N251 Exam One Prep U/ End of ChapterQuestions

The poison control nurse receives a call from the caregiver of a young school-age child who may have ingested a poisonous substance. Which is the priority response by the nurse?

"Check breathing and heart rate." Exp: Initial treatment for a victim of suspected poisoning involves maintaining breathing and cardiac function. After that, rescuers attempt to identify what was ingested, how much, and when. Definitive treatment depends on the substance, the client's condition, and if the substance is still in the stomach.

What nursing action best demonstrates an activity focused on the safety goal of reducing the risk of healthcare-associated infections (HAIs)? a. Providing an in-service on the appropriate technique to be used when providing indwelling catheter care b. Monitoring all visitors for presence of possible infections and restricting visitation when appropriate c. Formulating an institutional policy requiring all employees to be vaccinated yearly against the flu d. Assessing all patients for history of infections within the previous 12 months

A

Your nurse manager informs you he is using the tool "Asking Why 5 Times" to investigate medication error in which you were involved. What was the nurse manager doing? a. Conducting root cause analysis b. Applying concepts of just culture c. Assessing outcomes for CMS d. Using bundles of care

A

The nurse is teaching an unlicensed assistive personnel (UAP) about fire safety. Which UAP statement demonstrates that teaching has been effective?

A: "I will rescue clients from harm before doing anything else." Exp: The RACE acronym should be used when managing a fire: Rescue, Alarm, Confine, and Extinguish. Teaching has been effective when the UAP knows to rescue patients first.

The poison control nurse receives a call from the parent of a 2-year-old child. The parent states, "I just took a quick shower, and when I finished, I walked into the kitchen and found my child with an open bottle of household cleaner." What is the poison control nurse's appropriate response?

A: "Is your child breathing at this time?" Exp: nitial treatment for a victim of suspected poisoning involves maintaining breathing and cardiac function, so the nurse will ask about the child's respiratory status. Definitive treatment depends on the substance, the client's condition, and if the substance is still in the stomach; vomiting should not be induced until more information is gathered. Instructing the parent about leaving the child alone is not therapeutic at this time.

As members of the quality improvement committee of a large health care institution, a group of nurses are reviewing recent incident reports. Which staff member has most likely committed an intentionally reckless behavior?

A: A nurse who signed for the administration of a client's anti-seizure medication after realizing that she forgot to give it Exp: Falsifying records to conceal errors and failing to assist a client not assigned to the nurse are examples of reckless behaviors that put clients at substantial risk. Tardiness, workplace conflict, and accidental errors need to be addressed, but there is no evidence of the malice that constitutes intentionally reckless behavior.

An experienced nurse has a reputation for being conscientious and caring, so the nurse is shocked and embarrassed to have committed a medication error for the first time in her career. The nurse's supervisor should use what approach when responding to this event?

A: Collaborate with the nurse to identify any supplementary education that would be beneficial Exp: All nurses, whether experienced or inexperienced, have learning needs. A nurse's strong track record does negate the possible need for some remedial education. It would be inappropriate of the manager to have the nurse address the error in isolation. Assignment of a mentor is likely not necessary, though a dialogue should precede this decision.

Municipal authorities have requested that the local hospital become more environmentally responsible. Which action best promotes environmental sustainability in a hospital setting?

A: Implementing a system to sort recyclables from waste that contains toxins or body fluids. Exp: In recent years, the practice of disposing of all hospital waste as trash has come into question; there are many recyclables in a hospital setting. Mass incineration would be considered a step backwards. Single-use equipment can never be safely sterilized for reuse. Disposable bed linens would reduce water usage, but at the cost of vastly increased trash production.

A nurse was covering for a colleague during the colleague's scheduled break and nearly administered an intravenous antibiotic to the wrong client, catching the error while programming the IV pump. What is the nurse's best response to this adverse incident?

A: Report the event using the appropriate documentation so processes can be examined to promote safety. Exp: In an organization with a strong culture of safety, staff are empowered to report errors and near misses to alert organizational leaders to system issues. This involves formal, written documentation (an incident report), not just verbal or informal discussion. System-wide improvements are more valuable than the nurse's individual learning needs.

The nurse is teaching the caregiver of an infant about safety. Which teaching will the nurse include?

A: Supervise your child on the changing table. Exp: Infants are especially vulnerable to injuries resulting from falling off changing tables or being unrestrained in automobiles. Therefore, the nurse teaches the caregiver to supervise the child on the changing table. Placing household cleaners out of reach, buying protective sporting equipment, and teaching about peer pressure risks are appropriate for older children, not infants.

The manager of a geriatric medicine unit is reviewing some of the incident reports that have been filed over the past several months. One report describes an event where a nurse raised all four side rails of a confused client's bed, causing the client to fall when he tried to climb over them to go to the restroom. Which of the following statements about this incident is most accurate?

A: The client's nurse committed an active error by raising all four of the side rails. Exp: The nurse erred in raising the client's side rails and facilitating a fall. The location of the restroom does not constitute a latent error because this is not a systemic or procedural flaw that makes an error possible. Root cause analysis would have to be undertaken to determine the true root causes, but the client's diagnosis and the nurse's decision making are likely to be considered to be contextual factors, not the ultimate causes of the event.

A nurse prepared a client's medication, brought it to the client's bedside and then realized at the last minute that the medication was for another client of similar age and appearance. Follow-up to this event should include:

A: completing an incident report describing this near mis Exp: Even though the client did not receive the wrong medication, this is a near miss and warrants an incident report. This would be considered an active error rather than a latent error. Suspension would be highly unlikely since there is no evidence of malice or gross negligence. This event may or may not warrant modifications to the overall way that medications are administered on the unit.

A nurse is caring for a client who is being treated for complications of diabetes. Which action by the nurse best reduces the client's risk of experiencing an adverse outcome while receiving care?

A: monitoring the client's health status frequently and thoroughly Exp: Regular assessment and early detection of changes in the client's status are critical in preventing adverse outcomes. In most cases, assessment is even more important than other aspects of care, even though these may be valid and appropriate. These would included documentation, timely care, and collaboration.

Which action by the unlicensed assistive personnel (UAP) requires intervention from the nurse when providing care to an older adult client who is at risk for falls?

A: provides slippers for ambulation Exp: Older adults often wear slippers to accommodate swollen feet. Although slippers are more comfortable, less expensive, and less tiring to put on than shoes, they do not offer much support or traction. The nurse should intervene to remind the UAP that better footwear should be utilized. Placing the bed at the lowest setting, clearing a path from the bed to the bathroom, and having the client sit in bed before standing increase safety while minimizing risk for falls.

A nurse has completed an incident report after a client tripped on an electrical cord in the hospital hallway and had a fall. The incident report will most likely be analyzed by:

A: the hospital's health and safety committee Exp: Incident reports are primarily used by internal safety review boards. State boards of nursing are not privy to them. They are not submitted to OSHA under most circumstances. The client's primary care provider would be made aware of the incident, but this person is not the ultimate recipient of the report.

Root cause analysis would identify an active error in which adverse event?

Ans: A nurse drew up 20 units of insulin rather than 2 units by misreading the lines on the syringe Exp: Active errors are most often one-time events that are attributable to an individual's actions. Latent errors may be due to equipment design issues, faulty maintenance, or poor organizational structure.

A novice nurse has made what is considered a human error while performing as medication nurse on a busy long-term care nursing unit. What intervention implemented by the unit's nurse manager would be most appropriate in this situation to help prevent similar errors in the future? a. The incident is recorded in the nurse's permanent employee file. b. The nurse is asked to identify and discuss the factors that contributed to the making of the error. c. The nurse manager provides a verbal warning to the nurse and explains that another error will result in disciplinary action. d. The nurse is told by the nurse manager that everyone makes mistakes occasionally but to be more careful in the future.

B

A patient is scheduled to receive metoprolol for blood pressure control at 09:00. The order reads: "for SBP greater than 90, 25 mg PO daily." Prior to administration, the nurse rechecks the blood pressure and finds it to be 90/50 with a heart rate of 68. This is an example of using what type of nursing skill? a. The nursing process b. Critical thinking c. The Nurse Practice Act d. Medical simulation

B

The nurse is writing a planned outcome on the computer for a patient who is diagnosed with chronic kidney disease and is on a renal diet. What is the most important aspect in developing this step of the nursing process? a. The nurse's understanding of patient care b. The patient's feelings regarding a renal diet c. The nurse's ability to manage feeding time during the day's schedule d. The patient's knowledge in choosing which food items in a renal diet

B

You have been asked to participate in a committee writing a policy for the care of a patient with an indwelling catheter. What is most important to include? a. Information retrieved from a website directed toward the lay public b. The nationally recognized catheter-associated urinary tract infection prevention bundle c. The policy from a well-respected nearby hospital d. Information from a nursing textbook that is more than 10 years old

B

The Nurse is caring for a patient who had abdominal surgery yesterday. Which nursing action reflects an initial assessment step of the nursing process? a. Monitoring the patient's pain level 30 minutes after medication administration b. Listening to breath sounds at the beginning of the shift c. Reflecting on the patient's pain response after getting out of bed d. Checking the patient's blood pressure 30 minutes after the administration of an antihypertensive medication

B (baseline)

A nurse receives a patient at handoff who is experiencing acute changes in neurologic status. Which nursing action should be done first? a. Call the physician. b. Perform a neurologic assessment. c. Administer an antihypertensive medication stat. d. Move the patient back to bed.

B (first step of nursing process)

A new nurse is caring for four patients for the first time. One patient is admitted with respiratory distress, reports no shortness of breath, SpO2 is 95% on 2LNC, and RR is 18. The other patient is admitted for a laparoscopic prostatectomy, complains of 6/10 pain, and has new onset of hematuria in the Foley catheter. The third is an IV drug user with abscess and pain 3/10 and wants to go outside to smoke. The final patient is an elderly confused patient admitted with a urinary tract infection and is determined to be a fall risk. Which patient should be the nurse's priority? a. Patient 1 b. Patient 2 c. Patient 3 d. Patient 4

B (patient 2)

Which description of value-based purchasing is most accurate? a. Ensuring "never events" never occur b. Conducting a thorough investigation to analyze the root cause of all errors c. Adjusting reimbursement based on measurement of processes, outcomes, and patient satisfaction

C

A hospital's policies and procedures are being reviewed in light of the Joint Commission 2015 Hospital National Patient Safety Goals. What change in practice most directly addresses these goals?

Care of clients with indwelling catheters will be tracked more closely to reduce the incidence of UTIs. Exp: Improved catheter care is one of the 2015 Patient Safety Goals. The goals do not explicitly address telephone communication, changing IV sites, or the replacement of any remaining paper-based health records.

The nurse uses evidence-based practice findings in the development of a care plan. This is an example of which type of nursing skill?

Cognitive skill

A nurse is involved in selecting the appropriate nursing diagnosis for a client. Which techniques would the nurse likely use? Select all that apply.

Cue clustering Cluster interpretation Diagnostic validation

A nurse is conducting an admission assessment on a confused patient brought in by his son. Which of the following would be included in primary sources for information? Select all that apply: a. Physical assessment b. Health history per the patient's son c. Clinical notes in the computer system from a past admission d. Patient's report of physical symptoms

D

A nurse is revising a plan of care for a patient with dysphagia (difficulty swallowing) related to an esophageal mass. The patient's goal was to eat more than 50% of a blenderized diet, but he is reporting 8/10 pain and shortness of breath when eating. Which phase of the nursing process is impacted when the nurse develops an intermediate goal of pain less than 4/10 while eating? a. Assessment b. Outcomes/planning c. Implementation d. Evaluation

D

Which statement about patient safety is correct? a. Physicians have sole responsibility for patient safety. b. Safe patient care is the same as quality care. c. High scores on HCAHPS surveys indicate patient safety. d. Nurses play an important role in keeping patients safe.

D

Which statement is true about latent errors? a. They are errors whose effects are not known for a long time. b. Latent errors cause minimal effects to patients. c. Latent errors are traceable to a particular individual. d. They are errors that are due to system issues.

D

The nursing student is reviewing assessment findings to organize existing cues into a pattern. This is known as which phase of the nursing process?

Diagnosis

The nurse, working on a rehabilitation floor, has obtained a pair of crutches for a client from the physical therapy department. The nurse and the client set a goal of using the crutches twice daily to ambulate down the hall. However, at the end of the day, the client was only able to ambulate one time because the crutches were the incorrect height. The client's inability to ambulate best represents which phase of the nursing process?

Evaluation

A nurse is examining alternatives and judging the worth of evidence as part of preparing the plan of care for a client. The nurse would most likely be involved in which phase of the nursing process?

Planning

What is the most important reason for the nurse to develop critical thinking and clinical reasoning?

To provide quality care with nursing ability and knowledge

True or False: Many authors have defined critical thinking. Each definition differs slightly, but all view critical thinking as a positive process that helps people make decisions and take action.

True

A nurse has gathered data through interview, observation, and physical assessment of a client and has formulated diagnostic statements. What would the nurse do during the outcome identification phase?

formulate client-focused goals

A health care institution's most recent strategic plan includes a commitment to creating a culture of safety. The organization can best meet this commitment by:

having every employee focus on safety, not only direct care providers.

Self-evaluation is a method that nurses use to promote their own development and to grow in confidence in their nursing roles. This process is referred to as:

reflective practice.

A group of student nurses is working on developing various nursing skills and are at various stages of skill acquisition. The instructor determines that which student is at the novice stage?

the student who uses rules to guide practice

Critical thinking is important in making an effective nursing judgment. Which technique would be most effective for the nursing student to adopt to improve classroom success?

turn errors into learning opportunities