Fundemental Exam 2 Study Gide

18.A nurse wants to provide patient-centered care to a patient of another culture. Which question is the most culturally sensitive when talking about a patients illness?

a. What do you call your problem?

3.The nurse is caring for a patient who gives indications of being a victim of abuse. The nurse understands that abuse is which of the following? (Select all that apply.)

a. Can be physical battering b. Is sometimes manifested as sexual assault d. Is sometimes classified as emotional abuse e. Can be psychological in nature

32.A nurse is evaluating care for a patient. Which action should the nurse take?

a. Compares patient findings with the goals and outcomes

20.Only one nurse was scheduled to care for 12 postsurgical patients with a nursing assistant. The nurse is concerned for the safety of the patients and the nursing license. What is the most appropriate first step in this situation?

a. Contacting the nursing supervisor and documenting the action If a nurse is assigned to care for more patients than is reasonable for safe care, he or she should notify the nursing supervisor. If the nurse is required to accept the assignment, he or she must document this information in writing and provide the document to nursing administrators

6.The nurse has just completed an assessment on a patient with a fractured right femur. Which data will the nurse categorize as objective?

a. The patients toes of right foot are warm and pink.

15.A patient is confused and is attempting to get out of the hospital bed. The nurse is tired after working for more than 10 hours and is concerned for the patients safety. What is the best action that the nurse should take to prevent the patient from harm?

Ask a family member to sit with the patient. Asking a family member to sit with the patient is the best answer because it does not restrain the patient physically or chemically.

1.A 73-year-old patient with hypertension is awaiting a triple cardiac bypass surgery. The patient is hard of hearing and did not understand what the surgeon said regarding the surgery. The daughter is concerned that the patient does not understand the risks of the surgery. If not clarified, this would be a violation of what principle?

Autonomy Autonomy refers to a persons independence. As a principle in bioethics, autonomy represents an agreement to respect a patients right to determine a course of action. Justice refers to the principle of fairness: fair treatment and fair distribution of health care resources

19.The nurse is caring for a family within an impoverished community. What is it important for the nurse to understand about families?

a. They are made up of a set of interacting individuals related by blood, marriage or adoption.

3.A registered nurse who works on an oncology unit discussed pain control options that the primary health care provider had ordered with a patient undergoing treatment for pancreatic cancer. The patient requested that the intravenous (IV) pain medication be given on a regular basis. The nurse agreed to provide the IV pain medication as requested and continued to reevaluate the pain levels. The nurse is following which ethical principle?

Fidelity Fidelity refers to the agreement to keep promises. The principle of fidelity also promotes the obligation of a nurse to follow through with the care offered to patients.

1.A nurse is working with the parents of a seriously ill newborn. Surgery has been proposed for the infant, but the chances of success are unclear. To help the parents resolve this conflict, which steps should the nurse take to process the ethical dilemma? (Select all that apply.)

Gathering all relevant information surrounding this dilemma, Clarifying own values and opinions about the issues, Considering possible courses of action

9.A nurse wants to follow nursing standards of care. Which document should the nurse follow?

Health care facilitys written procedure manual The health care facilitys written procedure manual is defined as a standard of care. Standards of care are defined by the following: (1) State Nurse Practice Acts, (2) state and federal hospital licensing laws and accreditation rules, (3) professional and specialty organizations, and (4) written policies and procedures of the nurses health care facility.

23.A patient has lost 10 pounds in the last 2 months from breast cancer and chemotherapy. The chemotherapy has caused the patient to not eat. Which nursing diagnosis should the nurse use to develop the plan of care?

Imbalanced Nutrition: Less Than Body Requirements Related to Decreased Food Intake

2.A 45-year-old mother of two children has cirrhosis of the liver and is on a waiting list for a liver transplant. She had to meet certain criteria to be eligible to receive a liver. She understands that she is next on the list for a donor liver that matches. This is an example of which ethical principle?

Justice Justice refers to the principle of fairness. In health care, the term is used to reflect a commitment to fair treatment and fair distribution of health care resources

10.Although a registered nurse has been working for several years as a staff nurse on an adult oncology unit, the nurse recently transferred to a pediatric unit in the hospital. The nurse will be in orientation for several days to learn about the different systems and will need to demonstrate proficiency in various pediatric areas such as medication administration. Which behavior is the nurse demonstrating?

a. Competency In the practice of nursing, competence ensures the provision of safe nursing care (proficiency in pediatric medication administration). The agreement to practice with competence is a common denominator for all state regulations and is in the nursing code of ethics.

2.A nurse wants to follow the American Nurses Associations Social Media Policy (2011). Which actions should the nurse take? (Select all that apply.)

Never name or describe a patient, Never post an image of the patient, Never disparage a fellow employee.

13.A patient is about to undergo a new, controversial bone marrow transplant procedure. The procedure may cause periods of pain and suffering. Although nurses agree to do no harm, this procedure may be necessary to promote health. This is an example of which ethnical principle?

Non-maleficence Non-maleficence refers to the fundamental agreement to do no harm. The principle of nonmaleficence promotes a continuing effort to consider the potential for harm even when it is necessary to promote health

Which information indicates the nurse has an accurate understanding of the State Nurse Practice Act? answer:It is a statute enacted by state legislature.

Nurse Practice Acts are examples of statutes enacted by state legislatures to regulate the practice of nursing. Common laws are based on judicial decisions or case law precedent.

12.A nurse completes an occurrence report. Which is the best way for the nurse to document this occurrence?

Patient found lying on right side on floor. No noted injuries, patient stated, I slipped on a wet spot on the floor. I dont think I am injured.

8.Which behavior is the best way for a nurse to avoid being liable for malpractice?

Practicing nursing that meets the generally accepted standard of care The best way to avoid being liable for malpractice is to give nursing care that meets the generally accepted standard of care.

11.A registered nurse is caring for a patient 2 days after a colon resection. The patient called for assistance to go to the bathroom. Instead of waiting for help, the patient decided to get up without help. The patient fell but was not injured. After contacting the patients primary health care provider, which action should the nurse take next?

Submit an incident report. When there is a deviation from the standard of care, such as a patient or visitor falls or an error is made, a nurse makes specific documentation of the event or incident in the form of an occurrence/incident report.

18.A nurse is teaching the staff about how to process an ethical dilemma. Which order should the nurse use to present the steps?

The steps to process an ethical dilemma include the following: (1) Is this an ethical dilemma? (2) Gather all information relevant to the case. (3) Examine and determine your own values and opinions about the issues. (4) State the problem clearly. (5) Consider possible courses of action. (6) Negotiate the outcome. (7) Evaluate the action.

The nurse is caring for a patient who refuses to cooperate for a dressing change. The nurse tells the patient that he or she will tie the patient down if the patient does not hold still. Which action did the nurse commit?

a. Assault Assault is an intentional threat toward another person that gives that person a reasonable fear of harmful contact. No actual contact is required for an assault to occur.

1.A nurse is collecting data on a patient who is being admitted into hospice care. The nurse collects data from both the patient and the family so that a clear picture of the patient status is obtained. The nurse is currently involved in which step of the nursing process?

a. Assessment Assessment is the deliberate and systematic collection of data about a patient. The data will reveal a patients current and past health status, functional status, and present and past coping patterns.

26.A nurse is caring for a patient and performs several interventions. Which action by the nurse is an independent nursing intervention?

a. Turning every 2 hours

3.A postoperative patient is continuing to have incisional pain. As part of the nurses assessment, the nurse notes that the patient is grimacing when he or she changes position. The patients grimace can be useful in the assessment and can be described as which of the following?

a. Cue Grimacing is a cue. A cue is information that a nurse obtains through use of the senses. An inference is your judgment or interpretation of these cues

17.A 67-year-old male patient of French heritage is admitted to the hospital. The patient is interviewed by a nurse from a Korean family. The nurse did not make eye contact with the patient while conducting the interview. This disturbed the patient because the patient thought that the nurse might be trying to hide something. Which factor most likely influenced the behavior of the nurse and patient?

a. Culture Communication and culture are interrelated in the way individuals express feelings verbally and nonverbally.

11.Which behavior best indicates that the nurse is fulfilling ethical responsibilities?

a. Delivers competent care Delivers competent care is the best example because the American Nurses Association (ANA) and the International Council of Nurses (ICN) publish codes of ethics for nurses that set principles of behavior for nurses to embrace.

5.Homeless children are more likely to do which of the following? (Select all that apply.)

a. Drop out of school. b. Develop risky behaviors. d. Develop long-term health problems.

11.A student nurse is caring for a 4-year-old patient who has been admitted to the pediatric unit with acute asthma. As the student nurse admits the patient, he learns that both parents smoke in the home. The nurse plans to discuss with the parents the implications of smoking around the patient and to provide them with information on smoking cessation. This is an example of what approach to family nursing?

a. Family as context When you view the family as context, your primary focus is on the health and development of an individual member existing within a specific environment (i.e., the patients family

2.A woman is making plans for her holiday dinner and shares with her butcher that she will be inviting her family. When the butcher asks who will be coming, she replies, My two children and their spouses, my ex-son-in-law is bringing my grandson, and my ex-mother-in-law is coming. This is an example of which of the following?

a. Family durability Family durability is the intrafamilial system of support and structure that sometimes extends beyond the walls of the household

1.When providing care for families, of what should the nurse be aware? (Select all that apply.)

a. Family hardiness is the internal strength and durability of the family. b. Resiliency helps to evaluate healthy responses in stressful times. d. Along-term illness in one family member affects the entire family e. Family members may be a primary force for coping.

21.A patient died from suspicious circumstances. What should the nurse do next?

a. Notify the coroner. State statutes specify that, when there are reasonable grounds to believe that a patient died as a result of violence, homicide, suicide, accident, or death occurring in any unusual or suspicious manner, you need to notify the coroner. Notifying the newspaper would break confidentiality.

1.A nurse is about to administer a medication and notices that the physicians or primary health care providers order looks incorrect regarding the amount of the medication. What should the nurse do? (Select all that apply.)

a. Notify the physician or health care provider. b. Do not carry out the order. e. Notify the supervisor or nurse manager.

10.A nurse is interviewing a patient being admitted to the hospital for surgery. During the interview, the nurse introduces self and explains that will be gathering some information. The nurse is in which phase of the interview?

a. Orientation The orientation phase begins with introducing oneself and ones position and explaining the purpose of the interview

11.A nurse is teaching the staff about the phases of the interview process. Which information should the nurse include in the teaching session?

a. Orientation, working, termination The three phases of the interview process are orientation, working, and termination. Assessment, evaluation, and planning are phases in the nursing process.

15.A nurse is teaching the staff about the International Council of Nurses Code of Ethics. Which major element of the Code should the nurse include in the teaching session?

a. People The major elements of the Code include: Nurses and People; Nurses and Practice; Nurses and the Profession; and Nurses and Co-workers. It does not include pride, power, and problems.

25.When a nurse suspects child abuse or neglect, which action must the nurse take?

a. Report it to the proper legal authority. Health care providers are required to report incidents such as child, spousal, or elder abuse; rape; gunshot wounds; attempted suicide; and certain communicable diseases

28.A nurse must ask a family member to consider an organ donation. In which order should the nurse contact the individuals?

a. Spouse, e. Adult son or daughter, b. Parent f. Adult brother or sister d. Grandparent c. Guardian

4.The cause of family violence is complex and multidimensional. Factors associated with family violence include which of the following? (Select all that apply.)

a. Stress c. Psychopathology d. Learned family behavior

8.The family is the primary social context in which health promotion and disease prevention take place. Placed in this context, it is reasonable for the nurse to assume which of the following is true?

a. The familys beliefs, values, and culture strongly influence health behaviors. The familys beliefs, values, culture, and practices strongly influence the health-promoting behaviors of its members. When the family satisfactorily meets its goals through adequate functioning, its members tend to feel positive about themselves and their family

7.To establish the elements of malpractice against a nurse, which must be proved by the patient?

a. The patient must have been harmed as a result of the injury. To establish the elements of malpractice, the patient or plaintiff must prove the following: (1) the nurse defendant owed a duty to the patient, (2) the nurse breached that duty, (3) the patient was injured because of the nurses breach of duty, and (4) the patient has accrued damages as a result of the injury.

15.The nurse is admitting a Hispanic patient to the oncology unit of the hospital. To provide culturally competent care, the nurse needs to determine the influence of culture on the patients family. Which of the following questions would best accomplish this?

a. What types of foods do you eat? To determine the influence of culture on a family, you might want to ask the patient about his or her cultural background. Then ask questions concerning cultural practices

21.A patient states, Im burning up, and I have a fever. The nurse takes the patients temperature, observes the skin for flushing, and feels the skin temperature. This is an example of __________ subjective data.

a. validating Validation of assessment data is the comparison of data with another source to confirm accuracy. The nurse reviews data to validate that measurable, objective physical findings support subjective data

15.A patient is admitted to the hospital after a motorcycle accident. The nurse in the emergency room is assessing vital signs, general appearance and behavior, and performing a head-to-toe examination of all body systems. What is the nurse doing?

a.Making a medical diagnosis

14.Which patient would the nurse consider to be competent to give informed consent?

b. A 16-year-old emancipated minor Even though an emancipated minor has not achieved the legal age of consent, he or she may give consent for procedures and treatment. If a patient is unconscious, you need to obtain consent from a person legally authorized to give consent on his or her behalf.

5.A registered nurse is working on a pediatric oncology unit and caring for four children undergoing chemotherapy. Today a new nursing assistive personnel (NAP) who has passed a competency examination is assigned to the team. The nurse will delegate a portion of the fundamental nursing tasks to the NAP during the shift, but realizes that he or she is still responsible for his or her own actions and is accountable for the care. The nurse is following which principle of behavior?

b. Code of ethics The code of ethics reflects underlying principles that include responsibility, accountability, respect for confidentiality, competency, judgment, and advocacy.

26.A nurse is maintaining precise records regarding the dispensing, wasting, and storage of a drug that is securely locked. Which drug is the nurse administering?

b. Controlled substance Controlled substances are securely locked away, and only authorized personnel have access to them. Maintain precise records regarding the dispensing, wasting, and storage of controlled substances. There are criminal penalties for the misuse of controlled substances

2.Domestic violence includes which of the following? (Select all that apply.)

b. Dating relationships c. Spouses e. Child abuse

19.Which action by the nurse is the final step in a complete assessment?

b. Documentation of findings

16.The nurse is admitting a 45-year-old patient and asks about her family. The patient states that she lives with her daughter and son-in-law. The nurseknows that this is an example of which of the following family forms?

b. Extended The extended family includes relatives (aunts, uncles, grandparents, and cousins) in addition to the nuclear family. The nuclear family consists of husband and wife (and perhaps one or more children).

13.A clinic nurse stopped at an automobile accident to assist. There was one victim who was not breathing. The nurse provided CPR at the scene, but the victim died. The victims family sued the nurse. Which will provide the best protection to the nurse in this case?

b. Good Samaritan Law The Good Samaritan Law protects the nurse because CPR is within a nurses scope of practice. Although Good Samaritan Laws provide immunity to the nurse who does what is reasonable to save a persons life, if the nurse performs a procedure for which he or she has no training, the nurse will be liable for any injury resulting from that act

9.The parents of an 18-year-old who joined the military and is being deployed overseas, discuss with him how they plan to stay in touch and purchase a laptop computer for him to take with him so they can e-mail and use the webcam to see each other. What approach to stress does this family exhibit?

b. Hardiness Family hardiness is the internal strengths and durability of the family unit. A sense of control over the outcome of life, a view of change as beneficial and growth producing, and an active rather than passive orientation in adapting to stressful events characterize family hardiness

14.A nurse is attempting to complete the nursing admission data on a patient. To complete the admission and formulate a plan of care, the nurse needs to do which of the following?

c. Evaluate the form, structure, and function of the family. Areas included in family assessment are the form, structure, and function of the family; its developmental stage; and its progress toward or accomplishment of developmental tasks. It is essential to assess the patient and family thoroughly.

14.A patient with a history of seizures is being admitted to the hospital after a grand mal seizure took place at a shopping mall. The patients spouse accompanied the patient to the hospital and is being interviewed by the nurse. Which question should the nurse ask to quickly focus on the patients symptoms?

b. How long did the seizure last? How long did the seizure last? is the question that will quickly focus on the patients symptoms. Once patients tell their story, use a problem-seeking interview technique. This approach takes the information provided in the patients story and then more fully describes and identifies specific problem areas

4.A postoperative patient has denied the need for pain medication. The nurse has noted that the patient describes the pain as a 1 on a 0 to 10 scale. The nurse also notes that the patient grimaces when he or she changes position and guards the incision. The nurse believes that the patient is experiencing pain based on the information gathered in the assessment. What is this phenomenon known as?

b. Inference The nurse made a judgment, which is an inference, that the patient is experiencing pain. An inference is a nurses judgment or interpretation of a cue.

24.A nurse develops a nursing diagnosis for a patient. What is the rationale for the nurses actions?

b. It allows a nurse to develop an individualized plan of care.

16.As part of the admission process the nurse asks if the patient has an advance directive. The patient doesnt know for sure. What is the nurses best response?

b. It is a living will. Many times the decision regarding lifesaving treatment is in writing in the patients living will or advance directive. Living wills are documents instructing the health care provider to withhold or withdraw life-sustaining procedures in a patient who is terminally ill

30.A patient has an outcome of ambulating three times a day. The patient does not ambulate the entire day. What should the nurse do next?

b. Reassess the patient. When there is failure to achieve a goal, no matter what the reason, repeat the entire nursing process sequence for that nursing diagnosis to discover changes the plan needs.

25.A patient is suffering from shortness of breath. How should the nurse write the expected outcome for this patient?

b. The patient will breathe unlabored at 14 to 18 breaths per minute by the end of the shift.

23.Which situation will enable a nurse to use restraints?

b. To ensure the patients safety Regulations set the standard that all patients have the right to be free from seclusion and physical or chemical restraints except to ensure the patients safety in emergency situations. The standards specifically prohibit restraining patients for staff convenience, punishment, or retaliation

13.When a family is in a transitional phase of the life cycle perspective (e.g., birth of a first child), it is important for the nurse to do which of the following?

b. Use the knowledge of stress and coping to assist in family care. Your knowledge of stress and coping will assist in family care

8.A registered nurse has recently been reassigned to the gynecology unit at the hospital. The nurse is strongly against abortion because of religious beliefs and contacts the nursing supervisor regarding the assignment because the unit cares for women who are undergoing abortions. The nurse is having a conflict in which area?

b. Values The nurse is having a conflict in values because of religious beliefs and abortion. A value is a personal belief about the worth of an idea, a custom, or an object.

18.A married couple takes four children to an immunization clinic. The nurse notes that the childrens permission slips include three children with one last name and one child with a different last name. On questioning the parents the nurse discovers that this family group is an example of a(n) _____ family.

b. blended The blended family is formed when parents bring unrelated children from prior or foster parenting relationships into a new, joint living situation.

2.The nurse is admitting a patient to the unit and asks the patient about the health history. The nurse is engaged in which component of the nursing process?

c. Assessment The nurse is in the assessment phase. An assessment database includes a patients comprehensive health history, which includes information about a patients physical and developmental status, emotional health, social practices and resources, goals, values, lifestyle, and expectations about the health care system

13.As a nurse is obtaining a health history from a patient, the nurse uses comments such as go on. Which technique is the nurse using?

c. Back-channeling This is known as back-channeling, which is the practice of giving positive comments such as all right, go on, or uh-huh to the speaker. These indicate that a nurse has heard what the patient says and is attentive to hear the full story.

10.What should the nurse do when planning goals for a family?

c. Be flexible since families are continually changing.

3.A nurse is caring for a patient. Visitors at the bedside include the patients life partner, widowed mother, sister, and nephew. The nurse acknowledges that current trends in American families include which of the following?

c. Changing family patterns Families are constantly changing. People may marry later, delay childbirth, and couples choose to have fewer children or none at all. The number of people living alone is expanding and accounts for approximately 26% of households.

18.An RN has been caring for a patient. The nurse received an erroneous order for a medication. The primary health care provider has a reputation for impatience and irritability. Knowing this health care providers nature, which action by the nurse would be most appropriate?

c. Clarify the order with the primary health care provider. A nurse will assess all physician or health care provider orders, and if the nurse determines they are erroneous or harmful, obtain clarification from that physician or health care provider.

19.Which task can a nurse safely delegate to a student nurse who is working as a nursing assistant?

c. Collecting intake and output data During the time when a student nurse works as an employee of a health care facility, perform only tasks that appear in a job description for a nurses aide or nursing assistant

6.A student nurse is working on a community health project with her peers. One of the concerns in her community is the rise in homelessness resulting from the economy. The student nurse understands that which of the following is true?

c. Families with children are the fastest growing segment of the homeless population. The fastest growing segment of the homeless population is families with children. This includes complete nuclear families and single-parent families. More than 794,000 homeless are enrolled in the public school systems

1.The student nurse is talking to her friends about holiday plans with their families. One friend described her family as her mother, brother, and sister-in-law. Another stated her family consisted of her mother, father, grandmother, and her aunt. The student nurses family is her mother, stepfather, sister, and stepsister. The uniqueness of these families is known as which of the following?

c. Family diversity Family diversity is the uniqueness of each family. Family resiliency is the ability of the family to cope with expected and unexpected stressors.

29.A nurse is delegating care of patients to the nursing assistant personnel (NAP) and a licensed practical nurse (LPN). Which situation indicates the nurse needs more instruction on delegation?

c. NAP to insert an indwelling catheter

9.A 2-year-old patient is being admitted to the outpatient surgery for a tonsillectomy. Which will provide the best primary source of information for what comforts the patient when stressed?

c. Parents Family members and significant others are primary sources of information for infants, children, critically ill adults, patients with mental handicaps, or patients who are unconscious or have reduced cognitive function

28.A home health nurse is providing care to a patient. Which action by the nurse is a physical care technique?

c. Performing range-of-motion exercises

7.A student nurse is responsible for assessing a patient, who is abrupt and requests that the assessment be done later by a nurse. As the student nurse charts the interaction, which statement is the best way to document what happened?

c. States, I want a registered nurse to do my assessment

A registered nurse was accused of patient abandonment when the nurse became angry, quit the job, and left the hospital before the end of the shift. This is an example of violating legal standards/guidelines set by which organization?

c. The State Board of Nursing Nurse Practice Acts permit the State Board of Nursing to set rules, regulations, and guidelines that specifically define the standard of care in nursing practice.

8.A mother of five children is admitted to the hospital for abdominal pain. The nurse asks a series of questions before performing a physical assessment. The patient answers the questions. When asking the patient some other questions, the patients spouse starts to answer. As the admission process progresses and the nurse gathers subjective data, the nurse requests that the patient answer the next questions. What is the rationale for the nurses behavior?

c. The patient is the best source of information.

14.A community health nurse states, I wish we had just a portion of the dollars spent repairing atherosclerotic hearts to teach the community about cardiovascular risk factors. The nurses statement stems from what philosophy?

c. Utilitarianism Utilitarianism determines the value of something based primarily on its usefulness. Deontology defines actions as right or wrong according to principles

7.A nurse bases ethical decisions on the effect, or consequences, an act will have and uses the following guidelines: the greatest good for the greatest number of people. Which ethical system is the nurse using?

c. Utilitarianism Utilitarianism guides us to measure the effect, or consequences, that an act will have. The greatest good for the greatest number of people is the guiding principle for action in this system

6.Which chart entry by a nurse would require follow up?

d. 0820 Occurrence report completed. Do not document in the nurses notes that an occurrence report was comp.

17.A nursing instructor is raising her two granddaughters after her daughter and son-in-law were killed in a motor vehicle accident. How is this family form best described?

d. Alternative pattern of relationship Alternate patterns of relationships include multi-adult households, skip-generation families (grandparents caring for grandchildren), communal groups with children, nonfamilies (adults living alone), and cohabitating partners.

9.A 9-year-old patient was severely burned and has been undergoing whirlpool treatments to debride the wounds. The patient is crying and does not want to go to the physical therapy department for treatment. The registered nurse caring for the patient knows that, even though it is uncomfortable, the patient needs to have the therapy for the wounds to heal properly. The nurse is demonstrating which ethical principle?

d. Beneficence The principle of beneficence promotes taking positive, active steps to help others. It encourages a nurse to do good for the patient. Beneficence guides decisions in which the benefits of a treatment pose a risk to the patients well-being or dignity.

7.The nurse is caring for a 78-year-old patient with liver cancer. The patient and his wife live at home. In addition to caring for the patient, the nurse also assesses caregiver stress in the patients wife. Which of the following indicates caregiver stress?

d. Contracting pneumonia Assess for caregiver stress, such as tension in relationships with family and care recipient, changes in level of health, changes in mood, and anxiety and depression.

17.A nurse is processing an ethical dilemma by focusing on relationships and stories of the participants. Which ethical system is the nurse using?

d. Ethics of care Ethics of care suggest that health care workers resolve ethical dilemmas by paying attention to relationships and stories of the participants and by promoting a fundamental act of caring. Attention to relationships distinguishes the ethics of care from other ethical viewpoints because it does not necessarily apply universal principles that are intellectual or analytical.

4.In regard to American families, the nurse understands that which of the following is true?

d. Father-only families are on the rise. Although mothers head 83% of single-parent families, father-only families are on the rise. The number of single-parent families appears to be stabilizing at about 26% of all families with children. Forty-one percent of children are living with mothers who have never married; many of these children result from an adolescent pregnancy.

An RN suffers from chronic back pain that was the result of an injury suffered when pulling a patient up in bed. The nurse is addicted to pain medication and has recently been accused of stealing narcotics. This is an example of which violation of the law?

d. Felony A felony is a serious offense that results in significant harm to another person or society in general. Felony crimes may carry penalties of monetary restitution, imprisonment for greater than 1 year, or death.

6.The mother of a 45-year-old patient is a retired physician and requests to discuss the patients plan of care with the nurse caring for the patient. What is the nurses best response to this request?

d. I will have to get the patients permission before I can share that information. Even family members or friends of the patient are not permitted access to the patients personal health information without the patients consent.

20.A patient with bilateral pneumonia is admitted to the intensive care unit. The nurse who initially prepared the plan of care identified that the patient had the collaborative problem of Potential complications: hypoxemia. What made the nurse classify this as a collaborative problem?

d. It requires both nursing and physician-prescribed interventions.

A student nurse must pass the NCLEX before practicing as a registered nurse. NCLEX stands for __________ Examination.

d. National Council Licensure To be licensed in a state, a nurse must have a passing score on the National Council Licensure Examination (NCLEX) to obtain the initial license and meet the educational requirements set by the state.

22.A patient falls out of bed because the nurse did not raise the side rails. Which action did the nurse commit?

d. Negligence Negligence is conduct that falls below the generally accepted standard of care of a reasonably prudent person. A felony is a serious offense that has a penalty of imprisonment for greater than a year or possibly even death such as practicing nursing without a license.

4.A registered nurse knows that an oncology patient undergoing a bone marrow transplant will spend weeks in isolation in the hospital. During that time the patient will be at an increased risk for infection and other complications and may not recover. The nurse ensures that the patient has been given information regarding the risks and potential benefits of the procedure. The nurse is following which ethical principle?

d. Non-maleficence The principle of nonmaleficence (do no harm) promotes a continuing effort to consider the potential for harm even when it is necessary to promote health. It is helpful in guiding your discussions about new or controversial technologies.

16.When admitting a patient to the hospital, the nurse asks if has problems eating since the patient had a stroke. The patient denies any problems and states that does not require assistance. After lunch, the nurse notes that the patient has not eaten most of the food and has spilled much of the food. These cues lead the nurse to believe that the patient is not functioning at the level indicated upon admission. The nurse is using which type of information to make this deduction?

d. Nonverbal behavior Observation of the level of function is different from what a nurse learns about function during the interview. A nurse observes what the patient does, such as self-feeding or making a decision, rather than what the patient says he or she can do.

22.Upon assessment, the nurse finds that a patient has a heart rate of 66 beats per minute, a respiratory rate of 12 breaths per minute, and a blood pressure of 120/80 mm Hg. The nurse obtained which type of data?

d. Objective

5.A nurse is collecting data during the assessment of a patient. During the assessment, the nurse collects both subjective and objective data. Which information should the nurse consider as subjective data?

d. Sharp, burning pain

27.A nurse is writing a care plan for a newly admitted patient. Which outcome statement did the nurse correctly write?

d. The patient will identify the need to increase dietary intake of fiber by July 4.

24.Which information indicates the nurse has an accurate understanding of when the institutions malpractice insurance covers the nurse?

d. While working within the scope of employment If a nurse works for a health care institution, generally the institutions insurance will cover the nurse during employment.

5.A nurse is admitting a teen-aged woman to the Labor and Delivery unit to have her baby. She is not married but is holding hands with her boyfriend who is the babys father. The nurse realizes that:

d. teenage pregnancies affect teenage fathers as well as mothers. Teenage fathers also have stressors placed on them when their partner becomes pregnant. These young men have poorer support systems and fewer resources to teach them how to parent.

17.Which example demonstrates a breach of confidentiality and a violation of the Health Insurance Portability and Accountability Act (HIPAA) of 1996?

d.Sharing with other nurses in the cafeteria that a patient is HIV positive Although HIPAA does not require such things as soundproof rooms in hospitals, it does mandate that nurses and health care providers avoid discussing patients in public hallways and provide reasonable levels of privacy in communicating with and about patients in any matter.

16.The code of ethics for nursing sets forth ideals of nursing conduct and was developed by what organization?

d.The American Nurses Association The American Nurses Association (ANA) and the International Council of Nurses (ICN) publish codes of ethics for nurses that set principles of behavior for them to embrace.