"

B. "What did your health care provider tell you about your need to be admitted?"

A nurse is assessing vital signs on a pregnant client during a routine prenatal visit. The client states, "I know labor will be so painful, it sounds awful. I am sure I will not be able to stand the pain; I really dread going into labor." What is the best response from the nurse? A. "Don't worry about labor, I have been through it and it is not so bad." B. "You're worried about how you will tolerate the pain associated with labor." C. "I would recommend keeping a positive attitude." D. "There are many good medications to decrease the pain; it will not be so bad."

B. "You're worried about how you will tolerate the pain associated with labor."

To provide effective nursing care, the nurse should engage in what type of communication with the client and significant others? A. Intrapersonal communication B. Therapeutic communication C. Metacommunication D. Purposive communication

B. Therapeutic communication

Carl Rogers (1961) studied the process of therapeutic communication. Through his research, the elements of a "helpful" person were described. They include all of the following except which choice? A. empathy B. analysis C. comfortable sense of self D. positive regard

B. analysis

A nurse has been working on a telemetry unit for 6 months. The nurse arrives at work in the morning and overhears a night shift nurse talking about the new nurse. The night shift nurse is heard saying, "That new nurse is only here to meet a doctor and get married." The best response by the new nurse would be to: A. call hospital security and ask them to take a report. B. ask to speak to the night shift nurse in private and explain how the comment made the new nurse feel. C. approach and tell the night shift nurse that the night shift nurse is "out of line." D. ignore the comment and begin the shift.

B. ask to speak to the night shift nurse in private and explain how the comment made the new nurse feel.

The registered nurse on a busy telemetry floor is delegating tasks to an unlicensed assistive person (UAP). Which task is appropriate for the UAP to complete? Assessing a client's wound Bathing a combative client Taking an order over the telephone from a health care provider Inserting an indwelling urinary catheter

Bathing a combative client

The nurse is caring for a 60-year-old client with an improper bowel movement regimen. Which is the most appropriate method for the nurse to use in teaching this client? Talk to the client's relatives and get a detailed account of the client's history. Refer the client to internet resources on proper bowel health. Have the client join a small group of other clients with the same problem and facilitate group discussions. Begin the session with a reference to the client's actual experience.

Begin the session with a reference to the client's actual experience.

A nurse is discussing cataract treatment with a client. Which statement by the nurse would be most therapeutic? A. "My grandfather also benefited from laser surgery." B. "You should try laser surgery." C. "Have you ever thought of laser surgery?" D. "Why don't you try laser surgery?"

C. "Have you ever thought of laser surgery?"

A nurse is asking a colleague about a situation. Which response best demonstrates assertive communication? A. "You always act like this." B. "Why are you treating me this way?" C. "I think there is a better way to handle this." D. "What is your problem with me?"

C. "I think there is a better way to handle this."

When the preoperative client tells the nurse that the client cannot sleep because the client keeps thinking about the surgery, an appropriate reflection of the statement by the nurse is: A. "You shouldn't be nervous. We perform this procedure every day." B. "It sounds as if your surgery is a pretty scary procedure." C. "The thought of having surgery is keeping you awake." D. "You have a great surgeon. You have nothing to worry about."

C. "The thought of having surgery is keeping you awake."

A nurse is completing a health history with a client being admitted for a mastectomy. During the interview the client states, "I do not know what to do. I am not sure if I really need this surgery." Which response by the nurse demonstrates active listening? A. "I understand your confused, what do you think you should do?" B. "I understand you are not sure about having the surgery. Why do you think you really do not need the surgery?" C. "You seem unsure. Tell me your concerns about your surgery." D. "You seem unsure, please let me know if you decide to postpone the surgery until you are no longer unsure."

C. "You seem unsure. Tell me your concerns about your surgery."

Which nurse would most likely be the best communicator? A. An advanced practice nurse B. A nurse who is bilingual C. A nurse who easily develops a rapport with clients D. A nurse who is proficient in sign language

C. A nurse who easily develops a rapport with clients

A client is diagnosed with diabetes. The client's adult child offers to serve as an interpreter, because the client does not speak the dominant language. Which is the best action for the nurse to take? A. Involve a friend who speaks both the dominant and the client's languages. B. Allow the client's child to interpret. C. Contact a professional interpreter. D. Ask a fellow nurse who knows some words in the client's language to help.

C. Contact a professional interpreter.

While assessing a client, the nurse notices that the client seems to be distracted from the questions being asked. The nurse attempts to identify factors that may be affecting the communication. What would the nurse identify as an internal influencing factor? A. Noise B. Privacy C. Experience D. Ambience

C. Experience

When assessing a client's nonverbal communication, the nurse should assess which aspect as being the most expressive? A. Eye contact B. Hand gestures C. Facial expressions D. Posture

C. Facial expressions

A home care nurse discusses with a client when visits will occur and how long they will last. In what phase of the nurse-client relationship is this type of agreement established? A. Working phase B. Evaluation phase C. Orientation phase D. Termination phase

C. Orientation phase

When attending a staff meeting, a nurse is participating in what type of communication? A. Interpersonal communication B. Intrapersonal communication C. Small-group communication D. Organizational communication

C. Small-group communication

A dialysis nurse is educating a client on caring for the dialysis access that was inserted into the client's right arm. The nurse assesses the client's fears and concerns related to dialysis, the dialysis access, and care of the access. This information is taught over several sessions during the course of the client's hospitalization. Which phase of the working relationship is best described in this scenario? A. The orientation phase B. The introduction phase C. The working phase D. The termination phase

C. The working phase

A nurse is attempting to complete an admission database. While taking the history, the nurse notices the client appears uncomfortable and slightly tachypneic. The nurse should: A. ask questions as quickly as possible. B. tell the client to rest and allow a family member to answer. C. allow the client to set the pace. D. use only open-ended questions.

C. allow the client to set the pace.

A nurse is attempting to calm an infant in the nursery. The nurse responds to the highest developed sense by: A. offering the neonate infant formula. B. staring into the neonate's eyes and smiling. C. swaddling the child and gently stroking its head. D. softly humming a song near the neonate.

C. swaddling the child and gently stroking its head.

A nurse was informed that a family member was involved in a car accident and transported to the emergency department in the same facility. What action by the nurse best demonstrates understanding of client privacy? Finding the emergency medical technicians who transported the family members and inquiring about the injuries Calling the client information desk to find out the room number of the family member Accessing the electronic health record of the family member to find out extent of injury Asking the emergency department nurse for information on the family member

Calling the client information desk to find out the room number of the family member

A nurse is preparing to document client care in the electronic medical record using the SOAP format. The client had abdominal surgery 2 days ago. How would the nurse document the "S" information? Client is requesting pain medications, is grimacing, and is diaphoretic. Client states expecting some pain, but it is more severe than anticipated. Abdomen soft, slightly tender on palpation. Incision clean, dry and intact. Positive bowel sounds all four quadrants. Client states, "I have more pain in my belly today than I did yesterday. My pain is about a 7 out of 10."

Client states, "I have more pain in my belly today than I did yesterday. My pain is about a 7 out of 10."

When caring for a client, the nurse observes that the client enjoys reading books and magazines. In which learning domain does the client's learning style fall? Cognitive Affective Interpersonal Psychomotor

Cognitive

A nurse manager is trying to resolve a conflict between the day and night shifts. The nurse manager wants to convince the involved persons to set aside their differences, determine a priority common goal having to do with improved client care, and accept mutual responsibility for achieving this goal. The nurse manager is using which type of conflict resolution? Collaborating Avoiding Competing Compromising

Collaborating

An active, otherwise healthy, older adult client presents to the clinic with severe osteoarthritis in both knees. The nurse knows this client does not want to be a burden on the family, and the client remains stoic despite reporting the pain as severe. The client avoids the topic of surgery and attends church weekly. The client's family is supportive of any decisions the client makes regarding health. Which of the assessment data is most important to forming an individualized education plan for this client concerning treatment for osteoarthritis?

Personal perception of health and aging

The nurse is preparing to teach a client about postsurgical care after a laparoscopic cholecystectomy. Which factor should the nurse most consider when determining whether the client is ready and able to learn? Physical condition Social and economic stability Culture Emotional health

Physical condition

A home health nurse states to her client, "I am very proud of you. You gave your first insulin injection without a problem. You have done wonderfully and are learning fast." What technique is the nurse using to compliment the client's progress? Motivation Positive feedback Reinforcement Health promotion

Positive feedback

An informatics nurse specialist is extracting data from the facility's electronic health record in an attempt to identify clients at risk for developing catheter-related bloodstream infections. When gathering this data, the nurse specialist is using which technique? Big data Predictive analytics Genomics Data visualization

Predictive analytics

A 46-year-old obese client has been diagnosed with hypertension and type 2 diabetes. The client acknowledges the need to lose weight. The client recently visited a local fitness club, obtained a membership, and has signed up for their next water aerobics class. According to the Transtheoretical Model of Change, what stage of change is this client in related to her weight loss? Precontemplation Maintenance Contemplation Preparation

Preparation

An informatics nurse specialist is engaged in evaluating a clinical information system. At which time would the nurse specialist anticipate the need to obtain help from a statistician? Just before documenting the outcome evaluation During the literature search When preparing how to display the data When determining the data collection method

When determining the data collection method

A community health nurse provides information to a client with newly diagnosed multiple sclerosis about a support group at the local hospital for clients with the disease and their families. Providing this information is an example of: a consultation. reporting. conferring. a referral.

a referral.

After a nurse manager implements a solution to the problem of delays in obtaining supplies, the first task for the manager is to: make an appointment with the chief nursing officer. ask the staff members for other solutions. plan to monitor the supply cabinets. assess whether the desired results have occurred.

assess whether the desired results have occurred.

The nurse needs to understand the teaching-learning process when administering educational interventions. psychosocial interventions. health care provider-initiated interventions. technical interventions.

educational interventions.

When documenting the care of a client, the nurse is aware of the need to use abbreviations conscientiously and safely. This includes: using only those abbreviations that are defined in full at another location in the client's chart. using only abbreviations whose meaning is self-evident to an educated health professional. limiting abbreviations to those approved for use by the institution. ensuring that abbreviations are understandable to clients who may seek access to their health records.

limiting abbreviations to those approved for use by the institution.

During a recent visit to the clinic, a client tells the nurse, "I've been using my cell phone to track and record the foods that I eat so that I can better understand if I'm making healthy food choices." The nurse interprets the client's statement as reflecting which technology? Pharmacogenomics Patient portal mHealth Telemedicine

mHealth

A nurse is caring for a client experiencing biliary colic from uncomplicated cholelithiasis. The client asks, "My doctor says I should have surgery to remove my gallbladder. Do you think it is really necessary?" What is the nurse's best response? A. "It is a minimally invasive surgery with rapid recovery time, so you will do fine." B. "You should follow your health care provider's recommendation and have the surgery." C. "When you see the health care provider this morning, request more information about the surgery." D. "Share with me the advantages and disadvantages of your options as you see them."

D. "Share with me the advantages and disadvantages of your options as you see them."

A nurse is completing a health history with a newly admitted client. During the interview, the client presents with an angry affect and states, "If my doctor did a good job, I would not be here right now!" What is the nurse's best response? A. Stand and say, "I can see this interview is making you uncomfortable, so we can continue later." B. Nod and say, "I agree. If I were you, I would get a new doctor." C. Smile and say, "Don't worry, I am sure the health care provider is doing a good job." D. Be silent and allow the client to continue speaking when ready.

D. Be silent and allow the client to continue speaking when ready.

The client is an 18-month-old in the pediatric intensive care unit. The client is scheduled to have a subgaleal shunt placed tomorrow, and the client's mother is quite nervous about the procedure. The nurse tells the client's mother, "The surgeon has done this a million times. Your son will be fine." This is an example of what type of nontherapeutic communication? A. Giving advice B. Being moralistic C. Rescue feelings D. False reassurance

D. False reassurance

When caring for a psychiatric client, a nurse would make a formal contract with the client during which phase of the nurse-client relationship? A. Working phase B. Termination phase C. Intimate phase D. Orientation phase

D. Orientation phase

An informatics nurse is assisting with the design of an clinical information system for use by the staff of a health center. The nurse is working to ensure that the system reflects usability by making sure that the screen display is visually clean and uncluttered and that it provides only the information needed for decision making. Which concept of usability is the nurse incorporating? consistency simplicity forgiveness naturalness

simplicity

The nurse manager calls a staff into a unit meeting to discuss client satisfaction. During the meeting, several staff members assume control. The nurse manager does not intervene to regain control of the group. Which type of leadership style is the nurse embodying? Democratic Quantum Autocratic Laissez-faire

Laissez-faire

A nurse is discussing the benefits of smoking cessation with a client. The nurse informs the client that smoking cessation will reduce the client's risk for cancer, improve respiratory status, and enhance the quality of life. The nurse also shares a personal story of smoking cessation, provides information on other individuals who have successfully quit, and encourages the client to attend a support group for smoking cessation. The client discusses feelings on smoking cessation and verbalizes a desire to quit smoking. What type of counseling did the nurse provide to this client? Developmental Situational Motivational Long-term

Motivational

When a client says, "I don't care if I get better; I have nothing to live for, anyway," which type of counseling would be appropriate? Long-term counseling Short-term counseling Professional counseling Motivational counseling

Motivational counseling

A nurse manager is changing the policy for scheduling staff on a critical care unit. The schedules will be changed and an announcement was made regarding this to the staff. Based on Lewin's change theory, in what stage of change is the manager participating? Unfreezing Moving Transforming Freezing

Moving

A nurse is caring for a client with pneumonia. Which task is most appropriate for the nurse to delegate to an experienced unlicensed assistive personnel (UAP)? Instructing the client about the need to alternate activity with rest Administering nebulizer treatments as needed Assessing for shortness of breath Obtaining vital signs every 4 hours

Obtaining vital signs every 4 hours

An informatics nurse specialist has been involved in obtaining feedback about a clinical information system recently implemented in the facility. The information gathered provided recommendations for improving the satisfaction of the end users when using the system. Which aspect is the informatics nurse specialist addressing? Interoperability Usability Meaningful use Optimization

Optimization

An informatics nurse specialist is involved with implementing strategies to improve the performance of the clinical information system being used. As part of this process, the nurse specialist is working on updating the plans of care in the system to reflect changes to a procedure based on new evidence. The nurse is also working to streamline the display screens to reduce the need to document the same information in three different areas. The nurse specialist is addressing which aspect of the system? Optimization Standard terminology Interoperability Usability

Optimization

On a medical unit, the nurses complain that they have no voice in the decisions that are made in the operation of the unit. The nurses state they are always told by the nurse manager to perform tasks instead of being asked. Which of these best describes the leadership style of the nurse manager? Democratic Laissez-faire Nondirectional Autocratic

Autocratic

Which nurse-to-provider interaction correctly utilizes the SBAR format for improved communication? "I am calling about Mr. Jones. He has new onset diabetes mellitus. His blood glucose is 250 mg/dL (13.875 mmol/L), and I wondered if you would like to adjust the sliding scale insulin." "I am calling about Mr. Jones, who has diabetes mellitus. His blood sugar seems high, and I think he needs more insulin." "I am calling about the patient in room 212. He has new onset diabetes mellitus, and I wondered if you would like to adjust the sliding scale of insulin." "I am calling about Mr. Jones in room 212. His blood glucose is 250 mg/dL (13.875 mmol/L), and I think that is high."

"I am calling about Mr. Jones. He has new onset diabetes mellitus. His blood glucose is 250 mg/dL (13.875 mmol/L), and I wondered if you would like to adjust the sliding scale insulin."

A staff nurse is talking with a clinical nurse leader and asks, "What exactly do you do?" Which statement by the clinical nurse leader would be appropriate? "I collaborate with health care teams to promote client care." "I'm an advanced practice nurse with a specific specialty area." "I'm an administrator involved with client care." "My position is one of management."

"I collaborate with health care teams to promote client care."

The parents of a hospitalized 10-year-old ask the nurse if they can review the health care records of their child. What is the appropriate response from the nurse? "No, the health care provider will not give you access to review the records." "Are you questioning the care of your child?" "I will arrange access for you to review the record after you put your request in writing." "Only the client has the right to review the health care records."

"I will arrange access for you to review the record after you put your request in writing."

The unit nurse manager has just completed a workshop on best practices on documentation. Which statements made by the nurse would indicate that learning was effective? Select all that apply.

"I will write, print, or type information legibly." "I will use only agency-approved abbreviations." "I will draw a straight line through any blank space."

The nurse has provided education to a client about home care for an open surgical wound on the lower left extremity. When evaluating learning through the cognitive domain, what statement by the nurse would be appropriate? "Tell me about what signs of infection you will report to the health care provider." "I notice that you do not have the dressing secured. Place a piece of tape on the wrap." "Let's see how you irrigate the wound with saline." "I would like you to demonstrate how to change the dressing on your leg."

"Tell me about what signs of infection you will report to the health care provider."

A 56-year-old client meets with the nurse for education about a recently diagnosed atrial fibrillation. The client verbalizes concerns about being away from work too long and doubts about the necessity of having blood tests every week, as the client has no symptoms. Which is the best motivational statement by the nurse for this client? "Atrial fibrillation is when your upper heart beats ineffectively and blood clots can go to your brain. Would you like some printed information about this?" "The medicine and blood work can help prevent blood clots, which can lead to strokes. What do you know about warfarin therapy?" "You have to take your warfarin and go to the clinic every week for a blood draw. It's not the most convenient way to live, but you have to do it." "Your doctor wants you to take your warfarin every day, go to the clinic every week to have blood drawn, and then wait for any dosage change. Do you understand?"

"The medicine and blood work can help prevent blood clots, which can lead to strokes. What do you know about warfarin therapy?"

While the nurse is caring for a hearing impaired client, and a family member of the client states, "What do you think is the best way to communicate?" What is the best response by the nurse? "Limit communication to avoid frustration." "Encourage family members to increase their vocal pitch." "Use flash cards and writing pads." "Use words that begin with 'f,' 's,' 'k,' and 'sh' to communicate."

"Use flash cards and writing pads."

A nurse is counseling several clients for depression. Four of them do not seem to be improving, which leads the nurse to suggest a referral to a psychiatric nurse practitioner. Which of these clients would be most likely to attend the scheduled appointment? A 45-year-old female who is unsure of the benefit of psychiatric care, on a fixed income, and has good family support A 51-year-old male who walks to most places because of a lack of transportation, has a low income, and works days A 28-year-old female who works nights, is willing to try, and asks about insurance coverage of the appointment A 36-year-old male who uses public transportation, is unable to read, and wants to confer with a pastor

A 28-year-old female who works nights, is willing to try, and asks about insurance coverage of the appointment

Which clinical situation is addressed by the provisions of the Health Insurance Portability and Accountability Act (HIPAA)? A client wishes to appeal her insurance company's refusal to reimburse for a diagnostic test. A client who resides in Indiana has required hospitalization during a vacation in Hawaii. A client has asked for a second opinion regarding treatment options for her diagnosis of ovarian cancer. A client has asked a nurse if he can read the documentation that his health care provider wrote in his chart.

A client has asked a nurse if he can read the documentation that his health care provider wrote in his chart.

Two nurse managers working on different units in a hospital are planning for a major change to occur on both units. One nurse manager reports to the other having identified a key power player on the unit. Which description most applies to a key power player in this context? An employee who will resist the change A regular employee who is a natural leader Someone who spreads untrue rumors Someone in whom the nurse manager can confide

A regular employee who is a natural leader

A nurse is caring for a client who is newly diagnosed with terminal cancer. The nurse enters the client's room and finds the client sitting in the dark crying. Which statement conveys empathy by the nurse? A. "I know this is hard for you. Is there any way I can help?" B."I am so sorry you are going through this. Can we talk?" C. "Can you please tell me why you are crying?" D. "Sitting in the dark is not going to cure your cancer. Let's open the curtains."

A. "I know this is hard for you. Is there any way I can help?"

A client was recently diagnosed with metastatic lung cancer. The nurse finds the client crying in the room. Which statement made by the nurse best demonstrates the use of empathy? A. "I see you are upset. Would you like to talk?" B. "I see you have been crying. Do you want me to call someone for you?" C. "Don't worry, I have seen lots of people with cancer do fine." D. "I am sorry to hear you have cancer. I would be upset too, is there anything I can do?"

A. "I see you are upset. Would you like to talk?"

The nurse is caring for a client at the end stage of life. The client is crying and states to the nurse, "I just cannot believe I am going to be leaving my children without a parent. I am not ready to go." What response by the nurse demonstrates the expression of empathy to the client? A. "It sounds as though you are most concerned about how your children will feel." B. "This is so sad and I feel so bad that you are in this situation." C. "I am so sorry that I am crying with you when you need my support the most." D. "This just is not fair at all and I do not understand why this is happening to you."

A. "It sounds as though you are most concerned about how your children will feel."

A client with a cardiac dysrhythmia was recently prescribed metoprolol and is at a follow-up appointment at the cardiologist's office. The client tells the nurse, "I feel depressed, tired, and I have no desire to exercise." To determine a cause-and-effect relationship, the nurse should ask: A. "Were you tired and depressed before starting the new medication?" B. "Have you tried exercising at all in the last week or two?" C. "Tell me about the foods you are eating." D. "Do you check your blood pressure and pulse before you take your medication?"

A. "Were you tired and depressed before starting the new medication?"

A 70-year-old client had a cholecystectomy 4 days ago. The client's daughter tells the nurse, "My mother seems confused today." Which question would be best for the nurse to ask to assess the client's orientation? A. "What is your name?" B. "Is your name Evelyn?" C. "Is today the first day of the month?" D. "Are you in a hospital?"

A. "What is your name?"

What nursing care behavior by the nurse engenders a client's trust in the nurse? A. A nurse answers the client's questions about an upcoming test in a calm gentle voice while making eye contact with the client. B. A nurse answers the client's questions about an upcoming test while completing documentation in the EHR. C. A nurse tells the client, "Do not worry about the test, I have never cared for anyone that had problems with it." D. A nurse tells the client, "My shift will be over in 45 minutes, I will let the oncoming nurse know you have questions about tomorrow's test."

A. A nurse answers the client's questions about an upcoming test in a calm gentle voice while making eye contact with the client.

An informatics nurse specialist has conducted the initial testing of an update to the clinical information system and is preparing to conduct further testing. Which area would the nurse test next? Ability of the system to work for a specific function Ability of the system to function in its entirety as designed Ability of the system to work for an entire workflow Ability to work when multiple users are using the system

Ability of the system to work for a specific function

The new nurse is having difficulty managing the time required to care for a group of complex clients and is several hours behind in completing nursing interventions. Which intervention should the nurse complete first? Complete a medication reconciliation form on a client who has recently been admitted to the hospital. Administer a dose of digoxin that is two hours behind schedule. Obtain discharge orders for a client who is ready to be transferred to a long-term nursing facility. Perform a dressing change to an abdominal abscess that is three hours behind schedule.

Administer a dose of digoxin that is two hours behind schedule.

Conflict has emerged on a nursing unit because new graduates have found that some of the more experienced nurses are manipulating the client assignment to ensure a lighter workload during night shifts. How should the manager of the unit best address this conflict? Reassure the new graduates that the more experienced nurses are acting in the interests of both staff and clients. Arrange for the newer nurses to organize the client assignment for a trial period. Gather evidence over the next several weeks in order to determine if the practice is indeed happening. Arrange a meeting where the issue can be discussed and addressed by as many of the nurses as possible.

Arrange a meeting where the issue can be discussed and addressed by as many of the nurses as possible.

The parent of a 33-year-old client who is admitted to the hospital for drug and alcohol withdrawal asks about the client's condition and treatment plan. Which action by the nurse is most appropriate? Take the parent to the client's room and have the client give the requested information. Explain the reasons for the hospitalization, but give no further information. Ask the client if information can be given to the parent. Provide the information to the parent.

Ask the client if information can be given to the parent.

The nurse is caring for an older adult client who states the need to use the restroom. Which safety intervention must the nurse perform first?

Assess the need for assistance with ambulation.

The nurse must instruct a 35-year-old client with Down syndrome about the use of an albuterol rescue inhaler. Which documentation demonstrates appropriate individualization of the education plan for this client? Assessed the client's understanding of health and answered questions on an age-appropriate level while the television was on in the room Assessed the client's understanding of illness; assessed motor skills and developmental stage; provided clarification Taught lesson at an adult developmental level (age 35) using short sentences and assessed motor skills Taught lesson at a school-age developmental level in an authoritarian style while the client was at meal time

Assessed the client's understanding of illness; assessed motor skills and developmental stage; provided clarification

A client informs the nurse about being committed to quitting smoking to improve health. During discussion, the nurse asks the client "on a scale of 0 to 10, how likely are you to attend a support group?" Which strategy of motivational interviewing is the nurse using with the client? Prioritizing Elicit-provide-elicit Assessing importance Evoking change talk

Assessing importance

Nurses use social media to share ideas, develop professional connections, access educational offerings and forums, receive support, and investigate evidence-based practices. Which is an example of the proper use of social media by a nurse? A. A nurse posts pictures of a client who accomplished a goal of losing 100 lb and later deletes the photo. B. A nurse uses a disclaimer to verify that any views the nurse expresses on Facebook are the nurse's alone and not the employer's. C. A nurse describes a client on Twitter by giving the room number rather than the name of the client. D. A nurse describes a client on Twitter by giving the client's diagnosis rather than the client's name.

B. A nurse uses a disclaimer to verify that any views the nurse expresses on Facebook are the nurse's alone and not the employer's.

A nurse is interviewing a client who has come to the clinic for a follow-up visit. The nurse notices the client does not make eye contact and speaks while looking down. How should the nurse respond? A. Sit silently until the client looks up and makes eye contact. B. Assume a position at eye level with the client and continue with the interview. C. Stop the interview and ask, "How are you feeling?" D. Touch the client's hand and say, "You seem upset, is there something bothering you?"

B. Assume a position at eye level with the client and continue with the interview.

A nurse is educating a 4-year-old client about cast care following a tibia-fibula fracture. Which action is not developmentally appropriate to include in the nurse's teaching? A. Ensuring the client's parents are present B. Blocking 30 minutes of time for skill teaching C. Using dolls to demonstrate psychomotor skills D. Giving stickers as a reward for task completion

B. Blocking 30 minutes of time for skill teaching

Which quality in a nurse helps the nurse to become effective in providing for a client's needs while remaining compassionately detached? A. Commiseration B. Empathy C. Sympathy D. Kindness

B. Empathy

An informatics nurse specialist is preparing a presentation for a local community group about advances in technology in health care. Part of the presentation will focus on technological advances to promote greater client participation in managing health. Which component would the nurse likely describe as playing a major role? Electronic health record Predictive analytics Clinical information system Patient portal

Patient portal

The nurse documents a progress note in the wrong client's electronic medical record (EMR). Which action would the nurse take once realizing the error? Contact information technology (IT) staff to make the correction. Create an addendum with a correction. Immediately delete the incorrect documentation. Contact the health care provider.

Create an addendum with a correction.

A nurse is caring for a client who sustained head trauma. The client is in a medically induced coma and on mechanical ventilation. The client's parent is at the bedside in tears. The parent states, "I just want my child to know I am here." To address the needs of the parent and the client, what would be the nurse's most appropriate response? A. Place the client's hand on the parent's hand and reassure the parent that things will be fine. B. Place a chair next to the bed and then leave the room to allow the parent to grieve. C. Encourage the parent to bring in pictures of the family that can be displayed in the room. D. Place a chair next to the bed and encourage the parent to hold the client's hand.

D. Place a chair next to the bed and encourage the parent to hold the client's hand.

The nurse is caring for a postoperative client who refuses a blood transfusion due to religious beliefs. The nurse is demonstrating trustworthiness when taking which action in response to the client's treatment wishes? A. explaining the health consequences of refusing to undergo the prescribed treatment B. asking the client's family to discuss the importance of the prescribed treatment with the client C. recommending assessment of the client's cognitive capacity to make health care decisions D. contacting the interprofessional care team to discuss alternative treatment options

D. contacting the interprofessional care team to discuss alternative treatment options

A nurse is preparing to provide discharge instructions to a postpartum client regarding infant care. Before beginning the education session, the nurse should: A. ask all visitors to leave the room. B. ask the client's partner to leave the room to allow the client to focus. C. ask the client if she is able to read. D. eliminate as many distractions as possible.

D. eliminate as many distractions as possible.

A nurse is preparing to enter a client's room to perform wound care. The shift report revealed that this client has a tunneling wound in the sacral area that cannot be staged. The wound was also documented as having a foul odor. The nurse is nervous because the nurse has not often performed wound care on a complex wound. Using effective intrapersonal communication, this nurse should: A. inform the client that several nurses will be needed to care for this wound. B. tell the unlicensed assistive personnel (UAP) to gather supplies and to prepare to cleanse and dress the wound. C. ask the charge nurse to change the assignment. D. tell oneself to "remain calm" and remember that the nurse was trained to perform this skill.

D. tell oneself to "remain calm" and remember that the nurse was trained to perform this skill.

An informatics nurse specialist is describing the framework underlying informatics practice. Which component of the framework would the nurse specialist describe as discrete entities without interpretation? Wisdom Knowledge Information Data

Data

The nurse is working to enhance time management skills and has to administer pain medications to several clients, obtain vital signs, and assist clients with bathing. What should the nurse do next? Obtain vital signs. Bathe clients. Administer pain medications. Delegate bathing and vital signs tasks.

Delegate bathing and vital signs tasks.

A staff nurse works on a medical unit where staff retention is very high. There is a sense of equality between the leader and the staff nurses. The unit decisions and activities are shared between the leader and the group. The designated nurse leader practices which leadership style? Transformational Autocratic Democratic Laissez-faire

Democratic

The nurse has recently been promoted to nurse manager on a pediatric unit and has decided to accept input from staff regarding changes they would like to see on the unit. Which type of leadership style is the nurse embodying? Democratic Laissez-faire Quantum Autocratic

Democratic

The nurse is preparing to teach a client from Generation X about hypertension. Which teaching approach should the nurse plan to implement? Provide brochures about low-sodium foods. Ask a family member to do meal planning to alleviate the burden for the client. Demonstrate the MyFoodPyramid phone app, to show the best food choices on a lunch tray. Have the client repetitively choose appropriate foods from various menus.

Demonstrate the MyFoodPyramid phone app, to show the best food choices on a lunch tray.

The registered nurse (RN) and unlicensed assistive personnel (UAP) are working together to admit a pediatric client to a nursing unit. Which task would be inappropriate for the RN to delegate to the UAP? Securing the client on a papoose board Initiating intravenous therapy Gathering equipment needed for intravenous therapy Soothing the client during the procedure

Initiating intravenous therapy

Which developmental consideration is a nurse assessing when determining that an 8-year-old child is not equipped to understand the scientific explanation of the child's disease? Psychosocial development Motor development Intellectual development Emotional maturity

Intellectual development

A nurse working in a primary care provider's office is using the clinical information system to review a client's health information. The nurse is able to review the client's last visit to the primary care provider as well as information from a recent hospitalization, and also a visit that the client made to the cardiologist last week. The nurse's ability to review this information is based on which aspect of the clinical information system? Usability Interoperability Security Optimization

Interoperability

After talking with a group of staff nurses on the medical-surgical unit, the nurse manager identifies a need for change. When developing a plan for change, which question would the nurse manager need to ask first? How quickly can the change be made? Is the group ready for making the change? Are there individuals within the group who might resist the change? Is the behavior something that can be changed?

Is the behavior something that can be changed?

Nurses at a health care facility maintain client records using a method of documentation known as charting by exception (CBE). What is a benefit of this method of documentation? It provides and refers to a client's problem by a number. It records progress under problems, intervention, and evaluation. It provides quick access to abnormal findings. It documents assessments on separate forms.

It provides quick access to abnormal findings.

A nurse leader on a unit allows the staff to make all decisions and direct themselves, including filling out the work schedule. The nurse leader is practicing which leadership style? Transformational Democratic Laissez-faire Autocratic

Laissez-faire

The nurses at a health care facility were informed of the change to organize the clients' records into problem-oriented records. Which explanation could assist the nurses in determining the advantage of using problem-oriented records? Problem-oriented recording has numerous locations for information where members of the multidisciplinary team can make entries about their own specific activities in relation to the client's care. Problem-oriented recording gives clients the right to withhold the release of their information to anyone. Problem-oriented recording makes it difficult to demonstrate a unified approach for resolving clients' problems among caregivers. Problem-oriented recording emphasizes goal-directed care to promote the recording of pertinent data that will facilitate communication among health care providers.

Problem-oriented recording emphasizes goal-directed care to promote the recording of pertinent data that will facilitate communication among health care providers.

The nurse manager for a surgical unit is planning a significant change in how the unit functions. Which action by the nurse manager would be most effective in helping overcome resistance to the planned change? Threaten to end the staff's employment if they do not adopt the change. Provide incentives for adopting the change, such as time off. Demand loyalty and commitment from the staff in adopting the change. Refuse to hear any discussion about adopting the change.

Provide incentives for adopting the change, such as time off.

A nurse assisting a new mother in the act of breastfeeding represents which form of learning? Psychomotor Simplistic Affective Cognitive

Psychomotor

An informatics nurse is reading a journal article about standard terminologies. The nurse demonstrates a need to reread the article when identifying which example as reflecting a standard terminology? NANDA Nursing Diagnoses PubMed Clinical Care Classification System Nursing Interventions Classification

PubMed

In SBAR, what does R stand for? Reinforcing data Report Recommendations Response

Recommendations

Several nurses are discussing their impressions of the newly implemented electronic health record with an informatics nurse specialist. They say, "There is so much information on one screen, it hard to tell what we should do first. It's not really clear." The informatics nurse specialist interprets the comments as reflecting an issue with which area? Optimization Usability Security Interoperability

Usability

The nurse recognizes that a new mother is having difficulty breastfeeding. The nurse demonstrates various positions in which to hold the infant while feeding. The nurse also educates the mother on ways to ensure proper latching. The new mother attempts to breastfeed the infant again using the new techniques and is successful. Which statement in this scenario illustrates Lewin's stage of refreezing? The nurse demonstrates various positions in which to hold the infant while feeding. The new mother attempts to breastfeed the infant again using the new techniques and is successful. The nurse recognizes that a new mother is having difficulty breastfeeding. The nurse also educates the mother on ways to ensure proper latching.

The new mother attempts to breastfeed the infant again using the new techniques and is successful.

When a nurse is planning for learning, who must decide who should be included in the learning sessions? The health care team The client and the client's family The doctor and nurse The nurse and the client

The nurse and the client

The nurse is finding it difficult to plan and implement care for a client and decides to have a nursing care conference. What action would the nurse take to facilitate this process? The nurse consults with someone in order to exchange ideas or seek information, advice, or instructions. The nurse, along with other nurses, visits clients with similar problems individually at each client's bedside in order to plan nursing care. The nurse meets with nurses or other health care professionals to discuss some aspect of client care. The nurse sends or directs someone to take action in a specific nursing care problem.

The nurse meets with nurses or other health care professionals to discuss some aspect of client care.

The registered nurse (RN) wants to delegate a task to an unlicensed assistive personnel (UAP) but is unsure if the task can be delegated. What is the best resource for the RN to use in determining if the task is appropriate? A nurse mentor or a nurse preceptor The nurse practice act or facility's policy and procedures A more experienced nurse working on the same unit The medical practice act website

The nurse practice act or facility's policy and procedures

Which example may illustrate a breach of confidentiality and security of client information? The nurse informs a colleague that she should not be discussing client information in the hospital cafeteria. The nurse accesses client information on the computer at the nurses' station, then logs off before answering a client's call bell. The nurse provides information over the phone to the client's family member who lives in a neighboring state. The nurse provides information to a professional caregiver involved in the care of the client.

The nurse provides information over the phone to the client's family member who lives in a neighboring state.

Which of these statements regarding a nurse manager role is accurate? The nurse manager's main role in the nursing unit is to manage the unit budget. To effectively manage the nursing unit, the nurse manager should also be a leader. The nurse manager will decide on the financial targets for the nursing unit. A healthy work environment is not within the scope of the nurse manager's role.

To effectively manage the nursing unit, the nurse manager should also be a leader.

A nurse is working as part of a group on developing strategies to meet the health care needs of the children being served by the facility. The nurse identifies the need for expanded play therapy programs. The nurse works to motivate others in the group and promote a common vision. The nurse and the group communicate openly and honestly with the others involved, focusing on the process as well as the outcomes. The nurse is exhibiting which style of leadership? Transformational Laissez-faire Democratic Transactional

Transformational