Chapter 12

At an interprofessional meeting, nurses discuss appropriate uses for an organizational ethics committee. Which referral do the nurses identify as appropriate? a. Giving input into policies affecting work life balance b. Providing interprofessional input on clinical care c. Determining if the patient's cultural beliefs are valid d. Advising the board of nursing on policy for licensure

b.

The nurse reports to their manager that informed consent was not obtained from a patient for whom HIV testing was already performed. The nurse suggests which intentional tort may have been committed? a. Assault b. Battery c. Invasion of privacy d. False imprisonment

b.

When documenting a dressing change to a residual right limb, the nurse erroneously documents that the dressing change was performed on the left leg. How will the nurse most appropriately correct the documentation? a. Use white correction fluid to cover the error and neatly write over the correction b. Draw a single line through the error, write "mistaken entry," add correct information, and date and initial c. Blacken out the error with permanent marker and rewrite the note in the next available space d. Leave the entry in place, create a correctly written entry below, and cite the charting error above

b.

What is the term for the beliefs held by the individual about what matters? a. Ethics b. Values c. Morals d. Bioethics

b. Rationale: set of beliefs that are meaningful in life and that influence relationships with others

A nurse is caring for a patient who is a practicing Jehovah's Witness. The physician orders 2 units of packed cells based on his low hemoglobin and hematocrit levels. The nurse states to the surgeon that it is unethical to go against the patient's beliefs even though his blood counts are very low. What is the best description of the nurse's intentions? a. Acting in the patient's best interest b. Siding with the patient over the surgeon c. Observing institutional policies d. Being legally responsible

a.

A nursing student is on clinical rotation in a long-term care facility. Which action best reflects the student acting as advocate? a. Telling the health care team that a patient clearly stated they do not want to be transported to the hospital b. Avoiding input in care conferences, as patient advocacy is primarily performed by the health care provider c. Assisting the primary nurse in making good health care decisions for patients and residents d. Deferring to whatever decisions patients and residents want

a.

A registered nurse has had her license suspended after being convicted of being impaired at work. What governing body has the authority to revoke or suspend a nurse's license? a. The State Board of Nurse Examiners b. The employing healthcare institution c. The National League for Nursing d. The Supreme Court

a.

Which of the following parties is responsible for obtaining informed consent from a patient? a. The person performing the procedure, study, or treatment b. The patient's family or significant other c. The patient's nurse d. The nursing supervisor

a.

A nurse who fails to log off a computer after documenting patient care has breached patient confidentiality? T or F

Answer: A. TrueRationale: A nurse who fails to log off a computer after documenting patient care has breached patient confidentiality.

One of the purposes of creating a patient record is to evaluate the quality of care patients have received and the competence of the nurses providing that care.A. TrueB. False

Answer: A. TrueRationale: One of the purposes of creating a patient record is to evaluate the quality of care patients have received and the competence of the nurses providing that care.

A patient has the right to obtain, review, and revise the patient information in his or her health record. T or F

Answer: B. FalseRationale: A patient has the right to obtain and review, but not revise the patient information in his or her health record.

Which method of documentation is unique in that it does not develop a separate care plan but instead incorporates the care plan into the progress notes? A. Source-oriented records B. Problem-oriented records C. PIE (problem, intervention, evaluation) D. Focus charting

Answer: C. PIE (problem, intervention, evaluation)Rationale: PIE charting incorporates the care plan into progress notes in which problems are identified by number. In source-oriented records, each health care group keeps data on its own separate form. Problem-oriented records are organized around patient problems rather than around sources of information. Focus charting brings the focus of care back to the patient and the patient's concerns.

Which scenario is an example of certification? a. A nurse who demonstrates advanced expertise in a content area of nursing through special testing b. A hospital that meets the standards of the Joint Commission c. An education program that meets the standards of the National League for Nursing d. A graduate of a nursing education program who passes the NCLEX-RN

a.

While riding in the elevator, a nurse discusses the HIV-positive status of a client with other colleagues. The nurse's action reflects: a. invasion of privacy. b. defamation of character. c. professional negligence. d. false imprisonment.

a.

Nurses practicing in a critical care unit must acquire specialized skills and knowledge to provide care to the critically ill client. These nurses can validate this specialty competence through what process? a. Certification b. Accreditation c. Licensure d. Litigation

a. Rationale:

A nurse incorporates the "five values that epitomize the caring professional nurse" (identified by the American Association of Colleges of Nursing) into their home health care practice. Which attribute best reflects agreement with the code of ethics and accepted standards of practice? a. Altruism b. Autonomy c. Human dignity d. Integrity

d.

Nursing students enrolled in a leadership and management course discuss the roles of the nurse manager during post conference. What roles should the students include in the discussion? Select all that apply. a. Developing and overseeing a unit budget for staff and patient care b. Hiring, evaluating, and promoting staff growth c. Performing patient care d. Developing treatment plans to improve care and patient outcomes e. Handling escalating situations between caregivers and patients

a, b, e. Rationale: Responsibilities of the nurse manager include overseeing day-to-day operations, designing and managing a budget, supervising and providing training to team members, hiring and evaluating nursing staff, handling escalating situations between patients and health care providers, and collaborating to attain optimal patient outcomes. Nurse managers' roles do not typically include performing patient care or developing treatment plans.

A chief nursing officer with a transformational leadership style is developing a plan for success to obtain Magnet status. What are the most appropriate strategies for the leader to use? Select all that apply. a. Sharing their vision of excellence in patient care and high-level education b. Encouraging nurses to incorporate evidence-based practice through hospital committees and to join nursing organizations c. Promoting compliance by reminding subordinates that they have a good salary and working conditions d. Ensuring employees are kept abreast of new developments in their department and the larger organization e. Writing the Magnet application and supporting documentation with limited input from the nursing staff f. Encouraging nurse managers and nurses to self-schedule as long as proper coverage is maintained

a, b. Rationale: Transformational leaders inspire, motivate, create intellectually stimulating practice environments, and challenge themselves and others to grow personally and professionally. They demonstrate caring and vulnerability, communicating honestly and openly. They are risk takers and pay attention to process as well as outcomes. Instituting a reward program and reminding workers that they have a good salary and working conditions are examples of transactional leadership, which is based on a task-and-reward orientation. Ensuring that employees keep abreast of new developments in nursing care is a characteristic of quantum leadership. The group and leader work together to accomplish mutually set goals and outcomes with the democratic leadership style, and the laissez-faire style encourages independent activity by group members, such as setting their own schedules and work activities.

A nurse who is considered a servant leader is working in an economically depressed community setting up a free mobile health clinic. Which actions best exemplify a servant leader? Select all that apply. a. Motivating coworkers to solicit funding to set up the clinic b. Setting only realistic goals that are present oriented and easily achieved c. Forming an autocratic governing body to keep the project on track d. Spending time with supporters to help them grow in their roles e. Ensuring that other's lowest priority needs are served f. Prizing leadership because of the need to serve others

a, d, f. Rationale: To serve as servant leaders, nurses need to invest in those who support the organization's values, show passion, can play to their strengths, and demonstrate a positive attitude. They should develop their vision to see the future related to a current anticipated need and motivate others to follow and engage. They also need to provide ongoing opportunities for collaborations, sharing, reflection, encouragement, and celebration as well as hard work. The servant leader allows others to have a voice, to exercise control, and to practice leading themselves. The servant first makes sure that other people's highest priority needs are being served. The best test, and most difficult to administer, is: Do those served grow as people? Do they, while being served, become healthier, wiser, freer, more autonomous, more likely themselves to become servants?

Nursing students approaching graduation and licensure are required to read the state nurse practice act. Which topics in the law will they identity as guides to professional practice? Select all that apply. a. Actions resulting in discipline b. Clinical procedures c. Medication administration d. Scope of practice e. Delegation policies f. Medicare reimbursement

a, d. Rationale: Each state has a nurse practice act that protects the public by broadly defining the legal scope of nursing practice. Practicing beyond those limits makes nurses vulnerable to charges of violating the state nurse practice act. Nurse practice acts also list the violations that can result in disciplinary actions against nurses. Clinical procedures are covered by the health care institutions themselves. Medication administration and delegation are topics covered by the board of nursing. Laws governing Medicare reimbursement are enacted through federal legislation.

A nurse informs the client that the client has no choice and must take a bath in the morning. What type of leadership does this exemplify? a. Directive leadership b. Participative leadership c. Shared governance d. Institutional governance

a.

A nurse is using the PIE format to document care of a patient who is diagnosed with type 2 diabetes. What information does the nurse need to complete documentation in this format? a. Patient problem list b. Narrative notes describing the patient's condition c. Overall trends in patient status d. Planned interventions and patient outcomes

a. Rationale: In the PIE format, patient problems are numbered; documented in the progress notes; worked up using the Problem, Intervention, Evaluation (PIE) format; and evaluated each shift. Resolved problems are dropped following the nurse's review. Narrative notes allow nurses to describe a condition, situation, or response in their own terms. Overall trends in patient status can be seen immediately when using charting by exception (CBE). Planned interventions and patient-expected outcomes are the focus of the case management model.

An attorney representing a patient's family who is suing for wrongful death calls the nurse to obtain a better understanding of the nurse's actions. How will the nurse respond? a. "I can't talk with you; you will have to contact my attorney." b. "I will answer your questions, so you'll understand how the situation occurred. c. "I hope I won't be blamed for the death because it was so busy that day." d. "First tell me why you are doing this to me. This could ruin my career!"

a. Rationale: The nurse should not discuss the case with anyone at the facility (except the risk manager), with the plaintiff, with the plaintiff's lawyer, with anyone testifying for the plaintiff, or with reporters. This is one of the cardinal rules for nurse defendants.

A nurse is providing care to a client and is preparing the client for breakfast. The nurse assists the client out of bed to the chair and then helps the client open the items on the breakfast tray. The client begins to eat breakfast. The nurse tells the client, "I'll be back in about 10 minutes to check on you. In the meantime, here is your call light in case you need me." About 10 minutes later, the nurse returns to check on the client. The nurse is demonstrating which ethical principle? a. Fidelity b. Nonmaleficence c. Autonomy d. Justice

a. Rationale: keeps promises and commitments made to others

Which word is best described as protection and support of another's rights? a. Advocacy b. Paternalism c. Autonomy d. Ethics

a. Rationale: protection and support of another's rights

Which of the following are examples of virtues that can exemplify character and conduct as a professional nurse? Select all that apply. a. Trustworthiness b. Humility c. Deception d. Conflict e. Compassion

a., b., e.

A nurse on a surgical unit is concerned about a colleague's possible substance use disorder. Which signs and symptoms could support the nurse's suspicion? Select all that apply. a. Exhibiting diminished alertness and somnolence while working b. Attending multiple continuing education conferences c. Offering to medicate coworkers' patients for pain d. Making incorrect narcotics counts and creating wastage e. Leaving the unit frequently

a., c., d., e.

The new nurse works at a hospital that uses paper records. The nurse writes a narrative note about administration of a pain medication, pictured above. Based on documentation guidelines, which suggestions would improve the nurse's charting? Select all that apply. a. Leave no blank space after each entry; draw a line. b. Identify each entry with AM/PM instead of military time (2400 hour cycle). c. Sign each entry. d. Provide qualifiers for pain, such as quality and quantity. e. Make observations of client behavior, not interpretations. f. Use different color of ink to highlight medication administration.

a., c., d., e.

A graduate nurse and preceptor are discussing protected health information (PHI) and HIPAA laws. The preceptor explains that PHI can be released without the patient's signed authorization in which situations? Select all that apply. a. News media are preparing to report on a patient who is a public figure. b. Data are needed for the tracking and notification of disease outbreaks. c. Protected health information is needed by a coroner. d. Child abuse and neglect are suspected. e. Protected health information is needed to facilitate organ donation. f. The sister of a patient with Alzheimer's disease wants to help provide care.

b, c, d, e. Rationale: According to HIPAA, a health institution may share PHI without written patient authorization for tracking disease outbreaks, infection control, statistics related to dangerous problems with drugs or medical equipment, investigation and prosecution of a crime, identification of victims of crimes or disaster, reporting incidents of child abuse, neglect or domestic violence, responding to a valid subpoena, and providing information needed by coroners, medical examiners, funeral directors, and law enforcement in the case of a death from a potential crime and for facilitating organ donations. The nurse does not provide information to a news reporter without the patient's express authorization; typically, a hospital representative communicates with the media. A patient who has Alzheimer's disease will still need a release to share information; this may be given by the power of attorney.

A nurse caring for patients in the intensive care unit develops values from their experiences when forming a personal code of ethics. Which statements correctly guide this process? Select all that apply. a. People are born with values. b. Values act as standards to guide behavior. c. Values are ranked on a continuum of importance. d. Values influence beliefs about health and illness. e. Value systems are not related to personal codes of conduct. f. Nurses should not let their values influence patient care.

b, c, d. Rationale: A value is a belief about the worth of something, about what matters, that acts as a standard to guide our behavior. A value system is an organization of values in which each is ranked along a continuum of importance, often leading to a personal code of conduct. A person's values influence beliefs about human needs, health, and illness; the practice of health behaviors; and human responses to illness. Values guide the practice of nursing care. An individual is not born with values; rather, values are formed during a lifetime from information from the environment, family, and culture.

A nurse answers a call light and finds the patient on the floor. After the health care provider examines the patient and finds no injury, the nurse returns the patient to bed and fills out an incident report. What statements are true about incident reports? Select all that apply. a. They can be used as disciplinary action against staff members. b. They can be used as a means of identifying risks. c. They can be used for quality control. d. They must be completed by the facility manager. e. They make facts available in litigation cases. f. They should be documented in the patient record.

b, c, e. Rationale: Incident reports are used for quality improvement and should not be used for disciplinary action against staff members. They are a means of identifying risks and are filled out by the nurse responsible for the injured party. An incident report makes facts available in case litigation occurs; in some states, incident reports may be used in court as evidence. A health care provider completes the incident form with documentation of the medical examination of the patient, employee, or visitor with an actual or potential injury. Documentation in the patient record should not include the fact that an incident report was filed.

A nurse manager is planning to update a health care provider's office from paper to electronic health records (EHR) by using the eight-step process for planned change. Place the following actions in the order in which they should be initiated: a. The nurse devises a plan to switch to EHR. b. The nurse records the time spent on written records versus EHR. c. The nurse attains approval from management for new computers. d. The nurse analyzes all options for converting to EHR. e. The nurse installs new computers and provides an in-service for the staff. f. The nurse explores possible barriers to changing to EHR. g. The nurse follows up with the staff to check compliance with the new system. h. The nurse evaluates the effects of changing to EHR.

b, f, d, c, a, e, h, g.

A nurse caring for patients in the city-run health clinic expresses a commitment to social justice. Working toward which action best exemplifies this attribute? a. Providing honest information to patients and the public b. Promoting universal access to health care c. Planning care in partnership with patients d. Documenting care accurately and honestly

b.

A nurse manager who is working to institute the SBAR communication process for all health care providers is meeting resistance to the change. How does the manager best approach the resistance? a. Containing the anxiety in a small group and moving forward with the initiative b. Explaining the change and listing the advantages to the person and the organization c. Reprimanding those who oppose the new initiative and praising those who willingly accept the change d. Quickly introducing the change and involving staff in implementation of the change

b.

A nursing student is preparing to administer medications and asks the clinical instructor about legal liability in clinical practice. What is the most appropriate response? a. "Students are not responsible for their acts of negligence resulting in patient injury." b. "Student nurses are held to the same standard of care that would be used to evaluate the actions of a registered nurse." c. "Hospitals are exempt from liability for student negligence if the student nurse is properly supervised by an instructor." d. "Most nursing programs carry group professional liability making student personal professional liability insurance unnecessary."

b.

A nurse erroneously administered two tablets of acetaminophen totaling 650 mg to their patient. When reporting this to the nurse manager, the nurse states, "there are two tablets in a package labeled '325 mg. acetaminophen.' The prescription reads 'administer 325 mg of acetaminophen;' therefore, I administered what was in the package." Based on a philosophy of just culture, what should happen next? a. The nurse should be found at fault for not clarifying the order. b. The package labeling should be reviewed with the pharmacy. c. The nurse should be disciplined. d. No follow-up is needed as the medication is over the counter.

b. Rationale: A just culture is committed to accountability and safety. Nurses are encouraged to disclose clinical errors and potential error situations without the fear of punitive actions, allowing others to learn from this experience. Health care workers within the organization discuss concerns and challenges related to patient care, turning them into opportunities for improvement.

A nursing student is actively working toward strengthening their leadership skills. What action will best assist the student to meet this goal? a. Being self-reliant in solving problems b. Being self-directed and asking for assistance when needed c. Using written communication instead of face-to-face communication d. Reporting nurses who do not follow policies to the nurse manager

b. Rationale: Leader behavior includes being self-directed and knowing your limitations; demonstrating a commitment to excellence; having a clear vision and strategic focus that allow movement forward toward a creative solution; showing commitment to and passion for your work; and displaying problem-solving skills, trustworthiness and integrity, respectfulness, accessibility, empathy and caring, desire to be of service, and responsibility to enhance the personal growth of all staff.

The nurses at an acute care hospital participate in a committee focused on achieving Magnet status. Which action do the nurses suggest to help achieve this goal? a. Centralizing the decision-making and scheduling process b. Promoting self-governance at the unit level c. Deterring professional autonomy to promote teamwork d. Promoting evidence-based practice over innovative nursing practice

b. Rationale: Magnet hospitals use a decentralized decision-making process, self-governance at the unit level, and respect for and acknowledgment of professional autonomy. In Magnet hospitals, 14 characteristics, the Forces of Magnetism, have been recognized that identify quality patient care, excellent nursing care, and innovations in professional nursing practice.

A nurse receives a call from a friend requesting information on her mother-in-law who was just admitted to the hospital. How does the nurse best respond? a. "You shouldn't be asking me to do this. I could be fined or lose my job for disclosing this information." b. "I'm sorry; per privacy laws, I can't give out patient information—even to my best friend or a family member." c. "Because of HIPAA, you could get in trouble for asking for this information unless you are authorized by the patient to receive it." d. "Why are you asking? Are you extremely worried?"

b. Rationale: The nurse should immediately clarify they must adhere to HIPAA laws to protect patient privacy and confidentiality. Mentioning penalties for breaches of privacy sidesteps the need to clearly introduce or reinforce the policy. It may be appropriate to ask the friend about her concerns, only after clarifying privacy laws.

A new home health nurse and preceptor are reviewing charting for a patient with advanced lung cancer who receives Medicare benefits. When reviewing a draft of the new nurse's documentation, which statement will the preceptor correct? a. Explained to family that irregular respirations or agitation may occur when the patient is actively dying b. Patient seemed in better spirits and reported going out for ice cream with his family yesterday c. Stage 3 pressure ulcer dressing on sacral area is dry and intact; due to be changed tomorrow d. Performed medication reconciliation with focus on pain management and anticoagulation

b. Rationale: To receive Medicare services, the patient must be homebound, still needs skilled nursing care, or that the patient is dying, among others. Leaving the home for ice cream may interfere with home care benefits.

What would be an example of the nurse practicing fidelity?The nurse: a. regulates visitors. b. stays with a client during death as promised. c. withholds information as requested. d. provides continuity of care.

b. Rationale: fidelity is to keep promises and commitments made to others

Nursing students are discussing the care-based approach to ethical practice. What actions will the students ensure are included in the discussion? Select all that apply. a. Understanding that the needs of the many prevail versus the needs of the few b. Promoting the dignity and respect of patients as people c. Attending to the individual attributes of each patient d. Cultivating responsiveness to others and professional responsibility e. Understanding that moral skills include kindness, attentiveness, compassion, and reliability

b., c., d. e.

A patient with an advanced directive and do-not-resuscitate order is sobbing and reporting severe pain. The nurse contacts the provider, who refuses to increase the medication dose due to the patient's hypotension. What actions would the nurse take next? Select all that apply. a. Lodge a complaint with the state board of nursing b. Consult with the ethics committee c. Contact a different health care provider d. Speak with the nurse manager Request a palliative care consultation

b., d., e.

A nurse who is working in a hospital setting uses value clarification to help patients understand the values that motivate patient behavior. What patient actions help the nurse determine if they demonstrate "prizing" during this process? Select all that apply. a. They stop smoking after a diagnosis of lung cancer. b. They show off a new outfit that after losing 20 lb. c. They choose to work fewer hours following a myocardial infarction. d. They adopt a low-cholesterol diet. e. They join a gym and schedule classes throughout the year. f. They proudly display a certificate for completing a marathon.

b., f.

A nurse is caring for a postoperative patient who has a prescription for morphine 2 mg IV every 3 hours. Which examples documenting pain management best reflect recommended guidelines? Select all that apply. a. 6/12/25 0945 Morphine 2 mg administered IV. Patient's response to pain appears to be exaggerated. M. Patrick, RN. b. 6/12/25 0950 Morphine 2 mg administered IV. Patient appears to be comfortable. M. Patrick, RN. c. 6/12/25 1015 Administered morphine 2 mg IV at 0945, patient reporting pain as 2 on a scale of 1 to 10. M. Patrick, RN. d. 6/12/25 0945 Patient reports severe pain in right lower quadrant. M. Patrick, RN e. 6/12/25 0945 Morphine IV 2 mg will be administered to patient every 3 hours. M. Patrick, RN f. 6/12/25 0945 Patient states they do not want pain medication despite return of pain. After discussion, patient agrees to try morphine 2 mg IV. M. Patrick, RN

c, d, f. Rationale: The nurse should enter information in a complete, accurate, concise, current, and factual manner, indicating the date and both the time the entry was written and the time of pertinent observations and interventions. When charting, the nurse should avoid the use of stereotypes, derogatory terms, and judgments such as "response to pain appears to be exaggerated" or "seems to be comfortable." Stating that medication will be given does not document care given; this prescription/intervention belongs in the plan of care.

A health care provider has been urgently paged to another unit and asks a nurse to enter a pain medication prescription for their patient in the electronic medical record. Which response by the nurse is most appropriate? a. "Thank you for taking care of this; I'll be happy to enter a verbal order into the electronic health record." b. Get a second nurse to listen to the order, write the order on the health care provider order sheet, and ensure both nurses sign it. c. "I'm sorry; verbal orders can only be accepted in an emergency. Please enter this quickly before leaving this unit." d. Try calling another resident for the order or wait until the next shift.

c.

A new graduate nurse tells the preceptor they want to obtain recognition in wound care, a specialty area of nursing. What credential will this nurse need to seek? a. Accreditation b. Licensure c. Certification d. Board approval

c.

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

c.

A nurse is overheard in the hospital cafeteria making false comments about a client. The nurse is guilty of: a. Slander b. Libel c. Invasion of privacy d. Assault

c.

A patient admitted through the emergency department for a severe infection is receiving intravenous (IV) antibiotics. The patient, who has been oriented, demands the nurse remove the IV because the patient is leaving now. What action will the nurse take? a. Apply soft wrist restraints b. Perform a neurologic assessment c. Explain that after signing an "against medical order form," the patient may leave d. Call the patient's family to encourage the patient to stay

c.

A client who has suffered a cerebrovascular accident is unable to swallow and refuses the insertion of a feeding tube. In order to promote the client's autonomy, the nurse should perform which action? a. Promptly arrange for a swallowing assessment b. Assess the client's understanding of the risks and benefits of tube feeding c. Communicate the client's wish to the family and health care team d. Inform the client of their rights under the law

c. Rationale: Autonomy is self-determination; being independent and self-governing. To implicate autonomy the nurse is going to provide information and support the patient and family during the decision that is right for them, including collaborating with other members of the health care team to advocate for the patient.

An RN on a telemetry unit is falling behind while performing assessments and administering medications. Which task can the nurse safely delegate to the AP? a. Assessing a patient who has just arrived on the unit b. Teaching a patient with newly diagnosed diabetes about foot care c. Documenting a patient's I & O in the electronic health record d. Helping a postoperative patient out of bed for the first time

c. Rationale: Documenting a patient's I & O on a flow chart does not require professional judgment and can be delegated to AP. Professional nurses are responsible for the initial patient assessment, discharge planning, health education, care planning, triage, interpretation of patient data, care of invasive lines, administering parenteral medications. What they can delegate are assistance with basic care activities (bathing, grooming, ambulation, feeding) and things like taking vital signs, measuring intake and output, weighing, simple dressing changes, transfers, and postmortem care.

A nursing professor pulls a student aside to discuss documenting a patient's blood pressure of 202/122 but not reporting this to the primary nurse. When discovered, the patient was transferred to the intensive care unit for treatment and monitoring. How does the faculty best explain to the student that their inaction reflects negligence? a. "You did not re-assess your patient." b. "There was poor interprofessional communication with the health care team." c. You failed to act as a reasonably prudent nurse would under similar circumstances." d. "This action is consistent with a felony criminal action."

c. Rationale: Negligence is defined as performing an action that the reasonably prudent nurse would not perform or failing to act as a reasonably prudent nurse would in similar circumstances. Negligence may be an act of omission or commission. Criminal law concerning state and federal criminal statutes includes murder, manslaughter, criminal negligence, theft, and illegal possession of drugs. Public law regulates relationships between people and the government. Private or civil law includes laws relating to contracts, ownership of property, and the practice of nursing, medicine, pharmacy, and dentistry. a

A nurse is asked to act as a mentor to a new nurse. What action will the mentor expect to perform? a. Accepting payment to introduce the new nurse to their responsibilities b. Hiring the new nurse and assigning duties related to the position c. Enabling the new nurse to participate in professional organizations d. Advising and assisting the new nurse to adjust to the work environment of a busy emergency department

d.

A patient with dysphagia has been admitted with a third episode of aspiration pneumonia in less than a year. The health care provider insists that for safety, the patient must have a feeding tube placed. The patient declines the tube and later asks the nurse if they should reconsider. What is the most appropriate nursing response? a. "The feeding tube will prevent aspiration and is the safest option for you." b. "You could swallow thickened liquids and puréed foods more easily." c. "Tell me your understanding of what may happen without the feeding tube." d. "You said cooking and dining with your family is important, and I understand your decision."

c. Rationale: The nurse assesses the patient's understanding of the cause and consequences of aspiration and pneumonia. The nurse can provide further information on pneumonia and sepsis if needed, while supporting the patient's decision. The patient has already declined treatment; therefore, the nurse assesses whether the patient understands the decision before discussing the intervention. The nurse may suggest safer swallowing options or consultation with a speech therapist after assessing the patient's knowledge.

The nurse on an oncology unit is caring for a patient admitted for dyspnea and wheezing. What is most important for the nurse to include in the change-of-shift report to the oncoming nurse? a. Partial bath was given b. Patient received physical therapy c. CT scan revealed a mass in the right lung d. Patient did not eat lunch today

c. Rationale: The nurse's shift or handoff report includes basic identifying information about the patient. The outgoing nurse includes the patient's current health status and changes during their shift, response to nursing and medical therapy, pertinent monitoring and assessment findings (e.g., lab and radiology data), pain management, changes in orders (medications, intravenous fluids, diet, and rationale), upcoming/ongoing tests and procedures, and instructions for these, such as NPO after midnight, unfilled prescriptions for the next shift to follow up on, and patient and family questions, concerns, and needs.

A client diagnosed with cancer has met with the oncologist and is now weighing whether to undergo chemotherapy or radiation for treatment. This client is demonstrating which ethical principle in making this decision? a. Beneficence b. Confidentiality c. Autonomy d. Justice

c. Rationale: autonomy is to be self-determination; being independent and self-governing

A school nurse interviewing parents of a child who is doing poorly in school determines that the parents practice a laissez-faire method of discipline. What are examples of this form of value transmission? Select all that apply. a. Before meals, a boy says a prayer that he learned from his parents. b. A boy is taken for ice cream to celebrate his good report card. c. An adolescent boy explores religions of friends in hopes of developing his own faith. d. A boy is taught how to behave in public by his schoolteacher. e. An adolescent girl is punished for staying out too late with her friends. f. An adolescent girl tries alcohol at a party with her friends.

c. and d. Rationale: laissez-faire method of disciple is the leadership style in which the leader relinquishes all power to the group. That being said, those who use the laissez-faire approach to value transmission leave children to explore values on their own

A nurse uses the ISBARR format to report the deteriorating mental status of a patient using morphine via a patient-controlled analgesia pump (PCA) for postoperative pain. Place the following nursing statements related to this call in the correct ISBARR order. a. "I am calling about Mr. Sanchez in Room 202 who is receiving morphine via a PCA pump for pancreatic cancer." b. "Mr. Sanchez has been difficult to arouse, and his mental status has declined over the past 12 hours." c. "You want me to discontinue the PCA pump until you see him tonight at patient rounds." d. "I am Rosa Clark, an RN working on the second floor of South Street Hospital." e. "Mr. Sanchez was admitted 2 days ago following a diagnosis of pancreatic cancer." f. "I suggest a decrease in the dose of morphine."

d, a, e, b, f, c.

A charge nurse on the step-down unit will likely use which leadership style during resuscitation efforts for a cardiac arrest? a. Democratic b. Laissez-faire c. Servant d. Autocratic

d.

A nurse receives a prescription for an analgesic for a patient who has compound fractures of the tibia and fibula. What schedule will the nurse use to administer the medication? Electronic health record (EHR) Health care provider order sheet 8:00 AM: Hydromorphone 1 mg IV every 2 hours PRN severe pain. -S. Jones, MD a. When the patient requests it b. Every 2 hours on the even hours c. Daily, every 2 hours d. As requested, 2 hours or more after the last dose

d.

A patient died during routine outpatient surgery, and the nurse was accused of having failed to monitor and interpret vital signs. Which fact must be established to prove them guilty of malpractice or negligence? a. The surgeon testifies the nurse's action was pure negligence, saying that the patient could have been saved. b. This patient should not have died since they were healthy, physically active, and involved in the community. c. The nurse intended to harm the patient and was willfully negligent, as evidenced by the tragic outcome. d. The nurse had a duty to monitor the patient, and due to the nurse's failure to perform this duty, the patient died.

d.

After observing conflicts between nurses about scheduling, a nurse manager compliments the nurses for achieving the monthly goal of no patient falls. What strategy for conflict resolution did the manager display? a. Collaborating b. Competing c. Compromising d. Smoothing

d.

Nursing students enrolled in a leadership and management course attend clinical on a surgical unit. As they are planning their day, they note one student has a complex patient with multiple medications and the need for frequent turning, pressure injury wound care, and tube feedings. Which action by the group best reflects effective teamwork and coordination? a. Asking patients to prioritize what they want to accomplish each day b. Including a "nice to do" for every "need to do" task on the list c. "Front loading" their schedules with "must do" priorities d. Scheduling times to assist the student with the complex patient

d.

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

d.

The parent of a young school-age child wants them to learn about healthy dietary choices related to diabetes. Which method of value transmission would be most helpful? a. Depriving the child of their favorite toy when they consume foods not on their diet b. Lecturing the child on the merits of healthy and unhealthy food choices c. Allowing the child to experiment and discuss the outcomes on their blood glucose d. Offering healthy meals and snacks and acting as a role model for healthful eating

d.

A patient being discharged from the hospital asks to receive a copy of their medical record. What information will the nurse give the patient? a. "I'm sorry, but patients are not allowed to copy their medical records." b. "I can make a copy of your record for you right now." c. "You can read your record while you are still a patient, but copying records is not permitted according to HIPAA rules." d. "I'll check with the medical records department to determine how you request a copy."

d. Rationale: According to HIPAA, patients have a right to view and receive a copy of their health record; update their health record; get a list of the disclosures a health care institution has made, independent of disclosures made for the purposes of treatment, payment, and health care operations; request a restriction on certain uses or disclosures; and choose how to receive health information. The nurse should be aware of facility policies regarding the patient's right to access and copy records.

A patient with brain cancer questions whether they should agree to palliative radiation treatments despite possible memory loss, or enjoy their remaining time with friends and family. What is the most appropriate response by the nurse? a. "I can't advise you. This is such an individual decision." b. "If you receive the radiation, might you live a bit longer?" c. "What does your family think you should do?" d. "What is most important to you with the time you have left?"

d. Rationale: Advocacy is the protection and support of another's rights. The nurse assesses the patient's goals and advocates to support their wishes. Nurses do not make ethical decisions for patients; rather; the nurse facilitates patient decision making by interpreting and providing information, encouraging verbalization of feelings, and facilitating communication with family, primary nurse, health care provider, or clergy.

A nurse follows a prescription written by the health care provider to administer a medication to which the patient is allergic. How does the nurse interpret their liability for administering this medication? a. The nurse is not responsible because they were following the provider's orders. b. The nurse is responsible because they administered the medication. c. The health care provider is responsible because they ordered the drug. d. The nurse, health care provider, and pharmacist bear responsibility for their actions.

d. Rationale: Nurses are legally responsible for carrying out the orders of the health care provider in charge of a patient unless an order would lead a reasonable person to anticipate injury if it was carried out. If the nurse should have anticipated injury and did not, both the prescribing health care provider and the administering nurse are responsible for the harms to which they contributed.

The nurse manager reviews the medical record of a patient who has accused a nurse of negligence after requiring a "needless" admission to the intensive care unit postoperatively. Which entry in the electronic health record requires follow-up by the manager? Exhibit: Electronic health record (EHR) Nursing Notes: Postoperative follow-up 12:20 pm: patient still reporting incisional pain of 10/10, provider contacted, increased morphine from 1 mg to 2 mg every hour 2: 15 pm: dime-sized, dark red-brown blood stain on dressing; area circled 2:30 pm: patient reports incisional pain, 7/10, 2 mg morphine administered 2:45 pm: vital signs T 99.2°, P 120, RR 20, BP 84/48; will continue to monitor a. Inappropriately recorded vital signs b. Pain treated without appropriate assessment c. Failure to follow up on tachycardia and hypotension d. Lack of interpretation of vital signs and follow-up

d. Rationale: Nurses are responsible for gathering assessment data including vital signs and interpreting them considering the patient's condition and trends. The nurse did not document interventions from the health care provider for typical symptoms of shock, including tachycardia and hypotension.

A hospice nurse is caring for a patient with end-stage cancer. Which action demonstrates the nurse's commitment to promoting the patient's autonomy? a. Competently administering pain medication b. Giving undivided attention when listening to patient concerns c. Keeping a promise to obtain a counselor d. Supporting the patient in obtaining a durable power of attorney

d. Rationale: The principle of autonomy obligates nurses to provide information and support patients' and their surrogates' need to make decisions that advance their interests. Acting with justice means giving each person their due, acting with fidelity involves keeping promises to patients, and acting with nonmaleficence means avoiding doing harm to patients.

A nurse is looking for trends in a postoperative patient's vital signs. In which part of the electronic health record will the nurse find this information? a. Admission sheet b. Admission nursing assessment c. Progress notes d. Graphic record

d. Rationale: While one set of vital signs may appear on the admission nursing assessment, the best place to find sequential recordings demonstrating a pattern or trend is the graphic record. The admission sheet and flow sheet do not include ongoing vital sign documentation.

A nurse is providing care to an older adult client who was just diagnosed with cancer. The client together with the immediate family discuss their preferences with the health care providers involved. The health care providers offer their clinical recommendations about possible treatments. Ultimately, the group arrives at a decision. The nurse interprets this decision-making process as reflecting which type? a. Clinical b. Paternalistic c. Client sovereignty d. Shared

d. Rationale: shared decision respects and uses the preferences of the patient and the expertise and judgment of the clinician