Budgeting quiz, Change, Conflict, Communication quiz, Organizational Structure and Power quiz, Delegation and Prioritization Saunders sample quizes module 5, Models of Care, Quality Care and Safety quiz, Legal and Ethical Issues in Leadership and Man...

Brenda hears a few minutes of taped report from a new graduate nurse about a client who is scheduled for a colectomy today. Which statements by the new nurse indicate that the nurse needs a review of giving hands-off report? Select all that apply. "She can be sort of demanding at times." "She had pain medication, with good results." "Her bowel sounds are hypoactive in all four quadrants." "She had trouble getting to sleep, but I gave her a sleeping pill at 0100 and after that she slept for 5 hours." "The preoperative checklist is completed except for administration of the preoperative medication, which is on call."

"She can be sort of demanding at times." "She had pain medication, with good results." RATIONALE: It is important to conduct oneself professionally when giving report about clients. The nurse should provide objective measurements or observations about the client, not use critical comments or judgmental language such as "demanding" or "difficult." The nurse should also provide evaluation of the results of nursing or medical measures in specific, objective terms and avoid the use of vague terms such as "good" or "poor," which do not provide sufficient information about the client.

Just before her discharge, Lynn Ann decides that she wants to review her medical record. She calls the nurse and says, "I'd like to read my chart before I leave. I want to see the pathology report for myself." Which responses by the nurse are appropriate? Select all that apply. "Sure! Let me go make a copy for you." "Well, that's not really allowed. Why don't you believe what your doctor told you?" "The nursing supervisor will be glad to review your record with you in case you have questions." "We can't let you look at it now, but you can ask your doctor about reviewing it when you see her." "Yes, you'll be able to review your record. Let me go and check on the correct procedure for doing that first, though."

"The nursing supervisor will be glad to review your record with you in case you have questions." "Yes, you'll be able to review your record. Let me go and check on the correct procedure for doing that first, though." RATIONALE: Per HIPAA regulations, the client has the right to inspect and have a copy of his or her medical record. Lynn Ann just wants to review her record; she is not asking for a copy at this time. However, clients may have questions about what is in the chart, and the institution's policies for client review of medical records must be followed. Asking a client why he or she wants to read the record is challenging the client and not therapeutic; it is not necessary to delay the review by asking the primary health care provider, although the primary health care provider should be informed of the client's request.

The nurse determines that which clients are capable of giving consent? Select all that apply. A 15-year old who seeks treatment in a clinic for signs/symptoms of the flu A 17-year old who is seeking treatment for a substance abuse problem A married 17-year old who requires treatment for a suspected respiratory infection A 17-year old soldier in the U.S. Army who requires sutures for a laceration sustained while home on leave A 14-year old who requires an ankle x-ray for a fall sustained while vacationing with a friend's family

A 17-year old who is seeking treatment for a substance abuse problem A married 17-year old who requires treatment for a suspected respiratory infection A 17-year old soldier in the U.S. Army who requires sutures for a laceration sustained while home on leave RATIONALE: Although guidelines for legal consent for medical treatment are guided by state law, generally situations in which minors can provide consent for treatment include: lawfully married or a parent (emancipated); pregnancy (excluding abortions); venereal disease; or a drug or other substance abuse problem. The 15-year-old who seeks treatment in a clinic for symptoms of the flu, and the 14-year-old who requires an ankle x-ray for a fall sustained while vacationing with a friend's family require the consent of a parent or legal guardian before treatment can be provided.

3. An RN with three years of experience becomes the nurse manager of a surgical unit. The nurse invites an experienced UAP, who has worked on the unit for 12 years, to be a member of the unit's Performance Improvement Team. The UAP declines the invitation, but continually voices disagreement to other staff about the manager and any recommendations made by the manager's PI team. Which of the following theories should the RN consider as a possible explanation of the UAP's behavior? A. Principal agent theory B. Human capital theory C. Servant leadership theory D. Quantum leadership theory

A. Principal agent theory (Principals (managers must be aware that some agents followers/staff may sabotage efforts of a leader because they have their own agenda/goals to be achieved. The UAP may harbor feelings of resentment toward the younger less experienced nurse manager who is now is position of authority and the UAP may be seeking ways to keep the RN from being successful in her new role.)

Lisa, the case manager, contacts the family of the client in room 5116, Mr. Flint. He is scheduled for one more infusion of chemotherapy this morning and hopes to go home later today. His wife will need to give him injections when he goes home. At what time do discharge planning and teaching for Mr. Flint begin? At the time of admission Once he begins to feel better The day of Mr. Flint's discharge At the midpoint of the hospitalization

At the time of admission RATIONALE: Discharge planning is an interprofessional process that ensures that the client will receive continuity of care after leaving the hospital or other health care facility. It is essential that discharge planning be started at the time of the client's admission to the hospital so that all the aspects of care may be arranged efficiently. For this reason, the other options are incorrect.

8. What type of leadership theory is thought to be needed in a complex ever changing healthcare system? A. Thought leadership B. Quantum leadership Servant leadership D. Authentic leadership

B. Quantum leadership (focuses on skills needed for rapidly changing environments, such as health care industry)

1. In which of the following conditions would a laissez-faire leadership style be most effective? A. Health crisis requring activation of disaster plan. B. Technology start-up company looking to capture market of health care information apps for young adults between 18 and 35 years of age. C. Nursing administration is promoting a shared governance model to promote retention of its nursing staff. D. Newly finded community outreach program with multiple diverse constituencies each with unique goals

B. Technology start-up company looking to capture market of health care information apps for young adults between 18 and 35 years of age. B. Technology start-up company looking to capture market of health care information apps for young adults between 18 and 35 years of age. (this requires a more democratic or authoritarian approach so that the decisions can be made for optimal use of funds with input from all community members without wasting time or resources)

Which of the following actions would one expect to be used by the nurse manager who uses an intuitive approach to decision-making? A. Takes considerable time to analyze available options. B. Seeks consensus from team members before finalizing a decision. C. Makes a quick spontaneous decision based on recognized patterns of prior experience. D. Sets clear objectives to achieve the desired outcome.

C. Makes a quick spontaneous decision based on recognized patterns of prior experience. (Intuitive decision-makers make spontaneous rapid decisions that are based on recognizing patterns of prior experiences and knowledge)

A nurse manager selects two staff RNs to solicit ideas from the staff of all three shifts regarding ways to improve shift reporting. The RNs will present a report to the manager and staff; and, the manager will discuss the evidence-based pros and cons of each suggestion before asking for consensus on the method of shift reporting to be implemented. What leadership style is evident? A. Authoritarian B. Authentic C. Democratic D. Laissez-faire

C. Democratic (AS the leader has opened communication to the staff, and is seeking sharing in decision making process with guidance being offered.)

2. Which of the following actions is most descriptive of a transactional leader? A. Empowers followers. B. Has long term vision. C. Uses contigency rewards. D. Focus is on effects.

C. Uses contigency rewards. (in order to garner support for projects or to get staff on board with group goals, the transactional leader offers rewards based on performance (e.g if you perform this activity, you will receive this tangible reward)

Which of the following conflict resolution styles is most effective to achieve long term resolution of the issue causing the conflict? Accommodating Avoiding Competing Collaborating

Collaborating (Collaborating style of conflict resolution represents a high level of cooperation and high level of assertiveness)

According to Rodgers Theory of Innovation, which of the following characteristics of change or the change process are associated with facilitating change? Full simultaneous implementation across the agency Increased complexity Compatibility with values of staff and/or agency Observable positive results Offers some relative advantage over the old way

Compatibility with values of staff and/or agency Observable positive results Offers some relative advantage over the old way

Which of the following is a characteristic or behavior that is representative of a leader? A. Lead both willing and non-willing followers. B. Has authority through a formal role in the organziation. C. Utilize resources to achieve an organizational goal D. Emphasizes interpersonal relationships.

D. Emphasizes interpersonal relationships. (A leader is concerned with others and focuses on group processes)

. Which of the following statements is TRUE about analyzing options when trying to reach a sound decision? A. Limit the number of options to 2 to 3 so analysis can be more in-depth. B. Ask members of the team to each present their views about each option. C. Keep the current process unless refutable evidence exists that another option is superior. D. Generate as many alternative options as possible to broaden possibility of identifying a successful strategy.

D. Generate as many alternative options as possible to broaden possibility of identifying a successful strategy. (Most people limit options to consider, it is important to consider many options when seeking to solve a problem)

Which of the following is a component of Emotional Intelligence theory? A. Heart B. Innovation C. Humility D. Motivation

D. Motivation (working for reasons that go beyond salary and position are an inherent component of Ei)

Which of the following is NOT a distinguishing trait of an integrated manager-leader? A. Focus on larger organizational needs. B. Emphaisize vision, values, and motivation. C. They are visionary and think long-term. D. They resist change to keep organizational processes intact.

D. They resist change to keep organizational processes intact. (This is not a trait, integrated leader-managers embrace change as needed to help organizations stay current)

What communication pattern is most often used by an authoritarian nurse leader? Horizontal Upward Downward Grapevine

Downward (Authoritarian leaders use downward communication and direction to subordinates)

According to HIPAA, in which situations could a client's PHI be used or disclosed? Select all that apply. For treatment purposes For any type of research For health care payment purposes To administer health care benefits To provide information to a family member at any time during the client's hospital stay For learning purposes for medical and nursing students if the client provides permission to do so

For treatment purposes For health care payment purposes To administer health care benefits For learning purposes for medical and nursing students if the client provides permission to do so

Which strategy for effective change is operationalized by the manager who is skilled in interpersonal relationships and decides to focus the change implementation plan by addressing peer pressure and group norms influences among staff rather than sharing information? Rational-empirical Normative-educative Power-coercive

Normative-educative

The nurse is demonstrating client advocacy in which of these situations? Select all that apply. Helping a client bathe Changing a client's abdominal dressing Including the client in the formulation of a nursing care plan Ensuring that the client has been informed of the treatment plan Sharing the client's viewpoint regarding treatment during an interdisciplinary health care conference

Including the client in the formulation of a nursing care plan Ensuring that the client has been informed of the treatment plan Sharing the client's viewpoint regarding treatment during an interdisciplinary health care conference RATIONALE: The nurse must act as a client advocate and speak up for or act on behalf of the client, protect the client's right to make his or her own decisions, and uphold the principle of fidelity. The nurse serves as an advocate by ensuring that the client has been informed of the treatment plan and including the client in developing the plan of care. The nurse should also share the client's viewpoint with others, such as the interdisciplinary health care team, involved in the client's care. Helping a client bathe and changing a client's abdominal dressing are nursing interventions but are not specifically associated with the role of advocacy.

A nurse manager is reviewing ethical principles with the nursing staff. Which example does the nurse manager provide to explain the concept of fidelity? Keeping a promise made to the client Supporting the client's right to informed consent Determining the order in which clients are cared for Avoiding harm to the client in the performance of nursing care

Keeping a promise made to the client RATIONALE: Ethical principles are codes that direct or govern nursing actions. Fidelity is the duty to do what one has promised. Autonomy refers to respect for an individual's right to self-determination. Justice is the equitable distribution of potential benefits and tasks and determining the order in which clients should be cared for. Nonmaleficence refers to the obligation to do or cause no harm to another.

The office nurse reviews the signed consent form and determines that which pieces are components of informed consent? Select all that apply. Cost of the procedure/surgery Name of the procedure/surgery Description of the procedure/surgery Person(s) performing the procedure/surgery Potential risks and adverse effects of procedure/surgery

Name of the procedure/surgery Description of the procedure/surgery Person(s) performing the procedure/surgery Potential risks and adverse effects of procedure/surgery RATIONALE: Information needed for informed consent includes the name and description of the procedure, the name of the person(s) performing the procedure, and risks and potential adverse effects of the procedure. Informed consent does not include the cost of the surgery. Other information includes the approximate length of recovery time needed and the consequences of refusing the proposed treatment.

Which of the following statements most accurately describes a nurse who is using a passive-aggressive communication style? Nurse confronts peer to discuss mix-up in vacation schedule. Nurse regularly berates another staff member In front of patients and other staff calling the nurse disparaging names and saying she is competent. Nurse voices enthusiastic agreement to manager about an agency committee assignment, but then fails to attend any meetings and tells other committee is waste of time. No answer text provided.

Nurse voices enthusiastic agreement to manager about an agency committee assignment, but then fails to attend any meetings and tells other committee is waste of time.

At 7:45 a.m., Carol checks all of her clients. Sal is not experiencing any dyspnea, but he tells Carol that he is tired because he didn't get any sleep during the night. Judy tells Carol that she is beginning to experience abdominal discomfort and will need pain medication as soon as she is able to have it, at 8:30 a.m. Carla is still sleeping, and James tells Carol that he is restless and anxious about the cardiac catheterization. Place the following planned actions in order of priority, with 1 being the first priority and 4 the last.

Order Sequencing Option 1 Talking to James about the cardiac catheterization procedure 2 Asking the nursing assistant to help Sal with bathing 3 Administering pain medication to Judy 4 Waking Carla and helping her prepare for breakfast

Brenda leaves the unit at 1 p.m. to attend the quality improvement committee meeting. The committee is beginning an audit of medication errors, and committee members have expressed a desire to use evidence-based practice as they study this problem. The committee members participate in a review of evidence-based practice by completing a short exercise. Place the steps of evidence-based practice in order, with 1 as the first step and 6 as the last. From the first step to the last step, what are the order of actions that make up the evidence-based process?

Order Sequencing Option 1. Ask a clinical question. 2. Collect the best and most relevant evidence. 3. Critically appraise the evidence you gather. 4. Apply or integrate evidence along with your clinical expertise, client preferences, and values in making a practice decision or change. 5. Evaluate the practice decision or change. 6. Communicate your results.

6. Which Medicare part pays for outpatient care, including laboratory and radiologic tests and primary care visits? Part A Part B Part C Part D

Part B

The nurse identifies which characteristics as part of the case management approach to health care delivery? Select all that apply. Provides an individualized plan of care for the client Represents an interprofessional health care delivery system Involves one nurse who supervises all other primary health care providers Includes a comprehensive approach that promotes quality and cost-effective care Requires only a case manager to implement the care for all of the clients in the facility

Provides an individualized plan of care for the client Represents an interprofessional health care delivery system Includes a comprehensive approach that promotes quality and cost-effective care RATIONALE: Case management is an interprofessional approach to health care delivery in which available resources are used to promote quality, cost-effective, comprehensive care. It comprises assessment and development of a plan of care, coordination of all services, consultation, referral, and follow-up. A case manager coordinates the client's care from the point of admission and after discharge. The case manager initiates an individualized nursing plan of care as appropriate, assesses the client's needs for equipment such as oxygen or wound care supplies, and explores available resources to provide the client with such supplies. The case manager provides resources that will help the client maintain the greatest possible degree of independence and provides the client with information on discharge procedures and the plan of care. The case manager is not responsible for supervising other primary health care providers and does not implement care for all of the clients in the facility.

Which phase of Lewin's change model would include the nurse manager assuring ongoing support is available to staff to help with day to day aspects of the new innovation? Unfreezing Movement Refreezing No answer text provided.

Refreezing (Continued support is needed to help staff to adapt to change and develop self-confidence in performing necessary tasks. If difficulties arise w/o staff support, staff will revert to the old method)

The next morning, a nursing student walks into the room and awakens Lynn Ann. The student greets her and says, "Hi, I'm here to take care of you today. I hope you don't mind." The student then begins to ask Lynn Ann questions about her past health history and surgery. Lynn Ann is tired, needs some medication for pain, and does not really want to talk at the moment. She tries to tell the student that another time would be better. The student insists, "No, I need to do this now to finish my paperwork" and continues to ask questions. Which client rights did the student violate in this situation? Select all that apply. Right to privacy Right to consent or refuse a treatment Right to considerate and respectful care Right to expect that the hospital will provide necessary health services Right to know the names and roles of the persons who are involved in care

Right to privacy Right to considerate and respectful care Right to know the names and roles of the persons who are involved in care RATIONALE: The client has the right to know the names and roles of the persons involved in her care. In this situation, the student did not introduce herself. The right to privacy also means that a person must be left alone and remain anonymous if he or she chooses. The student has ignored Lynn Ann's request to talk at another time, another violation of the client's right to considerate and respectful care. This situation does not illustrate violation of the right to consent to or refuse treatment, because the student did not administer a treatment. The right to expect the hospital to provide necessary health services is also not an issue in this situation.

Which of the following strategies should the nurse manager use to improve the likelihood of staff accepting a proposed change to the agency's mandatory overtime policy? Wait until policy is formally implemented to present to staff. Solicit early and often the opinions and views of the staff to share with administration while policy is being developed. Offer opportunities for staff to hear from representatives of collective bargaining organizations. Remind staff that failure to adhere to revised mandatory policy will lead to termination.

Solicit early and often the opinions and views of the staff to share with administration while policy is being developed.

A nurse is preparing a report for a client who is being transferred from the coronary care unit to a medical nursing unit. The nurse plans to include which information in the transfer hands-off report? Select all that apply. The client's home address The client's resuscitation status The client's medical record number The client's needs and priorities for care Client assessments or interventions that are required after transfer

The client's resuscitation status The client's needs and priorities for care Client assessments or interventions that are required after transfer RATIONALE: A transfer report is made to provide continuity of care. It may be given by one nurse to another nurse by phone or in person, such as when a client is being transferred from one nursing unit to another. The report should include the following information: client's name, age, primary health care provider, and diagnosis; current health status, current plan of care, and client requests; client's needs and priorities for care; any assessments or interventions that are needed after transfer (e.g., laboratory tests, medication administration, dressing changes); the need for any special equipment; and any additional considerations for care (e.g., resuscitation status; precautionary considerations; cultural, religious, or family issues). The receiving nurse must be given an opportunity to repeat the information and to ask questions about the client's status. The client's home address and medical record number are not a part of the transfer report and are not directly related to client needs.

The nurse asks Madeleine whether she has discussed her health care decisions with her daughters. Madeleine tells the nurse that she plans to do so when they visit and that she would like to have a living will completed. Madeleine asks the nurse about the procedure for preparing a living will and wonders whether it can be done while she is in the hospital. How should the nurse respond? The living will must be legally prepared. Madeleine's primary health care provider may prepare the living will. The hospital's client-advocate representative may prepare the living will. Madeleine must have the living will prepared after she is discharged from the hospital.

The living will must be legally prepared. RATIONALE: An instructional living will is a document that instructs the primary health care provider to withhold or withdraw life-sustaining procedures when death is imminent. The document must be legally prepared, with appropriate witnessing of the client's signature. Requirements for the execution of living wills vary from state to state, but generally two witnesses, neither of whom may be a relative or primary health care provider, are needed when the client signs the document. The client's lawyer may prepare the document while the client is hospitalized.

After eating lunch, Margaret gets out of bed and walks to the bathroom. On her way back from the bathroom she becomes lightheaded and grabs at the over-bed table, which rolls into the wall, causing Margaret to fall to the floor. The nurse rushes into the room on hearing the noise and finds Margaret lying on the floor. The nurse takes Margaret's vital signs and assesses Margaret for injuries. After determining that Margaret has sustained no further injuries, the nurse assists Margaret back into bed. Which statement indicates negligence on the part of the nurse with regard to Margaret's fall? Margaret did not call for assistance to get out of bed. The nurse placed Margaret's call bell within her reach. The nurse did not instruct Margaret in how to use the call bell. The nurse instructed Margaret to call for assistance to get out of bed.

The nurse did not instruct Margaret in how to use the call bell. RATIONALE: If a nurse does not instruct a client in how to use a call bell, the client cannot call the nurse for assistance. Negligence, conduct that falls below the standard of care, includes acts of commission as well as acts of omission. If a nurse gives care or fails to give care that does not meet standards, he or she may be held liable for negligence. The nurse must instruct the client in the use of the call bell, place the call bell within reach, and instruct the client to call for assistance to get out of bed.

Later that evening, a newly hired nurse comes to the emergency department and states to the nurse caring for Angela, "I've been assigned to work here, but I don't have a computer password yet. May I use yours?" How should the nurse respond? Select all that apply. The nurse gives the new nurse the password, then changes it at the end of the shift. The nurse gives the new nurse the password and asks her not to give it to anyone else. The nurse states, "No, I can't give you my password. It's against our hospital policy to share passwords." The nurse states, "I can't give my password to you, but I'll open the client records for you so that you can enter your own data." The nurse states, "Let's call the information technology department and see what they can do about getting a password for you."

The nurse states, "No, I can't give you my password. It's against our hospital policy to share passwords." The nurse states, "Let's call the information technology department and see what they can do about getting a password for you." RATIONALE: Passwords are essential for keeping client information confidential. One's password should not be known to anyone but the user and the information systems administrator. Passwords for health care agency computer systems should not be shared with anyone else, under any circumstances. The nurse should help the new employee obtain a new password within the guidelines of the health care facility.

Mrs. Crenshaw, in room 5129, is scheduled to be transferred to a nearby long-term care facility at 4 p.m. Lisa asks Mrs. Crenshaw's nurse, Mike, to give a transfer report to the nurse at the long-term care facility. What is the primary purpose of this transfer report? To document client care To ensure continuity of care To communicate the client's allergies To summarize the client's plan of care

To ensure continuity of care RATIONALE: A transfer report is given when a client moves from one unit to another or from one facility to another. The primary purpose of the transfer report, as with any type of nursing report, is to ensure continuity of care even though the circumstances or location has changed. Communicating information about a client's allergies and summarizing a client's plan of care are components of a transfer report but not its primary purpose. Documentation of client care is also not the purpose of a transfer report. Documentation is a continuous and ongoing process carried out during the client's hospital stay.

Before beginning the charge nurse report, Brenda steps into the staff nurses' report room to listen to a few minutes of the taped report. Brenda identifies which pieces of information as components of an effective hands-off report? Select all that apply. Treatments Priority needs Discharge plan Assessment findings Biographical information

Treatments Priority needs Discharge plan Assessment findings RATIONALE: An effective hands-off report describes the health status of each client and tells the members of the oncoming shift what care and priorities the client will need. Simply reading documented or biographical information, which is easily obtained from the client's record, is not sufficient or necessary. Nurses must review significant information about the client to have a baseline for comparison during the next shift. Items in a hands-off report include background information, assessment, nursing diagnosis, priority needs, treatments, teaching plan, family information, and discharge plan.

2. When detailing the budget, which of the following costs would the nurse manager identify as a variable and controllable expense? Mortgage payment for new building Unit supervisor's salary Unit supplies for wound dressings Equipment depreciation

Unit supplies for wound dressings (the unit supervisor's salary is a variable, but salaries are set by agency or by collective bargaining agreement and not under control of the manager)

Which of the following is a key principle of managed care? Group of answer choices Use of primary care providers as gatekeepers Focus on early promote hospitalization Increased choice by patients and providers for treatments. Limited accountability to payors

Use of primary care providers as gatekeepers

The nurse determines that which situations represent the use of evidence-based practice in clinical decision-making for client care? Select all that apply. Encouraging a client to take a laxative twice a week to prevent constipation Using information about the client's preferences and values when planning care Using a research-based scale to routinely assess a client's risk for skin breakdown Manually lifting a client rather than using a slider board to transfer a client from a bed to a stretcher Asking a primary health care provider for a prescription to insert a urinary catheter for a client who is experiencing incontinence

Using information about the client's preferences and values when planning care Using a research-based scale to routinely assess a client's risk for skin breakdown RATIONALE: Evidence-based practice is an approach to client care in which the nurse integrates the client's preferences, clinical expertise, and the best research evidence to deliver quality care. Encouraging a client to take a laxative to prevent constipation promotes laxative dependency; rather, the nurse would encourage practices such as increased fluid intake and consumption of a high-fiber diet. Manually lifting a client rather than using a slider board to transfer a client from a bed to a stretcher could result in injury to health care workers and does not reflect good practice; rather, the nurse would use assistive devices that will help prevent injury. Inserting a urinary catheter might result in an infection; rather, the nurse would institute noninvasive measures for the client experiencing incontinence.

3. What guide is used for determining personnel standards for care is used for home care? NCH/PPD Minutes per case Skill mix Visits per month

Visits per month

Dr. Famm tells Lynn Ann that a biopsy of the pancreatic mass should be performed. After discussing this recommendation with Dianne, Lynn Ann decides that she would like a second opinion about the biopsy. She calls the nurse at Dr. Famm's office to discuss her decision. Which response by the nurse is appropriate? "A second opinion may be helpful in helping you make your decision." "Time is of the essence, and you should not waste time getting a second opinion." "A second opinion is really not necessary because Dr. Famm is one of the best primary health care providers for this type of problem." "Most people think about getting a second opinion but don't end up doing so because it takes a while to get an appointment with another primary health care provider."

"A second opinion may be helpful in helping you make your decision." RATIONALE: The client has a right to make decisions about his or her plan of care before and during the course of treatment, to refuse a recommended treatment or plan of care, and to be informed of the consequences of such action. It is the client's right to request and receive a second opinion from another primary health care provider. Telling the client that of time is the essence or that getting a second opinion is not really necessary is inappropriate and can induce fear in the client. The nurse should not make generalized statements such as telling the client that it takes too long to get an appointment with another primary health care provider.

A client with polycystic kidney disease requires a kidney transplant. After several tests, it is determined that the client's brother is a histologically compatible donor. The client is told about the findings and informed that kidney transplant surgery will be scheduled. The client tells the nurse that he does not want the kidney transplant and asks to speak to his primary health care provider about other treatment options. Which statement by the nurse is appropriate? "Can we talk about the reasons that you do not want the kidney transplant?" "You're probably just nervous about the surgery. Sleep on it, and then we'll talk about it tomorrow." "Your brother was so excited about being able to help you. What a disappointment it's going to be for him to hear this." "Are you kidding? Do you know how lucky you are to have a compatible donor? Not too many people get a second chance at life."

"Can we talk about the reasons that you do not want the kidney transplant?" RATIONALE: The client has the right to accept or refuse a treatment. This includes the right to decide to become an organ donor and the right to refuse an organ transplant as a treatment option. The appropriate nursing response is to focus on the client's feelings and provide an opportunity for the client to verbalize his thoughts and concerns. Placing the client's feelings on hold, instilling guilt in the client, and showing disapproval are all inappropriate and nontherapeutic responses.

Lynn Ann decides to have the surgery to remove the pancreatic mass, and the surgery is performed by Dr. Donlon. Lynn Ann is told that the mass was malignant but that it was encapsulated, there was no evidence of local invasion or metastasis, and that she will not need to undergo chemotherapy. Dianne comes to the hospital to visit, approaches Lynn Ann's nurse, and asks about the outcome of the surgery. How should the nurse respond to Lynn Ann's sister? "Everything went great. Lynn Ann has a very good prognosis." "Let's go into the conference room. I don't want to talk about Lynn Ann here in the hallway." "You're a nurse! You know the rules! I can't discuss Lynn Ann's condition with you!" "Dr. Donlon has explained everything to Lynn Ann. You'll need to talk to Lynn Ann about her status

"Dr. Donlon has explained everything to Lynn Ann. You'll need to talk to Lynn Ann about her status RATIONALE: The client has the right to privacy, and the nurse must protect the client's privacy as much as possible. The nurse should not discuss any information with anyone but Lynn Ann herself about Lynn Ann's diagnosis. Doing otherwise would violate the client's right to privacy. Therefore, the correct response is to explain that any information about Lynn Ann's condition will have to be obtained from Lynn Ann

After Madeleine talks to her physician, a do-not-resuscitate (DNR) order is written. However, Madeleine's daughter expresses concern: "My mother isn't near death, is she? Does this mean you're going to stop giving her medical care?" Which of these responses by the nurse are correct? Select all that apply. "Unfortunately, yes; it does mean that she will die soon." "She will still be taking medications to treat her heart failure." "A do-not-resuscitate order means that your mother wishes to have all medical treatment stopped at this time." "It means that if her heart stops, she has chosen to let nature take its course rather than let us take measures to keep her alive." "A do-not-resuscitate order does not indicate that her death is coming soon. It just helps us follow her wishes in the event that her heart does stop."

"She will still be taking medications to treat her heart failure." "It means that if her heart stops, she has chosen to let nature take its course rather than let us take measures to keep her alive." "A do-not-resuscitate order does not indicate that her death is coming soon. It just helps us follow her wishes in the event that her heart does stop." RATIONALE: A "do not resuscitate" or "no code" order indicates that the client wishes that no extraordinary measures be taken if cardiac arrest occurs. It does not mean that all medical treatment will be stopped or signal that the end of life is near. The DNR order must be written by the health care provider after consultation with the client.

One of Madeleine's daughters comes in for a visit and talks to Madeleine about her wishes. She is willing to call an attorney for assistance but asks the nurse, "What's the difference between a durable power of attorney for health care and an instructional living will? I'm so confused!" Which of these responses by the nurse is correct? Select all that apply. "They're the same thing, actually." "With a durable power of attorney for health care, the family decides who will serve as the client's representative." "The client specifies who will hold the client's durable power of attorney for health care, and that person does not have to be a family member." "With either of these documents you are telling your primary health care provider that you no longer want any medical care and that you want to die." "The living will is a legal document that tells the primary health care providers and family members what your wishes are about life-sustaining treatments if you can no longer make decisions." "The durable power of attorney for health care is a legal document in which you name someone else to make decisions about your health care if you are no longer able to make these decisions."

"The client specifies who will hold the client's durable power of attorney for health care, and that person does not have to be a family member." "The living will is a legal document that tells the primary health care providers and family members what your wishes are about life-sustaining treatments if you can no longer make decisions." "The durable power of attorney for health care is a legal document in which you name someone else to make decisions about your health care if you are no longer able to make these decisions." RATIONALE: Both the living will and durable power of attorney for health care are legal documents in which a person specifies his or her wishes about health care decisions in the event that the person cannot make these decisions on his or her own. The instructional living will is a document that provides instructions for health care providers and family members. The durable power of attorney for health care is a legal document in which a person designates another person, such as a family member or a friend, to make health care decisions when the person becomes unable to do so. The client selects the proxy, not the family members.

Lynn Ann schedules an appointment with another primary health care provider, Dr. Anna Donlon, to obtain a second opinion. Dr. Donlon tells Lynn Ann that biopsy is unnecessary at this time because she will need extensive abdominal surgery to remove the mass, regardless of whether it is benign or malignant. After Dr. Donlon leaves the examining room, Lynn Ann says to the nurse, "I can't believe that I need surgery; I feel fine! Lately I've read quite a bit about herbal products and alternative therapies, and I think I should give that a try before I have the surgery. What do you think?" Which response by the nurse is appropriate? "I have so many people ask me about alternative therapy. Personally, I don't think that it works." "You'd better not try that stuff if you plan to have Dr. Donlon treat you. She's totally against using that stuff." "How much have you read? Did you read about the adverse effects of these herbal products? If you had, you wouldn't use them." "We have an alternative therapy department here at the clinic. It is important to be well informed about the available therapies and how they are believed to work. Would you like the phone number so that you can schedule an appointment?"

"We have an alternative therapy department here at the clinic. It is important to be well informed about the available therapies and how they are believed to work. Would you like the phone number so that you can schedule an appointment?" RATIONALE: The client has the right to be informed about treatment options. If the client requests information about a treatment option, the nurse must help the client obtain that information. The nurse should not give his or her opinion to the client. The incorrect options are nontherapeutic responses.

A primary health care provider asks a client to participate in a cardiac research study, and the client agrees. After the primary health care provider leaves the client's room, the client says to the nurse, "I don't really want to participate in the study, but I didn't want to say no to my doctor. He's done so much for me; I guess this is the least I can do for him." How should the nurse respond to the client? "Well, you've signed the consent form, so you're committed to participating." "Yes, he has done a lot for you, hasn't he? But all that you need to do is tell him that you changed your mind." "You have the right to consent to or decline participation in a research study. Even though you have agreed to participate, you have the right to change your mind." "I know other clients who have participated in this study, and they didn't mind it at all. You might as well participate; before you know it, the study will be over with."

"You have the right to consent to or decline participation in a research study. Even though you have agreed to participate, you have the right to change your mind." RATIONALE: A client has the right to consent or decline to participate in research and the right to change his or her mind about the treatment plan. Even though the client has signed the consent form, he or she is not committed to participating. Telling the client that he or she is committed to participating because the consent form has been signed violates the client's rights. The primary health care provider may or may not have done a lot for the client; regardless, agreeing with the client is a nontherapeutic communication technique. Telling the client that other clients who participated in the study did not mind participating at all is generalizing, which is nontherapeutic.

A nurse planning client assignments for the day has an LPN and a nursing assistant on the nursing team. Which client should the nurse most appropriately assign to the LPN? A client who is scheduled for an electrocardiogram and a chest radiograph A client with stable congestive heart failure who has early-stage Alzheimer disease A client who has been treated for dehydration who is weak and requires assistance with bathing A client with emphysema who is receiving oxygen at a rate of 2 L/min by nasal cannula and becomes dyspneic on exertion

4 RATIONALE: The nurse would most appropriately assign the client with emphysema to the licensed practical nurse. This client has an airway problem and has the highest priority needs of the clients presented in the options. The client who has been scheduled for testing, the client who needs assistance with daily needs, and the client who has early stage Alzheimer disease in addition to a stable cardiac problem can appropriately be cared for by the nursing assistant.

The nurse determines that which situations violate the rights? Select all that apply. A client with anxiety is offered the opportunity to participate in an experimental drug research program. A client with somatization disorder is allowed to keep her clothing and personal effects with her during the hospitalization. A client is refused acceptance into a university health sciences program because of a diagnosis of obsessive-compulsive disorder. A primary health care provider prescribes an intramuscular sedating medication for a client who is hyperactive without discussing the treatment with the client. A client with a paranoid disorder is informed that once he is hospitalized he will not have telephone rights and will not be able to communicate with anyone outside the hospital.

A client is refused acceptance into a university health sciences program because of a diagnosis of obsessive-compulsive disorder. A primary health care provider prescribes an intramuscular sedating medication for a client who is hyperactive without discussing the treatment with the client. A client with a paranoid disorder is informed that once he is hospitalized he will not have telephone rights and will not be able to communicate with anyone outside the hospital. RATIONALE: The mentally ill client has rights similar to those of the client who does not have a mental illness. The mentally ill client has the right to refuse participation in experimental treatments or research such as a drug research program. The hospitalized mental health client also has the right to keep clothing and personal effects with him or her. The client has the right to education, so denying him or her acceptance into a university because of mental illness is a violation of the client's rights. The client also has the right to give informed consent, so prescriptions must be discussed with the client. Not allowing a hospitalized client to communicate with persons outside the hospital is a violation of the client's rights.

Carol is assigning clients to her team members. Which client should Carol assign to the nursing assistant? A client scheduled for a colonoscopy A client with an arteriovenous fistula in the right arm who is scheduled for hemodialysis A client who is stable but was treated with furosemide and oxygen therapy during the night for pulmonary edema A client who requires frequent ambulation with a walker and must be encouraged to maintain her independence in carrying out activities of daily living

A client who requires frequent ambulation with a walker and must be encouraged to maintain her independence in carrying out activities of daily living RATIONALE: When assigning clients to nursing staff, the nurse must match the task to the delegatee in keeping with the state's nurse practice act and the health care institution's descriptions of various jobs. A client who requires frequent ambulation and encouragement to carry out activities of daily living may be attended to by the nursing assistant. The client scheduled for a colonoscopy will require preparation for the procedure in addition to frequent observation after the colonoscopy. The client with an arteriovenous fistula will require predialysis procedures and assessment of the fistula for patency. The client with pulmonary edema who was treated with furosemide and oxygen therapy and is in stable condition will still require frequent assessments.

Which of the following are strategies for safety recommended by the Leapfrog Group? Select all that apply. A. Computerized physician ordering B.Evidence-based hospital referral C. All RN nursing staff. D. Intensive care unit physician staffing. E. Clinical pathways used for all patient diagnoses

A. Computerized physician ordering B.Evidence-based hospital referral D. Intensive care unit physician staffing.

10. What is the primary reason that a decentralized organizational structure would be seen as ideal? A. Flat structures save money for the organization as there are fewer high-salaried administrators. B. A decentralized structure keeps decision-making closest to those affected by the decisions. C. Every department can make its own autonomous decisions without any accountability to higher authority. D. This type of structure rarely requires modifications and changes as situations arise within the HC agency.

A. Flat structures save money for the organization as there are fewer high-salaried administrators. B. A decentralized structure keeps decision-making closest to those affected by the decisions.

9. Which of the following elements supports increased power for nursing as a profession? (SELECT ALL THAT APPLY). A. Numbers in the profession B. Issues related to gender C. Consumers and providers call for change D. Increased education and knowledge base E. Movement away from the "art" of nursing

A. Numbers in the profession B. Issues related to gender C. Consumers and providers call for change

5. By what process is shared governance typically achieved by the nurses of a health care agency A. Representation of staff on nursing councils focused on varied elements of practice. B. Regular anonymous voting by all nurses on all policy decisions. C. Unit managers serve on councils to bring ideas from staff to upper level management. D. Decisions are made by the members of one shared governance council that represents all staff.

A. Representation of staff on nursing councils focused on varied elements of practice.

2. According to Weber, what type of power is the basis for a bureaucracy? A. Referent B. Coercive C. Connected/related D. Legal/rational

D. Legal/rational (Legal rational authority is legitimate power within an organization given by a person's official title or role.)

What does the nurse understand with regard to a DNR order? The DNR order is applicable for the length of the client's hospitalization. The primary health care provider is the person who is primarily responsible for making the decision regarding a DNR order. A DNR order indicates that no resuscitative measures at all, including the administration of medication, should be instituted. Agency and/or state guidelines must be followed with regard to notification of the client or family about consideration of a DNR order.

Agency and/or state guidelines must be followed with regard to notification of the client or family about consideration of a DNR order. RATIONALE: A DNR order is written by a primary health care provider when a client has indicated a desire to be allowed to die if he or she stops breathing or his or her heart stops beating. Agency and state guidelines must be followed with regard to notification of the client or family about consideration of a DNR order. The DNR order must be reviewed on a regular basis in accordance with agency and state policy and must be clearly defined so that other treatment, not refused by the client, will be continued.

The nurse is reviewing Angela's laboratory results and discovers that her pregnancy test result is positive. The nurse asks Angela, "When was your last menstrual period?" Angela answers, "I'm not sure. Am I pregnant?" The nurse tells Angela that the pregnancy test result was positive, and Angela starts sobbing: "That's all I need right now!" Who else should the nurse notify? Select all that apply. Angela's mother Angela's husband Angela's primary health care provider The nurse's co-workers on the same shift The nurse on the oncoming shift, during report The radiology technician who comes in to perform a chest x-ray

Angela's primary health care provider The nurse on the oncoming shift, during report The radiology technician who comes in to perform a chest x-ray

A 16-year-old girl arrives at the women's health center and tells the nurse that she thinks she is pregnant. The nurse obtains subjective data from the client and informs her about the laboratory procedures used to test for pregnancy. Which action should the nurse take in obtaining informed consent to treat the client? Asking the 16-year-old girl to sign the informed consent Asking the 16-year-old girl for permission to call one of her parents Giving the 16-year-old girl permission forms to take home for her parents to sign Telling the 16-year-old girl that her boyfriend will need to provide consent for her pregnancy te

Asking the 16-year-old girl to sign the informed consent RATIONALE: A minor is a client under the age of legality (usually 18 years) as defined by state statute. Parental or guardian consent should be obtained before treatment is initiated for a minor except in the case of an emergency, in situations in which the consent of the minor is sufficient (e.g., treatment related to substance abuse or a sexually transmitted infection, testing for HIV and AIDS, birth control services, pregnancy, or psychiatric services, or if a court order or other legal authorization has been obtained). Asking anyone other than the client to sign the informed consent would be incorrect

A student nurse who has been assigned to care for a client on a medical unit arrives at the unit and asks the nurse in charge for the client's medical record so that she may review it. Which action should the charge nurse take? Making a copy of the record for the student Giving the student the client's medical record Sitting with the student while the student reviews the record Asking the client for permission for the student to review the medical record

Asking the client for permission for the student to review the medical record RATIONALE: A client's medical record is confidential. Only staff members directly involved in a client's care have legitimate access to a client's record. Any other individual must obtain permission from the client to review the record. Medical records should not be copied. If it is necessary to copy a record, the client must give permission.

Which action should Carol plan to take as she functions in the role of team leader? Assigning herself the most difficult clients Assigning clients to each team member and coordinating each client's care plan Assigning the licensed practical nurse to take the vital signs of all of the clients Assigning the nursing assistants the tasks of replenishing the clients' water pitchers and changing beds

Assigning clients to each team member and coordinating each client's care plan RATIONALE: Team nursing involves the delivery of care by staff of various educational preparations. A registered nurse leads the team, which may comprise other registered nurses, licensed practical nurses, and nursing assistants. The team members provide direct client care to groups of clients, under the direction and coordination of the team leader. Functional nursing involves the division of tasks. The team leader usually does not have a direct client care assignment. Functional nursing involves the assignment of specific nursing tasks to team members.

7. Which of the following statements made by a member of a nursing committee is indicative of "groupthink"? A. "I would like to offer an alternate suggestion for handling absenteeism on the weekends." B. "I was considering another way, but I will go along with what the majority wants." C. "I know my views may not be in agreement with the team, but I would like to be heard." D." It is important for the members to consider all options, so let everyone has a voice in this matter.

B. "I was considering another way, but I will go along with what the majority wants." (The nurse is afraid to speak up in disagreement - simply agrees with the group)

Based on their experience and review of current literature, the ICU nurses and physicians determine the acceptable rate for unplanned self-extubations should not exceed 1 USE per 100 patient hours of intubation. What does this value indicate? A. Best practice B. Benchmark C. Clinical variance D. Risk ratio

B. Benchmark (A benchmark is a target number that agencies use to examine their effectiveness in care against the standard of care based on other similar clinical settings)

7. Which element of malpractice is addressed by the following statement: the nurse did not activate the bed alarm when the patient with dementia was admitted to the room. A. Duty B. Breach of duty C. Proximate cause D. Injury

B. Breach of duty

What is the ethical decision-making framework that supports the inherent rights of each individual as opposed to the common good? A. Utilitarianism B. Deontology C. Consequentialism D. Ethical relativism

B. Deontology (includes rights-based thinking, which believes in the inherent rights of each individual)

1. Which of the following characteristics are part of an informal organizational structure? A. Roles and functions are systematically arranged. B. Emphasis is on relationships among the employees. C. Rank and hierarchy are evident. D. A visible framework is used to designate authority. Next

B. Emphasis is on relationships among the employees. (Employees through social relationships may give power to one of their own in a informal manner)

Which of the following tools is NOT used in Root Cause Analysis? A. Pareto diagram B. Failure/effect mode analysis C. Five WHYs D. Fishbone diagram

B. Failure/effect mode analysis

3. Which type of organizational structure is implemented by the health care agency administrators who temporarily readjust the line of authority within in the organization in order to give increased authority to a multidisciplinary team to function at a level necessary to complete a government re-accreditation process? A. Informal B. Bureaucratic C. Ad-hoc D. Flat

C. Ad-hoc

4. Which action should the effective nurse manager take when she observes two nursing units to have very different, conflicting sub-cultures regarding patient and family interactions with staff that may ultimately affect the units' satisfaction rates? A. Mandate that all nursing units follow the patient and family interactions processes that she determines are most effective. B. Have multiple meetings with all staff from the two units to have them negotiate a compromise. C. Ask for a timely meeting with nurse managers from both units to remind them of the agency's mission and values regarding patient and family interactions. D. Conduct a 6-month analysis of the satisfaction surveys from both units before discussing this issue with managers.

C. Ask for a timely meeting with nurse managers from both units to remind them of the agency's mission and values regarding patient and family interactions.

A nurse, who is working in the Neonatal Intensive Care Unit, is caring for a preterm infant (delivered at 28 weeks) who has multiple congenital anomalies making survival beyond a few days of life highly unlikely. The parents are very distraught about the infant's condition; and, in addition, they are in disagreement as to whether life supporting measures should be continued or not. The nurse has listened to both parents and knows they have very conflicting thoughts about what is best for the child. What should the nurse do to best support the parents A. Continue to listen to both parents in a non-judgmental manner. B. Tell the parents you know what would be best for the child because of your six years working in the NICU. C. Consult with members of the ethics committee for advice and guidance in ways to support the parents. D. Ask other staff caring for the chil to take sides on the best course of action

C. Consult with members of the ethics committee for advice and guidance in ways to support the parents. (The ethics committees are multidisciplinary and should be consulted in cases which such conflict exists. Members can offer recommendations for parents in a manner that is not judgemental or coercive)

Which of the following factors would aid in promoting a culture a safety? A. Avoid considering human factors in the work setting to increase objectivity. B. Use workarounds (shortcuts) to maximize available time for providing care. C. Disclose errors that occur, including near misses. D. Focus attention on the effects of erors, not the causes.

C. Disclose errors that occur, including near misses.

8. Which type of power is evident as used by the nurse manager in the following interaction: The nurse administrator asks the agency's Wound Ostomy Continence (WOC) nurse to provide training and evaluation of each nurse on the Spinal Cord Injury Unit on the use of a new turning bed and skin care protocol? A. Coercive B. Referent C. Expert D. Reward

C. Expert (the WOC nurse has expertise in skin care for vulnerable people)

6. Which of the following statements is TRUE about Magnet designation? A. All hospitals within a larger health care system must achieve Magnet recognition by applying at the same time. B. Magnet designation has not been shown to have any correlation with patient outcomes. C. Magnet designation recognizes excellence in nursing care. D. Magnet designated hospitals must have all BSN nurses in order to meet qualifications.

C. Magnet designation recognizes excellence in nursing care.

What type of variation has occurred when a client develops an infection post-operatively and requires a longer hospitalization than indicated in the original critical pathway? A. Negative provider variance B. Negative patient variance C. Negative clinical variance D. Negative operational variance

C. Negative clinical variance

The evening shift nurse manager has a limited number of professional nurses available for patient assignments on the unit, but the manager does have a few LPNs and several unlicensed personnel. Which of the following models of care would be best for the supervisor to use when making patient assignments? A. Functional B. Primary C. Team D. Total

C. Team (Team Nursing Divides patient assignment with teams of mixed levels of nursing staff. Teams must be led by RN)

A client tells the nurse he wants to leave the hospital against medical advice (AMA). The client's son arrives for visiting hours and argues with the father, insisting that he stay. What is the best action of the nurse acting as an advocate for the client? A. Insist the father stay so that his health is not put at risk. B. Tell the client that he cannot leave the hospital unless his son is willing to take him home. C. Tell the client that he can leave and document comments made by the client, witnesses, and any follow-up information provided to the client. D. The nurse should call the physician and request the MD write an order for discharge.

C. Tell the client that he can leave and document comments made by the client, witnesses, and any follow-up information provided to the client. (A mentally competent adult client has the right to leave the hospital AMA. Trying to keep the him could result in false imprisonment charges against the nurse. The nurse should provide necessary information for follow-up care and the nurse should document comments made by the client. (D. While the nurse should notify the MD of client's desire to leave AMA, the MD should not be asked to write an order for discharge)

A nurse stops along the road to assist victims of a multi-car accident. Which of the following events would invalidate coverage under the Good Samaritan Act? Group of answer choices A. The nurse stops CPR on a non-responsive victim when she can no longer continue. B. The nurse has personal malpractice insurance that covers incidents outside of formal employment site. C. The nurse accepts a generous tip from the parents of a toddler with a fractured femur. D. One of the victims develops a wound infection at the site where the nurse placed a non-sterile dressing to stop active bleeding.

C. The nurse accepts a generous tip from the parents of a toddler with a fractured femur.

What is true about the action that may taken against a nurse who commits an act that does not violate a legal statute but is in violation of the ANA's Code of Ethics? A. Nurse can face legal charges for any ethical violation. B. No disciplinary or legal consequences can be brought against the nurse since Codes of Ethics are not binding. C. The nurse may face disciplinary actions from the agency and/or the state board of nursing. D. Snce the ANA does not have influence over individual State Practice Acts, so the SBON will never know about any ethical violations that occur.

C. The nurse may face disciplinary actions from the agency and/or the state board of nursing. (ALthough violations of the Code of Ethics may not rise to level of any criminal wrongdoing, both the agency (in policies) and State Board of Nursing May determine actions deemed unprofessional warrant disciplinary action, Such as imposing a temporary suspension or revoking the license to practice.)

A primary health care provider writes a prescription for furosemide, 80 mg/day by mouth, for a hospitalized client with a diagnosis of heart failure. When the nurse brings the medication to the client, the client states that he normally takes only 40 mg of the medication each day. Which action on the part of the nurse would be most appropriate? Administering 40 mg instead of 80 mg Calling the primary health care provider who wrote the prescription Explaining to the client the need for the higher dose Checking the drug formulary and asking the client to read the information about safe dosage of the medication

Calling the primary health care provider who wrote the prescription RATIONALE: A nurse is obligated to fulfill a primary health care provider's prescription unless he or she believes a prescription to be harmful to the client. If the client questions a prescription, the nurse should contact the primary health care provider for clarification. A nurse who fulfills an inaccurate prescription may be legally responsible for any harm inflicted on the client. The nurse is responsible for clarifying an unclear or inappropriate prescription, or any prescription that is otherwise in question, with the primary health care provider. Administering 40 mg instead of 80 mg, explaining to the client the need for additional medication, and asking the client to read information about safe dosage of the medication are all inappropriate actions.

. Which of the following factors would NOT be included by the nurse who is presenting the essential components of managed care? A. Managing cost B. Patient education C. Health promotion D. Patient choice

D. Patient choice (patient choice, because it is limited in most managed care programs. Focus is on reducing costs through appropriate resource use with health promotion, early identification of disease and self-care strategies))

The nurse goes to check on Margaret and finds her crying. Margaret says, "I don't know what to do. My doctor has just told me that I have hepatitis, and I may have given it to my family, but I don't want them to know that I have this disease! Please don't tell them; it's none of their business." Which actions by the nurse are ethically correct? Select all that apply. Consulting the hospital's ethics committee. Documenting what the client has said in the medical record. Telling Margaret, "If you don't tell your family, we will have to do it." Telling her, "Margaret, I won't tell your family, but let's discuss what could happen if you don't tell them." Promising not to tell Margaret's son but, when he visits, telling him what Margaret has said.

Consulting the hospital's ethics committee. Documenting what the client has said in the medical record. Telling her, "Margaret, I won't tell your family, but let's discuss what could happen if you don't tell them." RATIONALE: In this situation, the nurse is challenged to balance the client's wish for privacy and confidentiality against the safety of her family members. Telling her son after promising not to tell him violates the ethical standard of fidelity (keeping promises). Threatening to tell her family violates the ethical standard of beneficence. Offering to discuss the situation with her is important. Though it is also important to document her statements, the nurse should go beyond that and also consult the hospital's ethics committee for assistance with this situation.

A nurse is caring for a client who is scheduled for surgery at 11 a.m. A member of the operating room staff calls the nurse at 9:30 a.m. and informs her that the client must be premedicated and transported to the operating room by 10 a.m. The nurse immediately administers the sedative medications as prescribed. At 10 a.m., as the nurse is getting the client ready for transport, she notes that the informed consent for surgery has not been signed by the client. Which action should the nurse take? Contacting the client's surgeon Having the client sign the informed consent Calling the operating room and cancel the surgery Asking the client's significant other to sign the informed consent

Contacting the client's surgeon RATIONALE: Informed consent indicates the client's agreement to participate in the treatment or surgical procedure. Legally, the client must be mentally and emotionally competent to give consent. A client who has been administered sedative medications or any other medication that might affect his or her ability to make rational decisions should not be asked to sign a consent form. It is the primary health care provider's responsibility to obtain informed consent from the client or legal guardian; therefore, the nurse should contact the surgeon. It is inappropriate and illegal to ask a significant other to sign an informed consent for a client who is legally competent to do so. It is not within the realm of a nurse's role to cancel surgery.

Michael tells the hospital nurse that he really doesn't understand this surgical procedure and that he is somewhat concerned because he will be awake during the surgery. Which action on the part of the nurse is appropriate? Asking Michael why he signed the consent form Contacting the surgeon to report that Michael has questions and concerns about the surgery Telling Michael not to be concerned about being awake, because a large drape will be used to cover his abdomen Telling Michael that he will not be awake during surgery and that the anesthesiologist will be visiting him to talk about the medication that will be administered

Contacting the surgeon to report that Michael has questions and concerns about the surgery RATIONALE: If the client raises questions about the surgical procedure, the nurse must determine whether the client is truly informed about the procedure. If the nurse determines that questions need to be answered and concerns addressed, the appropriate action is for the nurse to contact the surgeon to ensure that the client receives whatever additional clarification or information is necessary. Telling Michael not to be concerned about the surgery and asking him why he signed the consent form are nontherapeutic actions. Surgical procedures must be addressed by the surgeon, who must discuss the client's concerns with the client and provide explanations to the client.

What is the premise underlying a "just culture" regarding errors in healthcare? A. Persons responsible for the error must be identified and brought to justice. B. Just the errors that resulted in serious harm to patients are analyzed. C. Finding out who/what is at fault is not considered since the guiding premise is that human error will always result in mistakes. D. Blame on the individual is not paramount; rather, it is to examine factors leading to errors to avoid their replication.

D. Blame on the individual is not paramount; rather, it is to examine factors leading to errors to avoid their replication.

1. A client has given written legal authorization for her husband to have access to her protected health information. After the physician tells the woman her breast cancer has spread extensively and she has a prognosis for survival of about 6 months, the woman begs the nurse not to tell her husband. The nurse promises the woman that she will not disclose any information to her husband. The husband arrives to the unit and tells the nurse he has feeling the prognosis is not good and he asks if the doctor has told his wife anything about the test results. The nurse knows she has promised the woman not to disclose the prognosis but she wants to tell the husband the truth because her own experience has taught her it will be better for both of them to know and the woman is not making the best judgment in this case. What ethical principles are the primary sources of this ethical conflict? A. Justice and veracity. B. Beneficence and fidelity. C. Fidelity and a HIPAA violation. D. Fidelity and paternalism.

D. Fidelity and paternalism. (fidelity is keeping one's promises, Paternalism - One individual assumes the right to make decisions for another - The nurse is torn between the decision to keep her promise to the woman, paternalism is that the nurse knows what is best for the woman, the woman is not making the best judgement in this case, even though it is against what the woman herself has requested) B. Beneficence and fidelity (incorrect, while fidelity is keeping one's promises, is involved in this conflict, beneficence deals with doing good. It is not posing conflict here)

The nurse notes the critical pathway for the client with asthma exacerbation includes timing and dosing for nebulizer treatments with bronchodilators. The physician's admission orders do not include any orders for nebulizer treatments. What should the nurse do? A. Notify the nursing supervisor about the medication error. B. Administer the treatments per the critical pathway. C. Ask the client to sign a waiver for a care variance. D. Place a call to verify the provider care variance.

D. Place a call to verify the provider care variance. (Since this treatment is commonly given, the nurse should clarify with the physician the variance from the pathway given the lack of orders for nebulizer treatments.)

What type of audit is being conducted to evaluate performance when the nurse examines patient medical records following their discharge in order to evaluate certain care processes. A. Cohort B. Concurrent C. Prospective D. Retrospective

D. Retrospective (Care processes are examined for patients already discharged)

A nurse witnesses another nurse signing out narcotics that are not administered to the patients. What should the nurse do? A. Confront the nurse with the fact it was observed that narcotics were taken and not given to patients. B. Tell the oncoming shift medication nurse that patients may be needing pain medication before time permits. C. Ask the nurse if the narcotics were given without saying anything about what action was observed. D. Speak to the nursing supervisor in private about the observed event.

D. Speak to the nursing supervisor in private about the observed event.

1. What term describes the use of historical knowledge of short-term and long-term fluctuations in census to plan budgetary costs related to staffing needs? Retrospective audit Forecasting Strategic Plan Prospective payment system

Forecasting

After the admission assessment, the nurse reviews Margaret's medical record and notes that the primary health care provider has written prescriptions. Which prescription should the nurse question? Chest x-ray today Incentive spirometry every hour Ibuprofen 400 mg every 4 hours prn Out of bed to chair with assistance only

Ibuprofen 400 mg every 4 hours prn RATIONALE: The nurse would question "Ibuprofen 400 mg q4h prn" because it does not indicate a route of administration. The components of a medication prescription, in addition to the date and time at which the prescription was written, are the name, dosage, and route and frequency of administration of any medication and the primary health care provider's signature. The other prescriptions are complete.

A nurse assigned to care for a client with chronic obstructive pulmonary disease (COPD) reviews the client's care plan. Which of the following should the nurse identify as a priority concern for the client? Weight gain related to an increase in appetite Loneliness related to a lack of support systems Fear related to the outcome of the disease process Inability to clear respiratory tract because of excessive mucus production

Inability to clear respiratory tract because of excessive mucus production RATIONALE: Maintaining a patent airway is always the first priority. Loneliness and fear involve psychosocial needs and would be considered after physiological needs are addressed. The client with COPD is most likely to experience a decrease in nutrition due to the increased metabolic effects that occur.

A nurse employed in the emergency department (ED) cares for a male client who has sustained a gunshot wound, but the client dies in the ED. The client, who was having a romantic affair with a married woman, was shot by the woman's husband. The nurse tells a neighbor about the incident and the affair and also reports to the neighbor that the woman's husband was arrested by the police for murder. What offense has the nurse committed by sharing this information with the neighbor? Libel Fraud Assault Invasion of privacy

Invasion of privacy RATIONALE: The client has the right to be free of unwanted intrusion into his or her personal affairs. Invasion of privacy includes violation of confidentiality, intrusion on private client or family matters, and sharing of client information with unauthorized persons. Defamation (libel or slander) occurs when a person makes false statements that result in damage to an individual's reputation. Fraud is a deliberate deception intended to produce unlawful gain. Assault occurs when a person puts another person in fear of harmful or offensive contact.

Madeleine expresses concern to the nurse about the need for having one of her daughters act as a spokeswoman in the event of an emergency should additional decisions need to be made. What should the nurse tell Madeleine? Once the living will is in place, there is no need for a spokesperson. As long as she has shared her wishes with her daughter, there is no need for a spokesperson. The primary health care provider will keep Madeleine's family informed in the event of an emergency. Madeleine may appoint a person to carry out her wishes or to make decisions on her behalf if and when she is no longer able to do so.

Madeleine may appoint a person to carry out her wishes or to make decisions on her behalf if and when she is no longer able to do so. RATIONALE: A durable power of attorney for health care is a legal document that appoints a person (health care proxy) chosen by the client to carry out his or her wishes as expressed in the advance directive or to make decisions on the client's behalf if and when he or she is no longer able to do so. It is the primary health care provider's responsibility to keep the client's family informed about the client's condition in an emergency, but this option is unrelated to the subject of the question. A spokesperson may still be necessary even if a living will is in place.

A registered nurse orienting a new nursing graduate provides the graduate with ideas that will help him/her with time management. Which tips should the registered nurse provide? Select all that apply. Keeping a log of daily activities takes too much time and is not at all useful. Jot quick notes during the day and perform all client documentation at the end of the day. Make client rounds at the beginning of the work shift and collect assessment data on each assigned client. Avoid delegating tasks to others, because others may think that the graduate can't manage the assignment. Try anticipating a client's needs before care so that all necessary supplies and items may be brought to the client at one time.

Make client rounds at the beginning of the work shift and collect assessment data on each assigned client. Try anticipating a client's needs before care so that all necessary supplies and items may be brought to the client at one time. RATIONALE: Time management involves using techniques and principles to limit the time spent on low-priority needs and to ensure that time is invested in activities of high priority. The nurse should make client rounds at the beginning of the work shift and collect assessment data on each assigned client. The nurse can anticipate the client's needs before care so that all necessary supplies and items may be brought to the client at one time. The nurse should also plan to document task completion and necessary client data throughout the day rather than waiting until the end of the day, delegate tasks when appropriate, and keep a daily hour-by-hour log to help provide structure to the tasks that must be accomplished.

The nurse prepares to transcribe the primary health care provider's medication prescriptions. Which of the prescriptions noted in this medication record should the nurse question? Select all that apply. Metoprolol 50 mg/day Atorvastatin 10 mg/day by mouth Ramipril 1 tablet/day by mouth Levothyroxine 137 mcg/day by mouth Metformin and sitagliptin 50 to 1000 mg twice daily

Metoprolol 50 mg/day Ramipril 1 tablet/day by mouth Metformin and sitagliptin 50 to 1000 mg twice daily RATIONALE: The components of a complete medication prescription are the date and time when the prescription was written; the medication's name, dosage, route of administration, and frequency of administration; and the prescribing primary health care providers or primary health care provider's signature. The ramipril prescription indicates that 1 tablet should be administered, but a specific dosage is required. The metoprolol and metformin/sitagliptin prescriptions do not indicate the route of administration. All of these prescriptions require clarification. The remaining prescriptions are complete.

The nurse treats the lacerations and prepares to interview Angela to gather additional subjective data about her injuries and medical history. Which action on the part of the nurse is appropriate? Moving Angela to a private room for the interview Calling Angela's husband and asking him to be present for the interview Asking another nurse to sit in and listen during the interview because Angela's injuries were the result of abuse Calling the police department and requesting that an officer be present to hear what Angela has to report about the abuse

Moving Angela to a private room for the interview RATIONALE: Confidentiality is a client's right to privacy regarding his or her health care information. The nurse is legally bound to protect the client from indiscriminate disclosure of health care information that may cause harm. Disclosure of confidential information exposes the nurse to liability for invasion of the client's privacy. The nurse would move the client to a private room for the interview so confidential information is not overheard by others. The nurse would not call the client's husband. Having the client's husband present might prevent the client from providing accurate information and could provoke additional conflict. The client's permission must be obtained before another nurse is asked to sit in and listen during the interview. Although cases of abuse must be reported, it is inappropriate to request that a police officer be present during the interview. These options are inappropriate.

The next day, Carol's report sheet for her client assignment reads as follows: REPORT SHEET — CAROL Sal DeCarlo, 56 years old, was admitted to the hospital at 6:30 AM with respiratory distress and a fever of 101.8°F. Bilateral pneumonia was diagnosed after chest radiography. He is receiving oxygen by nasal cannula, and intravenous antibiotics will be started after a sputum specimen is obtained. James Fiore, 65 years old, was admitted to the hospital 2 days ago. He has a diagnosis of angina pectoris. His condition is stable, and he is scheduled for a cardiac catheterization at 1 PM. Judy Sharon, 62 years old, underwent abdominal surgery yesterday. The nurse who gives report to Carol notes that Judy has received pain medication as needed every 4 hours and that she is due to receive her next dose at 8:30 AM. Carla Sorenson, 65 years old, was told yesterday that she has inoperable lung cancer and will need to undergo radiation therapy. The nurse who gives report to Carol notes that Carla received a prescribed sedative at bedtime and has slept soundly through the night. Carla is scheduled to meet with the radiologist at 11 AM. Which action should Carol plan to take first after receiving report from the night nurse? Preparing the pain medication for Judy Sharon Obtaining a sputum specimen from Sal DeCarlo Talking to Carla Sorenson about what to expect when she meets with the radiologist Assisting James Fiore with morning care and helping him prepare for the cardiac catheterization

Obtaining a sputum specimen from Sal DeCarlo RATIONALE: The nurse would first obtain a sputum specimen from Sal so that the prescribed antibiotics may be started. Judy's pain medication should be prepared at the time of administration. Additionally, the report contains no data that indicate that Judy will need the medication at 8:30 a.m. Carla is scheduled to meet with the radiologist at 11 a.m., and James is scheduled for cardiac catheterization at 1 p.m.; therefore, it is not urgent that Carole attend to these clients first.

4. What is a disadvantage of a critical pathway? Provides standardized predictions for care and outcomes for persons with similar diagnoses. Pose a difficulty in accepting variations that occur due to unique patient circumstances. Leads to improved outcomes due to evidence-based care in interprofessional practice. Analyzes both clinical and financial aspects of care.

Pose a difficulty in accepting variations that occur due to unique patient circumstances. (Variances are looked at with disfavor and pose difficulties for clinical providers who may want to address issues outside of the standardization of care

Margaret's primary health care provider calls back to prescribe an x-ray and some blood chemistry studies. Which actions taken by the nurse who is taking a verbal prescription are correct? Select all that apply. Asking the unit secretary to document the prescription in the client's medical record Delaying implementation of the prescriptions until the primary health care provider can come in to acknowledge them Reading back the prescriptions to the primary health care provider before the primary health care provider hangs up the phone Documenting the prescriptions in the client's medical record as soon as the primary health care provider hangs up the phone Recognizing that the verbal prescription must be legally acknowledged by the primary health care provider as soon as possible, usually within 24 hours

Reading back the prescriptions to the primary health care provider before the primary health care provider hangs up the phone Documenting the prescriptions in the client's medical record as soon as the primary health care provider hangs up the phone Recognizing that the verbal prescription must be legally acknowledged by the primary health care provider as soon as possible, usually within 24 hours RATIONALE: Ideally, the primary health care provider or prescriber documents a prescription, but if a verbal prescription is necessary, the nurse should read the prescription back to the primary health care provider and document it in the client's medical record immediately. The primary health care provider or prescriber must acknowledge the prescription as soon as possible; most policies specify that this must be done within 24 hours. The nurse would not ask the unit secretary or any other person to document the prescription; this is illegal and could also result in an error. Implementation of verbal prescriptions is not delayed until a signature is acknowledged.

A nurse employed in a medical unit arrives at work and is told that she will be floated to work in the delivery room for the day because several nurses who work there have called in sick with the flu. The nurse is reluctant to float because she has never worked in the delivery room. The nurse takes which actions? Select all that apply. Reporting to the delivery room Contacting the hospital legal department and reporting the situation Refusing to go to the delivery room because she has never worked in that unit Informing the supervisor of her lack of experience in caring for clients in the delivery room Requesting that she be allowed to go home because she is also experiencing signs/symptoms of the flu Reporting to the delivery room and asking that she spend the day reading the procedure manual for the unit.

Reporting to the delivery room Informing the supervisor of her lack of experience in caring for clients in the delivery room RATIONALE: Nurses are sometimes required to float from areas in which they normally practice to other nursing units. A nurse in a floating situation must not assume responsibility beyond his or her level of experience or qualification; he or she should inform the supervisor of any lack of experience in caring for the type of clients found on the new nursing unit. It is inappropriate and unnecessary to report the situation to the legal department. Asking to go home and refusing to go to the delivery room are both inappropriate actions that constitute abandonment. Although the nurse should request and be given orientation to the new unit, spending the day reading the procedure manual for the unit does not help alleviate the staffing situation in the delivery room.

A nurse is gathering subjective data from a client being admitted to the hospital. The client tells the nurse that she has already prepared an advance directive. On the basis of this information, which action should the nurse take? Requesting a copy of the advance directive and placing it in the client's medical record Telling the client that the new hospitalization invalidates the existing advance directive Telling the client that it is best to prepare a new advance directive with each hospitalization Asking the hospital's client advocate representative to review the hospital's policies regarding advance directives with the client

Requesting a copy of the advance directive and placing it in the client's medical record RATIONALE: It is incorrect to tell the client that a new hospitalization invalidates the existing advance directive or that it is best to prepare a new advance directive with each hospitalization. Asking the client advocate representative to review the hospital's policies regarding advance directives with the client has no useful purpose or reason.

Carol has finished planning the assignments for the day, has provided a client report, and has given directions about client care to each member of the team. What other specific action does Carol perform? Accountability for each assignment lies with the team member it was given to She must evaluate each team member's performance and each client's outcomes It is not necessary to follow up with each team member unless a client complains about care She must develop a written and specific time-management outline for each team member that identify the priorities of care for each client

She must evaluate each team member's performance and each client's outcomes RATIONALE: Delegation is the process of transferring a selected nursing task in a situation to an individual who is competent to fulfill that specific task. It involves achieving outcomes and sharing activities with other individuals who have the authority to accomplish the task. Even though a task may be delegated to someone, the nurse who delegates maintains accountability for the overall nursing care of the client. Only the task, not the ultimate accountability, may be delegated to another. The nurse provides clear directions about the task and ensures that the team member understands the expectations. The nurse is also responsible for follow-up with each team member and must evaluate the team member's performance and the client's outcomes. It is not necessary for the nurse to develop a written and specific time-management outline for each team member, but the nurse must provide guidance and assistance to the team member as needed.

5. Which of the following is an example of productive work time? Vacation time TIme spent in direct patient care Lunch breaks Attending continuing education programs

TIme spent in direct patient care (Only time spent in direct patient care counts towards productive work time)

The emergency department nurse completes the interview with Angela, and with Angela's permission calls a social worker to speak to her. While the social worker is talking with Angela, Angela's husband arrives at the emergency department and requests information about Angela's physical status. Which action should the nurse take initially? Telling Angela's husband that this information cannot be shared with him Dialing 911 and letting the police know that Angela's husband is at the emergency department Telling Angela's husband that this information will be shared with him once the social worker has completed the interview Calling the security department and requesting that a security guard be sent to the emergency department to ask Angela's husband to leave hospital property

Telling Angela's husband that this information cannot be shared with him RATIONALE: Confidentiality is a client's right to privacy regarding his or her health care information. Health care information is not shared with others, including family members or friends of the client, without the client's consent. Therefore, the nurse would initially tell Angela's husband that the information cannot be shared with him. Contacting the police is not appropriate unless the client has formally filed charges against her husband. Calling the security department and requesting that a security guard ask the client's husband to leave hospital property is not appropriate initially and could cause agitation in a person who is believed to have violent tendencies.

Michael tells the nurse that he is much too nervous about having surgery and that he has changed his mind: He does not want the surgery. Which action should the nurse take? Telling Michael that he is contracted to having the surgery since signing the informed consent Telling Michael that there is nothing to be nervous about because such surgical procedures are performed every day Telling Michael that he has a right to change his mind Telling Michael that it is his choice but that his surgeon will be very upset because the cancellation will cause a disruption in the operating room schedule

Telling Michael that he has a right to change his mind RATIONALE: The client has a right to make health care decisions and to change his mind in regard to treatment even if he has signed the informed consent. The primary health care provider must be notified, and the rejection should be documented in the client's record. Telling Michael that there is nothing to be nervous about or that he will upset the operating room schedule avoids his feelings and concerns and is inappropriate and nontherapeutic.

A nurse is describing the situations that constitute invasion of client privacy to a group of staff members. The nurse knows that which situations violate the client's privacy? Select all that apply. Describing a treatment to a client in a secluded area Telling a family member about the client's condition Taking photographs of the client during the client's birthday party Asking the client for permission to allow a nursing student to observe a procedure Accessing a neighbor's medical record to find out about his or her health care status

Telling a family member about the client's condition Taking photographs of the client during the client's birthday party Accessing a neighbor's medical record to find out about his or her health care status RATIONALE: The client has a right to privacy and the right to protection against unreasonable and unwarranted interference in his or her private affairs. Some of the situations that violate this right include taking photographs of the client, releasing medical information to an unauthorized person, leaving the curtains or room door open while a treatment or procedure is being performed, allowing individuals unconnected to the client's care to observe a treatment or procedure without the client's consent, leaving a confused or agitated client sitting in the nursing unit hallway, interviewing a client in a room with only a curtain between clients or where conversation can be overheard, and accessing medical records when one is not unauthorized to do so. Describing a treatment to a client in a secluded area and asking the client for permission to allow a nursing student to observe a procedure are measures to protect the client's privacy.

A male primary health care provider who has been making sexual comments to a female nurse for some time asks the nurse to help him collect equipment with which to perform a procedure on a client. While in the supply closet, he places his hands on the nurse and tells her that he would like to take her to dinner. Which action should the nurse take first to best deal with the unwanted sexual advances? Calling the nursing supervisor and reporting the primary health care provider's behavior Telling the primary health care provider that she will be filing a report regarding his behavior Calling the American Medical Association (College of Nurses) and reporting the primary health care provider's behavior Telling the primary health care provider that his behavior is making her uncomfortable and that he needs to stop it immediately

Telling the primary health care provider that his behavior is making her uncomfortable and that he needs to stop it immediately RATIONALE: Sexual harassment is any unwelcome conduct of a sexual nature. A nurse who is being sexually harassed should first start with the most direct measure and tell the harasser that the behavior is making him or her uncomfortable and that it must be stopped immediately. If this measure is not effective in ending the harassment, the nurse may file a complaint against the perpetrator. Reporting the primary health care provider's behavior is not the best measure to take first. The initial goal is to stop the behavior, not punish the perpetrator, and to maintain some type of harmonious relationship.

The emergency department nurse is sitting in the conference room attached to the nurses' station, using the computer to update Angela's medical record. The nurse hears the two unit secretaries, who are in the nurses' station, talking about Angela. One secretary says to the other, "Gosh, that girl has been here so many times for injuries. I wouldn't stand for that abuse. I hope she'll finally do something about that big bully." Which action on the part of the nurse is appropriate? Ignoring the secretaries and continuing to work Telling the secretaries that Angela's information is confidential and should not be discussed Stopping what she is doing and letting the secretaries know that Angela is finally doing something about the abuse Telling the secretaries that they can find out all of the information about Angela's plan by reading her medical record

Telling the secretaries that Angela's information is confidential and should not be discussed RATIONALE: Information about a client's medical condition and any issues related to the client is confidential and should not be discussed openly. In a nurse-client relationship, information is not to be shared with a third party who is not directly involved in the client's care. If the nurse overhears an individual who is not directly involved in the client's care talking about a client's condition, the nurse must intervene to stop the conversation and remind the individual that the conversation is inappropriate. Ignoring the secretaries and telling them that Angela is doing something about her abuse are inappropriate actions. A client's record is confidential, and no one should be reading a client's medical records unless that person are involved in the client's care.

A nurse is preparing to work as a volunteer at a seafood festival, in charge of the first aid tent. What does the nurse understand about her work as a volunteer? Select all that apply. That she will not be provided legal immunity under the state's Good Samaritan law That she must have professional liability insurance, because the Good Samaritan law will not apply That Good Samaritan laws vary by state, and she must be aware of the law in the state in which she is volunteering That she will be covered by the Good Samaritan law as long as she provides nursing care within acceptable standards That she will not be covered by the Good Samaritan law, because it applies only to accidents that occur on highways

That Good Samaritan laws vary by state, and she must be aware of the law in the state in which she is volunteering That she will be covered by the Good Samaritan law as long as she provides nursing care within acceptable standards RATIONALE: Good Samaritan laws are passed by state legislatures. Because these laws vary by state, the nurse must be aware of the law in the state in which he/she is volunteering. Such laws encourage health care professionals to assist in emergency situations without fear of being sued for the care they provide. The law limits liability and offers legal immunity for people helping in an emergency, provided that they render reasonable care. Immunity from lawsuit applies only when all conditions of the state law are met (e.g., the primary health care provider receives no compensation for the care provided and the care given is not intentionally negligent). All nurses are encouraged to obtain their own professional liability insurance; if the nurse does have his or her own professional liability insurance the Good Samaritan law will still apply.

The nurse reviews the documentation written in the client's medical record by the student nurse. Which statements made by the student nurse reflect incorrect documentation and require correction? Select all that apply. The client CO pain and was given his PM. The client's abdominal dressing was changed. The client is a complainer and has repeatedly stated that the nurses take too long to answer his call bell. The client ate 50% of breakfast and 50% of lunch and consumed 100% of his protein snack. The client was able to sit in the chair for 30 minutes without experiencing shortness of breath or tiredness.

The client CO pain and was given his PM. The client's abdominal dressing was changed. The client is a complainer and has repeatedly stated that the nurses take too long to answer his call bell. RATIONALE: Documentation guidelines must be followed to help ensure when information about a client is being recorded, and all documentation must be objective, factual, and complete. Judgmental and evaluative statements should be avoided, so the notation that the client is a complainer is incorrect. Simply documenting that the client's abdominal dressing was changed is an incomplete statement; the nurse should also document the appearance of the wound and its size, as well as whether any drainage was noted and, if so, the drainage's characteristics, and how the client tolerated the procedure. Unacceptable abbreviations such as CO or PM must not be used because of the possibility of inaccurate interpretation by other members of the health care team. The notations that the client ate 50% of breakfast and 50% of lunch and consumed 100% of his protein snack and that the client was able to sit in the chair for 30 minutes without experiencing shortness of breath or tiredness both reflect correct, complete documentation.

The nurse calls Margaret's primary health care provider to report the fall, completes an occurrence report, and documents the occurrence in Margaret's medical record. Which statements should be included in Margaret's medical record? Select all that apply. The client was found lying on the floor. An occurrence report was placed in the medical record. The client's primary health care provider was notified. The client was not instructed in the use of the call bell. The client had no complaints of discomfort or pain after the fall. The client fell to the floor while ambulating from the bathroom back to bed.

The client was found lying on the floor. An occurrence report was placed in the medical record. The client was not instructed in the use of the call bell. RATIONALE: An occurrence report is a tool used to identify risk situations and improve client care. The report form should not be copied or placed in the client's record, and no reference should be made to the report form in the client's record. The occurrence report is not a substitute for a complete entry in the client's record regarding the occurrence. The nurse documents only an objective description of what was actually observed and any follow-up care that was rendered.

The nurse who is admitting Michael to the hospital reviews the medical record that was sent from the surgeon's office and checks the informed consent for surgery. Because Michael's signature on the consent form was witnessed by the nurse in the surgeon's office, the hospital nurse makes which determination? The surgeon's nurse has explained the surgical procedure to Michael. Michael has an adequate understanding of the surgical procedure. All of Michael's questions about the surgical procedure have been answered. The surgeon's nurse was a witness to Michael's signature of the consent form.

The surgeon's nurse was a witness to Michael's signature of the consent form. RATIONALE: The surgeon who performs the surgical procedure is responsible for explaining the procedure, as well as its risks, benefits, and possible alternatives, to the client. The nurse may be involved in the process of obtaining informed consent for medical procedures by witnessing the client's signature of the consent form after the surgeon has completed the informed consent process. This role is different from obtaining consent, for the nurse is either obtaining the client's signature (when the nurse becomes a witness to signature only) or watching the client sign the form in the presence of the surgeon. The nurse's signature on the consent form does not guarantee that the client has an adequate understanding of the surgical procedure or that he has had all of his questions answered.

Which of the following tasks should the nurse assign to a nursing assistant? Select all that apply. Colostomy irrigation Continuous tube feeding Urine specimen collections Stool specimen collections Ambulating a client who is unsteady Feeding a client who has difficulty swallowing food and fluids

Urine specimen collections Stool specimen collections Ambulating a client who is unsteady RATIONALE: The nurse must keep in mind the skills of the health care team member and the needs of the client to make the most appropriate assignment. In this case, the appropriate tasks for a nursing assistant would be to collect urine and stool specimens and to ambulate the client who is unsteady. The nursing assistant is trained to perform these activities. Colostomy irrigation and tube feedings are not performed by unlicensed personnel. The client having difficulty swallowing food and fluids is at risk for aspiration

The nurse assumes which responsibilities during the process of informed consent? Select all that apply. Witnessing the client's signing of the consent form Providing detailed information about the surgical procedure Clarifying the information that was given to the client by the primary health care provider Dispelling any misunderstandings that the client may have about the surgery Witnessing the client's understanding of the information given about the surgery

Witnessing the client's signing of the consent form Clarifying the information that was given to the client by the primary health care provider Dispelling any misunderstandings that the client may have about the surgery RATIONALE: The surgeon is responsible for getting the consent form signed, which must be done before sedation is given and the procedure is performed. The surgeon, not the nurse, is also responsible for providing detailed information about the procedure. The nurse's role is to clarify the information that has been given to the client, to dispel any misunderstandings about the procedure that the client may have, and to verify that the client has signed the form (witnessing the signature).