Fundamentals Exam #3

The pediatric nurse is caring for a​ 17-year-old client who has type 1 diabetes. What caring intervention can the nurse implement as the client transitions to​ adulthood? A. Emphasize the importance of having a medical home to routinely monitor and treat chronic conditions. B. Provide recommendations for a provider who can integrate all findings from specialists into a comprehensive overview. C. Advocate for the client to receive​ pain-relieving interventions for routine procedures such as blood glucose tests. D. Encourage the client to use a retail clinic for acute care problems unrelated to diabetes.

A A large care gap exists as young adults transition from pediatric​ care, monitored by​ parents, into autonomous primary care. Many young adults neglect to get care for chronic childhood conditions such as asthma or​ diabetes, so nurses should emphasize the importance of having a medical home and routinely monitoring and treating chronic conditions. Because of the need for consistent care and​ follow-up, a retail clinic would not be beneficial for this client. The use of​ pain-relieving interventions for routine procedures is more appropriate for​ infants, not adolescents or young adults. Finding a provider who can integrate all findings from specialists is more important for older adults than for young adults. A

Which theory of learning holds that knowledge acquisition is the ongoing assimilation and accommodation of new experiences and​ interpretations? A. Constructivist B. Behaviorist C. Social learning D. Cognitive

A Constructivist theory holds that knowledge acquisition is the ongoing assimilation and accommodation of new experiences and interpretations. In behaviorist​ theory, learning is thought to occur when an​ individual's response to a stimulus is either positively or negatively reinforced. In social learning​ theory, learning primarily results from instruction and observation. In cognitive learning​ theory, learning involves the processes of​ acquiring, processing, and using new information.

The nurse is caring for an older adult client who visits the clinic semiannually to help maintain quality of life. When providing caring interactions to this​ client, what intervention should the nurse​ avoid? A. Use of elderspeak B. Referral to a geriatrician C. ​Self-care D. Assessment for mental health problems

A Elderspeak is a simplified speech characterized by shorter sentences and words. This type of speech shows a negative attitude toward older​ adults, especially adults who are generally healthy and are only seeking care to enhance quality of life. Assessments of older adults should include mental health​ problems, and older adults may be referred to a geriatrician as needed.​ Self-care is related to the nurse caring for​ one's self, not the nurse caring for a client.

The nurse is caring for a client from a different culture who had a myocardial infarction and is receiving atorvastatin​ (Lipitor). The nurse assesses the​ client's diet to be very high in fat. Which is the best plan by the nurse to improve the​ client's diet and reduce the risk that the client may need additional​ medications? A. With the​ client's permission, discuss the dietary requirements with whoever prepares meals for the family. B. Ask the client if he would rather have another nurse who is from the same culture speak to him about his dietary needs. C. Consult a dietitian to teach the client about​ low-fat diets. D. Give the client information specific to his culture related to​ low-fat diets.

A Every culture has​ culture-specific diets; the nurse must include the individual in the family who does the meal preparation if a different diet is to be successful. Asking the client about having a nurse from the same culture speak to him is racist and implies that the nurse cannot understand the dietary needs of a client from another culture. At this​ point, a consult by dietary services is premature. Providing information is a good​ idea, but the nurse must also teach the client.

The nurse caring for an adult client from another country notices that the client consults with her mother on all healthcare decisions. What action by the nurse is the most culturally​ competent? A. Accept the behavior of the client and family member. B. Confront the​ client's mother to state the importance of the client making her own decisions. C. Ask the client why the parent is being consulted for every decision. D. Ask the​ client's mother to leave the room to provide the client with more privacy.

A In a multicultural​ society, human differences are accepted and respected. The nurse should accept this behavior because it might be a cultural​ norm, or it may be the way this client prefers to approach decisions about healthcare. Either​ way, all other choices are inappropriate and do not consider the​ client's cultural,​ family, or personal values.

The nurse is planning discharge teaching to a client with diabetes who has a large wound. Which is the priority action for the nurse prior to initiating teaching with this​ client? A. Asking the client to state what is known about the current dressing changes B. Assessing the​ client's ability to​ self-administer insulin C. Teaching the client how to take blood sugars D. Determining the​ client's reaction to having diabetes

A Nurses need to provide client education that will ensure the​ client's safe transition from one level of care to another and make appropriate plans for​ follow-up education in the​ client's home. Discharge plans must include information about what the client has been taught before transfer or discharge and what remains for the client to learn to perform​ self-care in the home or other residence.

The nurse is caring for a client who has recently received a permanent colostomy. The client will be going home in several days and requires discharge teaching. What should the nurse do when organizing the teaching​ experience? A. Ask the client to tell the nurse what he knows about caring for the colostomy. B. Break the information into small sessions to enhance learning. C. Make sure the​ client's spouse is present before the teaching session begins. D. Start from the beginning and proceed through all steps required to perform colostomy care.

A The nurse should find out what the client​ knows, and then proceed to the unknown. This gives the client confidence. This information can be elicited either by asking questions or by having the client take a pretest or fill out a form. Going over information already learned is not practicing good time management for the nurse or the client. Unless the client has attention problems or is an older​ adult, breaking up the sessions is probably unnecessary. Having the spouse present is always a good​ idea, but finding out what the client already knows is more important when organizing teaching.

The nurse documents that a client who has an infected leg developed a rapid heart​ rate, decreased blood​ pressure, and a fever of 101.8degreesF but does not report them to the provider. Two days​ later, the​ client's leg must be amputated due to severe infection and gangrene. Which legal concept​ applies? A. Failure to communicate B. Failure to document C. Failure to follow standards of care D. Failure to act as a client advocate

A ​Rationale: A failure to communicate has occurred because the nurse did not communicate the change in client condition to the provider. The specific change in condition was very suspicious for infection and deterioration of condition. The nurse did fail to act as an​ advocate, but this is mostly applicable to situations in which an order or plan of care is contrary to the​ client's best interest. The standard of care was not necessarily breached because the nurse technically followed orders.

The nurse suspects that a client is a victim of an assault. Which should be the​ nurse's priority​ action? A. Notifying the supervisor and contacting police to report the injuries as suspicious B. Reporting the suspicion to risk management and asking them to investigate C. Looking in the​ client's medical record to see if there is any history of assault or violence D. Documenting the findings and saying nothing to the other team members

A ​Rationale: Any injury that is suspected as part of an assault or abuse should be reported to law enforcement. The findings should be documented but must also be reported. Risk management may be consulted for guidance and​ verification, but they do not provide the report to law enforcement. A history of assault or violence may not be relevant to the current findings.

A client is being transferred from a community hospital to a large urban medical center. Which action should the nurse include when the emergency medical technicians​ (EMTs) request a copy of the​ client's insurance​ information? A. Making a copy or providing the necessary information and giving it to the EMTs B. Telling the EMTs to get a copy from the hospital business office C. Not giving the information D. Asking the​ client's family to provide the information

A ​Rationale: Because protected health​ information, including insurance​ information, can be disclosed to other caregivers for the purposes of​ treatment, payment, or​ operations, the nurse should provide relevant information to EMTs regarding any of these three areas. The nurse should not withhold the information because it is part of treatment. The nurse also should be able to provide health information without other providers needing to go to a business office or other source. The​ client's family is not involved in the disclosure of information related to​ treatment, payment, or operations between two covered entities.

The nurse in the emergency department greets and treats a variety of clients with the same level of care. Which professional nursing value is demonstrated by this​ nurse? A. Social justice B. Altruism C. Integrity D. Autonomy

A ​Rationale: Social justice is the equal treatment of all clients without regard to cultural or socioeconomic​ background, ethnicity,​ gender, religion,​ disability, or sexual orientation. Altruism is a concern for the welfare of others. Integrity is practicing in an honest and ethical manner. Autonomy is supporting the independent decision making of others.

A nurse whose brother was killed by a drunken driver is assigned to admit a client who has been in a car crash. The client is in police custody after being arrested for driving drunk for the third time. Which action on the part of the nurse aligns with the professional code of ethics for​ nurses? A. The nurse cares for the client in the same manner as for other clients. B. The nurse refuses care of the client. C. The nurse delegates all care of the client to an assistant. D. The nurse provides minimal care to keep the client alive.

A ​Rationale: The professional ethics code for nursing care aligns with the equal effort of care delivery to all clients despite differences in moral agreement between the client and the nurse. Refusal of​ care, purposeful delegation for the avoidance of​ care, and poor effort in equal care delivery do not align with the professional code of ethics for nurses.

The interdisciplinary team discusses a conflict in​ care-planning ideals between parents and an ill child. Which action should the interdisciplinary team first try to navigate this ethical​ issue? A. Developing a therapeutic relationship with the child and parents B. Calling the police C. Contacting the hospital ethics committee D. Asking a judge for guardianship of the child

A ​Rationale: The team would first develop a therapeutic relationship with the child and parents to discuss options and plan treatment. There is no indication that the police are needed. The ethics committee may be involved if the desires of the parents and child significantly diverge. Legal action would be taken if the parents were making poor decisions regarding the care of the child.

The nurse on an organ transplant unit is saddened by the death of a client and reflects on the many issues surrounding organ transplantation. Which issue is the nurse most likely to identify as the primary ethical concern in organ​ transplantation? A. The lack of organs for those needing transplantation B. The cost of organ transplantation C. The high risk of transplantation surgery D. The nursing shortage

A ​Rationale: These issues all influence the running of an organ transplantation​ program, but the primary ethical concern of organ transplantation is the lack of donor organs for those who need​ transplants, leading to difficulty in ethical decision making regarding who should receive these precious resources.

A client has a rare form of pancreatic cancer and qualifies to join a clinical trial of a new investigational drug. The nurse provides the client with complete risk information before the client signs up to become a research participant. Which principle of ethical decision making did the nurse​ honor? A. Veracity B. Beneficence C. Autonomy D. Justice

A ​Rationale: Veracity is the principle behind giving complete information before obtaining a​ client's informed consent. Autonomy is the right of​ self-determination. Justice ensures fair treatment. Beneficence means taking action to promote​ good, but because the nurse has no experience with the new​ drug, it is not known whether it will be good for the client.

During a performance​ appraisal, a unit manager praises a staff nurse on the ability to use presencing when caring for terminally ill clients. What did the nurse demonstrate that would exemplify this caring​ behavior? Select all that apply. A. ​Face-to-face discussions with clients B. Sitting quietly with clients C. Guaranteeing quality and safety in care D. Instructing clients on how they should perform certain functions E. Validating the​ client's experience through active listening

A B Presencing is a nursing concept that involves the interpersonal arts of perception and communication. Presencing is described as​ face-to-face discussions, silent​ immersions, and lingering presence. Instructing clients on how they should perform certain functions empowers the client. Guaranteeing quality and safety in care demonstrates competence. Validating the​ client's experience through active listening demonstrates compassion.

A nurse is interviewing a client at a clinic near a shelter for the homeless. Understanding the lack of resources this client has​ available, which should the nurse assess during the intake phase of the health​ history? Select all that apply. A. Social support available B. Any personal resources C. Access to medication D. Access to nutritious meals E. Number of times married

A B C D Homeless clients present unique and complex challenges. The nurse should inquire about any social​ support, personal​ resources, and access to prescribed medications and nutritious meals in order to plan care appropriately. The number of times the client has been married is irrelevant.

The nurse is teaching a class about the Office of the National Coordinator for Health Information Technology and meaningful use objectives. Which item should be​ included? (Select all that​ apply.) A. Engaging clients and their families in the​ client's care B. Reducing health disparities by improving safety and quality of care C. Improving care coordination to improve client outcomes D. Controlling and monitoring​ clients' healthcare choices E. Ensuring the security and privacy of protected medical information

A B C E ​Rationale: The Office of the National Coordinator for Health Information Technology​ (ONC) monitors the achievement of meaningful use​ objectives, which are reported back to the Centers for Medicare and Medicaid Services​ (CMS) in order to authorize financial reimbursement. Meaningful use objectives include improving care​ coordination, reducing health disparities among U.S. citizens by improving the safety and quality of​ care, ensuring the security and privacy of protected medical​ information, and engaging clients and their families in the​ client's care. Meaningful use objectives do not include controlling and monitoring​ clients' healthcare choices.

The nurse decides to take a few days of personal time to invest in​ self-nurturing activities. Which activities indicate the nurse is taking steps to care for​ self? Select all that apply. A. Participating in regular exercise B. Being active in church C. Eating one meal a day D. Participating in daily meditation E. Sleeping 4 hours each night

A B D Some examples of activities that can help the nurse care for self include a balanced​ diet, regular​ exercise, adequate rest and​ sleep, recreational​ activities, and meditation and prayer. Eating only once a day and sleeping for 4 hours each night are not activities that help the nurse care for self.

A nurse working in an assisted living facility is preparing an educational program regarding ageism for the colleagues on the unit. Which statements reflect​ ageism? Select all that apply. A. ​"The elderly are less likely to recover from​ illness." B. ​"Addressing an elderly client as​ 'Honey' or​ 'Sweetie' is​ disrespectful." C. ​"All elderly people are​ sickly." D. ​"The elderly are just​ lazy, and that is why they need help with activities of daily​ living." E. ​"If the client is competent to make​ decisions, I should not go to other members of the family for care​ decisions."

A C D Ageism is the term used to describe the deep and profound prejudice in American society against older adults. The beliefs that elderly people are​ sickly, less likely to recover from​ illness, and lazy are all examples of ageism. The nurse should always address the client by name and involve the client in care decisions if the client is competent to decide.

Which statement should the nurse recognize as being correct regarding nursing​ negligence? (Select all that​ apply.) A. It occurs without the deliberate intent to bring harm to another individual. B. It is conduct deviating from the standard of practice dictated by the profession. C. It is an unintentional tort. D. It is a crime. E. It is conduct that deviates from what a reasonable individual would do in a particular circumstance.

A C E ​Rationale: Negligence is defined as conduct that deviates from what a reasonable individual would do in a particular circumstance and is considered an unintentional tort. Negligence occurs without the deliberate intent to bring harm to another individual. Malpractice is defined as any conduct deviating from the standard of practice dictated by the profession. A crime is considered to be committed against the state rather than an individual.

While caring for a client with respiratory alkalosis caused by​ hyperventilation, the nurse decides that having students in the room may increase the​ client's anxiety.​ Therefore, he decides to have the students watch the assessment of a different client. Which type of knowledge is the nurse demonstrating when assigning another client for​ care? A. Empirical B. Aesthetic C. Personal D. Ethical

B Aesthetic knowledge is the art of nursing and is expressed by nurses in their creativity and style in meeting the needs of clients. This nurse is demonstrating aesthetic knowledge by being sensitive to the​ client's needs during the assigned shift. Empirical knowledge ranges from​ factual, observable phenomena to theoretical analysis. Personal knowledge is concerned with the​ knowing, encountering, and actualizing of the​ concrete, individual self. Ethical knowing focuses on matters of obligation or what ought to be​ done, and goes beyond simply following the ethical codes of the discipline.

The nurse provides medication teaching for a client who will be going home on new medications. Which statement by the client best illustrates compliance with the medication​ plan? A. ​"I think you should have waited until I was ready to go home. Maybe​ I'd remember​ better." B. ​"I'm glad to know about my new medications. It makes taking them all a lot​ easier." C. ​"I already knew most of what you told​ me." D. ​"If I take my medications as​ prescribed, I'll feel​ better."

B Compliance is best illustrated when the individual recognizes and accepts the need to​ learn, then follows through with appropriate behaviors that reflect learning. Learning about the medications helps the client understand why they are prescribed and improves the possibility for following the prescribed regimen. Statements of prior knowledge do not necessarily lead to​ compliance, and neither does merely restating the advice of the healthcare provider.

A community health nurse runs a clinic that provides health screening mainly to Mexican American and Filipino American clients. The nurse wants to have a class on smoking cessation for interested adults of this group. What action should the nurse take to adjust to their time​ orientation? A. Mail letters ahead of time to make sure clients are informed about the upcoming class. B. Organize the instructions around​ short-term objectives. C. Make sure that the classes are held at specific times. D. Make posters and place them in areas of the community frequented by these groups.

B Cultures with a predominant orientation to the present include the Mexican​ American, Navajo Native​ American, Appalachian,​ Eskimo, and Filipino American cultures. Preventing future problems may be less significant for these clients than for​ others, so teaching prevention may be more difficult. In such​ instances, the nurse can emphasize preventing​ short-term problems rather than​ long-term problems. Schedules have to be very flexible in​ present-oriented societies. Time constraints are not significant for cultures that are oriented to the​ present, so advertising about specific classes may not be effective. The nurse must be quite​ flexible, treat the​ culture's beliefs with​ respect, and not expect that cultural practices will change to reflect the​ nurse's needs.

During the physical examination of a client who took a fall that fractured his​ hip, the nurse notices an impairment of the​ client's hearing, but that the​ client's visual acuity and motor function do not seem to be impaired. The client answers questions very precisely and readily grasps the meaning of everything the nurse says when the client can face the nurse. When teaching this​ client, the nurse should make it a priority to A. provide only written instructions. B. make verbal instructions face to face with the client. C. use only visual media. D. use only physical demonstrations with written instructions.

B During the physical​ examination, the nurse may use findings to evaluate learning needs. In this​ client's case, verbal instructions are fine to use if the client is in a position to see the​ nurse's lips move. Written​ instructions, visual​ media, and physical demonstrations also might be useful for this client when​ indicated, but not exclusively.

In holistic​ nursing, the nurse should emphasize the​ client's personal responsibility in maintaining health. This idea is most closely related to which concept in caring​ interventions? A. Nursing presence B. Empowerment C. Compassion D. Competence

B Empowerment is the process whereby the client develops the autonomy to identify her own health needs in lieu of being instructed how to do so. This helps the client take personal responsibility in maintaining health. Nursing​ presence, compassion, and competence are less likely to help clients take personal responsibility for their own health.

A general term used for a variety of conditions in which an individual is born with a reproductive or sexual anatomy that does not seem to fit the typical definitions of female or male is A. transgender. B. intersex. C. genderqueer. D. homosexual

B Intersex is a general term used for a variety of conditions in which an individual is born with a reproductive or sexual anatomy that does not seem to fit the typical definitions of female or male. Homosexuality is a sexual preference for members of the same sex. Transgendered individuals do not identify with the gender assigned to their bodies. Genderqueer individuals​ don't identify with male or female exclusively but with both categories.

A nurse is caring for a child who is hospitalized for an exacerbation of asthma. The nurse is preparing discharge​ teaching, as the client will be going home on nebulizer treatments and an inhaler. The client and her family​ members, who are recent immigrants to the United​ States, speak little English. In addition to enlisting an interpreter to help with the language​ barrier, what should be a priority for the nurse in developing a teaching​ plan? A. Provide written instructions before discharge. B. Address any healing beliefs the family has. C. Make sure the child comes back for the​ follow-up appointment. D. Make sure the parents can set up the treatments for their child.

B Providing an interpreter to assist with communication is extremely important in this situation.​ However, if the prescribed treatment conflicts with the​ client/family's cultural healing​ beliefs, the client may not be compliant with the recommended treatments. To be​ effective, nurses must deal directly with any conflicts and differing values held by the​ client's parents. It is also important to provide written material and assess the psychomotor skills of the​ child, but the first priority is ascertaining any belief conflicts that may interfere with the treatment and cause the parents to resist the prescribed treatment or bringing the child back for a​ follow-up appointment.

A nurse is working in a neonatal intensive care unit​ (NICU). The nurse wants to teach a mother of a premature baby how to give her baby a bath. Which statement by the mother reflects a readiness to​ learn? A. ​"You'll give us written instructions before we go​ home, correct?" B. ​"I want to make sure my husband is​ here, in case I​ don't hear everything​ that's said." C. ​"I'm so afraid​ I'll hurt my baby with all these tubes and​ wires." D. ​"When my baby is just a little​ bigger, I'll feel more comfortable giving him a​ bath."

B Readiness to learn is the demonstration of behaviors or cues that reflect a​ learner's motivation,​ desire, and ability to learn at a specific time. The client who wants her husband involved is demonstrating motivation and willingness to learn. Statements about fear of the situation need to be addressed so that the fear will not inhibit the learning process. Wanting to wait until discharge or at least until the baby is older reflects uncertainty and possibly fear and should be addressed before learning can occur.

What is a good way for a nurse to prepare the environment for​ teaching? A. Emphasize the importance of paying close attention if client reactions demonstrate confusion. B. Evaluate client abilities to perform skills with return demonstrations. C. Keep to a strict schedule decided in advance. D. Inform students that they need to take effective notes because you will not be repeating yourself.

B Return demonstrations are an effective way to evaluate whether clients are able to perform newly learned​ skills, and they contribute to a good environment for teaching. Nurses should take time for​ teaching, not simply adhere to strictly predefined schedules. Nurses must be able to adapt teaching based on client​ reactions, and they should be prepared to repeat instructions.

A home health nurse is admitting a new client to the agency who was recently discharged from the hospital with a new diagnosis of pulmonary fibrosis. What is the best way for the nurse to evaluate whether the client is able to set up and administer a nebulizer​ treatment? A. The client reports success or failure with the treatment at a​ follow-up appointment B. Direct observation of behavior C. Oral description by the client of the treatment D. Written description by the client of the treatment

B The best way for the nurse to evaluate whether this client is able to set up and administer a nebulizer treatment is by direct observation of the client doing it. A written or oral description of the treatment does not as directly demonstrate that the client can set it up and administer​ it, and the client reporting success or failure at a​ follow-up visit​ doesn't give the nurse a direct means of evaluating what the client understands.

The nurse is caring for a client who has been diagnosed with diabetes mellitus. The client must learn how to independently perform fingerstick blood sugar analysis as part of the plan of care. The client​ says, "I already know what you are attempting to teach because I looked everything up on the​ internet." Which is the best action by the nurse based on the​ client's statement? A. Teach the​ client's support system how to perform the procedure. B. Watch the client perform a return demonstration of the skill. C. Give the client printed learning materials. D. Document that the client understands teaching.

B The nurse is responsible for documenting that the client can perform the skill that has been taught. Giving the client written directions or teaching the support individual does not meet the requirement that the client will perform the skill. The nurse cannot document that the client understands teaching until a return demonstration by the client is correctly performed.

The clinic nurse is caring for an infant during a routine wellness exam. The parents and infant immigrated to the United States 6 months ago. The mother explains that she believes that an herbal remedy is the best way to treat the​ infant's colic. Which action by the nurse is​ appropriate? A. Explain how herbal ingredients may be harmful to the infant. B. Ask the mother what the ingredients are in the remedy. C. Give the mother an alternate remedy for colic. D. Tell the mother not to use the remedy because there is no way to know what the​ ingredients' scientific effect may be.

B To recognize cultural​ practices, the nurse must acknowledge that use of old and home remedies is part of caregiving practices. Asking the mother what ingredients are in the herbal remedy allows the nurse to best evaluate what the mother is​ using, and then a determination of the benefit or detriment to the infant can be made in a nonjudgmental manner. Telling the mother not to use the​ remedy, giving an​ alternative, or making a judgment that any herbal ingredient is harmful does not recognize this cultural practice and shows insensitivity on the part of the nurse.

A client requires a longer length of stay because a nurse does not administer an ordered medication or document why the medication was not given. Which legal concept applies in this​ case? A. Scope of practice B. Failure to follow standards of care C. Breach of duty D. Failure to act as a client advocate

B ​Rationale: A nurse has a legal obligation to follow a healthcare​ provider's order. It is always appropriate to question an unclear or questionable​ order, but​ follow-up must​ occur, and documentation must support the decision not to follow the order. This was a specific failure rather than a general breach of duty. Scope of practice is not applicable to this scenario. Failure to act as a client advocate is applicable when an order or plan of care is not advisable and the nurse intervenes.

Which action by the nurse ensures that an order written by a healthcare provider is within the​ nurse's scope of practice in that particular​ state? A. Asking the designated supervisor B. Referring to the state nurse practice act C. Asking the healthcare provider if the order is permitted D. Referring to the hospital policy

B ​Rationale: A state nurse practice act defines the scope of practice for a professional nurse in that state. Hospital policy must support the scope of practice as defined by the nurse practice act. A nurse manager may be a good resource for verifying whether an action is​ permitted, but the nurse must be personally responsible for understanding the scope of practice. The healthcare provider is not responsible for understanding what is in the scope of practice of nursing in a particular state.

Two dialysis clinic nurses are discussing the recent death of a client with​ end-stage renal disease. One nurse believes that the​ client's decision to end treatment was correct. The other nurse thinks that the client should have continued treatment long enough to allow the client to talk to an estranged child. Which nurse is exhibiting client​ advocacy? A. The nurse who thought that the client should have had a chance to reconcile with a child is exhibiting advocacy. B. The nurse who believes that the​ client's decision to end treatment was correct is exhibiting advocacy. C. Both nurses are​ advocates; they are proposing choices that the client could have made. D. Neither nurse is an​ advocate; the client had no real choice and would have died soon anyway.

B ​Rationale: An advocate defends the cause of another​ individual, so the nurse supporting the​ client's decision to end treatment is an advocate. The nurse who gave the opinion that family reconciliation was a priority was not supportive of the client. Advocacy is not limited by the amount of time left in life. An advocate does not propose choices that the client could have made in the face of choices actually made.

The nurse promises to bring a client a requested hand​ towel, but an hour​ later, the nurse has not returned. Which moral principle has this nurse​ violated? A. Veracity B. Fidelity C. Justice D. Autonomy

B ​Rationale: Fidelity is a faithful agreement or​ promise, which has been broken in this situation. Justice is equal treatment of all clients. Veracity is​ truth-telling. Autonomy is respecting the​ client's decision making.

All clients have the right to be cared for by a competent and safe nurse according to which guideline for nursing​ care? A. Nurse practice acts B. Standards of practice C. Licensing process D. Code of ethics

B ​Rationale: Standards of practice describe the competency level of nursing care as described by the American Nurses Association​ (ANA), which outlines the rights of a client to have competent and safe nursing care. Nurse practice acts regulate the licensing and practice of nursing by describing the scope of practice but does not cover the​ client's rights to competent and safe nursing care. The licensing process establishes an assessment for a minimum knowledge base relevant to the client population that the nurse serves but does not cover the rights of clients. A code of ethics is a guide for carrying out nursing responsibilities while maintaining moral principles but is not associated with the right of clients to have competent and safe nursing care.

The nurse who lives in New Jersey is working at a hospital in New York but only has one nursing license. Which rule allows the nurse to practice in another​ state? A. Transition to practice B. Mutual recognition model C. Portability D. Competency certification

B ​Rationale: States that participate in the mutual recognition model allow nurses to practice in more than one state while holding a single nursing license. Portability is related to health insurance information. Competency is part of job skills and continuing education. Transition to practice refers to the skills acquired by novice nurses as they enter the workforce.

The nurse is reading a news article in which the ethical dilemma posed by​ end-of-life suffering is discussed. The article describes how a healthcare provider delivered a requested lethal dose of pain medication to a client with a terminal illness. Which​ end-of-life issue does this article​ address? A. ​Do-not-resuscitate (DNR) order B. Euthanasia C. Advance directives D. Assisted suicide

B ​Rationale: The administration of a lethal medication to a client is euthanasia. A DNR order is an example of an advance​ directive, a document that lets caregivers know the desires of the client regarding​ care, especially​ end-of-life care. In assisted​ suicide, the client is provided a lethal dose of medication for​ self-administration.

An older client without cognitive impairment refuses culture of a seeping wound. Which action should the nurse​ take? A. Discharging the client for noncompliance B. Respecting the​ client's decision C. Asking the client about withdrawing blanket consent D. Restraining the client so that the culture can be taken

B ​Rationale: The older adult has the right to refuse​ treatment, and the nurse is legally and ethically bound to respect this decision. The client would not be discharged by the nurse for refusing the culture. Restraining the client so that the culture can be taken is against the law. The client is allowed to refuse treatment under blanket consent.

Which factor should the nurse exclude as a benefit of electronic medical​ records? A. Recognizing the need for vaccines B. Notifying clients of upcoming appointments C. Identifying the need for mammograms D. Tracking client data over time

B ​Rationale: Tracking client data over​ time, identifying the need for​ vaccines, and identifying the need for mammograms are all benefits of electronic medical records. Notifying clients of upcoming appointments is not a benefit of electronic medical records.

The nurse is working with a client with a​ progressive, debilitating muscle disease. The client is struggling with treatment and​ end-of-life decision​ making, so the nurse begins the process of clarifying values. Which is the first step in this​ process? A. Examining possible consequences B. Listing alternatives C. Choosing a course of action D. Acting with a pattern

B ​Rationale: Values clarification is a​ seven-step process that begins with listing the alternatives. The next steps are examining possible consequences of​ choices, freely choosing a course of​ action, feeling good about the​ choice, affirming the​ choice, acting on the​ choice, and acting with a pattern.

A nurse makes a significant medication error. Which information should the nurse expect the risk manager to ask​ about? A. If the nurse will agree to have the error reported B. Any process that was in place that allowed the error to occur C. Whether the nurse intended to commit the error D. The hours the nurse worked the previous day

B ​Rationale: When an error​ occurs, it should always be​ reported, whether or not the nurse involved agrees. Reporting of errors should be nonpunitive and should not be considered a negative. Fatigue levels may be​ considered, but a nurse who is experiencing fatigue should not be allowed to work. It should be assumed that the nurse did not intend to commit the error because this could become a human resources or criminal issue. Reporting of errors is mostly beneficial when safety gaps in processes are identified. Then work can be done to improve processes and prevent future errors.

A hospital is preparing for the American​ Nurses' Credentialing​ Center's magnet hospital designation process. Nurse representatives on the Magnet Council consider several Professional Practice Models​ (PPMs) as their approach to nursing care. After selecting a PPM​ model, members of the Council plan a series of nursing grand rounds. These focus on the six Cs of caring in​ nursing: compassion,​ competence, confidence,​ conscience, commitment, and comportment. What particular nursing​ theory, philosophical​ approach, or framework of caring have the nurses decided to​ adopt? A. ​Watson's Theory of Human Care B. ​Roach's Theory of Caring as the Human Mode of Being C. Boykin and​ Schoenhofer's Nursing as Caring Theory D. ​Leininger's Theory of Culture Care Diversity and Universality

B ​Roach's Theory of Caring as the Human Mode of Being includes the six Cs of caring in nursing. The other three approaches to caring in nursing focus on other major tenets related to caring.​ Watson's Theory of Human Care emphasizes the role of authentic caring relationships in healing.​ Leininger's Theory of Culture Care Diversity emphasizes actions that​ preserve, maintain, and accommodate the cultures of diverse​ clients, and Boykin and​ Schoenhofer's Nursing as Caring Theory describes caring as an essential aspect of nursing and a process rather than a mere goal.

A nursing student has been assigned to present a teaching project to the​ class, using each of​ Bloom's taxonomy domains. The student has planned several activities to include when presenting the project to the class. Which activities are within the affective​ domain? Select all that apply. A. Class members must demonstrate a favorite nursing skill for the class. B. Class members must reflect on how they felt the first time they provided direct client care. C. Class members must identify two attitudinal changes that have occurred in their lives since beginning their nursing education. D. Class members must list the technical skills they have learned. E. Class members must read a paragraph about a new clinical​ trial, summarize the​ information, and present it to the rest of the class.

B C In cognitive​ theory, learning occurs across three primary​ domains: cognitive, or​ "thinking"; affective, or​ "feeling"; and​ psychomotor, or​ "skill." The affective domain includes emotional responses to​ tasks, such as​ feelings, emotions,​ interests, attitudes, and appreciations. Listing technical skills and reading or summarizing information is part of the cognitive​ domain, which includes​ knowing, comprehending,​ application, analysis,​ synthesis, and evaluation. The psychomotor domain includes​ hands-on motor​ skills, such as demonstration.

The nurse is discussing ethical​ end-of-life care of an older adult client with the interdisciplinary team. Which issue of care should the nurse include in the​ conversation? (Select all that​ apply.) A. Ability to pay for care and funeral expenses B. Autonomy C. Presence of depression D. Risks and benefits of treatment E. Cognitive impairment

B C D E ​Rationale: Autonomy, cognitive​ decline, depression, and understanding of the risks and benefits of treatment are common ethical issues in​ end-of-life care. Financial status is not included.

The family members of a recently deceased client wrote a letter to the unit​ manager, expressing their appreciation for the way the client was treated while dying in the hospital. The family mentioned characteristics that indicate the nurses were caring. What behaviors did the family most likely use to explain the caring actions of the​ nurses? Select all that apply. A. Established limits with the client B. Maintained client confidentiality C. Delivered care with style D. Respected the client E. Treated the client as a human being

B C D E Caring has been described as encompassing various intentions and actions. There are 10 behaviors within​ caring, which include appreciating the client as a human​ being, showing respect for the​ client, and treating client information confidentially. Delivering care with style describes aesthetic​ knowing, which includes the concepts of​ empathy, holistic​ thinking, compassion, and sensitivity. Establishing or setting limits is an action that a nurse would perform as part of​ self-care actions.

A nurse is providing a series of educational workshops for caregivers of older clients interested in promoting the health and​ well-being of their clients. Which would be appropriate topics for this​ group? Select all that apply. A. Responsible sexual behavior B. Safe driving evaluations C. Fall prevention D. Advance directives E. Medication use and side effects

B C D E It is important for caregivers of older clients to learn about how to prevent​ falls, medication use and side​ effects, safe driving​ evaluations, and advance​ directives, but it would be much less appropriate for this age group to include teaching about responsible sexual​ behavior, which would be better addressed to younger adult clients.

The nurse is discussing consent for care with a​ 16-year-old client who does not want to involve the parents in care. For which health condition may the minor seek care without parental​ consent? (Select all that​ apply.) A. Asthma B. Birth control C. Substance abuse D. Prenatal care E. Sexually transmitted infections

B C D E ​Rationale: Depending on state​ law, minors may obtain birth​ control, prenatal​ care, substance abuse​ counseling, and treatment for sexually transmitted diseases without parental consent. Parental consent is required for the​ long-term care of asthma.

The nurse is teaching a class regarding standards of care in nursing. Which statement by a participant indicates an​ understanding? (Select all that​ apply.) A. ​"The Joint Commission is the primary agency responsible for establishing nursing standards of​ care." B. ​"The American Nurses​ Association's standards of practice are the prevailing national nursing​ standard." C. ​"Nurse practice acts and administrative rules form the basis of the standard of care for​ nurses." D. ​"The nurse's specific job description will aid in defining the standard of​ care." E. ​"Employers can​ limit, but not​ expand, the nursing scope of​ practice."

B C D E ​Rationale: The American Nurses Association​ (ANA), not The Joint​ Commission, is primarily responsible for establishing nursing standards of care. All other choices are correct.

The nurse manager is concerned about how the stress of ethical dilemmas is affecting the nurses of the unit. Which intervention should the nurse plan for the staff to help them cope with ethical​ dilemmas? (Select all that​ apply.) A. Encouraging time at the bedside to foster immersion in the dilemma B. Modeling coping behaviors C. Planning education for coping D. Acquiring resources to ease the impact of future stressors E. Creating a network for peer support

B C D E ​Rationale: The nurse manager can use the framework from risk management to help combat the impact of ethical issues in the workplace. This includes modeling coping​ behaviors, planning education​ sessions, creating a support​ network, and acquiring resources. The nurse manager would want to encourage the nurses to spend free time away from the unit as a means of relieving pressure.

Which action by the nurse correctly exemplifies the seven rights of medication​ administration? (Select all that​ apply.) A. Checking for the right frequency by looking at the​ client's chart B. Checking for the right dose by performing a dose calculation and checking the medication C. Checking the prescribed order and looking at the time D. Verifying the right medication by asking the​ client, "Is this what you normally take at​ home?" E. Documenting administration of the prescribed order in the client record

B C E ​Rationale: Verifying the right time and dose and documenting the administration of the medication are all included in the seven rights of medication administration. Frequency is not one of the seven rights of medication administration. Although checking for the right medication is one of the seven​ rights, asking the client if the pill is what the client takes at home does not constitute checking the right medication. The nurse would need to verify that the medication is correct by checking the medication against the​ client's medication administration record.

Under the Health Insurance Portability and Accountability​ Act, which is an acceptable reason to disclose protected health​ information? (Select all that​ apply.) A. Press release B. Operations C. Nurse knowing the client personally D. Payment E. Treatment

B D E ​Rationale: The privacy rule of the Health Insurance Portability and Accountability Act specifies that protected health information may be disclosed to other covered entities for the purposes of​ treatment, payment, or operations. Protected health information cannot be shared as part of a press release or if the client is known by the nurse. It must meet one of the three allowed purposes.

A home health nurse is working with a client who has chronic obstructive pulmonary disease. Which nursing diagnosis will take the highest priority for implementing client​ education? A. Activity Intolerance B. Ineffective Breathing Pattern C. Impaired Gas Exchange D. Anxiety

C All of these nursing diagnoses are appropriate for the client who is experiencing chronic obstructive pulmonary​ disease, but the priority for the nurse to address is impaired gas exchange. If the​ client's oxygen level is too​ low, or the carbon dioxide level is too​ high, the​ client's life may be threatened. This client will also experience activity​ intolerance, anxiety,​ and, at​ times, ineffective breathing​ patterns, but the priority diagnosis is Impaired Gas Exchange.

A novice nurse is working in a busy emergency department of a hospital situated in a culturally diverse area of the city. Which should the nurse do when providing culturally competent​ care? A. Treat everyone who comes to the emergency department seeking care as having the same needs. B. Base the standard of care on the needs and attitudes of the dominant cultural group in the area. C. Acquire the underlying background knowledge necessary that will provide these clients with the best possible healthcare. D. Assume that working in this emergency department will be the same as in other care contexts the nurse has encountered.

C As healthcare​ providers, it is imperative to recognize common prejudices. Prejudices are prejudgments about cultural groups or vulnerable populations that are unfavorable or false because they have been formed without the background knowledge and context upon which to form an accurate opinion. Healthcare providers must acquire this background knowledge to develop their cultural competence. The nurse cannot treat every client as having the same​ needs, assume that the emergency department does not present a unique context that must be understood on its own​ terms, or base his standard of care on what best serves a single cultural​ group, dominant or not.

The nurse educator is preparing to teach a group of nursing students how to navigate the internet to research healthcare information. Which does the educator plan to include during​ lecture? A. A directory of campus internet sites of interest B. A directory of libraries C. How to search for and evaluate health information D. Information technology instruction

C Campus health centers that use the internet as a tool for health education must train nursing students regarding how to search for and evaluate the health information they find. Sites of interest for the campus would not directly impact the nursing program. Information technology is a subject that teaches nurses how to use technology for the delivery of care and communication. Libraries are​ important, but knowing about them would not be a part of this presentation.

During a care​ conference, the nursing student differentiates between the different theories of caring when discussing client care. Which type of knowledge is the student​ demonstrating? A. Ethical knowing B. Personal knowing C. Empirical knowing D. Aesthetic knowing

C Empirical knowledge is systematic and helps to​ describe, explain, and predict phenomena. This student is exhibiting empirical knowing as the student is able to analyze the different theories of caring. Aesthetic knowing is the art of nursing and is expressed in creativity and style in meeting the needs of the client. Personal knowing is concerned with​ knowing, encountering, and actualizing the​ concrete, individual self. Ethical knowing focuses on matters of obligation or what ought to be​ done, and goes beyond simply following the ethical codes of the discipline.

The nurse is evaluating the following​ goal: Client will select​ low-fat foods from a list by the end of the month. The​ client, who has different beliefs about​ food, has not been able to achieve this goal. Which action by the nurse is​ appropriate? A. Make sure that the client understands the importance of the goal. B. Extend the time frame and give the client a longer period to achieve the goal. C. Modify the plan of care to be consistent with the​ client's beliefs regarding food. D. Select a different goal.

C If the outcomes are not achieved for a client with different​ beliefs, the nurse should be especially careful to consider whether the​ client's belief system has been adequately included as an influencing factor and modify the plan of care to be consistent with the​ client's belief regarding food. Extending the time​ frame, selecting a different​ goal, or checking how the client understands the importance of the goal may not be as helpful as looking at the cultural practicesdashincluding dietary onesdashof the client.

Which acculturation behavior will the nurse observe in a client who has emigrated from another country to the United​ States? A. The client buys all needed products from the local store owned by people from the​ client's country. B. The client lives in a neighborhood that is populated predominantly with people from the​ client's country. C. The client attends church in the neighboring community to meet new people. D. The client speaks his native language only.

C Individuals experience acculturation when they begin to adapt or borrow habits of the new culture. The client who attends church in the neighboring community to meet new people is displaying acculturation. The other behaviors are examples of a client who may feel comfortable only in the​ client's culture.

The nurse places a client in a treatment room of the emergency department for treatment of abdominal pain and vaginal bleeding. The​ spouse, speaking for the​ client, asks that only a female provider examine his wife for the pelvic exam. The nurse recognizes that the client is from a culture that prohibits men from examining women. Which is the most culturally appropriate statement by the​ nurse? A. ​"Your spouse will be covered with a​ sheet, so it will not matter whether the examiner is male or​ female." B. ​"The request is unreasonable and cannot be​ honored." C. ​"Every attempt will be made to honor your​ request." D. ​"The male and female providers both respect​ privacy."

C Many cultures have religious beliefs that prohibit men from examining women and women from examining men. To provide culturally appropriate​ care, the nurse must recognize this as a legitimate request and make every attempt to honor this request. Although both male and female staff have professional and ethical responsibilities to respect a​ client's privacy, the nurse must still make efforts to meet the request of the client. The response of covering the client or stating the request is unreasonable shows insensitivity to the​ client's cultural need.

A nurse conducted a safety class for a group of older adult clients in the community on fall prevention. During a​ follow-up visit in the home of one of these​ clients, the nurse sees a number of fall hazards she identified during her class. What should the nurse document regarding the learning outcome for this​ client? A. The client might not have heard necessary information during the class. B. The client did not understand the teaching given in the class. C. The client did not comply with the teaching given in the class. D. The client understood the teaching given in the class but chose to ignore it.

C The client did not implement what he was taught in class given the evidence of fall hazards the class specifically addressed. The nurse should document the learning outcome as noncompliance. The client might not have heard necessary information during the class because of a hearing deficit or being​ distracted, the client might not have understood the information because of the way it was presented or for some other​ reason, or the client may have chosen not to comply with the​ teaching, but the nurse cannot know which of these might be the​ case, if​ any, without further evaluation of the client.

A client who had outpatient surgery is given an instruction sheet in preparation for discharge. When the nurse asks if the instructions are​ clear, the client​ says, "I'll read them later when I have my​ glasses; besides, you told me everything I need to​ know." Based on these​ statements, what would the nurse​ suspect? A. The client already knows the information. B. The client does not want the written information. C. The client may be unable to read the instructions. D. The client is ready to learn.

C The client who refuses to read instructions may not be able to read. The nurse should assess the​ client's ability to read to ensure proper treatment and to evaluate the​ client's understanding of the information. It is unlikely that the client does not want the information. The client said that​ he'd read the instructions​ later, and so is not opposed to written information. Although the nurse did provide verbal​ instruction, often clients forget portions because of the amount of information presented at discharge. The client may be ready to​ learn, but the​ client's inability to read may be masking that fact.

The nurse is conducting a class for a group of pregnant clients and wants to focus specifically on the risks of alcohol consumption for the developing fetus. Which topic should the nurse include with regard to safety of the​ fetus? A. Human growth and development B. Nutrition C. Lifestyle modification D. Stress management

C The nurse should focus on lifestyle modification if she plans to focus specifically on the risks of alcohol consumption for the developing fetus. Human growth and​ development, nutrition, and stress management are all worthwhile topics for these​ clients, but none of them as directly address the risks of alcohol consumption.

Which treatment program would be most appropriate for homeless clients whose type 1 diabetes requires daily insulin​ injections? A. Inpatient​ hospital-based care B. Partial hospitalization programs C. Outpatient clinic D. Home healthcare

C The outpatient clinic would provide the care the client requires in the most​ cost-effective manner. There is no indication for inpatient or partial hospitalization at this time. Because the client is​ homeless, home healthcare would not be the best option in this situation.

The nurse is caring for a client with a new tracheostomy. After completing a teaching session on tracheostomy​ care, what should the nurse include in the​ documentation? A. The language used for teaching B. The​ client's questions after the teaching session C. The need for additional teaching D. The supplies required for teaching

C The parts of the teaching process that should be documented in the​ client's chart include the need for additional teaching. Documenting the​ client's language is not necessary as it should already be in the nursing history. Supplies required for teaching are not documented. The​ client's questions are not​ documented, but the​ client's understanding at the end of the session is documented.

The nurse is caring for an adult client who has been diagnosed with high cholesterol. Which is important for the nurse to consider when teaching this adult​ client? A. Adults usually can find information on their own. B. Adults do not need to be evaluated for understanding as children do. C. Adults are more oriented to learning when the material is useful immediately. D. Adults are more likely to adhere to a regimen than are children.

C When teaching a​ client, the nurse considers that most people learn and retain information if the information is immediately useful. Some clients can find information on their​ own; however, not all information that the client can find is​ factual, and clients should be taught how to discern the difference between trustworthy information and unreliable and potentially dangerous information. All clients need to be evaluated to ensure that the right information was retained. Adults will not necessarily adhere to a regimen more than children will. Effective teaching and the​ client's readiness to learn help with adherence.

The nursing student is planning an educational program for a school project. The program is focusing on cancer detection education for a community group. What should the nursing student plan to include in order to address the various learning styles of the target​ group? A. Multicolored brochures with bright colors B. A lecture using many examples for each learning need C. ​Audiovisuals, examples, group​ discussions, and activities D. A game board with client matching terms

C When teaching a​ group, use strategies to address​ visual, auditory,​ manipulative, group, and​ problem-solving types of learners. Using different techniques and a variety of activities is a good way to match the various learning styles of group participants. Multicolored brochures would only address those learners who learn in the visual mode. Lecture may not meet the needs of the entire group. Games are a useful teaching tool but not necessarily useful when addressing a large group of individuals with varying learning styles.

The nurse administers an incorrect medication to a client and realizes the error a few minutes later. Which action should the nurse​ perform? A. Do not complete an incident report because the client did not experience any adverse effect. B. Complete an incident report and document the report in the medical record. C. Complete an incident report but do not document the report in the medical record. D. Document the error but do not complete an incident report unless the client has an adverse reaction.

C ​Rationale: An incident report should be completed for every event that occurs that is outside of the normal operations of the hospital. The completion of an incident report should never be mentioned in a medical record. An incident report should be completed whether or not the client experiences any harm. The facts surrounding the event should be documented in the medical record but not the incident report.

When a client is being transferred from a hospital to a rehabilitation​ center, the nurse calls to give the rehabilitation center a report. Which information may be disclosed to the rehabilitation​ center? A. Insurance information B. Information related to client preferences C. Anything related to treatment D. Any errors made the​ client's care

C ​Rationale: Any information relevant to the treatment of the client must be provided in order to ensure continuity of care. Insurance information should be​ provided, but it is provided through a separate process than client report. Errors do not need to be disclosed unless an error specifically altered client care. Any information related to client preference should be obtained by the receiving facility upon client arrival.

The nurse has a​ 7-year-old client recovering from​ partial-thickness burns to the arms and hands. This client has shown sensitivity to loud noises and bright​ lights, and at times if she is overstimulated she​ won't speak to or look at anyone but her parents until she calms down. The nurse considers the best teaching environment for this client to be the A. hospital cafeteria. B. pediatric ward waiting area. C. pediatric ward play area. D. ​client's room.

D Be sure all teaching interventions are implemented in a safe environment using a calm​ approach, and take care to address any concerns or fears of the child or​ parent/caregiver. In this​ client's case, the waiting or play areas for the pediatric ward are likely to be busy places and brightly lit. The cafeteria is also likely to be too loud and bright. The​ client's room, where the nurse can control to a greater degree the amount of light and​ noise, is best for teaching this client.

When a​ client's or​ family's wishes about a​ client's care clash with what the nurse believes would be the best possible care for the​ client, this could cause a conflict between caring interventions and what other nursing​ concept? A. Accountability B. Communication C. Quality Improvement D. Ethics

D Conflict between providing the best possible care for the client and the​ family's or​ client's wishes could lead to the nurse experiencing moral​ distress, which could lead to burnout. This is an ethical conflict for the nurse. Even in the midst of this​ conflict, the nurse should maintain the highest standards of accountability and communication. The nurse may use this situation to analyze institutional policies for quality​ improvement, but this process would not involve conflict.

A nurse in a rural community is employed in a facility that has had a shortage of nurses for several years. As a​ result, several nurses have left the institution citing burnout. To avoid risking​ burnout, the nurse regularly works​ out, practices​ yoga, socializes with friends once or twice a​ week, and participates in at least one annual national or state nursing conference. This approach to​ work-life balance reflects which concept within the framework of Caring​ Interventions? A. ​Self-compassion B. ​Self-actualizing C. ​Self-control D. ​Self-care

D Given the circumstances in which the nurse finds​ himself, the nurse has initiated the Caring Intervention of​ self-care to help him better cope with a stressful work environment. Although​ self-care involves aspects of having compassion for the​ self, exercising​ self-control, and being​ self-actualizing, self-care is the term included as part of the Caring Interventions framework that enhances​ nurses' professional practice and helps them to avoid burnout.

The novice nurse working in an​ inner-city hospital that serves a diverse client population​ states, "I want to learn everything possible about all of the​ clients." Which response by the seasoned nurse is​ appropriate? A. ​"I will give you a great book that describes all of the critical​ factors." B. ​"This will come with time as you get to know clients and then encounter​ problems." C. ​"You should always be​ nonjudgmental." D. ​"You need to first understand who you​ are."

D It is a priority for the nurse to develop an awareness of his or her own​ perceptions, prejudices, and stereotypes regarding the client populations that are served. Reading about culture and remaining nonjudgmental are strategies that can be incorporated after engaging in a​ self-awareness inventory. Although experience working with diverse clients will​ help, it will be more meaningful after engaging in a​ self-awareness inventory.

The nurse asks the client to repeat the information taught during the discharge teaching session. The client​ states, "I have forgotten everything you just​ said." Which action by the nurse would is appropriate at this​ time? A. Assigning another nurse to provide the teaching for the client B. Having the client wait to ask questions until after the presentation C. Asking the client their preferred learning strategies D. Repeating the information and having the client write it down as the nurse teaches

D It is important for nurses to evaluate their own teaching and the content of the teaching​ program, just as they evaluate the effectiveness of nursing interventions for other nursing diagnoses. The nurse should not feel ineffective as a teacher if the client forgets some of what is taught. Forgetting is normal and should be anticipated. Having the client write down​ information, repeating it during​ teaching, giving handouts on the​ information, and having the client be active in the learning process all promote retention.

A nurse is working at a healthcare clinic serving the needs of an​ inner-city population that is predominantly made up of minority people groups. A neighbor says the nurse must be brave because most of​ "those" people have guns and are in gangs. Which response by the nurse is​ appropriate? A. ​"It's very difficult for me when you discriminate like​ that." B. ​"It's okay because​ I'm not a gang​ member, so I will be​ okay." C. ​"Hey, it's a job like any other job. All jobs have​ problems." D. ​"That's an unfortunate stereotype. Can we talk about the​ reality?"

D It is the​ nurse's role to promote the act of​ bridging, linking, or mediating between groups of people from different cultural systems to reduce conflict or produce change. Calling the​ neighbor's comment discriminatory may increase conflict. Rationalizing or failing to confront the​ neighbor's perceptions does not promote cultural brokering.

The nurse is caring for a client who just had abdominal surgery. The​ client's nonverbal cues indicate​ pain, but the client denies the need for the pain medication prescribed by the healthcare provider. The nurse recognizes that this client is from a culture that feels it is inappropriate to complain about pain. Which action by the nurse is​ appropriate? A. Consult with the healthcare provider about providing pain medication without the​ client's knowledge. B. Allow the client to suffer in silence. C. Seek out a family member to convince the client to take the medication. D. Offer the pain medication to the client​ again, stating that providing comfort is the​ nurse's most important responsibility.

D Members of some cultures will typically not complain of pain or physical problems because they are taught​ self-restraint and the priority of the group over individual needs. Many people from these cultures will consider refusal of something offered as a gesture of courtesy. The nurse should take this into account when offering the pain medication to the client in a culturally sensitive way. Seeking out the intervention of a family member of the​ client, trying to administer the medication without the​ client's knowledge or simply allowing the client to suffer in silence are not appropriate actions.

A nurse is caring for a group of clients who are recovering in a rehabilitation hospital following total hip replacements. Which client is exhibiting the highest motivation to​ learn? A. A client who has been there the longest and is a great​ "coach" for newcomers B. The client who has just moved in and is already eager for discharge C. A client who has been struggling with following nursing directives regarding discharge goals D. A client who is excited to learn ambulation techniques

D Motivation is the desire to learn and influences how quickly and to what extent an individual learns. It is generally greatest when an individual recognizes a need and believes the need will be met through learning. The client who is excited to learn about ambulation techniques understands that learning about it will help take his recovery to a high level. Motivation must be experienced by the​ client, not by someone else​ (as in being a​ "coach" for​ newcomers). Clients who struggle with rules or following prescribed courses of treatment are not motivated to learn the best reason for their particular plan of​ action; they may be​ "bucking" the system. The client who is already waiting to go home may be eager for that to​ occur, but not necessarily to the extent of being ready to learn how to achieve this end.

A nurse is explaining the need to obtain laboratory tests on a client who has an infection and is of a cultural group different from the​ nurse's. During the​ interview, the client avoids eye contact and refrains from answering questions for long periods of time. Which does this behavior indicate to the​ nurse? A. Leave the room and come back after having learned more about this particular culture. B. The nurse should have another nurse finish the interview who might be more culturally aware of this​ group's customs. C. The nurse should come back at a different time when the client is feeling more communicative. D. In this​ client's culture, direct eye contact may show disrespect.

D Nonverbal communication includes​ silence, touch, eye​ movement, facial​ expressions, and body posture. In some​ cultures, direct eye contact may indicate disrespect. In​ addition, some cultures are quite comfortable with long periods of silence. Before assigning meaning to nonverbal​ behavior, the nurse must consider the possibility that the behavior may have a different meaning for the client and family. The nurse should not leave to come back later or try to find another nurse to take over this​ client's care; nurses should be able to communicate with clients from a diversity of backgrounds.

The client asks the​ nurse, "Why am I receiving this​ medication?" Which action should the nurse take if not familiar with the​ medication? A. Instructing the client to tell the nurse the reason why the client thinks the medication is being given B. Leaving the​ client's oral medication at the bedside and allowing the client to decide whether to take it C. Holding the medication and documenting that the client refused D. Looking up information on the medication and telling the client the reason it is being given

D Rationale: The nurse should urge the client to question any medication administered about which the client is unsure. The nurse also should be familiar with medications before administering them to a client. With this​ action, the new nurse is acting as a client advocate in preventing medication errors. Asking the client to tell the nurse the reason why the client thinks the medication is being given is inappropriatelong dashmany clients will not be able to do​ this, and this is the responsibility of the nurse. Leaving a medication at the​ client's bedside is never appropriate. Holding the​ client's medication because the client is asking about it is also inappropriate and does not improve the safety of medication administration.

A nurse is preparing to discharge a client who experienced a myocardial infarction. The client will have to make many lifestyle​ changes, and the nurse is providing instruction on how to implement a​ heart-healthy lifestyle. Which is the best description of the client education the nurse is presenting to this​ client? A. Dependent function of nursing that needs a healthcare​ provider's order to implement B. Activity nurses begin to learn after training on the job C. Way to establish the​ client's dependence on the nurse D. Important independent nursing function

D State nurse practice acts include client teaching as a function of​ nursing, thereby making teaching a legal and professional responsibility. Nurses seek to help clients manage their health independently. Nurses begin to learn about teaching during their training. Nurses are not dependent on healthcare providers when determining the learning needs of the client.

The client is admitted to the hospital following a​ miscarriage, and she is septic. The healthcare provider orders​ antibiotics, which the client​ refuses, stating,​ "I don't deserve them. I lost my baby because I had sex outside of​ marriage." Which is the appropriate response by the​ nurse? A. ​"I think you need to do what is best for​ you." B. ​"Do you think you should be punished because you had a​ miscarriage?" C. ​"I'll notify your healthcare provider about your​ decision." D. ​"You have a serious infection and really need the​ medication."

D Telling the client she needs the medication is providing the best care possible. Telling the client she needs to do what is best is​ inappropriate; the nurse knows she needs the medication. Calling the healthcare provider is​ inappropriate; the nurse knows the client needs the medication. Asking the client if she thinks she should be punished is​ inappropriate; she is septic and needs the medication.

The nurse notices that a​ client, who is from another​ country, appears uncomfortable when the nurse asks to look at the​ client's abdominal incision from a recent surgery. Which nursing action is the most culturally​ competent? A. Ask the client to explain why she is uncomfortable. B. Close the​ client's curtain to maintain privacy. C. Wait until the next assessment time to observe the incision. D. Explain the reason for the intervention using lay terms.

D The most culturally competent intervention is to explain to the client the reason for the intervention using lay terms. The nurse should close the​ client's curtain to maintain privacy for all​ clients; this is not necessarily just a culturally competent action. Asking the client why she is uncomfortable is confronting the client and is not culturally competent. Waiting until the next assessment time to observe the incision is​ inappropriate, as this can lead to missing important assessment findings regarding the state of the​ client's incision.

A female​ client, from a​ male-dominated culture, is being discharged after a lengthy hospitalization. Which action by the nurse prior to providing discharge instructions is​ appropriate? A. Make sure instructions are understood by the client. B. Ask the client when the best time for teaching would be. C. Ensure that the healthcare provider gives the instructions. D. Assess who the decision maker is in the family.

D The nurse needs to identify who has the​ "authority" to make decisions in a​ client's family. If the decision maker is someone other than the​ client, the nurse needs to include that individual in healthcare discussions. Nurses need an awareness of cultural variations of gender because they will be caring for diverse client needs. What might be considered sexism by one culture may not be in another. Regardless of who is present during the​ teaching, it is always necessary to make sure that the instructions are​ understood, but it is difficult to do that before instructions are given. Asking the client when the best time for teaching would be does not address the need for the decision maker of the family to be present. The nurse should not simply leave giving instructions to the healthcare provider.

During a sexual​ history, the client​ states, "I have always felt like a man trapped in a​ woman's body." The nurse should recognize that the client may identify as​ what? A. Heterosexual B. Bisexual C. Homosexual D. Transgender

D The term transgender refers to individuals who do not identify with the gender assigned to their body. For​ example, an individual who identifies as transgender may have typical female anatomy but feel like a male and seek to become male by presenting as male and taking hormones or electing to have sex reassignment surgeries. This​ client's statement relates to gender​ identification, not to the sexuality of the client.

A nurse is working with a number of clients at a free clinic. Which client population is at the highest risk for low levels of​ healthcare? A. Men who have protected sex with men B. Men who have sex with women C. Teenagers D. Undocumented immigrants

D The term​ "vulnerable population" refers to groups of people in our culture who are at greater risk for diseases and reduced life span due to lack of resources and exposure to more risk factors. People may be made vulnerable by immigration status. Men or teenagers as a group are not more likely to be at risk for lower levels of healthcare.

The nurse does not turn a client as​ ordered, and the client develops a pressure injury. Which legal concept​ applies? A. False imprisonment B. Scope of practice C. Foreseeability D. Breach of duty

D ​Rationale: A duty is a legally enforceable compulsion to act based on competency and experience. Not doing what should be done in this situation represents a breach of​ duty, which is defined as a deviation from the standard of care owed to the client. Foreseeability is another aspect of​ negligence, in that the nurse should have known the consequences of not performing the duty. Scope of practice and false imprisonment do not apply to this situation.

The nurse suspects that a child is a victim of abuse. The department of​ children's services investigates and finds no evidence of abuse. Which describes the consequences to the reporting​ nurse? A. The rest of the healthcare team will be questioned and possibly face legal action by the parents. B. The documentation will need to be changed by the nurse. C. The nurse will be fired and possibly sued. D. Good faith immunity will protect the​ nurse, and there will be no negative consequences.

D ​Rationale: Good faith immunity protects healthcare providers from any negative consequences if a report of suspected abuse or neglect turns out to be unfounded. This protects against the possibility of a lawsuit or having the rest of the healthcare team questioned. Documentation must not be changed or altered in any way based on the outcome of an investigation.

The government affects the process of transitioning to the use of electronic medical records​ (EMRs). Which statement by the nurse describes this​ process? A. ​"The Centers for Medicare and Medicaid Services monitors achievement of meaningful use​ objectives." B. ​"The Office of the National Coordinator for Health Information Technology is the sole agency overseeing transitioning to​ EMRs." C. ​"The Office of the National Coordinator for Health Information Technology authorizes financial​ reimbursement." D. ​"The Centers for Medicare and Medicaid Services monitors the transition of EMRs at the federal​ level."

D ​Rationale: On a federal​ level, the Centers for Medicare and Medicaid Services​ (CMS) and the Office of the National Coordinator for Health Information Technology​ (ONC) oversee the process of transitioning to the use of EMRs. The ONC monitors the achievement of meaningful use​ objectives, which are reported to the CMS to authorize financial reimbursement.

Which requires the nurse to protect the privacy and confidentiality of a​ client's protected health​ information? A. Code of ethics B. Nurse practice act C. Standards of practice D. Health Insurance Portability and Accountability Act

D ​Rationale: The Health Insurance Portability and Accountability Act​ (HIPAA) contains the privacy​ rule, which prevents the disclosure of protected health information unless it is for the purposes of​ treatment, payment, or operations. Nurse practice acts regulate the practice of nursing by outlining licensure requirements and defining the scope of practice. A code of ethics describes the practice of nursing while maintaining a moral code. Standards of practice identify the​ client's right to competent and safe nursing care but are not associated with the requirement to maintain confidentiality.

The nurse is caring for a client with a broken arm. On​ assessment, the nurse notes bruising that is not consistent with the story of a fall presented by the client. The client is withdrawn when the​ client's significant other comes to the bedside. Which action should the nurse​ take? A. Completing the discharge and releasing the client B. Calling the police C. Asking the significant other about the cause of the bruising D. Following legal reporting obligations for suspected domestic violence

D ​Rationale: The nurse has both moral and legal obligations to act on suspected or confirmed abuse and would follow the applicable law to report suspected domestic violence. The immediate action is any step indicated by state​ law, not necessarily calling the police immediately. The nurse would investigate the bruising with the significant other away from the bedside before releasing the client. The nurse would not break the confidentiality of the​ client's medical information by discussing findings with the significant other.

Which scenario should the nurse recognize as an example of failing to assess and monitor a​ client? A. The nurse fails to notify the healthcare provider in a timely manner when conditions warrant it. B. The nurse fails to act on prescribed​ orders, and the client suffers an adverse event. C. The nurse fails to document a​ client's allergy, and the client has an allergic reaction to a medication. D. The nurse fails to treat the client who reports a​ headache, and the client subsequently has a stroke.

D ​Rationale: The nurse who fails to treat a client who complains of a headache and then subsequently suffers a stroke is failing to assess and monitor. The other clinical scenarios are negligent acts that lead to malpractice.​ However, they do not fit the scenario of failing to assess and monitor.

The nurse delegates vital signs to an unlicensed assistive personnel​ (UAP). The UAP reports the vital signs to the​ nurse, which indicate hypotension and bradycardia. The nurse then assesses the client. Which moral principle is exhibited by the​ nurse? A. Fidelity B. Beneficence C. Nonmaleficence D. Accountability

D ​Rationale: Under the principle of​ accountability, the nurse is responsible for the outcomes of care rendered and the care given by trainees and subordinates. Fidelity is faithfulness to an agreement. Beneficence is the act of doing well. Nonmaleficence is the avoidance of causing harm.

The grandmother of a child in need of medical treatment tells a nurse that the parents are withholding consent for necessary care and asks whether this is legal. Which is the​ nurse's best​ response? A. ​"I cannot discuss issues about potential​ clients." B. ​"If you kidnap the child to get​ treatment, we'll treat the​ child." C. ​"The parents ultimately make the​ decision." D. ​"Withholding treatment could be viewed as child​ abuse."

D ​Rationale: Withholding necessary treatment of a child if the case is not futile is child abuse under the Child Abuse and Treatment Act of 1984. The nurse would teach the concerned grandmother and connect her with the needed resources to ensure the proper care of the child. The nurse would not focus on the consent of the parents or potential care of the child or encourage the grandmother to kidnap the child.

The nurse is reviewing the discharge instructions for administration of home medications with an older adult client. In considering the normal changes experienced with aging when developing a teaching plan for this​ client, what type of bias should the nurse be careful to​ avoid? A. Relativism B. Multiculturalism C. Fundamentalism D. Ageism

D Ageism is discrimination against older​ adults, which the nurse should guard against when developing a teaching plan for this client to ensure that no part of it depends on biases about older adults. Relativism and fundamentalism are ethical philosophies. Multiculturalism is many cultures existing in a society in which no culture dominates.

The nurse is caring for a client who is awaiting the results of a magnetic resonance imaging​ (MRI) scan to determine the extent of a malignant brain tumor. The results are posted in the medical record and indicate that the prognosis is not​ good, but the healthcare provider has not seen the report yet. The client asks the nurse about the results. Which is the​ nurse's best response under the principle of​ veracity? A. ​"I don't know whether the results have been posted. The healthcare provider will need to give you that​ information." B. ​"Your brain tumor has gotten worse and spread to other areas. Your condition is definitely​ worsening." C. ​"The results have been posted on your​ chart, and your healthcare provider will come speak to you after reviewing​ them." D. ​"I am not allowed to tell you test​ results."

C ​Rationale: Applying the principle of veracity requires the nurse to be​ truthful, but it is not in the scope of practice for a nurse to disclose information about test results or diagnoses. Acknowledging that results are available and that the healthcare provider will discuss them with the client is truthful. Disclosing the diagnosis is not permitted under the scope of practice of nursing. Saying that the nurse is not allowed to report results may be a true​ statement, but it is not supportive or client centered. Stating that the results are unknown is not a true statement.

The nurse delivering a seminar about ethics and nursing asks the audience to describe an issue that could lead to ethical conflict in the workplace. Which response indicates an issue that may give rise to an ethical​ conflict? A. ​"Focusing on palliative treatment and emphasizing the​ nurse's role leads to ethical conflicts in​ nursing." B. ​"Because of more stringent​ cost-containment methods, allocation of resources is becoming a less urgent ethical​ issue." C. ​"Staffing shortages are a critical ethical concern because research shows a link between staffing and safe client​ care." D. ​"Personnel issues are not a valid source of ethical conflict because​ they're usually rooted in personality​ clashes."

C ​Rationale: Staffing shortages represent a critical​ concern; many studies link adequate staffing and safe client care. Personnel issues can give rise to ethical conflicts in the nursing workplace. Because of increasingly stringent​ cost-containment methods, resource limitations are especially urgent issues. Another source of ethical conflict is the traditional healthcare power​ structure, including the focus on providing curative rather than palliative treatment and emphasizing the healthcare​ provider's role.

An emergency department nurse is contacted by a friend whose father is a​ long-term care resident in a nursing facility that has had a fire. The friend describes the father and asks to be informed if he arrives in the emergency department. As those injured in the fire begin to​ arrive, the nurse spots a man matching the description given by the friend. Which action should the nurse​ take? A. Calling the friend and saying that the father has arrived B. Taking a picture of the​ man, posting it on social​ media, and tagging the friend C. Identifying the man and confirming his emergency contact D. Telling the friend that nothing can be done

C ​Rationale: The best action by the nurse is to confirm the identity of the client and the​ client's contact information to see whether the friend is the emergency contact. If there is no way to confirm that the friend is related or should be​ contacted, there is nothing the nurse can do. The nurse would not notify the friend without the​ client's consent. The nurse should never post information about clients to social media.

The nurse planning to administer a blood pressure medication finds that the client is​ pale, diaphoretic, and tachycardic and has a blood pressure of​ 60/44 mmHg. Which action should the nurse​ take? A. Giving the medication as ordered B. Repeating vital signs in 30 minutes C. Holding the medication and notifying the provider D. Giving the medication but continuing to monitor the client

C ​Rationale: The nurse is obligated to​ validate, verify, and practice with a questioning attitude and act as a client advocate. The nurse should not follow an order that is not appropriate or that could lead to a worsening of the​ client's condition. If the medication is​ given, the blood pressure could drop further. A decision to withhold the medication cannot be made without notifying the provider.

The nurse is part of a committee charged with the moral dilemma of deciding how to spend a​ $50,000 donation from the estate of a former client. Which action on the part of the committee demonstrates​ utilitarianism? A. Investing the donation in a​ high-risk stock to attempt to increase the money available B. Building a new front entrance named for the donor to support the relationship with the family C. Securing vaccination stock to provide​ no-cost vaccines to approximately​ 2,000 children D. Covering the medical expenses of a single client who cannot afford the needed treatment

C ​Rationale: Utilitarianism aims to provide the most good for the greatest number of​ people, which is exemplified here by the provision of vaccinations to children. Investing the money is a​ high-risk option with unknown benefit. Covering expenses for a single client and supporting the relationship with the​ donor's family do not benefit the largest number of people.