Nursing (RN) Issues (EAQ's)

registered nurse is explaining the Quality and Safety Education for Nurses (QSEN) competencies to a nursing student. What information should the nurse provide about the competency teamwork and collaboration?

"A nurse should be able to work effectively within nursing and interprofessional teams by promoting open communication and shared decision-making to provide client care."

A registered nurse is educating a nursing student about nursing malpractice. What information should the nurse provide? Select all that apply.

"Nursing malpractice takes place when nursing care falls below the standards of care." "Nursing malpractice may be prevented by developing a caring rapport with the client." "Nursing malpractice may occur even when the nurses do not intend to harm the clients.

A registered nurse is teaching a nursing student about the components of the magnet model. What information should the registered nurse provide about exemplary professional practice according to the revised magnet model?

"Strong professional practice is established, and accomplishments of the practice are demonstrated.

A nursing student is listing key points about ethics and values. Which point listed by the nurse indicates a need for more education?

"The American Nurses Association (ANA) code of ethics ensures that the code remains constant." R: The American Nurses Association (ANA) code of ethics reviews and revises the code regularly to reflect changes in practice. The basic principles of the ANA code (such as responsibility, accountability, advocacy, and confidentiality) remain constant. A nurse's point of view offers a unique voice in the resolution of ethical dilemmas by including knowledge based upon clinical and psychosocial observations. Professional nursing promotes accountability, responsibility, advocacy, and confidentiality. Standards ethics in healthcare consist of autonomy, beneficence, nonmaleficence, justice, and fidelity.

A nursing student is listing the points that need to be remembered regarding the United Network for Organ Sharing (UNOS) program. Which point listed by the nursing student is accurate?

"The United Network for Organ Sharing (UNOS) has a contract with the federal government.

A registered nurse is educating a nursing student about the stages of changes in a client's health behavior. Which statement describes the stage of contemplation?

"The client considers a change within the next 6 months." In the contemplation stage, the client considers a change within the next 6 months. In the precontemplation stage, the client does not intend to make changes within the next 6 months. In the action stage, the client is actively engaged in strategies to change behavior. This stage lasts up to 6 months. When sustained change is noticed over time and begins 6 months after action has started and continues indefinitely, the client has reached the maintenance stage.

A nursing student is listing the points that need to be remembered about the loss of a client's medical records. Which point listed by the nursing student is accurate?

"There is an assumption that the care provided to the client was negligent. R: In case a client's medical record is lost, there is an assumption that the care provided to the client was negligent. Loss of medical records may lead to a malpractice claim. The entire institution is responsible for maintaining medical records. Primary healthcare providers need to demonstrate why the medical records were lost.

A registered nurse is instructing a trainee nurse on the various advantages of the team nursing care delivery model. Which statement provided by the trainee nurse post-training indicates a need for effective learning?

"This model is inflexible but uses a variety of staffing levels and mixes." R: An advantage of the primary nursing care delivery model is that it is flexible, and it uses a variety of staffing levels and mixes. The team nursing care delivery model has a high level of autonomy for the team leader. The team nursing care delivery model encourages each member of the team to work collaboratively. The team nursing care delivery model ensures that the care coordinator has time to manage unit issues.

A nurse is obtaining consent from an unemancipated minor to perform an abortion. When would the nurse consider the consent-giving process to be appropriately completed? Select all that apply.

- When consent has been given specifically by a court - When self-consent has been granted by a court order - When consent has been obtained from at least one parent of the minor

What are the steps of evidence-based practice (EBP) in order?

1. *Ask*ing the relevant clinical question 2 *Collecting* the most relevant and best evidence 3.Critically *appraising* the evidence collected 4. Integrating all evidence with one's clinical expertise and client preferences 5. Evaluating the practice decisio 6. Sharing the outcomes of EBP changes with other

According to informatics, a nurse should use information and technology to:

1. communicate 2. manage knowledge 3. mitigate errors 4. support decision-making.

What is a living will?

A living will is a written document that directs treatment on the basis of the client's wishes if he/she has a terminal illness or condition. A license allows registered nurses to offer the special skills to the public. A 'do not resuscitate' (DNR) order prevents primary healthcare providers from reviving clients or performing cardiopulmonary resuscitation (CPR). A durable power of attorney is a legal document that designates a person or persons chosen by a client to healthcare decisions on his/her behalf when the client is unable to do so.

What is the rationale for performing sponge, needle, and instrument counts in the operating room?

A nurse is responsible for performing sponge and instrument counts as a part of routine surgical standards.

A registered nurse is educating a nursing student about the importance of nursing documentation for performing risk management. What information should the nurse give? Select all that apply.

A nurse's documentation is the evidence of care that a client receives. "The nurse should note down assessments and significant changes in the client's health." "Nurses should always document the primary healthcare providers' responses whenever they are contacted."

What should a nurse understand about healthcare proxies or a durable power of attorney for healthcare?

A proxy is a legal document that designates a person or persons to make health care decisions on behalf of the client

A nursing student is examining the health services pyramid. Keeping in mind that care services begin at the bottom of this pyramid, in which order should care services be arranged?

According to the health services pyramid, 5. Tertiary health care forms the highest level of health care; these needs include intensive care and subacute care 4. The next level of health care is secondary health care services, which include emergency care and acute medical-surgical care. 3. A nurse should then address the primary health care needs of clients; these needs include prenatal and baby care and nutrition counseling. 2. Clinical preventive services form the next level of the pyramid. 1. population-based health care services come first.

The professional obligation of a nurse to assume responsibility for actions is referred to as what?

Accountability R: Nurses have an obligation to uphold the highest standards of practice, assume full responsibility for actions, and maintain quality in the knowledge base and skill of the profession; this is referred to as accountability. Individuality and responsibility are positive characteristics of the nurse but are not necessarily professional obligations. Bioethics is a field of study concerned with the ethics and philosophical implications of certain biologic and medical procedures and treatments.

A client tells the nurse, "I keep reverting to my old habit of drinking soda, although I have stopped drinking as much." What stage of health behavior change has the client reached?

Action Stage R: The client in this situation has reached the action stage of health behavior change. In this stage, old habits may get in the way of new behaviors. In the preparation stage, the client understands that the advantages of the health behavior change outweigh its disadvantages. In this situation, the client has already made changes in health behavior. In the maintenance stage, the client continues the health behavior change indefinitely. In the contemplation stage, the client may be ambivalent but is more ready to accept information regarding health behavior change.

Which is used for determining the hours of care and staff required for a group of clients?

Acuity record R: An acuity record is used to determine the hours of care and staff required for a given group of clients. A client's acuity level is based on the type and number of nursing interventions. Accurate acuity ratings justify overtime and the number and qualifications of staff needed to safely care for clients.

A nurse speaking in support of the best interest of a vulnerable client reflects which nursing duty?

Advocacy

Which act protects a person who is HIV positive?

Americans with Disablities Act

What are the instances when an adult can give consent for medical treatment? Select all that apply

An adult can give consent for medical treatment as a guardian for his or her ward. An adult can give consent for medical treatment as a parent for his or her unemancipated minor. An adult can give consent for the medical treatment of his or her brother or sister in case of an emergency if the client's parents are not present. *An adult cannot give consent for his or her emancipated minor. An adult can only give consent as a grandparent for a minor grandchild in emergency cases when the parents are not present.

urses are held responsible for the commission of a tort. What is the definition of a tort?

An illegality committed by one person against the property or person of another R: An individual is held legally responsible for actions committed against another individual or an individual's property. The application of force to the body of another is battery, which involves physical harm. Doing something that a reasonable person under ordinary circumstances would not do is the definition of negligence. An illegality committed against the public and punishable by the law through the courts is the definition of a crime.

What does a community-based nurse do as a change agent? Select all that apply.

As a change agent, the nurse empowers clients and families to creatively solve problems. As a change agent, the nurse works with clients to solve problems and helps them identify an alternative care facility. As a change agent, the nurse empowers clients to become instrumental in creating change within a health care agency. R: As an educator, the nurse helps clients gain the skills and knowledge needed for self-care. As a counselor, the nurse does not make decisions, but rather helps clients reach decisions that are best for them.

A nurse is caring for a client with pain after surgery. The nurse takes the blood pressure and pulse rate of the client and asks the client to rate the level of pain on the pain scale. Which standard of practice does the nurse perform?

Assessment R: When a nurse collects comprehensive data relevant to the client's health or the situation, it is considered assessment. In the given scenario, the nurse is assessing the client to minimize pain. Planning refers to instances when a nurse develops a plan to attain expected outcomes. Diagnosis refers to instances when the nurse analyzes the assessment data to determine the diagnoses or issues. Implementation refers to instances when the nurse implements the identified plan.

A registered nurse is teaching a nursing student about the standards of nursing practice. How would the nursing student define assessment?

Assessment is the process of collection of comprehensive data pertinent to the client's health and/or situation. Coordination of care refers to delivering care to the client. Diagnosis refers to analyzing the assessment data to determine the diagnoses or issues. Consultation is the process where a registered nurse discusses with other healthcare providers to influence the identified plan, enhance the abilities of other caregivers, and effect change.

A nurse who promotes freedom of choice for clients in decision-making best supports which principle?

Autonomy R: The principle of autonomy relates to the freedom of a person to form his or her own judgments and actions. The nurse promotes autonomy nonjudgmentally so as not to infringe on the decisions or actions of others. Justice means to be righteous, equitable, and to act or treat fairly. Beneficence relates to the state or act of doing good and being kind and charitable. It also includes promotion of well-being and abstaining from injuring others. Paternalism encompasses the practice of governing people in a fatherly manner, especially by providing for their needs without infringing on their rights or responsibilities.

refers to taking positive actions to help others. This involves keeping the interests of the client before self-interest.

Beneficence

A visitor from a room adjacent to a client asks the nurse what disease the client has. The nurse responds, "I will not discuss any client's illness with you. Are you concerned about it?" This response is based on the nurse's knowledge that to discuss a client's condition with someone not directly involved with that client is an example of what?

Breach of confidentilaity

A nurse is discussing various scenarios involving healthcare settings and services with other team members. Which scenario mentioned by the nurse is an example of continuing care?

Caring for a client with Parkinson's disease who requires day care service R: Caring for an older client with Parkinson's disease who requires day care service qualifies as continuing care. Explaining to a family member about the risks and benefits of screening for cancer qualifies as preventive care. Teaching a couple about the proper use of contraceptives and methods of promoting sexual health is considered primary care. Teaching a teenager about the importance of eating nutritious foods to prevent health issues is also considered primary care.

Which organization assists in establishing policies related to Medicare and Medicaid payment for meaningful use of EHRs?

Center for Medicare and Medicaid Services (CMS R: CMS rules specify how health care facilities and providers make meaningful use of the EHRs and technologies to receive payment from Medicare and Medicaid. The National Institutes of Health uses translational bioinformatics for medical research. The American Medical Informatics Association and the Health Informatics Management Systems Society have been involved in identifying nursing informatics competencies.

What information should the registered nurse provide when educating a nursing student about living wills? Select all that apply

Clients use living wills to declare any medical procedures they want or do not want when terminally ill. Living wills are written documents that direct the client's treatments in the event of a terminal illness or condition. Health care workers should always follow the directions of a client's living will

Which statement accurately describes correlational research?

Correlational research explores the relationships among variables of interest without any active intervention by the researcher

Which role does a nurse play when helping clients to identify and clarify health problems and to choose appropriate courses of action to solve those problems?

Counselor R: As a counselor, the nurse helps clients identify and clarify health problems and choose appropriate courses of action to solve those problems. As an educator, the nurse teaches clients and their families to assume responsibility for their own health care. A nurse acts as a change agent within a family system or as a mediator for problems within a client's community; this involves identifying and implementing new and more effective approaches to problems. As a case manager, the nurse establishes an appropriate plan of care on the basis of assessment findings and coordinates needed resources and services for the client's well-being along a continuum of care.

registered nurse is educating a nursing student about descriptive theories. Which point stated by the nursing student needs correction?

Descriptive theories help direct specific nursing activities R: Descriptive theories do not direct specific nursing activities. Instead, they help to explain client assessments. Descriptive theories are the first level of theory development. Descriptive theories explain, relate, and in some situations predict nursing phenomena. Descriptive theories describe phenomena, speculate on why they occur, and describe their consequences.

A nursing student lists the preventive and primary care services available in schools, primary healthcare provider's offices, occupational health clinics, community health centers, and nursing centers. Which service provided by these centers is most expensive?

Disease Management R: Disease management is the most expensive service provided by community health centers. Running errands is inexpensive, and if the person walks or rides a bike, can be used as a health promotion activity. Health education and routine physical examinations are inexpensive and can usually stop complications of diseases, which prevents from having to "manage" diseases, leading to costly and expensive treatment.

Which nursing behavior is an intentional tort?

Divulging private information about a client's health status to the media

The nurse needs to collect health care data for all employees at a multi-specialty hospital for research purposes. Which type of health information technology would the nurse access to obtain the needed information?

EHR - *Electronic health records* are the *official health records* of an individual, which can be *exchanged between facilities* and health care agencies. Electronic medical records are primarily prepared and maintained within a healthcare provider's facility; they are not shared between facilities. Clinical information systems consist of the information technology that provides the best tools for achieving quality outcomes for clients. The RHIO health record is an individual health record which can be exchanged among providers across geographic areas.

What important points should the nurse keep in mind when caring for an older adult to promote health? Select all that apply.

Encourage regular physical activity and the use of stress-management strategies Consider the client's social environment and strengthen social support to promote health Assess the client for fear of falling and provide support by making environmental changes

While teaching a nursing student, a registered nurse says "This is a study in which the investigator controls the study variable and randomly assigns subjects to different conditions to test the variable." Which type of research is the above statement?

Experimental research R: In experimental research, the investigator controls the study variable and randomly assigns subjects to different conditions to test the variable. In historical research, studies are designed to establish facts and relationships concerning past events. In evaluation research, studies test how well a program, practice, or policy is working. Exploratory research is an initial study designed to develop or refine the dimensions of phenomena or to develop or refine a hypothesis about the relationships among phenomena.

What are the elements of discovery of a lawsuit? Select all that apply.

Experts, medical records, and the depositions of witnesses are elements of discovery of a lawsuit. Proof of negligence is a part of a trial. Petition and elements of the claim are a part of the pleadings phase.

A nursing student is listing examples of active and passive health promotion strategies. Which strategy is an example of a passive health promotion strategy?

Fluoridation of municipal drinking water R: Passive strategies of health promotion help people benefit from the activities of others without direct involvement. The fluoridation of municipal drinking water is an example of a passive health promotion strategy. Active strategies of health promotion require clients to adopt specific programs for improving health. Weight-reduction programs, smoking-cessation programs, and drug abuse prevention strategies are examples of active health promotion activities.

Which opposing conflict would a middle-aged adult face according to Erikson's theory of psychosocial development?

Generativity versus Self-Absorption and Stagnation

A nursing student is listing the points that are applicable to grand theories of nursing. Which point mentioned by the nursing student needs correction?

Grand theories include Mishel's theory of uncertainty in illness. Mishel's theory of uncertainty in illness is not an example of a grand theory; it is a middle-range theory. Neuman's systems model is a grand theory. Grand theories require further specification through research. Grand theories are systematic and broad in scope and complexity. Grand theories do not provide guidance for specific nursing interventions; instead they provide the structural framework for broad and abstract ideas about nursing.

A nurse manager in charge of a unit overhears two nurses in a hall filled with visitors discussing a client on the unit who has AIDS. What should be the nurse manager's initial action?

Have a conference with the nurses and talk about the need for confidentiality

The school nurse conducts a class in nutrition planning for parents. What is the goal of school health nursing programs?

Health promotion

A client dies in the hospital 2 hours after being admitted. Who has the authority to decide if a post-mortem should be conducted?

If a client dies within 24 hours of being admitted to the hospital, the **medical examiner** has the right to decide whether a post-mortem should be conducted. If the client's death does not need to be reviewed by the medical examiner and the client has not requested an autopsy in writing, the surviving spouse may request a post-mortem. The nursing manager and the primary healthcare provider are not authorized to make decisions regarding a post-mortem.

What legal complications might a nurse face for using a restraint without a legal warrant on a client?

If a nurse uses restraints without a legal warrant on a client, he/she may be charged with *false imprisonment*.

When might a nurse be charged with client abandonment?

If a nurse walks out when staffing is inadequate R: The nurse should never walk out when staffing is inadequate because this action may result in client abandonment. If a nurse refuses to accept an assignment, then he or she is considered insubordinate. If a client suffers an injury due to inattention and the nurse had already brought this to the attention of the nursing supervisor, then the caregiver was attempting to act reasonably. If a nurse has to accept unreasonable assignments, he or she needs to make written protests to nursing administrators.

It helps achieve an organization's required competencies

In-service -

Which opposing conflict does a young adult face according to Erikson's theory of psychosocial development?

Intimacy versus Isolation R: According to Erikson's theory of psychosocial development, a young adult is likely to face Intimacy versus Isolation. An adolescent is likely to face Identity versus Role confusion. A toddler age 1 to 3 years of age is likely to face Autonomy versus Sense of Shame and Doubt. A middle-aged adult is likely to face Generativity versus Self-Absorption and Stagnation.

The family of a client infected with human immunodeficiency virus (HIV) wants to see the results of the client's blood tests, unaware that the client is infected. A nurse obliges the family's request without waiting for the client's consent. What legal charge may be brought against the nurse?

Invasion of privacy

How would the student nurse describe a quasi-intentional tort occurring during the practice of nursing?

It is an act that lacks intent but involves volitional action. R: A quasi-intentional tort lacks intent but involves volitional actions such as invasion of privacy and defamation of character. An intentional tort is a willful act that violates another's rights. This includes assault, battery, and false imprisonment. A tort is a civil wrong made against a person or property. An unintentional tort involves negligence and malpractice.

A nurse has made a nursing diagnosis without validating the data obtained from the client. Into what category does this error fall?

Labeling The nurse's error of failure to validate the data is categorized as labeling. Errors at the collecting level include inaccurate data, missing data, and disorganization. Errors at the clustering level include insufficient clusters of cues, premature or early closure, and incorrect clustering. At the interpreting level, errors include failure to consider conflicting cues and failure to consider cultural influences or developmental stage.

What are external barriers that can prevent a nursing professional from making morally correct actions? Select all that apply.

Lack of organizational support Lack of relationships with colleuges Inadequate staffing When faced with dilemmas, external and internal barriers may prevent a professional from acting in a morally correct way. This may cause moral distress. External barriers include inadequate staffing, lack of organizational support, and poor relationships with colleagues. These factors are present in the organizational environment and can lead a person to act in a particular manner. Internal barriers are factors within a person that prevent one from acting in a morally correct way. These include lack of assertiveness and perception of powerlessness.

Factors that affect the health and wellness of the client.

Lifestyle, environmental and genetic and physiological R: Spiritual and emotional factors are internal variables that influence health, health beliefs, and practices.

A nurse administers intravenous (IV) therapy to the wrong client. What possible legal complications might the nurse face in such situation?

MALPRACTICE

What is malpractice?

Malpractice is a type of negligence that is regarded as professional negligence.

Which member of the interprofessional team in a palliative care setting serves as the patient advocate, evaluating the physical, emotional, and spiritual needs of the patient?

NURSE

is the avoidance of harm or hurt. Weighing the pros and cons of the new treatment plan would involve this

Nonmaleficence

Which nurse participates in the development of nursing policies and procedures?

Nurse Educator

responsible for describing and defining the legal boundaries of the nursing practice within each state.

Nurse Practice Acts

A nurse is hired to work in a healthcare facility that has a completely computer-based client information system. The nurse in charge knows that the newly hired nurse is knowledgeable about this system when the nurse says what?

Patient info is immediatley availbel when this sytem is uded. The intent of these systems is to streamline documentation and recordkeeping for all appropriate health team members, including nurses. There is a reduction in medication errors with this type of system. Data are immediately available to appropriate health team members without the need to depend on record or chart availability. By streamlining documentation and recordkeeping, these systems increase opportunities for more direct client care by nurses.

The nurse is presenting information about hyperthermia to a group of nursing students. Which activities put a client at risk for this condition?

Performing strenuous activity in high humidity R: When a client performs strenuous activity in high humidity, it reduces heat loss from the body and results in hyperthermia. Activities such as snowmobiling, skiing, and hiking in cold weather may cause hypothermia because they occur in cold temperatures and may lower the body temperature.

The Magnet Recognition Program for health care organizations is based on fourteen forces of magnetism related to five magnet model components. Which force of magnetism is assessed to review the structural empowerment of the organization?

Personnel policies and programs R: Health care organizations that apply for Magnet status must demonstrate innovations in professional practice. One of the forces of magnetism that impacts the structural empowerment of the organization is its personnel policies and programs. Personnel policies of an organization should provide an innovative environment in which the staff are developed and empowered. Empirical quality outcomes are reviewed by assessing the quality of care. New knowledge, innovations, and improvements are reviewed by assessing the quality improvement of the health care organization. Interdisciplinary relationships are assessed to review exemplary professional practice.

Identify factors associated with an increased incidence of abuse within a family. Select all that apply.

Pregnancy Drug Abuse Sexual orientation

Identify factors associated with an increased incidence of abuse within a family. Select all that apply.

Pregnancy Drug Abuse Sexual Orientation

What is the role of a nurse administrator in a healthcare setting?

Preparing the budget, staffing, strategic planning of programs and services, employee evaluations, and employee development

According to the most recent Diagnostic and Statistical Manual of Mental Disorders, which statement is correct?

Prevalence of gender dysphoria ranges from five to 14 in 1,000 natal males R: According to the Diagnostic and Statistical Manual of Mental Disorders ( DSM) prevalence of gender dysphoria ranges from five to 14 in 1,000 natal males. Prevalence of gender dysphoria in 1,000 natal females ranges from two to three as per the DSM. Prevalence of transgender people is between one in 11,900 and one in 200,000 people, but this data is not present in the DSM. According to the Centers for Disease Control and Prevention, not DSM, invasive cancer of the cervix is the third most common cancer of the female genital system after ovarian and uterine cancers. It is not specific to one transwomen population.

A nurse uses therapeutic communication techniques in order to achieve desired client outcomes. Which communication technique is a part of therapeutic communication?

Providing relevant information to the client R: Because clients have the right to know about their health status, the nurse should provide them with all relevant information. This is a therapeutic communication technique that enables clients to understand what is happening and what to expect. Asking for explanations, showing sympathy and asking personal questions of the client are nontherapeutic communication techniques.

A nurse caring for a client from another country asks about the client's healthcare traditions. Which Quality and Safety Education for Nurses (QSEN) competency does the nurse comply with?

Pt centered care R: A nurse who provides compassionate and coordinated care to clients based on their preferences, values, and needs is providing patient-centered care. Asking about the healthcare traditions followed in the client's country is an example of patient-centered care. Safety involves minimizing the risk of harm to clients and primary healthcare providers. Informatics involves using information and technology to communicate, manage knowledge, mitigate errors, and support decision-making. Teamwork and collaboration involves nursing and interprofessional teams working together effectively to achieve quality client care.

oversees the exchange of client's information among the patient's healthcare providers and across geographic areas.

RHIO

Which nursing action is not likely to cause legal issues?

Refraining from leaving the client during a staffing shortage

What important points should the nurse keep in mind regarding orders from a primary healthcare provider to prevent any legal complications? Select all that apply.

Registered nurses should follow the primary healthcare provider's order unless the order seems to be harmful or is incorrect. Registered nurses should inform the nursing supervisor if the order looks inappropriate but the primary healthcare provider is required to confirm the order. Registered nurses should document that the primary healthcare provider was notified about an incorrect order, along with his or her response, follow-up, and the client's response.

What is the professional nurse's legal responsibility regarding child abuse?

Report any suspected abuse to local law enforcement authorities. R: Nurses and primary healthcare providers are legally responsible for reporting suspected or actual abuse. Child protective services may obtain a court order to grant temporary guardianship if it is found that the child is in immediate danger. The other answer options do not fulfil the nurse's duty to report suspected child abuse.

What services does block and parish nursing provide for preventive and primary care services? Select all that apply.

Respite care, running errands homemaker aides are services provided by block and parish nurses. Routine physical examinations are provided by a physician's office. Communicable disease control services are provided by occupational health.

A patient who underwent open heart surgery died 2 days after the surgery due to septicemia. Which tool will the nurse use to determine the cause of the patient's death?

Root cause analysis (RCA The root cause analysis (RCA) is an error prevention management tool that helps prevent sentinel events. Septicemia usually occurs when health care professionals do not follow hygiene procedures during the surgery. The sentinel events are the medical errors that lead to patient's death. Therefore the nurse would use RCA to find the cause of the patient's death. Plan-do-study-act (PDSA) is a quality plan. It does not help in detecting an error. Failure mode effective analysis (FMEA) helps identify the cause for near-miss and adverse events. Computerized physician order entry (CPOE) is a health information technology that helps in maintaining the record of medication prescribed for the patient.

What does a nurse understand about the secondary level of prevention?

Secondary prevention is focused on individuals who are in the early stage of their illnesses. R: The secondary level of prevention is focused on individuals who are experiencing health problems or illnesses. Tertiary prevention is aimed at helping clients achieve the highest level of function possible. The tertiary level of prevention is focused on minimizing the effects of a long-term disease or disability. The primary level of prevention is aimed at attaining health promotion through wellness development activities.

The nurse should understand the effects of internal and external variables to plan and deliver individualized care. Which variable is an example of an external variable?

Socioeconomic factors are considered to be external variables. Spiritual factors, developmental issues, and the perception of functioning are internal variables.

A nursing student is listing the different levels of the health care services pyramid. Under which type of health care services should the nursing student include subacute care?

Tertiary care

An adult client with mobility problems wishes to become an organ donor. Which act allows the client to donate his or her organs?

The *Uniform Anatomical Gift Act* gives the right to donate organs to any person who is at least 18 years old.

protects people with physical or mental disabilities against discrimination and ensures that they get fair opportunities and services in the social and professional spheres.

The Americans with Disabilities Act

forbids health plans from placing lifetime or annual limits on mental health coverage that are less generous than those placed on medical or surgical benefits.

The Mental Health Parity Act

Which of the following legal defenses are the most important for a nurse to develop?

The concept of *accountability* is of high priority in nursing practice. As a licensed professional, the nurse is always accountable, which means liable and answerable for his or her actions Dedication means to be committed, and assertiveness means to be confident. These are desired characteristics in a nurse but not legal defenses. Certification relates to achieving a higher level of knowledge or proficiency in one's area of specialization and is also not a legal defense.

The waiting area of a health care facility displays a pink triangle. What does this signify?

The health care facility welcomes lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) patients R: A waiting room in a health care facility marked with a pink triangle indicates that the health care facility is in a safe place for LGBTQ patients, and they can expect respectful and knowledgeable quality care. Other symbols might be used to represent areas that are meant for female and pediatric patients. There are no widely used symbols to designate transwomen-specific health care facilities.

A registered nurse is educating a student nurse about the concept of "floating." What information should the nurse provide? Select all that apply.

The nurse needs to learn about the policies of the institution regarding floating before accepting employment. The nurse must inform supervisors about any lack of experience in caring for the type of clients in the assigned nursing unit. The nurse needs to request and receive an orientation to the unit R: The nurse needs to request and receive an orientation to the unit. If a nurse is planning to join an institution, he/she should familiarize herself with the rules regarding floating before accepting employment. The nurses who need to float should inform the supervisors about any inability to carry out a desired task. The supervisors are liable to punishment if they assign any work to a nurse that is not related to their area of expertise or training. If the nurse is assigned more clients than is reasonable, the supervisor should be notified; however, this is related to short staffing issues.

What professional responsibility does the nurse display as a client's advocate?

The nurse protects the client's human and legal rights and provides assistance in asserting said rights

A nurse notices that a client is in spiritual distress. Which nursing action establishes the nurse as a caregiver?

The nurse provides therapeutic treatment to the client R: A nurse serves as a caregiver by meeting all the health care requirements of the client by providing measures that restore a client's emotional, spiritual, and social well-being. In the given scenario, the nurse provides therapeutic treatment to the client as a caregiver. As an educator, the nurse teaches the client about the signs of spiritual distress. As a client's advocate, the nurse communicates the wishes of the client to family members. The nurse follows the principle of accountability by collaborating with the agency chaplain to pursue the best treatment plan.

A nurse needs to obtain consent for the medical treatment of a child whose parent is a minor. What appropriate step should the nurse take to obtain consent?

The nurse should ask the minor to give consent R: The nurse obtains the consent from the minor whose child needs medical treatment. In case an unemancipated minor needs to give consent for an abortion, the nurse should wait for the consent of the court. The nurse should not ask adult siblings or the legal guardian of the minor to give consent if the minor's child requires medical treatment.

What points should a nurse keep in mind when caring for a client who belongs to a different culture? Select all that apply.

The nurse should be aware of his or her own cultural values and behavior patterns. The nurse should focus on understanding the client's traditions, values, and beliefs. The nurse should understand that unique cultural perceptions exist regarding health practices

A client with cancer is undergoing treatment in a hospital. The nurse finds the orders from the primary healthcare provider inappropriate. Clarification from the healthcare provider does not resolve the nurse's doubts. Who should the nurse contact and inform next?

The nurse should go to the *supervising nurse* or follow the *established chain of command* if he or she finds any discrepancies in the primary healthcare provider's orders. All nurses must act as *risk managers*, depending upon the situation. The nurse in question should follow the established chain of command to address his or her doubts. A nursing student is still a novice and is too inexperienced to handle such matters. A nurse administrator manages client care and the delivery of specific nursing services within a healthcare agency; a nurse administrator is not the appropriate person to ask for help in solving the problem at hand.

A group of nurses is preparing strategies to improve the quality of health care provided by the nursing team in the hospital. Which points should the nurse consider while preparing the strategies? Select all that apply.

The nurses should ensure that all adverse events are well documented. The nurses should be prepared to deal with events that may cause harm to a patient. The nurse should determine the root causes of the adverse events R: To improve the quality of care delivery, the nurses should be proactive and prepared to deal with any event before it occurs and harms the patient. For improving quality, the nurses should first find out the root cause of the adverse events to prevent them from recurring. Preventing the adverse events would only be possible if these events occurring in the hospital are identified. For this, it is very important that the adverse events are documented properly. To improve health care quality, the nurses should focus on both the process and outcome of the health care delivery system. The root cause analysis tool is used to assess the cause of sentinel events.

Whom on the interprofessional team helps the family members prepare for the patients death and also during greif and bereavement process?

The social worker. Therefore, the nurse involves the social worker in consoling the family members in this situation.

A student nurse is listing the different aspects of the healthcare services pyramid. Under which type of healthcare services should the student nurse include sports medicine?

The student nurse should include sports medicine under restorative care. It is not categorized as primary, tertiary, or preventive healthcare services.

A 3-year-old child with eczema of the face and arms has disregarded the nurse's warnings to "stop scratching, or else!" The nurse finds the toddler scratching so intensely that the arms are bleeding. The nurse then ties the toddler's arms to the crib sides, saying, "I'm going to teach you one way or another." How should the nurse's behavior be interpreted?

These actions can be construed as assault and battery R: Assault is a threat or an attempt to do violence to another, and battery means touching an individual in an offensive manner or actually injuring another person. The nurse's behavior demonstrates anger and does not take into account the growth and developmental needs of children in this age group. Although the behavior (scratching) needs to be decreased, this can be done with mittens, not immobilization. A 3-year-old child does not have the capacity to understand cause (scratching) and effect (bleeding).

What was the goal of the Executive Order Incentives for the Use of Health Information Technology and Establishing the Position of the National Health Information Technology Coordinator?

To develop a nationwide health information technology system R: President George W. Bush enacted the Executive Order Incentives for the Use of Health Information Technology and Establishing the Position of the National Health Information Technology Coordinator in 2004. The objective of this order was to develop a nationwide health information technology system. It also aimed to ensure availability of electronic medical records for all Americans by 2014. The Executive Order did not aim to provide medical insurance to Americans; this was enacted by the Patient Protection and Affordable Care Act. The Health Insurance Portability and Accountability Act was enacted to promote the privacy and confidentiality of client information.

What is the goal of Healthy People 2020?

To eliminate health disparities related to race, ethnicity, and socioeconomic status

A patient with congestive heart failure is receiving intravenous digoxin (Cardoxin) therapy. The registered nurse identifies that which items on the patient's care plan are appropriate for a licensed practical nurse (LPN) to perform? Select all that apply.

To provide safe care, the nurse should act within the scope of practice and certification. The licensed practice nurse (LPN) can monitor the vitals, ambulate the patient, and administer oral fluids to prevent dehydration. The LPN cannot administer medications intravenously and cannot formulate nursing diagnosis; therefore, these two actions do not fall within the scope of the LPN's practice.

which terms might the nurse use to describe a patient who was born a man but lives as a woman? Select all that apply.

Transgender Transwoman R: A patient who was born as a man but lives as a woman can be referred to as transgender or a transwoman. The nurse should also respect and use any other terminology the patient prefers. The terms "transvestite" and "he-she" are insensitive and offensive. The term "transgendered" is outdated; using the suffix "-ed" is inappropriate. A patient who was born as a woman but lives as a man can be referred to as a transman.

According to Quality and Safety Education (QSEN), what is patient-centered care?

Understanding that the client is the source of control when providing care

The nurse is entering a client's data in the electronic health record. What action should the nurse take to minimize ambiguity and confusion?

Use consistent, codified terminology

What activities should the nurse consider to be a part of the tertiary level of preventive care? Select all that apply.

Using a sheltered colony Providing selective placement Providing work therapy in hospitals

A geriatric patient with hypertension and diabetes mellitus is taking propranolol (Inderal) and insulin (Humulin N) therapy. Which interventions by health care professionals help prevent patient medication errors according to the Leapfrog Group?

Using computer physician order entry

What does a nurse understand by the quality improvement competency, according to Quality and Safety Education (QSEN)?

Using data to monitor the outcomes of care processes and use improvement methods to design and test changes to continuously improve the quality and safety of health care systems

A nursing student is listing examples of healthcare services. Which scenario is an example of restorative care?

Visiting a private residence to perform maggot-aided debridement therapy of a client's wound

What services do nurse-managed clinics provide in preventive and primary care services? Select all that apply.

Wellness counseling Health risk appraisal Employment readiness

What important points should the nurse keep in mind when witnessing consent forms? Select all that apply.

When witnessing the consent form, the nurse should confirm that the client's signature is authentic. The nurse should also ensure that the client has given the consent voluntarily. The nurse should never ask the student nurse to witness consent forms because it is a legal document.

EHR (electronic health record)

a computerized lifelong health care record for an individual that incorporates data from all sources that provide treatment for the individual

EMR (electronic medical record)

an electronic document that contains patient health information, gathered from different sources

Assault

any action that places the client or the nurse in fear of a harmful or offensive contact without consent.

What is negligence?

any conduct that falls below the standard of care.

Standards ethics in healthcare consist of

autonomy, beneficence, nonmaleficence, justice, and fidelity.

An unemancipated pediatric client is to undergo a routine medical procedure. Who is the appropriate authority to provide consent?

either of the child's parents R: For unemancipated pediatric clients, the parents are required to provide consent. Either parent may do so. The court intervenes in situations where the parents refuse to allow a child to undergo treatment. A grandparent may provide consent only if the situation is an emergency and the parents are not present. The client is underage and unemancipated; therefore if at all possible, consent must be obtained from one of the child's parents in a non life-threatening situation.

Which point is included in the World Professional Association for Transgender Health (WPATH) document regarding core principles of care for transgender patients?

informed consent R: The nurse must seek informed consent before providing treatment for a transgender patient. This is one of the core principles for health care professionals who care for transgender patients as per the document published by the World Professional Association for Transgender Health (WPATH). As per The Joint Commission recommendations for creating a safe and welcoming environment for lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) patients, the nurse should designate unisex or single-stall restrooms, post the patient's bill of rights and nondiscrimination policies visibly, and use the patient's choice of terminology in communication and documentation.

Battery

is any intentional touching without consent.

RHIO (Regional health Information Organization)

it is an electronic network of patient medical information gathered from multiple healthcare organization is same geographic area

Using a stretcher with worn straps is________; this oversight does not reflect the actions of a reasonably prudent nurse. The nurse is responsible and must ascertain the adequate functioning of equipment. The hospital shares responsibility for safe, functioning equipment.

negligent

sentinel event

unexpected occurrence involving death or serious injury

What is Libel?

written defamation of character.

The nurse is caring for a client diagnosed with a rare genetic disorder. Which domain of informatics would the nurse use to gather information about this condition to provide good quality client care?

clinical health care informatics R:Optimal health care can be delivered only if the clinician has in-depth knowledge of the client's condition. The nurse uses clinical health care informatics for gathering information about the client's condition. Clinical research informatics uses computer and information science to discover new knowledge relating to health and disease. Public health informatics uses information technology for improving the health of populations. Translational bioinformatics refers to the development of storage, analytic, and interpretive methods to assess the proactive, predictive, preventive, and participatory health of a population.

Regulatory Law (Adminstrative Law)

reflects the decisions made by administrative bodies such as the State Boards of Nursing when they set down the rules and regulations.

A nurse is educating the caregivers of an elderly adult with advanced Parkinson's disease about continuing care. What information should the nurse provide? Select all that apply.

"Adult day care centers are ideal for clients whose caregivers have to be away from home during the day." "Hospice care is a continuing care system that allows clients to live at home with comfort, independence, and dignity." "Nursing centers provide 24-hour custodial care in order to help residents achieve and maintain their highest level of functioning." R: Adult day care centers are ideal for providing continuing care to clients whose caregivers have to be away from home during the day. Hospice care is a type of continuing care that provides palliative care to clients within the comfort, dignity, and independence of their homes. Clients also go to nursing centers to receive continuing care. Nursing centers provide 24-hour custodial care. They help clients achieve and maintain their highest level of functioning. The primary objectives of providing restorative home care are health promotion and education. Clients recovering from chronic or acute illnesses or disabilities require restorative care. Continuing care is necessary for clients who are suffering from a terminal disease, who are disabled, or who were never functionally independent.

The nurse should understand the effects of internal and external variables to plan and deliver individualized care. Which variable is an internal variable?

*Emotional factors* are internal variables. Family practices, cultural background and socioeconomic factors are external variables.

A registered nurse is explaining the term "just culture" to the student nurse. Which explanation provided by the registered nurse is accurate?

"It refers to promoting open discussion whenever error occurs without fear of recrimination." R: The term "just culture" refers to the promotion of open discussion whenever errors occur without fear of recrimination. Fidelity refers to the agreement to keep promises. Beneficence refers to taking positive actions to help others. Accountability refers to the ability to answer for one's actions.

A registered nurse is teaching a nursing student about malpractice insurance. Which statement by the nursing student requires correction?

"Most private insurance policies for nurses are primary policies that begin covering the nurse even before all hospital insurance coverage has been exhausted." R: Most private insurance policies for nurses are excess policies that begin covering the nurse only after the hospital's insurance coverage has been exhausted. Malpractice insurance provides a defense when a nurse is in a lawsuit involving professional negligence or medical malpractice. If both the employing institution and the nurse are sued in a professional liability case, the nurse must notify his or her private insurance carrier of the lawsuit, even though the nurse has insurance through the hospital. If both the hospital policy and the private policy are considered primary and the hospital loses as a result of the nurse's act, the hospital may sue the nurse's private insurer to recover its losses.

A nursing student is listing the steps that need to be considered when preparing discharge planning for a client. Which steps listed by the nursing student are accurate? Select all that apply.

"Teach the client the safe and effective use of medications and medical equipment." "Develop a care plan that moves the client from the hospital to another level of healthcare." "Remember that discharge planning is a centralized, coordinated, interdisciplinary process."

A registered nurse is educating a student nurse regarding the role of value clarification in the resolution of ethical dilemmas. What information should the nurse provide?

"Value clarification involves tolerating differences of opinions

Which ethical principle is violated when the nurse forgets to give a painkiller to a patient as promised?

**Fidelity** involves being loyal by keeping promises, doing what is expected, performing duties, and being trustworthy. Justice refers to fair treatment and fair distribution of resources. Veracity involves being truthful to the patient. Nonmaleficence refers to acting in ways that prevent harm or risk of it.

A primary healthcare provider notes that all conventional treatment procedures have proved to be ineffective in managing a client's disorder. The primary healthcare provider decides to try an experimental treatment. The nurse ensures that the client has understood the implications of the new treatment plan thoroughly and then signs the client's consent form as a witness. Which basic healthcare ethic does the nurse follow in this situation?

*Autonomy* refers to the commitment to include clients in decisions about all aspects of care as a way of acknowledging and protecting their independence. In the given situation, the nurse ensures that the client has thoroughly understood the new treatment plan before gaining written consent. This ensures that the client is involved in the decision-making process appropriately. .

A nurse fails to act in a reasonable, prudent manner. Which legal principle is most likely to be applied?

*Malpractice* is the unskilled or faulty treatment by a professional that causes injury or harm to a client. It can result from a lack of professional knowledge or skill that can be expected in others in the profession, or from a failure to exercise reasonable care or judgment in the application of professional knowledge, experience, or skill. Malice is the desire or intent to inflict injury, harm, or suffering. Tort law is a wrongful act, not including a breach of contract of trust, that results in injury to another person and for which the injured person is entitled to compensation. Case law is law established by judicial decisions in particular cases instead of by legislative action.

A nurse withholds a prescribed opioid medication from a client requesting to be treated for intractable pain because the nurse fears the client will become addicted. In this situation, the nurse is adhering to which ethical principle?

*Paternalism* occurs if the nurse interferes with the individual's autonomy by disregarding the client's choices; the client has requested to be treated with a medication that has been prescribed by the healthcare team and the nurse is refusing to give it because of unfounded personal beliefs. The client's priority is pain relief and the nurse should be working with other health team members to achieve this objective. Veracity is defined as telling the truth. Autonomy, as an ethical principle, means that the nurse respects the client and the choices that are made. Beneficence commonly is referred to as "doing good;" it is related to the nurse's duty to help clients further their legitimate interest within the boundaries of safety.

Which organization's 2010 publication did not include a call to improve health care for lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) patients?

*The U.S. Department of Health and Human Services* published Healthy People 2010, which did not include any information related to the need to improve the health care for LGBTQ people. The Institute of Medicine's (IOM) report on LGBT health, The Joint Commission field guide for care of LGBT patients, and the World Professional Association for Transgender Health standards of care all included an emphasis on the need to improve health care for LGBTQ patients.

A nurse caring for a client with dementia notes that the primary healthcare provider has prescribed an experimental course of treatment. What important factor should the nurse keep in mind regarding the procurement of informed consent?

*The nurse should know that a client with a mental illness has the right to refuse treatment* until a court rules that he/she is incompetent for making health related decisions for himself/herself. The nurse should also remember that even clients with mental illnesses have to give their consent for medical procedures. Family members may give consent only if they are the healthcare proxies of the client. Primary healthcare providers should not perform procedures without the consent of the client.

What are the signs and symptoms observed in the human body with a decrease in body temperature? Select all that apply.

A client who has decreased body temperature may experience shivering due to contraction of the blood vessels in the body. The client who has decreased body temperature may not experience profuse sweating, flushed appearance, and dilated blood vessels. These signs and symptoms appear with an increase in body temperature.

What does the nurse understand by the word felony?

A felony is a crime of a serious nature that has a penalty of imprisonment for longer than one year or even death.

A registered nurse is educating a nursing student on the various classifications of torts. What acts are classified as intentional torts in nursing practice? Select all that apply.

A tort is a civil wrong made against a person or property. Torts may be classified as unintentional or intentional. Unintentional tort is negligence or malpractice. Negligence -conduct falls below standard of care i.e. taking a stop sign Malpractice: is negligence committed by a professional such as a nurse or physician. **Intentional torts are willful acts that violate another's rights. Examples are assault, battery, invasion of privacy and defamation of character** * Assault -verbal or offensive contact i.e. threaten to give injection w/o consent. * Battery -any intentional touching w/o consent i.e. actually give injection. * Invasion of Privacy * Intrusion on seclusion * Appropriation of name * Publication of private or embarrassing facts * Publicly placing one in a false light * Defamation of Character -publication of false statements that result on damage to a person's reputation. * Malice -person knows information is false and still publishes it. * Slander -if statement is ORAL. * Libel -if statement is WRITTEN ***Intentional torts include battery, assault, and false imprisonment. Unintentional torts include negligence and malpractice.***

Which professional organizations work towards identifying nursing informatics competencies? Select all that apply.

American Medical Informatics Association (AMIA) Health Information Management Systems Society (HIMSS) Technology and Informatics Guiding Education Reform (TIGER) initiative R: Certain professional organizations aim to bring technological changes and a proliferation of information and knowledge, as well as informatics competencies to all nurses. Such organizations include the American Medical Informatics Association (AMIA), Health Information Management Systems Society (HIMSS), and Technology and Informatics Guiding Education Reform (TIGER) initiative. The American Nurse Credentialing Center (ANCC) provides certification for informatics nurses. The Centers for Medicare & Medicaid Services (CMS) provide reimbursement for medical facilities to people.

Which antipyretic medication may cause Reye syndrome in children?

Asprin R: Aspirin (Anacin) increases the risk of swelling in the brain and liver, which are the main symptoms of Reye syndrome in children. Therefore aspirin is not recommended in children. Drugs such as naproxen (Aleve) and ibuprofen (Advil) do not induce swelling in the brain and liver; therefore, these drugs may not cause Reye syndrome. Dantrolene (Dantrium) does not induce swelling in the brain and liver; instead, it decreases calcium levels during malignant hyperthermia conditions.

A nurse is helping a client to maintain and regain health, manage his or her disease and symptoms, and attain a maximal level of function and independence through the healing process. What role is the nurse playing?

CAREGIVER R: As a caregiver, a nurse helps clients maintain and regain health, manage diseases and symptoms, and attain a maximal level of function and independence through the healing process. As a manager, the nurse coordinates the activities of members of the nursing staff in delivering nursing care and has personnel, policy, and budgetary responsibility for a specific nursing unit or agency. As a client's advocate, the nurse protects the client's human and legal rights and provides assistance in asserting these rights if the need arises. As a communicator, the nurse learns about a client's strengths and weaknesses and his or her needs through effective communication.

Which ethical principles govern a nurse's behavior when making difficult decisions about a patient's care at the point of care?

Clinical Ethics Clinical ethics help in decision-making in issues that involve bedside patient care and other patient-related issues. The principles of bioethics govern ethical issues in biological sciences and technology. Metaethics is a branch of philosophy that deals with fundamental questions about concepts. Research ethics are applicable toward research subjects, whether human or animal.

law based on judicial decisions made in courts when individual legal cases are decided.

Common Laws

What purpose does a community health center serve in preventive and primary care services?

Community health centers are outpatient clinics that provide primary care to a specific population

A nursing student lists examples of health promotion activities that can help patients maintain or enhance their present levels of health. Which examples are accurate? Select all that apply.

Health promotion activities enable clients to enhance or maintain their current health levels. Good nutrition and regular exercise are examples of such activities. Immunization against measles is an example of an illness prevention activity. Education about stress management and physical awareness are examples of a wellness education activity.

What services do community health centers provide in preventive and primary care services? Select all that apply.

Health screenings Physical assessments Disease management R: Health screenings, physical assessments, and disease management services are provided by community health centers in preventive and primary care services. Day care and acute and chronic care management services are provided by nurse-managed clinics.

A registered nurse notices that the insertion site of a client receiving intravenous medication is swollen. The nurse takes appropriate measures to treat the area and takes a photo of the insertion site and saves it in the client's electronic health record. Which Quality and Safety Education for Nurses (QSEN) competency is the nurse following?

INFORMATICS According to the Quality and Safety Education for Nurses (QSEN) competency, informatics is the use of information and technology to communicate, manage knowledge, reduce errors, and support decision-making. In the given scenario, the nurse takes appropriate measures to treat a swollen insertion site, takes a photo, and saves the photo in the client's electronic health record for future reference. This scenario qualifies for the informatics competency. The safety competency is used to reduce the risk of harm to clients and providers through both system effectiveness and individual performance. Client-centered care competency is used to provide compassionate and coordinated care based on respect to the client's preferences, values, and needs. The teamwork and collaboration competency is used to effectively function within the nursing and interprofessional teams to achieve quality client care.

Which guideline is useful for reducing disparity when caring for transgender patients?

Learning about the treatment options for transgender patients and requirements of follow-up care R: In order to reduce disparities in the health care delivery to transgender patients, it is appropriate for the nurse to develop individual treatment plans rather than assuming all transgender patients are the same. Learning about treatment options and requirements for follow-up care for transgender patients also helps the nurse provide the best care possible. It is appropriate for the nurse to learn about the health care needs of homosexual patients when caring for this population, but transgender patients are not necessarily homosexual, so this may not apply. The nurse should not automatically assume the patient wants to be referred to using pronouns of the gender with which he or she is living or of the sex with which he or she was born. Gender and sex exist on a spectrum, and the nurse should instead ask the patient how he or she self-identifies.

A nurse working in a Catholic hospital discourages patients from using contraceptives per hospital policy. Which category of ethics is the nurse following?

Organizational Ethics R: Organizational ethics help ensure smooth ethical operation of an organization. These ethical codes include sets of rules and regulations to guide the actions and behavior of the members of the organization. Societal ethics are norms that serve a large community and involve legal and regulatory mechanisms. Research ethics are applicable to those conducting research involving human and animal subjects. Professional ethics involve a set of ethical standards and expectations for members of that profession, but unlike organizational ethics, they may apply to many different companies.

According to *Avedis Donabedian*, which is the most important validator of quality and effectiveness of health care in a hospital

Patient outcomes acheived by the care provided R: Avedis Donabedian was a physician and founder of the *Donabedian model of care*. According to him, the patient outcomes obtained by health care delivery determines the quality and effectiveness of the health care. The number of patients admitted to a hospital does not indicate the quality of the health care delivered in the hospital. The values and goals presented by the hospital define the quality of the medical system. Similarly, the number of health care workers in the hospital does not determine the quality or effectiveness of the health care system.

A pregnant woman is admitted with a tentative diagnosis of placenta previa. The nurse implements prescriptions to start an intravenous (IV) infusion, administer oxygen, and draw blood for laboratory tests. The client's apprehension is increasing, and she asks the nurse what is happening. The nurse tells her not to worry, that she is going to be alright, and that everything is under control. What is the best interpretation of the nurse's statement?

Questionable, because the client has the right to know what treatment is being given and why R: The client's rights have been violated. All clients have the right to a complete and accurate explanation of treatment based on cognitive ability. All interventions should be explained, because they are not routine to the client. When administering treatment, the nurse is responsible for explaining what the treatment is and why it is being given. The Patient Care Partnership (Canada: The Patient's Bill of Rights) states that the client should be informed.

forbids the purchase or sale of organs.

The National Organ Transplant Act

A nursing student is recalling the definition of Nurse Practice Acts. What do the Nurse Practice Acts do?

The Nurse Practice Acts describe and define the legal boundaries of nursing practice within each state. They help to distinguish between nursing and medical practice and establish education and licensure requirements for nurses.

A client with diabetes mellitus experiences a sudden fall in blood glucose levels while travelling by air. The client is not carrying any medications or a copy of a personal medical record. Which type of health information technology would be beneficial for this client?

The PHR is an electronic health record which consists of health data and the treatment provided for the client. The client can enter the data and maintain these health records. It is easy to carry and helps healthcare providers provide treatment in emergency conditions. Clinical health care informatics seeks to transform client health by educating and training health care professionals. It does not help to provide emergency treatment to the client while traveling.

A nurse is teaching staff members about the legal terminology used in child abuse. What definition of battery should the nurse include in the teaching?

The application of force to another person without lawful justification R: Battery means touching in an offensive manner or actually injuring another person. Battery refers to actual bodily harm rather than threats of physical or psychological harm. Battery refers to harm against persons, not property. Behaving in a way that a reasonable person with the same education would not is the definition of negligence.

A nursing student is recalling the various stages of health behavior change. What are the characteristics of the preparation stage? Select all that apply.

The client requires assistance to plan changes in health behavior The client understands that the advantages of health behavior change exceed the disadvantages. The client makes small changes in health behavior in preparation for major changes in the next month. R: In the preparation stage, the client may need assistance in planning for the health behavior change. At this stage, the client understands that advantages of health behavior change exceed the disadvantages. The client, therefore, makes small changes to prepare for major health behavior change in the next month. In the contemplation stage of health behavior change, the client intends to make changes in health behavior in the next 6 months. In the preparation stage, the client becomes actively engaged in strategies to change his or her health behavior.

A nursing student is evaluating statements regarding the five levels of proficiency set forth by Benner. Which statement indicates that a nurse is in the advanced beginner stage?

The nurse is able to identify the basic principles of nursing care through careful observation According to the levels of proficiency set forth by Benner, a nurse in the advanced beginner stage is able to identify basic principles of nursing care through careful observation. A nurse in the novice stage learns about the profession through a specific set of rules and procedures. After reaching the competent stage, a nurse will be able to understand the organization and specific care required by certain clients. A nurse who has reached the proficient stage is able to assess an entire situation and transfer knowledge gained from multiple previous experiences.

A nurse is in the process of conducting research. What action indicates that the nurse is designing the study?

The nurse prepares questionnaires and selects the treatment plans necessary for the study. The stage of designing the study is when the nurse chooses the instrumentation for conducting the study. In this stage, the nurse prepares questionnaires and selects physiological measures, interviews, and treatments necessary for the study. The first stage of the research process involves identifying of the problem. At this stage the nurse may gather all relevant articles and review literature for the purpose of conducting the research. The stage of conducting the study involves the nurse obtaining approval from the appropriate authorities and enlisting research subjects. The nurse also monitors whether all investigators are following the appropriate study protocol in order to ensure accuracy of the findings.

A nursing student is listing the different aspects of the healthcare services pyramid. Under which type of healthcare services should the nursing student include family planning?

The nursing student should include family planning under *primary care*. Family planning is not a part of continuing care, restorative care or secondary acute care healthcare services.

What represents a significant shift in U.S. health policy in recent years?

There is a focus on better managing patients with multiple chronic conditions. The U.S. Department of Health and Human Services (USDHHS) has recently focused on strategies to improve the health status of patients living with multiple chronic conditions (MCCs), in order to better manage their long term care. Palliative care is offered to adults and children, but this is not a recent change or an official change to health policy. End-of-life care is covered by many health care insurance policies. There is no standardized support for patients wishing to end their lives; this remains controversial in U.S. health care.

Cost-effective and patient-centered care helps provide high-quality care to the patient.

Therefore the nurse should be able to work with fewer resources to reduce the cost of treatment. The nurse should ensure that the transition of patients between the departments is respectful, coordinated, and efficient to provide patient-centered care. Thus charge nurse B is providing high-quality care to the patient.

The adverse effects or complications caused by variation from the standard care or procedure are known as medical errors. Tracheotomy is a surgical procedure in which the surgeon makes an opening through the neck into the trachea. During this procedure, if the surgeon is not careful, the organs located near the trachea such as the thyroid glands may be ruptured and may lead to complications.

Therefore the presence of hole in the thyroid gland indicates medical error. R: Norm effects: Due to the insertion of tracheotomy tube, patients may feel uncomfortable for a few days. They may have difficulty in talking and swallowing fluids until they adapt to breathing through the tube. A hole is made in front of the neck for the insertion of the tube. Thus these findings are not indicative of medical errors.

What information should the nurse provide when explaining the benefits of illness prevention activities to a client?

These activities help protect clients from actual or potential health threats." R: Illness prevention activities help protect clients from actual or potential health risks and threats. Nurses impart wellness education to people to teach them to care for themselves in a healthy way. Health promotion activities enable clients to maintain or enhance their health levels. These activities also help people to reach an optimal state of physical, mental, and social well-being. Routine exercise and good nutrition are examples of health promotion activities.

In what order should a nurse follow steps of risk management to identify potential hazards and to eliminate them before harm occurs?

To eliminate potential hazards before harm occurs, the nurse should first 1. identify the possible risks 2. analyze the possible risks 3. act to reduce risks 4. evaluate the steps that have been taken.

The nurse reviews various standardized terminology before entering client data in the electronic medical record. What is the purpose of this review?

To ensure that client information is meaningful to other health care professionals

Why should organizations promote transparency in health care?

Transparency allows continuous feedback for improving patient outcomes

Which organization has a publication that includes the objective, "Aiming to develop a system to identify patients who are lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ)?"

U.S. Department of Health and Human Services (USDHHS Developing a system to identify patients who are LGBTQ is a goal stated in the USDHHS's Healthy People 2020. The CDC's publications have goals that differ from this one. The TJC field guide lists the recommendations for health care agencies in designing a safe environment for LGBT patient care. WPATH summarizes core principles that nurses and other health care providers should follow when caring for transgender patients.

When compared with their non-Hispanic white counterparts, which factors contribute to the health disparities Hispanic older adults face? Select all that apply.

Value differences Language barrier Lack of health care facility Inadequate health insurance R: The health of Hispanic older adults lags behind their white counterparts due to a number of factors. Beliefs and values of some older Hispanic patients may conflict with traditional Western health care views. Most nurses are not educated in Spanish, and this language barrier may affect health care delivery. Lack of health care access and inadequate health insurance also contribute to disparities. Although their diets may differ, it does not necessarily mean their nutrition is poor, so this is not a contributing factor.

A nurse advises a client to refrain from adding salt to food as a way to prevent high blood pressure. What kind of health care service is this?

When a nurse provides nutrition counseling to the client, it qualifies as **primary care**. In the given scenario, the nurse advises the client to refrain from adding salt in the diet in order to prevent high blood pressure. Tertiary care includes intensive care and subacute care. Preventive care includes blood pressure and cancer screenings, immunizations, mental health counseling and crisis prevention and community legislation. Restorative care includes cardiovascular and pulmonary rehabilitation, sports medicine, spinal cord injury programs, and home care.

What is a Sentinel Event?

a serious adverse event involving the death of the patient due to medical error. Therefore, the nurse manager will identify the **death** of a patient due to overdose of digoxin (Cardoxin) as a sentinel event.

Civil laws

protect the rights of individuals within society and provide for fair treatment in case civil wrongs or violations take place.

A nurse notes that a famous client has received an incorrect dose of medication due to the malfunction of the intravenous (IV) device, but does not inform the primary healthcare provider. Instead the nurse tells a colleague that the medication could not be given due to the client's inappropriate behavior. The nurse then updates media personnel about the client's health status. What legal charges may be brought up against the nurse? Select all that apply.

slander malpractice invasion of privacy R: Speaking falsely about a person is known as slander. In the given situation, the nurse misinforms the colleague about the client's behavior. This action may damage the client's reputation. Malpractice occurs when nursing care falls below the professional standards of care due to negligent acts. Because the nurse does not inform the primary health care provider about the incorrect medication dosage, the nurse may be charged with malpractice. Because the nurse informs media personnel about the client's health status, the nurse may be charged with invasion of privacy. The nurse will not be charged with libel because he or she did not document false information in the client's records. Because the nurse did not threaten the client or place him or her in physical or psychological danger, charges of assault will not be brought up.

Which statement made by a nursing student about Swanson's theory of caring needs correction?

Swanson's theory of caring provides a basis to help nurses understand how clients cope with uncertainty and the illness response. Swanson's theory of caring provides a basis for identifying and testing nurse caring behaviors to determine if caring will improve client health outcomes. Middle-range theories provide a basis to help nurses understand how clients cope with uncertainty and the illness response. The components of Swanson's theory of caring provide a foundation of knowledge for nurses to direct and deliver caring nursing practices. Swanson's theory of caring defines five components of caring: knowing, being with, doing for, enabling, and maintaining belief. Swanson's theory of caring was developed by Kristin Swanson by conducting extensive interviews with clients and their professional caregivers.

A nurse is educating a client about the tertiary level of prevention. What information should the nurse provide? Select all that apply.

Tertiary prevention focuses on preventing complications of illness. Tertiary prevention helps clients achieve as high a level of functioning as possible. Tertiary prevention aims at minimizing the effects of long-term disease or disability. R: Tertiary prevention is also known as preventive care since it aims at preventing further disability or reduced functioning in the clients. Even though clients may have developed limitations due to illness or impairment, tertiary prevention helps in achieving as high a level of functioning as possible. Tertiary prevention makes use of interventions that prevent complications and deteriorations in order to minimize the effects of long-term disease or disability. Tertiary prevention is applied when the client has a defect or disability that is permanent and irreversible. Tertiary prevention activities focus on rehabilitative care instead of diagnosis and treatment.

A nurse is evaluating different scenarios related to addressing different levels of client needs. Arrange which nursing actions are prioritized according to Maslow's hierarchy of needs.

1. Administering medications to regulate the client's body temperature of the client 2.Collaborating with the social service department to keep the client away from abusers 3. Contacting the client's family members in order to help the client mend relationships 4. Initiating therapeutic communication to boost the client's self-esteem Incorrect According to Maslow's hierarchy of needs, the basic level needs of a client should be met first before addressing higher level needs. The lowest level is to meet the client's physiological needs. Therefore, the nurse should first administer medications to regulate the client's body temperature. The next need is safety and security. The nurse should therefore ensure the safety of the client from abusers by collaborating with the social service department. The next level of need is love and belonging. To fulfill this need, the nurse should contact the client's family members. The next level of need is self-esteem. The nurse should use therapeutic communication strategies to bolster the client's self-esteem.

The nurse is preparing to insert an intravenous catheter in a thin, emaciated patient who is scheduled to begin intravenous fluid therapy. Which interventions should the nurse follow to provide high-quality care? Select all that apply.

1. The nurse should flush the IV line with normal saline to maintain patency. 2. The nurse should stop the insertion procedure when there is a break in technique. This intervention helps prevent catheter-related bloodstream infections and provides high-quality care to the patient. 3. The nurse should change the intravenous line every *72 to 96 hours* to prevent the risk of infection. **An 18-gauge needle is NOT an appropriate size needle to insert in a thin, emaciated patient**; it would cause *unnecessary trauma* and a *high risk of phlebitis*.

The nurses in a health care facility have developed a new care plan to prevent the risk of infection in patients with an indwelling urinary catheter in place. To determine if the changes prevent infections, the nurse manager uses the plan-do-study-act (PDSA). What is the order of steps that the nurse manager would follow to evaluate the changes?

1.Plan to test the change 2.Try out the change 3. Analyze what happened from the change 4. Determine what was learned R: Plan-do-study-act (PDSA) helps the nurses to determine whether the changes they are making in the care plan will help prevent urinary tract infections and improve the quality of care. While using this model, the nurse manager would first plan to test the changes made by the nurses. Then, the nurse manager tries out the changes suggested by nurses and analyzes the results of the new interventions. Finally, the nurse determines what is learned from the test and the result

A registered nurse is teaching a nursing student about Erikson's theory of psychosocial development. To which age group does Industry versus Inferiority apply?

6 to 11 years According to Erikson's theory of psychosocial development, Industry versus Inferiority applies to the 6 to 11 years of age group. Initiative versus Guilt applies to the 3 to 6 years of age group. Autonomy versus Sense of Shame and Doubt falls in the 1 to 3 years of age group. The Trust versus Mistrust stage applies to the birth to 1 year age group.

A nursing student is evaluating different examples of variables that influence the health beliefs and practices of clients. Which scenario is an example of an ***external variable***?

A client stops taking medications after the disappearance of symptoms to cut down on medical bills R: Socioeconomic factors are external variables often influence the health beliefs and practices of clients. A client facing economic constraints might stop taking medications after the disappearance of symptoms in order to cut down on medical bills. This situation is an example of an external variable. Emotional factors are internal variables that influence a client's health beliefs and practices. Feeling apprehensive about injections is an example of an emotional factor. Spiritual factors are also internal variables that influence clients. A client believing that organ transplants are sinful is an example of spiritual factors influencing health beliefs. A client's intellectual background is an internal variable. Relying on the Internet for education regarding healthcare practices is an example of the influence of intellectual backgrounds on health beliefs and practices.

A patient with a right-sided brain tumor had a surgery performed on the left side of the brain. The patient is presently in a coma. Which actions should the hospital take according to the Leapfrog Group's policy? Select all that apply.

Apologize to the family and caregivers of the patient. Agree to pay all costs related to the condition of the patient. Report the event to the joint commision R: The patient had undergone a surgery at the wrong site. This falls under the *"never events"* category. According to the Leapfrog Group's never event policy, the health care organization should report the event to The Joint Commission, state-reporting program for medical errors, or a patient safety organization. The organization should apologize for its mistake to the caregiver of the family and waive the entire amount required for the compensation of this never event. The hospital does not need to refer the patient to another hospital for the treatment. The facility should perform a root cause analysis for analyzing the cause of this never event.

A patient with a bleeding disorder is taking intravenous coagulant medications. The patient suddenly develops an embolic stroke as a result of drug overdose. Which actions by the hospital management does the Leapfrog Group suggest? Select all that apply.

Apologize to the patient and family Waive all costs directly related to the adverse effect Report the adverse event to The Joint Commission R: The aim of the Leapfrog Group is to make health care safer. In case of an adverse event, the Leapfrog Group suggests that the hospitals apologize to the patient and family. It also suggests waiving all costs directly related for the treatment of adverse effects. According to the Leapfrog Group, the hospital should report the adverse event to The Joint Commission and take measures to prevent this error in the future. The Leapfrog Group does not suggest including the details of medical error in the details; rather, it suggests performing root cause analysis. The hospital should maintain privacy and should avoid sharing the patient's details with other health care facilities.

What purpose does block and parish nursing serve in preventive and primary care services?

Block and parish nursing provides services to older clients or those who are unable to leave their homes. R: Block and parish nursing provides services to older clients or those who are unable to leave their homes. Community health centers provide primary care to a specific client population living in a specific community. Nurse-managed clinics provide nursing services with a focus on health promotion and education as well as on chronic disease. Occupational health services provide services that aim to increase worker productivity, decrease absenteeism, and reduce the use of expensive medical care.

A nurse is informing a client about the benefits of rehabilitation. What information should the nurse provide? Select all that apply.

Correct1 "Specialized rehabilitation services help clients and caregivers to adjust to lifestyle changes." Correct2 "Rehabilitation helps prevent complications associated with illness or injury at the initial stages." Correct3 "Rehabilitation helps clients attain their fullest physical, mental, social, vocational, and economic potential." R:Specialized rehabilitation services, such as cardiovascular, neurological, musculoskeletal, pulmonary, and mental health rehabilitation programs, enable clients and their caregivers to adjust to lifestyle changes and help them function with the limitations of their illness. At the initial stages, rehabilitation aims to prevent complications associated with the illness or injury. Rehabilitation enables clients to reach their highest physical, mental, social, vocational, and economic potential possible. Drug rehabilitation is only one type of rehabilitation program. Clients may require rehabilitation after a physical or mental illness, injury, or chemical addiction. When the client's condition stabilizes, rehabilitation helps to maximize his or her functioning and level of independence.

A child with hip dysplasia has undergone a closed reduction surgery. The nurse assesses the child 2 days after the surgery and feels that the treatment and care provided for the child were not effective. The nurse made this conclusion based on what findings?

Correct4 The child's femoral head did not return to the hip socket.

While entering data for a client in the electronic health record (EHR), the nurse uses North American Nursing Diagnosis Association (NANDA) International terminology to document which part of the nursing process?

Diagnosis R: The NANDA International terminology provides code numbers for the diagnosis of various diseases. Therefore the nurse would use NANDA International for entering the client's diagnosis. The NANDA International terminology does not give codes for planning, outcomes, and interventions. The nurse would document planning under the planning portion of the electronic health record. The nurse would use nursing interventions classification for entering interventions in the client's EHR. The nurse would use nursing outcomes classification for documenting the outcomes of the treatment in the EHR.

The nurse working in a cardiac center is preparing to enter client data using health information technology. The nurse needs to refer to this data during subsequent follow-up patient visits. Which type of record should the nurse use to enter patient's data?

EMR - is a client's health record within a healthcare provider's facility. These records are not intended to be shared between multiple facilities and agencies.

A nursing student is listing the different aspects of obtaining informed consent from clients. Which point mentioned by the nursing student needs correction?

Informed consent is an important part of the nurse-client relationship; it is a vital part of the nursing duty." Informed consent is a vital part of the relationship between the healthcare provider and the client. Nurses are responsible for making sure the healthcare provider explains any surgical procedure to the client including risks. Informed consent from clients should be obtained in all situations except emergencies, because failure to do so may lead to battery. Clients provide informed consent after they are made completely aware of the risks, benefits, alternatives, and consequences of refusing treatment. The person responsible for performing the procedure has the legal duty to disclose facts regarding the treatment in terms that the client is able to understand.

While visiting the hospital, the spouse of a client slips and falls on a recently washed floor in the hallway leading to the client's room. To meet the criteria of ethical practice, what action should the nurse who witnessed the occurrence take?

Initiate an agency incident report R: Health care agencies document the occurrence of any event out of the ordinary that results in or has the potential to harm a client, employee, or visitor. Falls by visitors are not required to be reported to state (provincial) health departments. However, incident reports are required to be presented to accrediting agencies for review when an agency is in the process of being accredited. Writing a brief description of the incident to be kept by the nurse manager is not a requirement of ethical practice. However, a nurse who is involved in an incident or is a witness to an incident should write an accurate description of the event, along with the names of individuals involved. This documentation should be kept by the nurse at home. Lawsuits may take several years before they come to trial, and personal notes may help the nurse recall the event. The documentation must accurately contain the same elements included in the formal incident report. Taking no action is irresponsible. All events out of the ordinary that result in or have the potential to harm a visitor should be documented in an agency incident report.

What should the nurse consider to be limitations of assisted living? Select all that apply.

Most residents need to pay privately. Only home care nurses can visit the clients. Average monthly fee is $3,022 for a private unit R: Most residents in assisted living need to pay privately. In assisted living, nursing care services are not always available, and only home care nurses can visit the clients. The average monthly fee is $3,022 for a private unit, thus assisted living is not always an option for individuals with limited financial resources. Medicaid covers respite care service but has strict requirements for services and eligibility. Initially, rehabilitation focuses on the prevention of complications related to the illness, and after the condition stabilizes, it helps to maximize the client's functioning and level of independence.

A nursing student is listing examples of unintentional torts. Which examples mentioned by the student are correct? Select all that apply

NEGLIGENCE MALPRACTICE An unintentional tort refers to any conduct that falls below the expected standards of care. Assault is an example of an intentional tort because it is a willful act that violates the rights of another individual. Invasion of privacy and defamation of character are examples of quasi-intentional torts. These are characterized by a lack of intent to do harm but volitional action and direct causation occur. Negligence and malpractice are examples of unintentional torts.

What is the subset of clinical health care informatics?

NURSING INFORAMTICS R: NI is the subset of clinical health care informatics. NI is a specialty that integrates nursing science, computer science, and information science to manage and communicate data, information, knowledge, and wisdom in nursing practice. Clinical health care informatics is a subdomain of clinical informatics. Public health informatics is one of the major domains of informatics that uses computer science and technology to improve public health. Clinical research informatics is a subdomain of clinical informatics.

Which is an appropriate action for the registered nurse regarding assisted suicide?

Nurses' participation in assisted suicide violates the code of ethics. R: According to the ANA, a nurse's participation in assisted suicide will violate their code of ethics. According to the American Association of Colleges of Nursing (AACN) and the International Council of Nurses', the nurse may have an open attitude toward the client's end of life. According to the American Association of Colleges of Nursing (AACN) and the International Council of Nurses', nurses may listen to the client's expressions of fear and to attempt to control the client's pain. According to the Oregon Death with Dignity Act (1994) the primary health care provider in the state of Oregon can participate in assisted suicide only if an individual with terminal disease makes an oral and written request to end his or her life in a humane and dignified manner.

When caring for a transgender patient, which would the nurse use to decide how to address the patient?

Patient's preference

Which statement is true about prescriptive theories?

Prescriptive theories are action-oriented R: Prescriptive theories are action-oriented. They test the validity and predictability of a nursing intervention. These theories address nursing interventions for a phenomenon, describe the conditions under which the prescription occurs, and predict the consequences. Descriptive theories help to explain client assessment. A middle-range theory tends to focus on a specific field of nursing. Descriptive theories are the first level of theory development.

A nursing student is recalling information about the primary level of prevention. Which statement accurately describes primary prevention?

Primary prevention is applied to clients who are physically and emotionally health R: Primary prevention is true prevention. This prevention is applied to clients who are considered to be physically and emotionally healthy. The tertiary level of prevention is directed at providing rehabilitative care to clients. Secondary prevention includes screening techniques and treatment of early stages of disease. Secondary prevention is focused on individuals who are ill and are at risk for further complications.

A nurse is caring for a community-dwelling older adult with hypertension. What interventions should the nurse take to ensure the client's well-being? Select all that apply.

Promote dietary modifications by using varied techniques Assess the client's current lifestyle and promote lifestyle changes Monitor the client's blood pressure and weight and establish blood pressure screening programs R: When caring for a community-dwelling older adult with hypertension, the nurse should promote dietary modifications, assess a client's current lifestyle and promote lifestyle changes, and monitor the client's blood pressure and weight and establish blood pressure screening programs. When caring for community-dwelling older women with cancer, the nurse should perform annual Papanicolaou (Pap) smears and mammograms for older adults. When caring for a community-dwelling older adult with arthritis, the nurse should teach the client about correct body mechanics and the availability of mechanical appliances.

What activities would the nurse participate in while providing a primary level of preventive care? Select all that apply.

Providing education about adequate housing and recreation Providing education about attention to personality development Providing instructions about good standard of nutrition adjusted to developmental phases of life R: While providing primary level of preventive care, the nurse should educate the client about the need for adequate housing and recreation. The nurse should also provide education regarding the need to pay attention to personality development. Helping clients to maintain a good standard of nutrition adjusted to developmental phases of life is also a part of primary level preventive care. While providing secondary level of preventive care, the nurse would participate in individual and mass screening activities. While providing tertiary level of preventive care, the nurse would help ensure that clients can access hospital and community facilities for retraining and education to maximize use of remaining capacities.

Which point is included in the *World Professional Association for Transgender Health (WPATH)* document regarding *core principles* of care for transgender patients?

Seeking informed consent before providing treatment R: The nurse must seek informed consent before providing treatment for a transgender patient. This is one of the core principles for health care professionals who care for transgender patients as per the document published by the World Professional Association for Transgender Health (WPATH). As per *The Joint Commission recommendations* for creating a safe and welcoming environment for lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) patients, the nurse should designate unisex or *single-stall restrooms*, post the *patient's bill of rights* and nondiscrimination policies visibly, and use the *patient's choice of terminology* in communication and documentation.

The student nurse is reviewing the electronic health record for clients in a health care facility. Which action by the student nurse may inhibit clients from disclosing personal information?

Sharing clients' data with family members R: Clients may not want their health information shared with others and may want to maintain their privacy. If the nurse retrieves client data from the electronic health records and shares it with family members, it may lead to clients not sharing information. The nurse can use client data for research without mentioning a client's personal details. The nurse can use client data for filing insurance to receive Medicaid payments. The nurse can discuss the client's illness with the client; doing so helps to understand the client's perspective and to provide effective care.

An elderly adult with Parkinson's disease falls while going to the bathroom and gets injured. The nurse taking care of the client informs the primary healthcare provider. What step should the nurse take to alert the risk management system?

The nurse should document the incident in the occurrence report tool. R: To alert the risk management system and to prevent the recurrence of such occurrences, the nurse should document the incident in the occurrence report tool. The nurse should provide information in the medical record about the occurrence; however, this will not alert the risk management system. The nurse should not document in the client's medical report that an occurrence report has been filed because this will alert all healthcare team members. The nurse should document in the client's medical report that the primary healthcare provider has been contacted because it might be useful in defending a lawsuit, but this action will not be a beneficial way to alert the risk management system.

An elderly adult suffered an injury after falling down in the washroom. The primary healthcare provider performed a surgical procedure on the client and orders a blood transfusion. A family member of the client mentions that blood transfusions are not permitted in their community. What should the nurse do in order to handle the situation?

The nurse should inform the primary healthcare provider and not give blood to the client R: The client or the client's family member has the right to refuse treatment and the nurse should value their beliefs and traditions. Therefore, the nurse should inform the primary healthcare provider and not perform the blood transfusion. The nurse should not wait for a court's order or explain or convince the family member to change his or her mind. The nurse should not proceed with the treatment because this may cause severe legal implications.

A health care worker is collecting data on the quality of health care provided in a health care center. The health care worker finds that too many nurses are attending to a single patient. What does the health care worker conclude from this?

The nursing team is not providing efficient care R: Too many nurses attending to a single patient indicates that the work that can be performed by a few nurses is being performed by many nurses. This indicates that the nursing team lacks efficiency. The inability of the nursing team to avoid injuries in the patient indicates that the nursing team is unable to perform safe care. The inability to address the problems of the vulnerable groups indicates that the nursing team is unable to provide effective care. The inability to address all the problems of the patient while providing care indicates that the nursing team is unable to provide patient-centered care.

What is the purpose of the failure mode effective analysis?

The purpose of the FMEA is to take actions to eliminate or reduce failures, starting with the highest-priority ones. Failure modes and effects analysis also documents current knowledge and actions about the risks of failures, for use in continuous improvement. FMEA is used during design to prevent failures. R: The failure mode effective analysis is a tool that is designed to prevent medical errors and system failures within a health care system. It analyzes the potential failure modes, analyzes the causes of system failures, finds solutions to the problem, and evaluates the effectiveness of those solutions. The root cause analysis tool is used to analyze the cause of sentinel errors in a hospital. The efficacy of the care provided and analysis of patient satisfaction are not the components of patient dissatisfaction.