Nursing Midterm Review Questions

A, B, C, D Continuing education updates the nurse's knowledge about the latest research and practice developments. In-service education programs are provided by a health care agency to increase the knowledge, skills, and competencies of nurses employed by the institution. Both can provide the nurse with continuing education credit. Master's degree programs are valuable for those in the role of nurse educator, nurse administrator, or advanced practice nurse. The DNP is a practice doctorate that prepares advanced practice nurses.

After licensure, the practicing nurse is required to update his or her knowledge about the latest research and practice developments. The most common way nurses do this is through _____ programs. (Select all that apply.) A. Continuing education B. Master's degree C. In-service education D. Doctorate of Nursing Practice

C Young adults have questions about sexuality. The patient will feel most comfortable discussing his sexual concerns further if the nurse establishes that it is normal to ask questions about sexuality. The nurse can then discuss in greater detail. Although it is normal for young adults to be curious about sexuality, the nurse should use caution in giving advice on taking sexual action. The nurse should promote safe sex practices. Telling the patient not to worry dismisses his concern. Telling the patient that he is abnormal might offend the patient and prevent him from establishing an open relationship.

An 18-year-old male client informs the nurse that he is not sure if he is homosexual because he is attracted to both genders. The nurse establishes a trusting relationship with the patient by saying: A. "Don't worry. It's just a phase you will grow out of." B. "Those are abnormal impulses. You should seek therapy." C. "At your age, it is normal to be curious about both genders." D. "Having questions about sexuality is normal. Have you noticed any changes in the way this makes you feel about yourself?"

B

An adult patient presents to the emergency department and is treated for hypothermia. Which risk factor should the patient be assessed for? A. Tobacco use B. Homelessness C. Low protein diet D. Chronic Respiratory Disease

B Most health care facilities apply yellow color-coded bands to patients' wrists to communicate to all health care providers that a patient is a fall risk.

An elderly patient presents to the hospital with a history of falls, confusion and stroke. The nurse determines the patient is at high risk for falls. Which of the following interventions is most appropriate for the nurse to take? A. Place the patient in restraints. B. Apply yellow wrist band that indicates Fall Risk. C. Ask a family member to stay with the patient. D. Silence fall alert alarm upon request of family.

B

An older adult is using a wheelchair to attend a physical therapy session. Which action by the nurse indicates safe transport of the patient? A. Position patient's buttocks close to the front of the wheelchair seat. B. Backs wheelchair into the elevator leading with large rear wheels first. C. Places locked wheelchair on same side of bed as patient's weaker side. D. Unlocks wheelchair for easy maneuverability when patient is transferred.

A A firm knowledge base is one of the essential attributes that provides a foundation for developing effective clinical reasoning.

Critical thinking is best learned by a nurse who possesses: A. a firm knowledge base. B. the ability to be creative. C. experience working as a nurse's aide. D. excellent verbal skills.

A An important step in preventing burnout is acknowledging one's own limitations, as well as what one's scope of work is while on the job. By doing this, the person will help to prevent emotional exhaustion and will limit the effects of chronic stress. Journaling and muscle relaxation are good stress-relieving techniques but are not directed at the cause of the workplace stress. Delegating if not applicable is an inappropriate coping mechanism.

Despite working in a highly stressful nursing unit and accepting additional shifts, a new nursing graduate has a strategy to prevent burnout. The best strategy would be for the new nurse to A. Identify limits and scope of work responsibilities. B. Write for 10 minutes in a journal every day. C. Use progressive muscle relaxation. D. Delegate complex nursing tasks to licensed professional nurses.

B Genomics is the study of inheritance, or the way traits are passed down from one generation to another.

Genomics can be used to: A. decrease the rate of infections. B. identify health problems the may make a patient at risk. C. assess a patient's response to a treatment plan. D. decrease the length of a patient's hospitalization.

C Currently, in the United States, the most common way to become a registered nurse (RN) is through completion of an associate's degree or baccalaureate degree program. Graduates of both programs are eligible to take the National Council Licensure Examination for Registered Nurses (NCLEX-RN) to become registered nurses in the state in which they will practice. Continuing education involves formal, organized educational programs offered by universities, hospitals, state nurse associations, professional nursing organizations, and educational and health care institutions. In-service education programs consist of instruction or training provided by a health care agency or institution. An in-service program is held in the institution and is designed to increase the knowledge, skills, and competencies of nurses and other health care professionals. A nurse who is completing a graduate program can receive a master's degree in nursing.

Graduates of baccalaureate degree or associate degree nursing programs are eligible to take which of the following to become registered nurses in the state in which they will practice? A. Certification Exam B. Nurse Practice Act Exam C. National Council Licensure Examination D. National League for Nursing Exam

A, B, C, D The Texas Board of Nursing is a state-level agency, not national.

Identify national organizations which focus on the safety needs of patients. Select All That Apply. A. The Joint Commission B. National Patient Safety Goals C. Quality and Safety Education for Nurses (QSEN) D. National Academy of Medicine E. Texas Board of Nursing

B The presence of risk factors does not mean that a disease will develop, however, risk factors increase the chances that the individual may develop a disease. Control of the risk factors does not guarantee that a disease will not develop. However, modification of risk factors may help the individual promote wellness and prevent illness.

Identify the potential consequences of risk factors such as genetics, age, physical environment and lifestyle of a client. A. A single risk factor has no influence on the occurrence of a disease. B. The risk of getting a disease is increased. C. The disease is guaranteed not to develop if there are no risk factors. D. Risk modification will have no effect on disease prevention.

A, B, C The patient's record is a valuable source of data for all members of the health care team. Ir's purposes include communication, legal documentation, financial billing by third-party providers (insurance companies, Medicare, Medicaid), education, research, and auditing/monitoring. Nursing process is a way of thinking and performing nursing care; it is not a purpose of a health care record.

Identify the purposes of a health care record. (Select all that apply.) A. Interdisciplinary communication B. Legal record C. Reimbursement D. Over-time pay E. Use of nursing process

D Nurse Practice Acts are Civil State Laws. Constitutional Laws are derived from federal and state constitutions. Criminal Law are defined by municipal, state and federal legislation to protect society and provide punishments for crimes. Common Law come from decisions made in the absence of law.

Nurse Practice Acts define nursing and the standards that nurses must meet. These include scope of practice, educational requirements and legal standards. Nurse Practice Acts are an example of which type of law? A. Constitutional B. Criminal C. Common D. Civil

Dietary tolerance is associated with both cultural food preferences and biologic variation

Nursing interventions that assist patients with positive self-evaluation can help change a poor self-concept. Telling a patient that he has completed a difficult task well, informs the patient of his realistic capabilities. A. Marital status B. Employment status C. Food preferences D. Ethics

B At the center of patient-centered care is the patient or family member as the source of control and full partner in providing care.

Patient-centered care is a model of nursing care in which A. nurses are totally responsible for planning patient care. B. a mutual partnership, between the patient, family, and health care team is developed. C. the patient and physician decide on the care the patient will receive. D. the decisions that are made, by the nurse, are in the patient's best interest.

A, B, C, D Nurses are educated to be members of an interdisciplinary team and to collaborate with other members of the health care team.

Select statements that are found in the Tarrant County College ADN Philosophy. Select all that apply. A. Human being are unique, complex, and holistic B. Health is a dynamic state of being C. Nursing education teaches values, ethics, skills, and knowledge D. Graduates are prepared to provide patient-centered care E. Graduates are prepared to provide patient care independently

C An EMR is the legal record that describes a single encounter or previous visits created in hospitals and out-patient health care settings.

Select the advantage of an Electronic Health Record (EMR). A. It provides documentation only for safety issues. B. It provides documentation only for standards of care. C. It provides records over the patient's lifetime. D. It is a record only for incident reports.

A, B, C, D All of the behaviors and characteristics are included in the ANA Standards of Professional Performance, except for a graduate degree.

Select the behaviors and characteristics that are listed in the American Nurses' Association (ANA) Standards of Professional Performance. Select All That Apply. A. Environmental Health B. Leadership C. Ethics D. Evidence-Based Practice and Research E. Graduate degree

D : The World Health Organization, as discussed in the article "Social mission in nursing: Reaffirming our roots," defines social determinants as "the conditions in which people are born, grow, live, work and age." These circumstances are shaped by the distribution of money, power and resources at global, national and local levels." (Gravens, K. & Goldfarb, S. (2020). Teaching and Learning in Nursing, 15, 248 - 250.

Select the best definition of term "social determinants." A. Changes needed in health care delivery B. Health policies that precipitate inequitable healthcare C. Genetic factors that increase an individual's risk for illness D. Conditions in which people are born into

A Falls are common inside and outside the healthcare environment, especially among older patients and ill or disoriented patients.

Select the factor the nurse would assess to be the primary consideration regarding an older patient's safety. A. Risk of falls B. Patient's support system C. Nurse's years of experience D. Patient's nutritional status

D Genetic anomalies can be tested for manifestation, severity, treatability and social significance. In law enforcement, DNA is used to identify criminal offenders. Currently, most states allow medical underwriting based on genetic information. Subsequently the legal and ethical consideration of the individual's right to autonomy, privacy, and confidentiality are being debated.

Select the legal and ethical concepts that are being considered as a result of genetic testing. Select All That Apply. A. Autonomy B. Privacy C. Confidentiality D. All of the above

A & E Transformational leadership defined by: teaches people how to think, motivates employees to find better ways of achieving a goal; raises the well-being, morale, and motivation level of a group, lead by example, meeting the needs of the followers is vital to achieving high work performance

Select those characteristics that define transformational leadership. Select all that Apply. A. Teaches people how to think B. Encourage employees to function independently C. Refers conflict resolution to senior management D. Leads by using reward system E. Leads by example

B, D Reflection is defined as those intellectual and affective activities in which individuals engage to explore their experiences in order to lead to new understandings and appreciations.

Select which of Blooms Taxonomies is implemented when patients are asked to discuss their attitudes about their treatment plan. Select all that apply. A. Cognitive B. Psychomotor C. Knowledge D. Affective

B, C, D

The General Adaptation Syndrome (GAS) describes how the body responds physiologically to stress. Select those statements that are true about the effect of GAS on various body systems. (Select All That Apply) A. Urine output is increased. B. Water reabsorption is increased. C. Blood glucose level is increased. D. Mental alertness is increased. E. Neuroendocrine system is deactivated.

B Guidelines for validating assessment data that are out of normal range include repeating the measurements, using another piece of equipment as needed to confirm abnormalities. In this situation, the nurse needs to be sure that the vital signs are accurate by validating them personally. Calling the physician and reporting the findings to the charge nurse before they have been validated would be premature.

The aide reports a client's blood pressure to the nurse because it is much higher than usual. What is the nurse's priority action? A. Verify the aide's ability to take vital signs. B. Validate abnormal vital signs and inform the provider. C. Ask another nurse to retake the vital signs. D. Document the vital signs and reassess at the next scheduled time.

D The Holistic Health Model promotes a patient's dynamic interactions among the emotional, spiritual, social, cultural and physical aspects of an individual's wellness.

The concept of the nursing Holistic Health Model (holism) is focused on A. an individual's spiritual or religious belief system. B. the partnership between the patient and the health care team. C. the patient's health literacy. D. the patient's health, spiritual, and cultural belief systems.

A Autonomy refers to the freedom to make decisions free of external control. In this case, the nurse questions the physician's order for a placebo because it supports the patient's autonomy. Although beneficence, taking a positive action for others, has implications here, it is not the primary operating principle. Justice refers to fairness and is most often used in discussions about access to health care resources. Fidelity refers to the agreement to keep promises.

The family is upset because the patient refuses additional chemotherapy. The family asks the nurse to try and change the patient's decision. Which of the following ethical concepts would guide the nurse's response? A. Autonomy B. Beneficence C. Justice D. Fidelity

D Transformational leadership style motivates employees to take ownership for their roles and to perform beyond expectation.

The leadership style that motivates employees to take ownership for their roles and to perform beyond expectation is: A. autocratic B. laissez-faire C. democratic D. transformational

A As a person ages, the effectiveness of all organs decreases. Decreased effectiveness of the kidney's ability to excrete by-products of drug metabolites puts the older patient at risk for drug toxicity.

The nurse closely monitors an older adult for signs of medication toxicity. Which physiological change is the reason for the nurse's action? A. Reduced kidney functioning B. Reduced esophageal stricture C. Increased gastric motility D. Increased liver mass

C Although all options can be considered risks to a patient's safety, the primary consideration would be left-sided weakness. The patient's inability to get out of bed, without assistance, makes the patient at risk for falls.

The nurse completed the health history of a newly admitted client. Select the information that would MOST significantly place the client at risk for harm. A. Problems with constipation B. History of smoking for 10 years C. Left-sided weakness D. Hay fever

D Lifestyle choices frequently affect adult safety. Smoking conveys great risk for pulmonary and cardiovascular disease. It is prudent to secure belongings. When an individual has been determined to be the designated driver, that individual does not consume alcohol, beer, or wine. Sleep is important no matter the age of the individual and is important for rest and integration of learning. The average young adult needs 6 1/2 to 8 hours of sleep each night.

The nurse discussed threats to adult safety with a college group. Which of the following statements would indicate understanding of the topic? A. "Our campus is safe; we leave our dorms unlocked all the time." B. "As long as I have only two drinks, I can still be the designated driver." C. "I am young, so I can work nights and go to school with 2 hours sleep." D. "I guess smoking even at parties is not good for my body."

C Values develop over time and are influenced by family, schools, religious traditions, and life experiences. The nurse must recognize that no two humans have the same set of experiences, and so differences in values are more likely the norm than the exception. Closer inspection of one's values may be a step in gaining understanding of another person's perspective. Calling for a consult, declining the assignment, and convincing the family to challenge the patient's directive are not ideal resolutions because they do not address the reason for the nurse's discomfort, which is the conflict between the nurse's values and those of the patient.

The nurse finds it difficult to care for a patient whose advance directive states that no extraordinary resuscitation measures should be taken. Which action may help the nurse find resolution with this personal conflict? A. Call for an ethical committee consult. B. Decline the assignment on religious grounds. C. Clarify his/her own personal values. D. Assess the patient for maladaptive coping

B Monitoring the patient's progress is part of the evaluation phase.

The nurse has been monitoring a client's progress on a new medication regimen and documenting signs of possible adverse effects. This illustrates which phase of the nursing process? A. Planning B. Evaluation C. Implementation D. Nursing Diagnosis

B The psychomotor domain is the skill domain and includes motor skills, such as being able to use an incentive spirometer. Cognitive abilities include the thinking process that begins with knowing, comprehending, and applying knowledge. The affective domain involves the attitudes or emotional responses and includes feelings, emotions, interests, and appreciations. Imitation is not one of Bloom's domains of learning. Evaluation Health promotion and maintenance Analysis

The nurse has provided client teaching regarding the proper use of an incentive spirometer. By mastering the use of this device, the client will demonstrate learning in which of Bloom's domains? A. Affective B. Psychomotor C. Cognitive D. Imitation

A, B, D, E Caffeine, alcohol, and nicotine consumed late in the evening produce insomnia. Worry over personal problems or situations frequently disrupts sleep. Alterations in routines, including changing mealtimes and staying up and shift work, can disrupt sleep.

The nurse has provided education to improve sleep. Which statements made by the client indicate learning has occurred? (Select all that apply) A. "Drinking coffee at 7 PM could interrupt my sleep." B. "Worrying about work can disrupt my sleep." C. "Exercising 1 hour before bedtime can increase relaxation." D. "Changing the time of day that I eat dinner can disrupt sleep." E. "Frequent changing of the shift I work can disrupt sleep."

B P&P 10th Edition pg. 334 Nurses make observations by commenting on how the other person looks, sounds, or acts. Stating observations often helps a patient communicate without the need for extensive questioning, focusing, or clarification. This technique can help start a conversation with a patient who is quiet or withdrawn. Do not state observations that will embarrass or anger a patient, such as telling someone, "You look a mess!" Even if you make such an observation with humor, the patient can become resentful.

The nurse has shared observations with the client regarding their looks, sounds or actions. After using this technique, it would be best for the nurse to: A. apologize because this can be demeaning for the client. B. allow the client time to confirm or correct the observations. C. continue with the interview as though nothing had happened. D. immediately restate the nurse's conclusion on the basis of the client's nonverbal response.

D

The nurse is administering medications to the patient who is in renal failure resulting from end-stage renal disease. The nurse is aware that patients with kidney failure would most likely have problems with which pharmacokinetic phase? A. Absorption B. Distribution C. Metabolism D. Excretion

A Parenteral drugs are directly absorbed into the bloodstream and therefore bypass the first-pass effect.

The nurse is administering parenteral drugs. Which statement is true regarding parenteral drugs? A. Parenteral drugs bypass the first-pass effect. B. Absorption of parenteral drugs is affected by reduced blood flow to the stomach. C. Absorption of parenteral drugs is faster when the stomach is empty. D. Parenteral drugs exert their effects while circulating in the bloodstream

C

The nurse is admitting an older adult to the surgical unit. What intervention is necessary when determining the safe use of side rails for this patient? A. Explain to the patient the need to call for assistance when side rails are up. B. Discuss whether the patient is accepting of having the side rails up. C. Assess the patient's ability to effectively follow instructions. D. Always keep the bed in its lowest position to the floor.

A Patient-centered care is an important component of a fall reduction plan. Patients should be instructed to wear rubber-soled shoes or non-slip socks for walking or transferring.

The nurse is caring for a client on fall precautions. What information should the nurse provide to the client regarding fall precautions? A. The client should be instructed to wear rubber-soled shoes or socks. B. All four side rails will remain in the "up" position. C. The client will be rounded on once a shift. D. The client will be restricted to bed during his hospitalization.

B Restraints are utilized only when alternatives have been exhausted, the patient continues a behavior that can be harmful to himself or others, and the restraint is clinically justified. In this circumstance, continuing to remove a needed nasogastric tube would meet these criteria. Refusing to call for help, although unsafe, is not a reason for restraint. Getting confused at night regarding the time or not sleeping and bothering the staff to ask for items is not a reason for restraint.

The nurse is caring for a hospitalized patient. Which of the following behaviors alerts the nurse to consider the need for a restraint? A. The patient refuses to call for help to go to the bathroom. B. The patient continues to remove the nasogastric tube. C. The patient gets confused regarding the time at night. D. The patient does not sleep and continues to ask for items.

A

The nurse is monitoring for Never Events. Which finding indicates the nurse will report a Never Event? A. A surgical sponge is left in the patient's incision. B. Lack of blood incompatibility with a blood transfusion. C. Pulmonary embolism after lung surgery. D. The patient does not sleep at night and continues to use the call bell.

C Implementation refers to the action phase of the nursing process in which nursing care is provided.

The nurse is providing skin care to a patient who cannot bathe herself. This is an example of what step in the nursing process? A. Assessment B. Planning C. Implementation D. Evaluation

C Half-life is the time it takes for one half of the original amount of a drug to be removed from the body.

The nurse is reviewing pharmacology terms for a group of newly graduated nurses. Which sentence defines a drug's half-life? A. The time it takes for the drug to cause half ot its therapeutic response. B. The time it takes for one half of the original amount of a drug to reach the target cells. C. The time it takes for one half of the original amount of a drug to be removed from the body. D. The time it takes for one half of the original amount of a drug to be absorbed into the circulation.

A, B, D The factors that promote sleep include: comfortable bedroom temperature and a hot bath. All the other factors interfere with sleep.

The nurse is teaching a group of adults who have problems sleeping. Select the factors that interfere with sleep and should be included in the presentation. (Select all that apply) A. Anxiety. B. Alcohol C. Comfortable bedroom temperature D. Late night television. E. Hot bath

A Primary prevention precedes disease or dysfunction and is applied to people considered physically and emotionally healthy. Health promotion includes health education programs, immunizations, and physical and nutritional fitness activities. Secondary prevention focuses on individuals who are experiencing health problems or illnesses and who are at risk for developing complications or worsening conditions. Activities are directed at diagnosis and prompt intervention. Tertiary prevention occurs when a defect or disability is permanent and irreversible. It involves minimizing the effects of long-term disease or disability through interventions directed at preventing complications and deterioration.

The nurse is working in a clinic that is designed to provide health education and immunizations. As such, this clinic is designed to provide A. Primary prevention. B. Secondary prevention. C. Tertiary prevention. D. Diagnosis and prompt intervention.

A, B, C, D Spiritual well being includes self-responsibility. Individuals who accept change in life are able to use their spiritual well-being as a source for adapting to changes dealing with the need for special diets, birth control choices, death, dying and grief; organ donation and physical imitations that may require prescribed exercise and physical therapy.

The nurse understands that a client's religious beliefs will impact which aspect of health care? (Select all that apply.) ✓A. Diet ✓B. Birth Control ✓C. Death and Dying ✓D. Organ Donation E. Exercise

D P&P 10 Edition pg. 113-4

The nurse who defines cultural competence as the recognition of the visible signs of a client's culture: A. understands cultural competence is about the patient's belief system. B. ensures an understanding of a patient's cultural beliefs and attitudes. C. has a strong foundation to provide individualized therapeutic care. D. has a limited understanding of cultural competence

A, C, D, E Diagnosing disease is not a nursing action. Evaluating the effectiveness of medical treatments is not a nursing action either. Nurses are to use the nursing process to evaluate the effectiveness of nursing interventions, not medical treatments. Identifying patient needs, determining priorities of care, setting realistic goals, and implementing nursing interventions are all steps in the clinical decision-making process.

The nursing process involves which steps in the clinical decision-making process? (Select all that apply.) A. Identifying client needs B. Diagnosing the disease process C. Determining priorities of care D. Planning goals and outcomes E. Implementing nursing interventions F. Evaluating effectiveness of medical treatments

C When older adults are using Benadryl (diphenhydramine), an over-the-counter medication for sleep, caution them that they may experience dizziness, drowsiness, confusion, constipation, and urinary retention because of the long duration of action of the medication. This can contribute to a fall in an older adult. Fish oil given for the treatment of cholesterol, although an issue after a fall with potential bleeding, is not a cause for the fall, nor is glucosamine, which is used in the treatment of joint issues. Neither of these substances are utilized for sleep. Vitamin C is used to support the immune system; it is not used for sleep and does not cause falls.

The older patient is visiting the clinic today. After waking up during the night, he sustains a fall. Which data obtained by the nurse, most likely would contribute to this fall? A. The patient has been taking glucosamine. B. The patient has been taking a fish oil. C. The patient has been taking Benadryl (diphenhydramine). D. The patient has been taking vitamin C.

A The sublingual route is under the tongue.

The patient is experiencing chest pain and needs to take a sublingual form of nitroglycerin. Where does the nurse instruct the patient to place the tablet? A. Under the tongue B. On top of the tongue C. At the back of the throat D. In the space between the cheek and the gum

A If two drugs have the same bioavailability and the same concentration of active ingredient, they are said to be bioquivalent (e.g., a drug with a trade name and a generic drug).

The patient is receiving two different drugs. At current dosages and dosage forms, both drugs have the same concentration of the active ingredient. Which term is used to identify this principle? A. Bioequivalent B. Synergistic C. Prodrugs D. Steady state

D Powdered form of drugs are absorbed faster because they do not need to be transformed into an absorbable form.

The patient is stating that he has a headache and asks the nurse which over-the-counter medication form would work the fastest to help reduce the pain. Which medication form will the nurse suggest? A. A capsule B. A tablet C. An enteric-coated tablet D. A powder

B Samples for measurement of trough levels are drawn just before the next dose.

The patient is to receive phenytoin (Dilantin) at 0900. When will be the ideal time for the nurse to schedule a trough level? A. 0800 B. 0830 C. 0900 D. 0930

D Self esteem relates to the need to be thought of well by oneself as well as by others and self actualization is related to the need to be well-fufiled, learn, create, understand, and experience one's potential. The firefighter is expressing both of these in his statement.

The patient states his occupation as a firefighter makes him feel a sense of satisfaction and is what he has always wanted to be. Based on Maslow, under which level of need would you list the data? A. Physiological and safety/security. B. Safety/security and love/belonging. C. Physiological and love/belonging. D. Self esteem and self actualization.

A A standard of safety before administering a medication is to check the label of the, against the Medication Administration Record (MAR), three times.

What is the nurse's priority action to protect a patient from a medication error? A. Reading medication labels at least 3 times before administering B. Administering as many of the medications as possible at one time C. Asking anxious family members to leave the room before giving a medication D. Checking the patient's room number against the medication record

B The stress response directly influences the immune system. Stress impairs immune function. As stress increases, the person is more susceptible to an increased risk for infection.

What is the potential risk factor to a patient, caused by the effect of stress on the immune system. A. Risk for blood clots B. Risk for infection C. Risk for anemia D. Risk for diabetes

D The National Patient Safety Goals of TJC are specifically directed to reduce the risk of medical errors. The goals highlight specific improvements in patient safety and ongoing problematic areas in health care. These evidence-based recommendations require health care facilities to focus their attention on a series of specific actions.

What is the purpose of The Joint Commission (TJC) National Patient Safety Goals? A. To improve the safety of nurses in health care settings B. To require nurses to maintain their CPR certification. C. To require that all nurses are in good standing with their state's Board of Nursing. D. To reduce the risk of medical error in hospitals.

D Protein binding can influence the drug's biological half-life. Since the unbound form is being metabolized and/or excreted from the body, the bound fraction will be released in order to maintain equilibrium.

When administring a new medication to a patient, the nurse reads that it is highly protein bound. Assuming that the patient's albumin levels are normal, the nurse would expect which result, as compared to a medication, that is not highly protien bound? A. Renal excretion will be faster. B. The drug will be metabolized quickly. C. The duration of action of the medication will be shorter. D. The duration of action of the medication will be longer.

A Open-ended questions are used to encourage the patient to express concerns.

When communicating with a client who appears to be upset, what would be the best communication technique? A. Open-ended questions B. Closed-ended questions C. Probing D. Confrontation

C Drugs that are given intravenously go directly into circulation and therefore act faster.

When given an intravenous medication, the patient says to the nurse, "I usually take pills. Why does this medication have to be given in my vein?" What is the nurse's best answer? A. "The medication will cause fewer harmful effects when given intravenously." B. "The intravenous medication will be absorbed slowly into the body's tissues." C. "The action of the medication will begin sooner when given intravenously," D. "There is a lower chance of an allergic reaction when drugs are given intravenously."

D Enzymes are the substance that catalyze nearly every biochemical reaction in a cell. Drugs can produce effects by interacting with these enzymes. For a drug to alter a physiologic response in this way, it may either inhibit, (most common) or enhance (less common) the action of a specific enzyme. This process is called selection interaction.

When reviewing the mechanism of action of a specific drug, the nurse reads that the drug works by selective enzyme interaction. Which of these processes describes selective enzyme interaction? A. The drug alters cell membrane permeability. B. The drug's effectiveness with the cell walls, of the target tissues, is enhanced. C. The drug is attracted to a receptor on the cell wall, preventing an enzyme from binding to that receptor. D. The drug binds to an enzyme molecule and inhibits or enhances the enzyme's action with the normal target cell.

A Attentive silence allows both the nurse and the patient time to reflect on what has taken place as well as encourage the patient to initiate and maintain the conversation.

When taking a history from a newly admitted client, the nurse notices the client frequently pauses and takes a while to complete their response. Select the nurse's best response to the client's behavior? A. Be silent and allow the client to continue at their own pace. B. Smile at the client and say, "Don't worry about all of this. I know I am making your nervous." C. Tell the client, "I can see you are having trouble remembering; I'll see if I can find someone else to answer my questions." D. Stand up and say, "We can continue it another time."

B Once the nurse has assessed the patient's condition, after the fall, and has helped the patient back to bed; the healthcare provider must be notified. The healthcare provider may want the nurse to implement orders for a more detailed assessment (e.g. x-ray, CT scan, MRI, etc.).

When the nurse discovers a patient on the floor, the patient states, "I fell out of bed." The nurse assesses the patient and then places the patient back in bed. Which action should the nurse take next? A. Do nothing; no harm has occurred. B. Notify the health care provider. C. Complete an incident report. D. Re-assess the patient.

B

Which agency has the authority to revoke a hospital's accreditation, which would have the effect of cutting off Medicare funding and many private insurers' funding. A. Social Security Administration B. The Joint Commission C. Social Security Administration D. Institute of Medicine

C When you are a student in a clinical setting, confidentiality and compliance with HIPAA are part of professional practice. Reading the progress notes of an assigned patient's record and giving a change-of-shift report to the oncoming nurse about the patient are behaviors that follow HIPAA and confidentiality guidelines. Students and health care professionals may not discuss a patient's examination, observation, conversation, diagnosis, or treatment with other patients or staff not involved in the patient's care. To protect patient confidentiality, ensure that written materials used in your student clinical practice do not include patient identifiers (e.g., room number, date of birth, demographic information), and never print material from an electronic health record for personal use.

Which behavior indicates the student nurse has an accurate understanding of patient confidentiality as protected by the Health Insurance Portability and Accountability Act (HIPAA)? A. The student prints material from the patient's health record for a graded care plan. B. The student carefully reviews the chart for all patients in the nursing care unit. C. The student gives a hand-off report to the primary nurse before attending post-conference. D. The student discusses the patient's progress with another student.

C Core self-esteem is the person's consistent, overall appraisal of self. The person acts or perceives events in ways which tend to support their level of self-esteem. Page 1239

Which choice is the best indication a client will regain a good sense of self-esteem after experiencing a second below the knee (BTK) amputation? A. The client stating, "I should have done a better job of following my diabetic diet." B. Family members that are always at the patient's bedside. C. The client stating, "Once I get my second prosthesis, I can get back to work." D. The client telling his wife, "I promise to take better care of myself."

B, C, E Oral medications that are swallowed, and go into the GI system, go through the liver, and undergo the first-pass effect.

Which drugs would be affected by the first-pass effect when administered? Select All That Apply. A. Sublingual nitroglycerin tablets B. Diphenhydramine (Benadryl) elixirs C. Levothyroxine (Synthroid) tablet D. Transdermal nicotine patches E. Esomeprazole (Nexium) capsules

C, D, E External variables influencing a patient's illness behavior include the visibility of symptoms, social group, cultural background, economic variables, accessibility of the health care system, and social support. Internal variables include the patient's perceptions of symptoms and the nature of the illness, as well as the patient's coping skills and locus of control.

Which external variables can affect illness and behavior? (Select all that apply.) A. Perception of the seriousness of the illness B. Patient's coping skills C. Cultural background D. Social support E. Socioeconomic status

A Nursing interventions that assist patients with positive self-evaluation can help change a poor self-concept. Telling a patient that he has completed a difficult task well, informs the patient of his realistic capabilities.

Which nursing intervention would best assist a client with a poor self-concept? A. Offer praise when a client successfully completes a task. B. Role model self-advocacy. C. Assist a client to set goals which may be hard to reach. D. Encourage a client to accept responsibility for themselves.

A, B, C Strategies the nurse can use to reduce professional liability include practicing within the scope of the RN license, fostering positive relationships with patients and families, following accepted standards and procedures, complete and timely documentation, and ongoing training.

Which of the following strategies can decrease the nurse's professional liability in practice? Select All That Apply. A. Stay within the scope of practice. B. Develop positive relationships with patients and families. C. Maintain professional continuing education. D. Record all care provided, at the end of the shift.

A, B, C Subjective data are collected from many sources: the patient, family members or significant others, nursing staff, and other healthcare team members.

Which of the following would be considered examples of subjective data? (Select all that apply) A. Comments made by the client's family. B. Description of a symptom by a client. C. A daughter telling a nurse what her mother looked like when she was very ill. D. A nursing assessment of the client's vital signs. E. The physical exam notes made by the physician.

C In obstructive sleep apnea, the upper airway becomes partially or completely blocked, diminishing airflow and stopping it. The person still attempts to breathe because the chest and abdominal movement continue, which results in loud snoring and snorting sounds. According to the ABCs of prioritizing care, airway and respiratory status take priority.

Which of the following would be most important for the nurse to monitor in a patient who has obstructive sleep apnea? A. Gastrointestinal function B. Circulatory status C. Respiratory status D. Neurological function

A, B, C, E The domain of nursing diagnoses includes only those health states that nurses are educated and licensed to treat. A nursing diagnosis is a judgment made only after data collection (assessment) and is used as a common language to communicate among health care providers. The nursing diagnosis statement does not include the medical diagnosis. The nursing diagnosis, like the plan of care, is specific to each individual client and the client's situation.

Which responses by the student indicate to the instructor that the student has an understanding of nursing diagnoses? (Select all that apply) A. The nursing diagnosis is based on assessment data gathered from the client and the family. B. The nursing diagnosis helps other health care professionals communicate and understand the plan of care. C. The nursing diagnosis describes client problems that are legally treatable by the registered nurse. D. The nursing diagnosis includes the medical disease process that the client is experiencing. E. The nursing diagnosis is specific to each individual client and their situation.

D Critical thinking behaviors are represented by asking relevant questions, setting priorities, and evaluating the worth of evidence (data).

Which statement(s) reflect(s) critical thinking behaviors? A. Recognizing issues and concerns. B. Identifying missing information. C. Evaluating worth of evidence. D. All of the above.

B, C Today spirituality is often defined as an awareness of one's inner self and a sense of connection to a higher being, nature, or some purpose greater than oneself.

Which statements best defines a person's spirituality? (Select all that apply.) A. A universal belief in truth, justice, and compassion B. Expression of person's inner being and meaning C. A quest to discover life's meaning D. An affirmation of life, peace, and harmony

B, C, E You look sad today is therapeutic because the nurse is sharing an observation. Tell me more about your concerns is encouraging the patient to focus on a specific area, which guides the patient to continue to share his/her feelings. Focusing is therapeutic.

Which statements, made by the nurse, would be non-therapeutic and tend to block communication? (Select all that apply.) A. "You look sad today." B. "Why are you so nervous?" C. "If I were you, I'd have the surgery." D. "Tell me more about your concerns." E. "I'm sure the test results will come out fine."

A Because of the effects of illness, family dynamics often change. The nurse must view the whole family as a patient under stress, planning care to help the family regain its maximal level of functioning and well-being. Psychiatric services may be a part of that plan but do not represent the entire plan. Offering false assurance is never acceptable.

A 62-year-old male client has had chronic obstructive pulmonary disease (COPD) for many years but has been unable to quit smoking. He states that he has always supported his family, and now the doctor says he can no longer work because of his condition and oxygen dependency. His wife will now have to go to work, and he is sure that she will not make enough money to pay the bills. Which aspect of discharge planning would be a priority for this client? A. Develop a plan of care for the family. B. Contact psychiatric services. C. Assure the patient that things will work out. D. Focus the plan of care on maximizing patient function.

C Nurses can influence policy decisions at all governmental levels. One way is to get involved in ANA's national efforts, such as Nursing's Agenda for the Future: A Call to the Nation. This effort is critical in exerting nurses' influence early in the political process. Nurses need to become serious students of social needs, activists in influencing policy to meet those needs, and generous contributors of time and money to nursing organizations and candidates to help legislate conditions that are likely to produce the best care possible.

A bill has been submitted to the State House of Representatives that is designed to reduce the cost of health care by increasing the patient-to-nurse ratio from a maximum of 3:1 in intensive care units to 2:1. The nurse realizes that A. legislation is politics beyond the nurse's control. B. national programs have no bearing on state politics. C. the individual nurse can influence legislative decisions. D. focusing on nursing care provides the best patient benefit.

C A change in appearance requires an adjustment in body image. In the assessment of self-concept and self-esteem, the assessment needs to determine the patient's perception of those factors that influence their self-concept. The patient needs to be given the opportunity to discuss how they perceive their illness or condition affecting their identity, their self-image and their ability to lead a normal lifestyle.

A client expresses concern that she and her partner will not have a fulfilling sexual relationship after her mastectomy. What information will help the nurse to assist the client? A. Whether her partner has ever had an extramarital affair B. Has the client communicated her sexual needs with her partner C. The client's feelings about her sexual attractiveness D. Whether the patient feels she has a strong marriage

C Cognitive is correct because the cognitive domain refers to problem-solving abilities and may involve recall and knowledge of facts. Physical is not one of the learning domains. Affective is incorrect because the affective domain refers to values and beliefs. Psychomotor is incorrect because the psychomotor domain involves behaviors such as learning how to perform a procedure.

A client has just reviewed his new diet, low protein and low potassium, with the dietitian. The client states he understands his diet. This reflects learning in which domain? A. Physical B. Affective C. Cognitive D. Psychomotor

B In needs theories, human needs are ranked on an ascending scale according to how essential the needs are for survival. Physiologic needs are those such as air, food, water, shelter, rest, sleep, activity, and temperature maintenance, which are all crucial for survival. Nutritional deficits would fall into this level and take priority over the others listed. Self -Care Deficit would fall in the fourth level self-esteem needs. Powerlessness is part of the need to develop ones maximum potential. It falls into the fifth and highest level of self-actualization. A potential problem is one that is likely unless interventions are provided. Since the situation does not exist at this time, Risk for Injury would be the lower priority need. Nursing Diagnosis Physiological integrity Application

A client is hospitalized with numerous acute health problems. According to Maslow's Hierarchy of Needs Theory, which nursing diagnosis would take the highest priority? A. Powerlessness related to chronic disease state B. Altered Nutrition, Less than Body Requirements related to inability to absorb nutrients C. Self-Care Deficit Hygiene related to weakness and debilitation D. Risk for Injury related to unsteady gait

B Disturbed body image possesses the clinical cues of behaviors of avoidance, monitoring, or acknowledgement of one's body

A female patient, prominent in the local media, has had surgery for a colostomy. The patient avoids looking at the colostomy and refuses visitors. Identify the most appropriate nursing diagnosis. A. Altered self-esteem related to colostomy and poor self-image B. Disturbed body image related to colostomy as evidenced by avoidance of colostomy C. Fear of rejection by others related to colostomy and altered self-image D. Altered role performance related to inability to cope with visitors

B : A & C are incorrect because genes interact with each other and the environment to predispose an individual to an illness; however, current research does not attribute the cause of an illness to the direct inheritance of specific genes. D is incorrect because the probability of developing an illness, as a result of genetic inheritance, varies according to a variety of factors.

A hospitalized patient asks about genetics and its relationship to illness. The nursing students best response would be: A. Genes interact with the environment to cause illness B. Genes may predispose individuals to certain illnesses C. Genes are the leading cause of many illnesses D. Genes increase the likelihood of developing an illness by 85%

A Properly performed, a hand-off report provides an opportunity to share essential information to ensure patient safety and continuity of care. Reimbursement costs and research priorities/opportunities are functions of the medical record. The purpose of the change-of-shift report is not to establish relationships but to ensure patient safety and continuity of care.

A new nurse asks the preceptor why a change-of-shift report is important since care is documented in the chart. Select the preceptor's best response. A. "A hand-off report provides an opportunity to share essential information to ensure patient safety and continuity of care." B. "A change-of-shift report provides the oncoming nurse with data to help set priorities and anticipate problems with the patient and/or his family." C. "A hand-off report provides an opportunity for the oncoming nurse to ask questions about staffing issues." D. "A change-of-shift report provides important information to caregivers and develops relationships within the health care team."

B The clinical care coordination skill this nurse needs to improve on is organization. This nurse needs to keep the patient report sheets in hand to anticipate what equipment and supplies a patient is going to need. Then the nurse may not have to leave the room so often; this will save time. The nurse in this example does not voice concern about decision-making skills, evaluation skills, or communication skills.

A new nurse expresses frustration at not being able to complete all interventions for a group of patients in a timely manner. The nurse leaves the end-of-shift report sheets at the nurse's station when caring for patients and has to go back and forth between rooms several times looking for equipment and supplies. This nurse could benefit from practicing better _____ skills. A. clinical decision-making B. organizational C. evaluation D. interpersonal communication

D Utilitarianism is a system of ethics that believes that value is determined by usefulness. This system of ethics focuses on the outcome of the greatest good for the greatest number of people. Deontology would not look to consequences of actions. The ethics of care would not be helpful because consensus on this issue is not achievable. Relationships, which are an important component of feminist ethics, are not addressed in this case.

A nurse advocates for the reform of the health care system on the basis that a large percentage of uninsured patients use emergency departments for primary care. The subsequent result is the increased cost of health care, for uninsured patients, that could have been minimized, if these patients had access to primary care physicians, before their health problem became an emergency. Select the ethical concept used by the nurse. A. Deontology B. Fidelity C. Feminist ethics D. Utilitarianism

D Orthostatic hypotension is abnormally low blood pressure occurring when a patient stands.

A nurse completed the history of a newly admitted patient. Which finding will alert the nurse the patient is at risk for falls? A. The patient is 55 years of age. B. The patient wears a hearing aid. C. The patient has a chronic illness. D. The patient experiences orthostatic hypotension.

C Use of exact measurements establishes accuracy. Charting that an abdominal wound is "5 cm in length without redness, drainage, or edema" is more descriptive than "large wound healing well." Include objective data to support subjective data, so your charting is as descriptive as possible. Avoid using generalized, empty phrases such as "status unchanged" or "had a good day." It is essential to avoid the use of unnecessary words and irrelevant details or personal opinions. "Patient is hard to care for" is a personal opinion and should be avoided. It is also a critical comment that can be used as evidence for nonprofessional behavior or poor quality of care. Just chart, "Refuses all treatments and medications."

A nurse has provided care to a patient. Which entry is correctly documented? A. Patient seems to be uncomfortable. B. Status unchanged, doing well C. Left abdominal incision 1 inch in length without redness, drainage, or edema. D. Patient is difficult to care for and refuses all treatments and medications. Family present.

A, C, E Stress causes prolonged changes in the immune system which increases the person's risk for infection, high blood pressure, diabetes, and cancer. Allostasis is a return to a state of balance.

A nurse is assessing a patient with prolonged stress.Which conditions will the nurse monitor for in the patient? Select All That Apply. A. Infection B. Low blood pressure C. Diabetes D. Allostasis E. Cancer

B As a patient advocate the nurse protects the patient's human and legal rights and provides assistance in asserting those rights of the need arises.

A nurse is caring for a patient who has decided not to continue with chemotherapy. The patient's family wants the patient to continue. The nurse explains to the family that the patient wants to go home and simply enjoy what is left of her life. The nurse is acting as the patient's: A. Educator B. Advocate C. Caregiver D. Communicator

D Situation - state the problem Background - put the situation in context and provide objective information Assessment - state the problem Recommendation - what does the physician need to do? Recommend what needs to be done.

A nurse is concerned about a change of mental status in an older patient and called the physician. The nurse suggested that a urine sample be collected and sent to the lab for urine cultures. Which step, in the SBAR communication tool, is the nurse implementing? A. Background B. Situation C. Assessment D. Recommendation

D About 20 million people in the United States are diagnosed with an STI each year, with the highest incidence occurring in men who have sex with men.

A nurse is preparing a community class about sexually transmitted infections. Which primary group will the nurse focus on for this class? A. Youth between the ages of 24 and 27 B. Pregnant women and their partners C. Bisexual women D. Men who have sex with other men

B Implementation is that part of the nursing process in which the nurse applies knowledge to perform interventions. Assessment is gathering data. Diagnosis is identifying patterns and making inferences. Evaluation is making criterion-based evaluations.

A nurse is providing a back rub to a client after administering a pain medication, with the goal that these two actions will help decrease the client's pain. Which phase of the nursing process is this? A. Evaluation B. Implementation C. Assessment D. Diagnosis

A

A nurse is teaching the patient and family about wound care. Which technique will the nurse teach to best prevent transmission of pathogens? A. Effective handwashing B. Saline wound irrigation C. Appropriate use of gloves D. When eye protection is needed

D The teaching process focuses on the patient's learning needs and willingness and capability to learn. Nursing and teaching processes are not the same. All the rest are components of the nursing process: Assess all sources of data and perform nursing care therapies.

A nurse is teaching the staff about nursing and teaching processes. Which information should the nurse include regarding the teaching process? A. Assess all sources of data. B. Identify that it is the same as the nursing process. C. Perform nursing care therapies. D. Focus on the client's learning needs.

C The nurse manager is planning a staff education opportunity in the given example. Staff education is one way the nurse manager supports staff involvement in a decentralized decision-making model. This nurse is providing staff education to other staff nurses on the unit, not to physicians. Interdisciplinary collaboration involves working with other disciplines such as medicine, physical therapy, respiratory therapy, etc. The question does not state that the nurse is establishing a practice committee. A poster presentation is a common teaching method.

A nurse manager sent one of the staff nurses on the unit to a conference about new, evidence-based wound care techniques. The nurse manager asks the staff nurse to prepare a poster to present at the next unit meeting, which will be mandatory for all nursing staff on the unit. The nurse manager is providing a learning opportunity in this situation through A. Nurse/physician collaborative practice. B. Interdisciplinary collaboration. C. Staff education. D. Establishing a nursing practice committee.

A A buccal medicine is a medicine given between the gums and the inner lining of the mouth cheek. This area is called the buccal pouch. Medicine is usually given in the buccal area when it is needed to take effect quickly.

A nurse teaches the patient about the prescribed buccal medication. Which statement by the patient indicates teaching by the nurse is successful? A. "I should let the medication dissolve completely." B. "I will place the medication in the same location." C. "I can only drink water, not juice, with this medication." D. "I need to chew my medication first for faster absorption."

D To increase accuracy and decrease unnecessary duplication, many health care agencies keep records or computers near a patient's bedside to facilitate immediate documentation of information as it is collected from a patient. A good system requires frequent and random changes in personal passwords to prevent unauthorized persons from tampering with records. When using a health care agency computer system, it is essential that you do not share your computer password with anyone under any circumstances. You destroy (e.g., shred) anything that is printed when the information is no longer needed. Taking nursing notes home is a violation of the Health Insurance Portability and Accountability Act (HIPAA) and confidentiality.

A nurse wants to reduce documentation errors on the computer system. Select the applicable documentation standard. A. Protect the privacy of the computer password. B. Verify with a more experienced nurse that entries are accurate. C. Print out and review all of the nurse's notes, for errors, at the end of the shift. D. Chart on the computer immediately after care is provided.

D When nursing students work as nursing assistants or nurse's aides when not attending classes, they should not perform tasks that do not appear in a job description for a nurse's aide or assistant. The nursing student should always follow the directions of the nurse, unless doing so violates the institution's guidelines or job description under which the nursing student was hired.

A nursing student, in the last semester of the nursing program, told the instructor that she got to insert a nasogastric tube while working as a nurse's aide. Select the instructor's appropriate response. A. "Just you be careful that you are following standards of care." B. "Remember to always review the hospital's procedure before doing a procedure." C. "Ask a nurse to supervise you when performing a procedure." D. "You are not allowed to perform any procedures other than those in your job description, even with a nurse's permission."

B Being able to sleep and feeling rested would indicate that outcomes are being met for sleep deprivation. Limiting a nap to 20 minutes is an intervention to promote sleep. Going to sleep within 30 minutes indicates that the patient may not be experiencing insomnia. Waking up during the night may indicate insomnia and decreasing fluids in the evening is an intervention to help prevent this situation.

A patient has received a nursing diagnosis of sleep deprivation. Which of the following statements by the patient would indicate that outcomes are being met? A. "I wake up only once a night to go the bathroom." B. "I feel rested when I wake up in the morning." C. "I go to sleep within 30 minutes of lying down." D. "I only take a 20-minute nap during the day."

A Present on admission (POA) identifies a condition that was present at the time an order was written for a patient to be admitted to an inpatient unit. This includes patients being admitted from the emergency department, observation unit or outpatient surgery.

A patient presented to the Emergency Department and had an IV started for stat medication administration, and was admitted to the hospital. When the patient arrived to the assigned floor, the admitting nurse noted the IV was infiltrated. Select the most relevant information that needed to be documented. A. The infiltration was present upon admission to the unit. B. The patient denied pain at the IV insertion site. C. The IV infiltration occurred in the Emergency Department. D. The name of the healthcare provider, in the Emergency Department, who started the IV.

D

A registered nurse interprets that a poorly written medication prescription reads 25 mg. The nurse administers 25 mg of a medication. It is later discovered the dose was 15 mg. Who is ultimately responsible for the error? A. Physician B. Pharmacist C. Hospital D. Nurse

B A health care provider can help to reduce situational stress factors for individuals. Providing the student with a list of resources is one way to begin this process, as part of secondary prevention strategies. This is not a medical or psychiatric emergency, so calling 911 is not necessary. Not all situational events go away. Not enough information is given to know whether the student would be best suited to leave college.

A senior nursing student contacts the college health clinic nurse regarding a freshman nursing student who is crying and having difficulty adjusting to college life. Which is the best response by the nurse? A. "Call 911 because your friend is suicidal." B. "Let's start by giving her a list of our university and community resources." C. "It is just a situational stressor and will go away within a few days." D. "Come with your friend to the health center to have her evaluated for suicidal ideation."

A, B, C, E Client education has long been a standard of professional nursing practice. All state nurse practice acts acknowledge that client teaching falls within the scope of nursing practice. Client education is an essential component of providing safe, client-centered care. Client education improves client outcomes and decreases health cost. The statement that people, who cannot read, cannot be educated is false. Patients can be taught verbally and, asked to repeat what they understood, for verification.

A student is asked by the nursing preceptor why client teaching is important. Which statements indicate the student understands the importance of client teaching? (Select All That apply) A. "Client education is a standard of professional nursing practice." B. "Client education helps the client achieve an optimal level of health." C. "Client education is an imperative component of safe, client-centered care." D. "Client education is not effective with patients who cannot read." E. "Client teaching falls within the scope of nursing practice."