1122 Exam 2

Justice

act fairly and equitably to all clients avoiding personal bias. all clients treated the same no matter what

communication strategies

active listening restating, clarifying, reflecting, paraphrasing, minimal encouragement, remaining silent, validating

A nurse is caring for a patient that says "I just want to die." For a nurse to comply with this request, a nurse should discuss:

advanced directive

Nurse-Patient Relationship: termination

alert pt to closing of relationship evaluate outcomes achieved

Select the statement that indicates an understanding of a major difference between the RN and LPN/LVN. a. The LPN/LVN initiates all health teaching for clients. b. The RN formulates nursing diagnoses. c. By law, the LPN/LVN functions in an independent role. d. The LPN/LVN interprets the results of research studies.

b

Which statement most accurately reflects a nursing communication difference that is age related? a. Speaking in a loud, high voice makes it easier for an elderly client to hear you. b. Discussing with school-age clients their illness in age appropriate terms. c. Giving a toddler having a tantrum a special treat. d. Using medical jargon and current slang to help a teenager to see you as human.

b

Which of the following statements differentiates the role of the LPN/LVN from the professional nurse? (Select all that apply.) a. The LPN/LVN is responsible for formulating all nursing diagnoses. b. The LPN/LVN has a collaborative role in health teaching for clients. c. The LPN/LVN is not employed in any charge/management positions. d. The LPN/LVN is responsible for triaging clients in an urgent care setting. e. The LPN/LVN is responsible for all members of the health care team.

b,

defense mechanisms

compensation denial displacement introjection projection rationalization regression repression sublimation suppression

Deontology

concerned w whether the action itself is right or wrong. not concerned w/ the consequence of the action

role of rn

controls regarding staff and care of clients. independent. initiates all phases of nursing process initiates all health teaching

nursing code of ethics

its in the nursing practice act. defines the values, morals, and standards in a specific discipline. SVN's are held to same standard as nurses

judging

judging a clients behavior like smoking when they have lung cancer. no helpful

Essential components of communication in professional nursing: collaboration

key factor in communicating essential health information and providing total care to pt.

Law vs. Ethics

law: minimum ethical requirement. its written and enforced ethics: guidelines that inform how to live or behave in society/certain situations

communication w hearing impaired

make sure room is well lit with limited background noise. consistent affirmative answers may mean they aren't hearing u.

belittling

mimicking or making fun of client. downplays importance of what's happening to client. what seems minor to you is major to them

moral distress vs moral resilience

moral distress: when nurses values/principals are challenged. when they cannot act according to those principals. Or when pt outcomes aren't aligning w how they thought it would go. Happens in end of life care moral resilience: sustain or restore integrity in response to moral complexity, confusion, distress, or setbacks. method for responding effectively to moral distress or ethical challenges.

body language

non-verbal communication: Posture, stance, gait, facial expressions, eye movements, touch, gestures, jewelry and make-up, generally communicate a person's thoughts more accurately than simple verbal interactions

most likely to deliver fragmented care

nursing homes

Types of questions

open ended- "What happened to your leg?" closed ended- "When did pain start?" focused- even more definitive than closed. "on a scale of 1-10 how do you rate your pain?"

Nurse-Patient Relationship

orientation/introductory working termination

probing

pushing for info beyond what is medically necessary. clients privacy no longer respected

Essential components of communication in professional nursing: delegation

receiving feedback to the person whom work was delegated is required by law. delegate respectfully. communicate therapeutically w colleagues during delegation process

Respect for autonomy

refers to respecting patients' rights to make decisions about their own healthcare. includes right to privacy

Essential components of communication in professional nursing

respect assertiveness collaboration delegation advocacy

Essential components of communication in professional nursing: respect

respect for pt and family conveyed verbally and non-verbally. ask name preference, provide privacy, encourage autonomy. control facial expressions and body lang. w challenging clients

goal of healthcare team

restore optimal physical, emotional, and spiritual health to client.

Defense Mechanism: Displacement

shifting agression-- punch walls/ yell @someone

Privacy means

the right patients have to decide what happens to their bodies and to choose care

Fidelity means

to be true and act in best interest of the patient.

Justice means

to deliver fair and equal treatment to all patients

Beneficence

to do good. place clients interest first, put clients needs above your own

living will

treatment a person wants to receive when they are unconscious or no longer able to make decisions. when a person wants to have CPR, or a ventilator, autopsy, designated spokesperson. Person needs to make copies of a living will to give to family.

veracity

truthfulness, honesty. keeping secrets is in direct opposition to veracity and autonomy

Defense Mechanism: Projection

- In which the pt refused to acknowledge unacceptable personal characteristics and transfer feelings, thoughts or traits onto another person. EX: Projecting emotions about self onto something or someone else.

Simple answers

"everyone feels this way". dismissive. Tell them instead "I'll be with u every step of the way"

false reassurance

"everything will be okay." "you'll be just fine" no way to guarantee what you tell client

Compensation : Defense Mechanism

- Covering up a real or perceived weakness by emphasizing a trait one considers more desirable. EX: A handicapped boy is unable to participate in football, so he compensates by becoming a great scholar.

sublimation (defense mechanism)

- Rechanneling of drives or impulses that are personally or socially unacceptable into activities that are constructive. EX: Mom of son killed by drunk driver, president of MADD.

Both morals and ethics are concerned with dealing with right or wrong behavior and character. (T/F)

T Morals and ethics both mean customs or habits and refer to the general area of rights and wrongs.

A parent has refused a blood transfusion for her 2-year-old son, but the doctor has asked the court to overrule her refusal. What is the nurse's best response? a. "In your son's case, beneficent paternalism (explain term) overrules respect for your autonomy." b. "In this hospital, the doctor knows best because of his/her superior knowledge." c. "We have saved many children by ignoring parents' religious beliefs and doing what is best." d. "He is too young to understand and make his own choice in something this serious."

A

The nursing profession has evolved over time. Which statement best describes how the nursing profession has evolved? a. Nursing discovered its unique role in providing care to the whole client, not just the diseased part, using evidence to make decisions. b. Nurses now view themselves as independent practitioners, able to meet all of their clients' needs. c. Because of the implementation of the nursing process and critical thinking in nursing schools, nurses now need to think independently to develop the best client plan of care. d. Nurses discovered that curricula and textbooks changed but not the work on client care units.

A

Which method of nursing care delivery is task oriented? A.) Functional nursing B.) Case method C.) Team nursing D.) Primary nursing

A

A patient states, "I don't seem to be getting my strength back." The nurse replies, "Don't worry. You are coming along just fine." This response is an example of a. false reassurance. b. active listening. c. disagreeing. d. probing.

A False reassurance involves telling the patient that there is nothing to worry about when that may or may not be true. Probing means pushing for more information. Disagreeing conveys disapproval of the patient's verbalization. Active listening is a therapeutic strategy.

Which ethical principle is breached when a nurse discusses a patient by name at home with a family member? A.) Fidelity B.) Privacy C.) Justice D.) Beneficence

A Fidelity means being faithful and true to the charge of acting in the best interest of the patient. In this example, it means protecting the privacy of the patient. Privacy itself refers to the right of patients to choose care and what happens to their bodies. Justice refers to fairness and treating patients equally. Beneficence refers to doing good.

Two-way communication differs from one-way communication because with one-way communication a. no feedback is expected. b. the impact is positive. c. the receiver contributes as much as the sender. d. body language does not affect the receiver.

A It is true that in one-way communication, the sender does not expect the receiver to provide feedback. The impact of one-way communication is not always positive. The receiver of one-way communication does not contribute to the interaction. Body language may affect the receiver.

Which action cannot be implemented by the licensed practical nurse? A.) Order and interpret laboratory tests. B.) Serve as a charge nurse. C.) Teach patients about cleanliness and nutrition. D.) Identify new nursing problems.

A Licensed practical nurses can initiate teaching for basic health habits such as cleanliness and nutrition and identify new nursing problems, which are then reported to the RN. Licensed practical nurses can be charge nurses in nursing homes and long-term care facilities. Nurse practitioners can order and interpret laboratory tests, as well as prescribe medication in their advanced practice role.

Which statement would the nurse disregard when considering the personal code of ethics applied to nursing? A.) A nurse may refuse to give postabortion care to a woman if ethically opposed to abortion. B.) A nurse may ethically refuse to assist with an abortion procedure if his or her objection is presented in writing and discussed during employment. C.) The nurse's best strategy is to seek employment in places that do not participate in ethical services of which he or she disapproves. D.) The nurse may present a statement of objection to a procedure, based on religious or moral reasons, before starting employment.

A Refusing to give postabortion care to a woman may be considered abandonment of the nurse's patient and is a legal problem. If the agency or hospital adopts a new procedure/service after a nurse has been employed that is incompatible with the nurse's moral or religious beliefs, then the nurse can discuss and present a written objection. If the agency/hospital offers services or procedures that are incompatible with a nurse's beliefs prior to hire, the nurse can discuss these during the interview or decide not to accept employment.

An LPN/LVN provides care that acknowledges the patient's preferences, needs, and values and communicates these to other members of the health care team. Which type of care is the LPN/LVN providing? A.) Relationship-centered care B.) Total patient care C.) Holistic care D.) Patient-centered care

A Relationship-centered care includes a therapeutic relationship with the patient and family. It also, unlike total, holistic, and patient-centered care, includes a professional relationship with members of the health care team for the purpose of respecting and responding to the patient's needs, preferences, and values.

Which type of active listening behavior is demonstrated when a patient reports chest pain and the nurse asks the location of the pain? A.) Clarification B.) Restating C.) Reflection D.) Summarizing

A Summarizing involves briefly stating the main idea. Reflection involves putting into words information received from the patient at the level of affective communication. Restating involves repeating in a slightly different way what the patient has said. Clarification, as exemplified here, involves asking a closed-ended question to ensure that the nurse has understood the patient.

Which outcome is emphasized in The Affordable Care Act? A.) Quality care alternatives B.) Less care for individuals with acute care needs C.) Decreased compensation for physicians D.) Fewer roles for nurses

A The Affordable Care Act supports high-quality, lower cost health care alternatives, many of which may be options in the community setting. Transition care is a major theme. With an aging population, including the nursing workforce, and increased care options, RNs and LPNs/LVNs may enjoy increased opportunities for employment.

Which ethical principle is demonstrated when a nurse gives the wrong medication to a patient and reports it immediately to the supervisor? A.) Beneficence B.) Fidelity C.) Justice D.) Nonmaleficence

A The example is more consistent with beneficence in which the concern is for the greater good or that of patient rather than for self. Nonmaleficence means to do no harm. Fidelity means to be true.

A way of practicing fidelity to a patient would be to a.document the patient's expression of feelings and wishes. b. develop the care plan without patient input. c.discuss the patient with friends at a social gathering. d.categorize the patient as a "down-and-out alcoholic."

A The nurse who documents the patient's expression of feelings or wishes without subjective interpretation is demonstrating fidelity (being true) to the patient. The other options demonstrate lack of fidelity.

A patient is crying. The nurse can correctly conclude from this type of nonverbal communication that a. the situation needs clarification. b. the patient is sad. c. the tears reflect happiness. d. the patient is in pain.

A The reason for the patient's crying cannot be determined on the basis of the data supplied. The patient could be sad, happy, or in pain. The situation needs clarification.

Which statement identifies the situation step in SBAR? A.) "Hello, my name is Mrs. Smith; I'm the charge nurse on 5N." B.) "Mr. Jones has been admitted with left-sided chest pain." C.) "Mrs. Jones is deteriorating rapidly and needs transfer." D.) "Jacob is on 4 L of oxygen by mask."

A This information is included in the situation step of SBAR. The information in option B is included in the background step of SBAR. The information in option C is included in the background step of SBAR. The information in option D is included in the assessment step of SBAR.

Which statement is true about communication? A.) Verbal, nonverbal, and affective communication must be congruent for the communication to be honest. B.) Medical jargon is usually helpful when communicating with patients. C.) Common expressions are not appropriate for patients. D.) Cultural characteristics do not influence communication.

A Verbal, nonverbal, and affective communication must mirror each other for the communication to be honest and trusted by the patient. Use of common expressions or colloquialisms is appropriate for some patients. Medical jargon is rarely helpful. Cultural characteristics can influence communication.

Healthcare Proxy

A person designated to make medical decisions for someone who is incapacitated. only for healthcare. not finances etc. like a durable power of attorney.

Introjection

A process of taking in the values and standards of others.

Which situation is important in resolving conflict situations? (Select all that apply.) Select all that apply. A.) See conflict as an opportunity to learn. B.) Ensure that the other parties know what they did wrong. C.) Avoid conflict at any cost. D.) Use "I" statements. E.) Think before reacting.

A, D, E, Conflict is a natural part of relationships and can be an opportunity to learn through the correction of wrong assumptions and information. When conflict is avoided, then it can escalate because there are misunderstanding and hurt feelings, which can affect patient care. When involved in conflict, it is important to show respect for the other parties and to use assertive communication that includes the use of "I" statements. Pausing to think enables time to gather thoughts and consider other information.

The following describes likely job settings and the job role of an LPN/LVN working as a vital member of the interprofessional team (Select all that apply.) a. Community: Team member for a chronically ill pediatric client in their home b. Long-term care: Charge nurse on the evening shift of a skilled care facility c. Acute care: Charge nurse on a surgical unit d. Community: Team member in a geriatric clinic e. Long-term care: Director of Nursing supervising skilled care and personal care units

A, b, D

Which health care members are considered part of the interdisciplinary team? (Select all that apply.) A.) LPNs/LVNs B.) Nurse practitioners C.) Clinical instructors D.) NAs E.) RNs F.) Student nurses

A,B,C,D,E,F Nurses in advanced practice roles (e.g., NPs), LPNs/RNs, student nurses, nursing assistants (NAs), clinical instructors, and RNs are all nursing members of an interdisciplinary team.

SPN/SVN are discussing the steps necessary to make an autonomous decision. Which statements indicate that the SPN/SVN understand the steps of autonomous decision-making? (Select all that apply.) a. Voluntary without pressure b. Fair to all parties involved c. Doctor suggests his personal solution d. Nurse provides evidence to assist the client in decision-making e. Personal gain is achieved

A,B,D

Which statements by the nurse are correct regarding informed consent and someone who requires an interpreter? (Select all that apply.) a. A professional interpreter is needed. b.If necessary, family members can make decisions regarding informed consent. c. A family member may interpret when convenient. d. Detailed medical information remains a priority. e.Professional interpreters are not effective in providing medical information.

A,B,D If a patient is illiterate or requires an interpreter, the method of obtaining informed consent must be adapted appropriately. Use of a professional interpreter rather than a family member is essential to provide detailed medical information accurately. A patient whose culture prefers to allow other family members to make final health care decisions is inconsistent with nursing's ethical belief in autonomy. However, in this situation, the method of obtaining informed consent may need to be adapted to meet the patient's beliefs within the scope of the law.

A health care provider has reprimanded you at the client's bedside. You feel an instant flash of anger, but you say nothing. When the health care provider leaves the room, you follow quickly to catch up before they move on to another room. Which of the following is an appropriate response? (Select all that apply.) a. "Dr. Jones, I wish to speak with you privately." b. "How dare you shame me in front of a client?" c. "Please explain what you wanted me to know." d. "In the future, please ask to talk to me privately, not at the bedside." e. "I am going to report you to my nursing supervisor."

A,c,d

If a nurse threatens to strike a patient while rushing toward the patient in an angry manner, which intentional tort has been committed? a. Assault b. Battery c. Negligence d. Invasion of privacy

ANS: A Assault takes place when a threat of bodily harm is associated with a feeling of imminent harm and a demonstration of force by the perpetrator. Actual physical harm must have occurred in order for the offense to be considered battery. Negligence is an unintentional tort, and invasion of privacy relates to disclosure of private information or simple intrusion into a person's personal space.

Which statement is true regarding codes of ethics and laws? a. Ethical codes hold professionals to a higher standard than the law. b. Laws limit the scope of codes of ethics in most professions. c. Breaking the law is not always an ethical code violation. d. Codes of ethics delineate punishments for breaking laws.

ANS: A Professional ethical code requirements exceed legal standards of practice. Codes of ethics expand on legal requirements rather than being limited by the law. Breaking any law is a violation of ethical standards, and punishment for breaking laws is established by the legal system.

Which Nursing diagnosis would be most appropriate for a patient expressing frustration with his inability to function independently following shoulder surgery? a. Powerlessness b. Social isolation c. Anxiety d. Fear

ANS: A The Nursing diagnosis of powerlessness denotes a lack of personal control over situations, which is reflected in this patient's verbalized frustration. Social isolation exists if a person desires additional contact with others and is unable to achieve it. The Nursing diagnosis of anxiety is defined as a general uneasiness while fear is a concern related to an identifiable source that is perceived as dangerous. No indications of social isolation, anxiety, or fear are evident in the patient's stated frustration.

What strategies would promote effective communication with a patient who is blind or deaf? (Select all that apply.) a. Provide adequate lighting when conversing with deaf patients. b. Stay within 3 to 6 feet while speaking to a visually impaired patient. c. Stay within 3 to 6 feet while speaking to a hearing-impaired patient. d. Utilize an interpreter to explain medical procedures to a deaf patient. e. Use light touch to arouse blind patients sleeping in a noisy environment.

ANS: A, C, D, E Providing adequate lighting assists people with hearing impairment to lip read. Staying within 3 to 6 feet of patients while talking is important when interacting with hearing-impaired patients, not visually impaired patients. Sign language interpreters are the best people to communicate detailed procedural information with deaf patients. Light touch will alert blind individuals who are sleeping that someone is present with them. This is especially true in a noisy environment when the person's approach cannot be heard.

An adult patient is mentally incompetent to make personal health care decisions. Which advance directive should the nurse refer first prior to contacting a person to provide consent for the patient? a. Living will b. Health care proxy c. Do not resuscitate orders d. Durable power of attorney

ANS: B A patient's health care proxy specifies who is to make health care decisions for individuals who are unable to comprehend information. It limits the scope of power of the designated individual to health care and treatment decisions. If a patient has not established a health care proxy, then the nurse would default to contacting a patient's durable power of attorney, who may be charged with the responsibility of making all legal decisions on behalf of the patient. A living will specifies treatment desired by patients if they are no longer capable of making decisions. Do not resuscitate orders are written by a patient's primary health care provider in consultation with patients, their immediate family members, and/or their health care proxy or durable power of attorney, if a health care proxy is not designated.

In order to effectively communicate via written e-mail with patients from an outpatient facility, a clinic nurse must implement which strategy? a. Look for visual cues. b. Verify shared information. c. Listen for voice inflection. d. Validate nonverbal signs.

ANS: B Electronic communication requires verification of information to avoid misinterpretation. Nonverbal signs, visual contact, and voice inflection cannot be evaluated via written e-mail communication.

Which action by a nurse demonstrates an understanding of diversity factors related to proxemics? a. Assigning a male nurse to care for a young female Middle Eastern patient who needs total care b. Standing at least 18" away from English-speaking patients when discussing medical concerns c. Recognizing the need for greater personal space of people born in highly populated areas d. Acknowledging the need of teens for greater physical contact than toddlers during hospitalization

ANS: B English-speaking people typically prefer at least 18" of distance between themselves when conversing. It is preferable to assign a same gender nurse to care for a young female Middle Eastern patient who will require personal care. People born in more densely populated areas typically require less personal space rather than more. Children demonstrate a need for greater personal space as they age.

What nursing intervention best demonstrates a commitment to patient autonomy? a. Encouraging a patient to ambulate independently following surgery b. Collaborating with a patient while developing the patient's care plan c. Establishing patient-centered goals for decreased chronic pain d. Assessing a patient for potential postprocedural complications

ANS: B Patient autonomy is supported when patients are encouraged to participate in personal care decisions. Encouraging patient ambulation and completing a patient assessment are responsibilities of the nurse to promote patient wellness. Writing patient-centered goals without input from the patient does not indicate a commitment to autonomy.

Which components must exist for nursing malpractice to be established? (Select all that apply.) a. Intent of harm to the patient b. Omitted or substandard care c. Injury resulting from care provided d. Responsibility to provide nursing care e. Emotional distress

ANS: B, C, D Dereliction, direct cause, duty, and damages must all be established in cases of malpractice. Intent to harm someone is not a requirement for malpractice, nor is emotional distress.

In relationship to a nurse's ability to communicate, effectiveness in which type of communication most demonstrates professional competence? a. Public b. Small group c. Interpersonal d. Intrapersonal

ANS: C A majority of nursing practice involves interpersonal communication with patients and other health care team members; therefore, excellent interpersonal skills are the most reflective of professional competence. A nurse's effectiveness in public speaking, small group leadership, and use of intrapersonal communication is less indicative of professional expertise.

Physical assessment of a patient requires the nurse to function most often in which area of a patient's space? a. Personal b. Social c. Intimate d. Public

ANS: C A majority of physical assessment functions such as monitoring blood pressure, assessing bowel sounds, and checking pedal pulses require touching the patient. Intimate space is considered to be a distance of 0 to 1.5 feet. Personal space according to the theory of proxemics is 1.5 to 4 feet. Social space is 4 to 12 feet and public space is considered to be more than 12 feet.

Which action by the nurse best demonstrates patient advocacy? a. Asking a hospitalized patient's name preference prior to care b. Fostering autonomy and independent decision making c. Arranging transportation home for a patient who is unable to drive d. Sharing evidence-based practice data with other health care professionals

ANS: C Advocacy requires a nurse to be assertive and "go the extra mile" in providing for a patient's needs. Calling a patient by a preferred name and fostering autonomy demonstrate respect. Sharing evidence-based practice data with other professionals is collaboration.

If a student nurse is asked by a staff nurse to complete a patient care procedure that the student has previously performed only in lab, what response by the student best exemplifies an ethical commitment to both safe practice and learning? a. Asking the staff nurse to perform the care procedure while the student observes b. Locating the clinical instructor to provide the patient care procedure with student oversight c. Reviewing the procedure prior to initiating the patient care with supervision of a registered nurse d. Requesting the help of another student who has previously performed the patient care procedure

ANS: C First reviewing the procedure and then completing it under the supervision of a registered nurse provide for both the patient's safety and the student's learning. Students should take every opportunity to apply their lab skills in real patient care settings. Asking the instructor or a fellow student to complete a procedure that has already been practiced in lab does not indicate an ethical commitment to safe practice or learning.

Which action by the nurse best illustrates the ethical concept of fidelity? a. Caring for an incarcerated patient without expressing disdain b. Weighing the benefits versus the risks of medical treatment c. Ensuring that patients receive care that is promised d. Endorsing equal access to health care for everyone

ANS: C Nurses demonstrate the ethical concept of fidelity by keeping their promises, which serves to enhance trust levels among themselves and their patients. Weighing the benefits and risks of medical treatment is necessary for sound decision making but is not an illustration of fidelity. Caring for all patients regardless of their actions and endorsing equal access to health care are both examples of a commitment to justice.

Which action by a patient indicates participation in the working phase of an effective nurse-patient helping relationship? a. Sharing of pertinent demographic data b. Exchanging of personal e-mail addresses c. Reflecting on the emotional aspects of illness d. Transitioning care to another health care provider

ANS: C Personal reflection is a component of the working phase of the nurse-patient helping relationship. Sharing of demographic data takes place during the orientation phase. Exchanging of personal e-mail addresses is a violation of professional role boundaries and should not take place in a nurse-patient helping relationship. Transferring responsibility for care is done during the termination phase.

Which statement by the nurse best promotes reflection on a patient's statement? a. "I don't quite follow what you are asking." b. "Tell me when you started having pain." c. "You seem excited to be going home." d. "Your vital signs are excellent today."

ANS: C Reflection focuses on feelings or emotions identified by the patient (either verbally or nonverbally) and is encouraged by stating, "You seem excited to be going home." Seeking clarification is exhibited in the statement, "I don't quite follow what you are asking." "Tell me when you started having pain" is a component of assessment. Informing a patient of his/her vital signs is a form of giving information.

Decisions regarding the legality of licensed practical nurses administering intravenous therapy established in the Nurse Practice Act are determined by which type of law? a. Constitutional b. Statutory c. Regulatory d. Case

ANS: C Regulatory law outlines how the requirements of statutory laws, such as the Nurse Practice Act, will be met. Constitutional law defines powers of governments and responsibilities of elected officials. Judicial decisions on specific court cases establish case law.

Veracity mandates which action by the nurse if a cancer patient inquires about diagnostic test results that show further metastasis of the patient's cancer? a. Telling the patient that the diagnostic test results are not available yet from the laboratory b. Avoiding contact with the patient to prevent accidental disclosure of the information c. Encouraging the patient to discuss the results with the provider who ordered the tests d. Sharing that the test results do not appear to indicate any significant changes at this time

ANS: C Veracity requires that a person tell the truth. Since the provider who ordered the diagnostic tests has the most extensive knowledge of the patient's case, it would be best for the patient to discuss the results with that person. In this way the patient can receive the diagnostic test results and immediately discuss possible implications and treatment options. Nurses are always honest with their patients and resist the urge to avoid uncomfortable situations.

When a patient with stool incontinence and significant body odor is admitted to the floor from the Emergency Department, what is the most appropriate first response of the nurse? a. Treat the incontinence episode in a matter-of-fact manner. b. Notify the ED personnel that transporting a patient in this condition is inexcusable. c. Explain how daily hygiene is important while assessing the patient. d. Assist the patient in getting cleaned up without expressing frustration.

ANS: D Focusing on the needs of the patient is the nurse's first priority. When a patient is ill and newly admitted to a nursing floor, it is most important to assist the patient with care needs and address procedural issues at a later time. Being matter-of-fact does not go far enough; the nurse needs to convey acceptance of the patient. At a later time, it may or may not be appropriate to use the proper channels of communication within the hospital to discuss issues concerning the condition of patients admitted to nursing floors. A discussion of daily hygiene is unnecessary and might be offensive.

What action by the nurse at the site of a motor vehicle accident is critical in order for requirements of the Good Samaritan Act to be met? a. Accepting compensation for professional services b. Transferring rescue efforts to family members c. Providing all needed emergency intervention d. Performing within nursing standards of care

ANS: D Good Samaritan laws in all states require that nurses provide care within their scope of knowledge and standards of care. This is the only way for nurses to avoid charges of negligence, even in the case of an emergency. No fees can be accepted or charged for services in order for a nurse's actions to be covered by a Good Samaritan Act. Rescue efforts should be transferred to equally competent professionals such as paramedics or emergency department personnel if the nurse is discontinuing care. Each nurse has a legal responsibility to provide only emergency care that is within his/her scope of nursing practice.

In the United States, practicing nursing without a license is what type of offense? a. Misdemeanor b. Malpractice c. Battery d. Felony

ANS: D Practicing nursing without a license in the United States is a felony rather than a misdemeanor due to the serious nature of the offense. Battery involves causing physical harm, which may not always occur as a result of someone impersonating a nurse. Malpractice is professional negligence. A misdemeanor crime is one of lesser consequence that might be resolved through a fine.

SPN/SVN are discussing the difference between personal and professional ethics. Which statements indicate the SPN/SVN's understanding of this concept? (Select all that apply.) a. Personal ethics means the same as beneficent paternalism. b. Professional ethics sometimes conflict with the law. c. Personal ethics provide guidelines for one's life. d. Professional ethics means you cannot abandon the client. e. Personal ethics can conflict with professional ethics.

B,C,D,E

What action by the nurse would most ensure accurate interpretation of patient communication? a. Providing feedback regarding the conveyed message b. Writing down the patient's conversational highlights c. Assuming significant cultural differences exist d. Verifying the patient's emotional state

Answer: a Feedback is the most effective way to avoid misinterpretation of a message. It helps ensure that the message sent is perceived by the receiver in a way that is consistent with the intention of the sender. Writing down conversational highlights is a form of documentation that can still be misinterpreted unless feedback is sought. Avoid making assumptions regarding cultural differences. Verifying a patient's emotional state provides insight into a patient's state of mind, but it does not ensure accurate interpretation of a conversation.

What strategy would be most effective in communicating with a highly anxious adult immediately before surgery? a. Providing specific, concise instructions b. Detailing likely causes of their anxiety c. Focusing on postoperative details d. Using instructional multimedia DVDs

Answer: a Only essential information supplied in short, succinct sentences can be comprehended by adults who are extremely anxious. The source of this patient's anxiety is already stated to be the surgery, so the nurse need not elaborate on it. Postoperative teaching is best completed well in advance of surgery and reinforced after completion of the procedure. Multimedia DVDs are not effective teaching tools immediately before surgery. They may be helpful for a patient to watch at least 24 hours before a scheduled procedure to allow time for elaboration on topics not totally understood by the patient. Nurses must always check with the patient to verify that critical information is understood regardless of what form of communication has been used.

On which ethical theory do nurses implement their care when they act on the basis of the needs of one specific patient rather than the potential consequences to other patients? a. Deontology b. Autonomy c. Utilitarianism d. Nonmaleficence

Answer: a The ethical theory of deontology focuses on the act rather than on the consequences. Autonomy is an ethical concept that values an individual's right to make personal decisions. Utilitarianism is an ethical theory that focuses on the consequences of an action and the good of many rather than of an individual. The ethical principle of nonmaleficence asserts an obligation to "do no harm."

If a patient is grimacing, what assessment statement or question would be most beneficial in identifying the underlying cause of the nonverbal communication? a. "Did you lose something?" b. "You appear to be having pain." c. "I will turn off the lights and let you rest." d. "May I get you something to relieve your tension?"

Answer: b Grimacing is a common nonverbal sign of pain. Sharing an observation encourages the patient to elaborate on nonverbal communication. Asking the patient whether something is lost indicates that the nurse has not attended to the nonverbal cues of the patient. It is important to do an assessment of the patient before initiating any interventions.

If a patient's verbal and nonverbal communications are inconsistent, which form of communication is most likely to convey the true feelings of the patient? a. Written notes b. Facial expressions c. Implied inferences d. Spoken words

Answer: b Nonverbal communication is the more accurate mode of conveying feelings. When a patient's verbal and nonverbal cues are incongruent, it is important to explore observations made by the nurse to discern the true feelings of the patient. Written notes, implied inferences, and spoken words do not provide the opportunity for observing nonverbal cues.

What is the best way for a nurse to avoid crossing professional practice boundaries with patients? a. Spend extensive time with a patient without visitors b. Focus on the needs of patients and their families c. Intervene in problematic patient relationships d. Relay personal stories when unsolicited

Answer: b The best way to avoid crossing professional practice boundaries is to focus on the patient's needs and those of the patient's family. Nurses should consistently avoid unsolicited self-disclosure of personal information, intervening in patient relationships, and spending excessive amounts of time with one patient. In addition to keeping patients' secrets, gaining personally from a relationship with a patient, and engaging in sexual overtures or behavior with a patient, are considered violations of professional boundaries.

Which defense mechanism is being exhibited when a 27-year-old patient insists on having a parent present during routine care? a. Denial b. Regression c. Repression d. Displacement

Answer: b Young adults who require their parents' presence for routine care are exhibiting regression, which is behavior consistent with earlier stages of development. Patients in denial refuse to see the reality of their situation. Repression is storing painful feelings in the unconscious, causing them to be temporarily forgotten. Displacement transfers emotional energy away from the actual source of stress to an unrelated object or person.

Which nursing intervention is the best example of patient advocacy? a. Collecting blood samples according to the physician's order each morning b. Assessing the vital signs of a patient who is receiving a blood transfusion c. Seeking an additional analgesic medication order for a patient who is experiencing severe pain d. Accompanying an ambulating patient who is walking for the first time after undergoing surgery

Answer: c Advocacy requires a nurse to work on behalf of others who may be unable to speak for themselves. When a patient is in pain and the physician or primary care provider is not present, a nurse must advocate for the patient's needs by initiating contact with the person responsible for addressing an immediate need. In this case, an order for additional pain medication is needed, which requires collaboration with the patient's physician. Collecting blood samples, assessing vital signs, and assisting a patient with ambulation are primary responsibilities of the nurse that do not require advocacy to meet the patient's need.

What would be the best therapeutic response to a patient who expresses indecision about recommended chemotherapy treatments? a. "Can you tell me why you are undecided?" b. "It's always a good idea to have chemotherapy." c. "What are you thinking about the treatments at this point?" d. "You should follow whatever your health care provider recommends."

Answer: c Asking open-ended questions allows patients to share freely on a subject. "Why" questions, using closed-ended questions, and giving advice are all nontherapeutic communication techniques that limit patient reflection and sharing on topics of concern.

Making prejudicial, untrue statements about another person during conversation may expose a nurse to being charged with what offense? a. Libel b. Assault c. Slander d. Malpractice

Answer: c Conversation that includes prejudicial and false statements about another person is an example of oral defamation of character or slander. Libel is the written form of defamation of character. Assault is a threat of bodily harm accompanied by a sense of imminent danger. Malpractice is professional negligence caused by unsafe practice.

What action should the nurse take if an alert and oriented patient asks the nurse for personal contact information? a. Ask the patient why the personal information is needed. b. Report the interaction to the nursing supervisor immediately. c. State that it would not be appropriate to share that information. d. Change the subject, and hope that the patient does not ask again.

Answer: c It is important for the nurse to immediately communicate that sharing personal contact information with patients is inappropriate and violates professional role boundaries. Asking "why" questions and changing the subject are nontherapeutic. Neither action will discourage the patient from further infringing on the nurse's personal right to privacy. Reporting the interaction to a supervisor may be helpful for preventing other nurses from experiencing similar requests; however, the first action taken by the nurse should be to maintain professional role boundaries.

What nursing intervention is best when a patient is struggling with the decision to abort an abnormally developing fetus discovered during genetic testing in the first trimester of pregnancy? a. Recommend additional testing b. Refer the patient to an abortion clinic c. Listen to the patient's concerns d. Discuss regional adoption agencies

Answer: c Listening is the best option for the nurse when patients are considering ethical care decisions. Patients often need someone to listen to their verbalized concerns to sort out feelings about the situation and make decisions that are best for them. The patient's primary care provider is responsible for recommending further testing or making requested patient referrals

A hospitalized patient experiences a sharp, stabbing pain while visiting with his spouse. Both the patient and his wife become very concerned, and the patient's call light is activated. What referent initiated communication between the patient and the nurse? a. Interaction between the patient and his wife b. Concern on the part of the patient's spouse c. Pain experienced by the patient d. Activation of the call light

Answer: c Pain is the referent that initiated the communication process. The interaction between the patient and his wife was the result of the patient's pain as was the concern of the patient's spouse. The call light could be considered a channel through which the patient's interaction with the nurse began.

What action should nurses who demonstrate accountability take if they forget to administer a patient's medication at the ordered time? a. Document the medication as refused by the patient. b. Administer the medication as soon as the error is discovered. c. Record the medication as given after making sure the patient is okay. d. Follow the administration and documentation procedures for medication errors.

Answer: d Agency procedures must be followed after every medication error. Care must be taken to adhere to medication administration recommendations and documentation requirements to legally record the incident and provide patient safety. Documenting that the patient refused or already took the medication, when that is not factual, is illegal and unethical, regardless of the patient's condition. Administering the medication as soon as the error is discovered may not be recommended, depending on the medication's potency and frequency of administration

If a student nurse overhears a peer speaking disrespectfully about a patient, nurse, faculty member, or classmate, what is the most ethical first action for the student nurse to take? a. Discuss the peer's actions during group clinical conference b. Ignore the initial occurrence and observe if it happens again c. Report the actions of the classmate to the clinical instructor d. Speak to the peer privately to prevent further occurrences

Answer: d Alerting the peer who has acted disrespectfully in a private setting is the most professional way to approach this situation. It is never appropriate for a professional to belittle or reprimand a peer in front of others. Ignoring disrespectful behavior may only perpetuate its occurrence. Seeking help from a clinical instructor would be appropriate if the peer does not respond to the initial intervention from the fellow student.

Which statement is most accurate regarding symbolic expression? a. Skills confidence can be shared most effectively by nurses through wearing distinctive clothing. b. Clothing choices by a hospitalized patient rarely reflects his or her economic resources. c. Make-up use by a patient is unnecessary for any reason during hospitalization. d. Nondramatic make-up use and minimal accessorizing by nurses demonstrates professionalism.

Answer: d Nurses demonstrate professionalism by adhering to institutional dress codes that require minimal accessorizing and cosmetic use. Wearing distinctive clothing is not linked to skills confidence. Clothing choices often reflect the economic resources of an individual, and make-up use by a hospitalized patient is a personal preference that should be honored.

What action should a nurse take if a patient who needs to sign an informed-consent form for nonemergency surgery appears to be under the influence of drugs or alcohol? a. Contact the physician to see what should be done. b. Ask the patient's spouse to sign the informed-consent form. c. Request permission to bypass the need for a signed consent form. d. Wait to have the informed-consent form signed when the patient is alert and oriented.

Answer: d When a normally competent patient is assessed to be under the influence of alcohol or drugs, it is the nurse's responsibility to delay a nonemergency procedure until legal informed consent can be obtained from the patient. Only in the case of an emergency is it possible to obtain informed consent from a spouse or designated power of attorney for a temporarily impaired adult. It is not necessary to contact the physician for guidance on what should be done, because there is an established legal procedure to follow. The nurse should contact the surgeon who is scheduled to perform the surgery and the operating room staff regarding the need to delay due to the patient's status.

Which factors influence whether a message is effectively communicated? (Select all that apply.) a. Timing of the conversation b. Educational level of participants c. Mode of communication used d. Physical environment of discussion

Answers: a, b, c, d Timing of a conversation dramatically influences the receptivity of the receiver. The educational level of those seeking to communicate has an impact on the type of language and technical terminology that can be used in conversation. Using more than one mode of communication can enhance the effectiveness of a message. Making sure the environment is devoid of excess noise and distraction can facilitate a greater understanding of shared information.

What legal consequences may a nurse experience if the nurse is convicted of a crime? (Select all that apply.) a. Loss of nursing licensure b. Employment affirmation c. Monetary penalty d. Unit transfer e. Imprisonment

Answers: a, c, e Nurses who are convicted of a crime may have their nursing licenses revoked, be required to pay fines or pay restitution to patients or their families for damages, and be incarcerated for various periods, depending on the severity of the crime. Nurses who commit crimes are most often placed on probation pending the outcome of court proceedings or dismissed from their employment, not affirmed or transferred to work on another unit.

Nursing students are held to which standards by the Code of Ethics for Nurses? (Select all that apply.) a. Clinical skills performance equal to that of an experienced nurse b. Demonstration of respect for all individuals with whom the student interacts c. Avoidance of behavior that shows disregard for the effect of those actions on others d. Accepting responsibility for resolving conflicts in a professional manner e. Incorporating families in patient care regardless of patient preference

Answers: b, c, d Nursing students are expected to demonstrate respect, avoid hurting others by their actions, and take responsibility for resolving conflicts in a professional manner, much the same as professional nurses. Student nurses are not required to perform clinical skills at the level of expertise exhibited by an experienced nurse. Involving a patient's family in care without the patient's approval indicates a lack of respect for patient autonomy.

"Jacob is on 4 L of oxygen by mask." What part of SBAR is this?

Assessment

After seemingly successful treatment for depression and a serious suicide attempt, a client will be in court this morning to be reviewed for release. The client tells the SPN/SVN, "As soon as I get out, I am going to kill myself. Promise me you won't tell anyone." What is the best ethical SPN/SVN action? a. The SPN/SVN promises not to tell anyone. Their personal ethic is to never break a promise when one is made. b. Despite respect for the client's autonomy, ensuring a safe environment is essential. The SPN/SVN reports the client's comment to their supervisor. c. The SPN/SVN believes in waiting to see what will happen and plans to do the same during the court hearing. d. The SPN/SVN keeps the promise made to the client but checks on the client very frequently.

B

Which measure is included in the nursing standards of practice? A.) Acceptability B.) Accountability C.) Autonomy D.) Advocacy

B Autonomy is the freedom to choose. Acceptability measures are not a part of the nursing standards of practice. Nurses are held accountable for all nursing actions that are performed, and the measures of accountability are the nursing standards of practice. Patient advocacy is an ethical and legal responsibility of nurses.

Which example justifies beneficent paternalism? A.) In the development of a care plan for a patient with substance abuse, the patient's input is ignored. B.) A physician asks the court for permission to perform a potentially lifesaving procedure for a child because the parents have refused to sign an authorized treatment form. C.) After a history has been collected from a long-time smoker about to undergo lung surgery for cancer, the patient is placed in a category of chronic smokers with poor prognosis. D.) A patient asks a nurse for an opinion on sinus surgery, and the nurse responds, "Well, if I were you, I would have it done."

B Beneficent paternalism refers to a disrespectful attitude toward the patient and what the patient has contributed to personal care and recovery and is evident in each of the options. Beneficent paternalism, however, is justified in option D because the physician has made a medical decision to save the child's life through legal processes. Options A, B, and C are examples of beneficent paternalism that are not justified by extreme circumstances.

Which roles are included under nursing management and executive roles? (Select all that apply.) a. Charge nurse b. Nurse manager c. Director d. Chief nursing officer e. Supervisor

B,C,D,E The four levels of nursing management include supervisor, nurse manager, director, and chief nursing officer (CNO). Charge nurse is not considered a level of nursing management.

Which statement does not apply to communicating with older adults? A.) Most older adults hear lower pitched sounds more clearly. B.) Communication is more difficult with older adults. C.) Visual information is more permanent than auditory information. D.) Detailed information is best given early in the day.

B Most older adults think more clearly in the morning. Older adult patients tend to hear low-pitched sounds more clearly and remember visual rather than auditory information. It is important to assume that the older adults can hear and communicate effectively.

Which educational specialty a research-focused degree? A.) Clinical nurse specialist (CNS) B.) PhD C.) Nurse practitioner (NP) D.) Doctorate of nursing practice (DNP)

B Nurses who have a research-focused doctorate have a PhD. The DNP is a clinically focused degree. A NP is practice focused, can prescribe, and differs from medical practitioners because of the focus of the NP on psychosocial aspects of patient treatment. A CNS provides role modeling and mentoring and is a clinical resource in a variety of roles.

Which groups are members of a nursing team? a.Occupational therapists, physical therapists, pharmacists b. RNs, LPN/LVNs, nursing assistants c. Radiologists, dietitians, respiratory therapists d. Physicians, pharmacists, dietitians, physical therapists

B RNs, LPN/LVNs, and nursing assistants are members of the nursing team who have been cross-trained to perform selected nursing tasks. The groups listed in the other options are not considered part of the nursing team.

The nurse is admitting a patient with a foul smelling leg wound. Which behavior by the nurse indicates an understanding of appropriate body language? a. Standing at the end of the bed with arms crossed b. Gentle touching of the patient's shoulder c. Using hand gestures to enhance verbal communication d. Facial grimacing at the sight of the wound

B Therapeutic touch, such as holding the patient's hand or touching the patient's shoulder, can provide comfort and may alleviate pain. This is especially true when a patient is undergoing a painful or stressful procedure. Making inappropriate facial expressions may be offensive and hurtful to patients or their family members. The nurse must control his or her facial expressions to avoid communicating disdain or judgmental attitudes in challenging patient care situations. Maintaining a neutral facial expression establishes an environment of caring and openness in which the patient and family members can feel safe to share their innermost concerns. The use of gestures may be challenging to nurses practicing in a multicultural environment. Although they may enhance verbal communication, gestures may be viewed as inappropriate by patients of various cultures. Standing with crossed arms may be indicating a lack of openness or acceptance.

Which ethical principle is being implemented when the nurse checks the temperature of formula before feeding an infant patient? A.) Fidelity B.) Nonmaleficence C.) Beneficence D.) Autonomy

B This is an example of nonmaleficence, which means to do no harm. Fidelity means to be true. Autonomy means to freely choose. Beneficence means to do good.

Which health care team member assists with budgeting, assignment, and evaluation of personnel and maintaining compliance with Medicare requirements? A.) Nursing assistants B.) Unit manager C.) Unlicensed assistive personnel D.) Nursing students

B Unit managers supervise and coordinate management functions for clinical units. Nursing assistants, nursing students, and unlicensed assistive personnel are not responsible for management functions of clinical units.

A 48-year-old woman is given information about what to expect postsurgically smiles and nods while the nurse is speaking. Given the characteristics of communication by women, which action should the nurse implement? A.) Assume that the patient agrees with the information. B.) Ask the patient to tell what she understood from the nurse. C.) Ask the patient if she has any questions about what has been said. D.) Assume that the patient has understood the information.

B Women tend to smile and nod during conversation, which does not necessarily signal that they have understood. It is important for the nurse not to take the smiling and nodding as either agreement or understanding and to ask the patient to repeat back what she thought she heard. A lack of questions may or may not indicate understanding.

When administering a bath to a hearing-impaired patient, what actions should the nurse carry out? (Select all that apply.) a. Speak very loudly into the patient's right ear. b. Control background noise as much as possible. c. Be wary of consistent affirmative answers. d. Adjust the lighting in the room. e. Turn away when responding to a question.

B,C,D When communicating with a hearing-impaired patient, the nurse should make sure that the area is well lit with as little background noise as possible. Hearing aids amplify all sounds, making noisy environments confusing and frustrating. Raising the voice level slightly, speaking clearly, and making sure that the patient can see the nurse's face helps to facilitate communication. Adequate lighting enhances the patient's ability to see the speaker's mouth and face and interpret nonverbal communication. Consistent affirmative answers to the nurse's questions may be an indication that the patient is not hearing the information being shared. Care should be taken to verify that patients truly understand the content of verbal interaction. Extra patience may be required by the nurse to demonstrate caring while communicating with hearing-impaired patients.

"Mr. Jones has been admitted with left-sided chest pain." What part of SBAR is this?

Background

Accountability

Being answerable to ones actions. one of the ethical responsibility's of nurses. Admits to actions w/out having to be questioned. the measures of accountability are the nursing standards of practice; that is, what a prudent nurse with your education and experience would do in a similar situation.

An LPN/LVN hears the following discussion just prior to change of shift. Which statement requires follow-up discussion to ensure the RNs understand the role (aligned with the NPA) of the LPN? a. "The LPN/LVNs assignment will focus on the patients with chronic but stable conditions." b. "The LPN can assist with the new admissions orienting them to the unit and providing data to the RN facilitating the initiation of a care plan." c. "The LPN/LVN can focus on the care for the high-acuity client who needs hourly monitoring due to his exacerbation of COPD." d. "The LPN/LVN is a critical member of the health care team supervised by a RN or health care provider."

C

Student practical nurses are discussing the concept of ethics. Which of the following statements indicate the practical nursing student's best understanding of the concept of ethics? a. "Ethics is an understanding of each person's legal right to access care." b. "Ethics is the worth assigned to an idea or an action, freely chosen, affected by maturity." c. "An understanding the meanings of words such as right, wrong, good, bad, ought, and duty is important to ethical decision-making." d. "An understanding of the customs, habits, and behaviors in a society that are approved by that society describes the term ethics."

C

Encouraging a patient to be involved in planning and carrying out his or her own care is a nursing action that supports the ethical principle of a. justice. b. privacy. c. autonomy. d. confidentiality.

C Autonomy means being free to choose. Possible patient choices include identifying goals and care measures compatible with one's culture, religion, and personal values. Confidentiality means avoiding sharing patient information with anyone not directly involved in care without the patient's permission. Privacy is the patient's right to choose care based on personal beliefs, feelings, or attitudes. Justice means the nurse must deliver fair and equal treatment to all patients, recognizing and avoiding personal bias.

Which of the following does not include ethical codes for LPNs? A.) National Association of Practical Nurse Educators and Services (NAPNES) B.) National Federation of Licensed Practical Nurse (NFLPN) C.) Hospital medical ethics committees D.) Nurse Practice Act

C Hospital medical ethics committees are multidisciplinary and assist with difficult ethical decisions. They do not provide codes of ethics for specific groups. NAPNES has an ethical code for LPNs. NFLPN has an ethical code for LPNs. The Nurse Practice Act has elements of the ethical code for LPNs.

Which best describes the role of the LPN/LVN? a. Works in an independent role b. Initiates all phases of the nursing process c. Assists with all phases of the nursing process d. Initiates all health teaching

C Initiating health teaching, working in an independent role, and initiating all phases of the nursing process are roles of the RN. An RN initiates all health teaching; an LPN/LVN initiates health teaching for basic health habits and reinforces the health teaching of the RN in other areas. An RN works in an independent role; an LPN/LVN identifies possible new nursing problems and reports them to the RN. An RN initiates all phases of the nursing process and formulates nursing diagnoses; an LPN/LVN assists with all phases of the nursing process and works with established nursing diagnoses.

Which example would illustrate how ethics has changed for nursing? A.) A patient does not want to have a diagnostic procedure. The nurse insists that he get ready for the procedure because his doctor has ordered it. B.) A patient has given consent for surgery. Her questions about her preoperative preparation suggest that she is unaware of the exact type of surgery that she is having. The nurse reassures her that "the doctor knows what he is doing." C.) A patient asks the nurse to keep the patient's addiction a secret even though the patient is taking prescribed drugs that could interact with alcohol. The nurse makes a decision based on ethical and legal knowledge. D.) A nurse wonders if it is appropriate to lie to a confused patient about his wife's death. She asks the physician for an order.

C Nursing was initially disease-focused, and both the nurse and patient were highly dependent on the decisions of the physician, who was seen to "know best." With the development of nursing theories and the nursing process and encouragement of critical thinking, nurses were able to make decisions based on additional needs of patients. The situation with the patient who has an addiction represents a legal and ethical decision that the nurse would need to make within her relationship with the patient. The situations in the other options represent nurse behaviors that would have been consistent with an earlier period in nursing and with dependence on the decisions of physicians.

Which example is indicative of one-way communication? A.) A nurse educates and clarifies medication instructions with a patient. B.) "You are telling me you have pain. Where is your pain and when did it start?" C.) "Give me your arm. I'm going to take your blood pressure." D.) A nurse repeats a physician's order back to the physician for accuracy.

C One-way communication is used to provide a command or give information without opportunity for feedback. In this example, the nurse tells the patient what to do and provides information without expectation of feedback. The other options are examples of two-way communication in which there is feedback or discussion.

During a shift report, the nurse briefly describes the history of a patient admitted with chronic gastrointestinal bleeding. In which SBAR topical area would this information be presented? a. Recommendation b. Situation c. Background d. Assessment

C The "B" in SBAR stands for "Background," or what led up to the current situation. The "S" stands for Situation or what is happening right now. The "A" stands for "Assessment," or what is the identified problem, concern, or need. The "R" stands for "Recommendation," or what actions or interventions should be initiated to alleviate the problem.

A patient is preparing for discharge. The patient needs teaching about new medications and help with care needs at home. Which members of the health care team will be involved in assisting this patient with the patient's teaching and discharge needs? A.) Unit manager, pharmacist B.) RN, LPN C.) RN, social worker D.) LPN, social worker

C The RN is the member of the health care team who initiates all health teaching, which includes education about medications and their side effects. The social worker assists the patient to organize care post discharge. The LPN/LVN can reinforce health teaching that has been initially provided by the RN. Unit managers supervise and coordinate management functions rather than providing direct patient care. Pharmacists prepare, compound, and dispense drugs ordered by the physician, dentist, or nurse practitioner.

A patient is admitted to a long-term care facility. The patient has acquired immune deficiency syndrome. The nurse spends less time with the patient than with her other patients on the unit because of the belief that the patient brought on the disease and does not deserve care. Which ethical principle is being breached? A.) Autonomy B.) Fidelity C.) Justice D.) Beneficence

C The breached ethical principle is justice. Justice means to deliver fair and equal treatment to all patients and to avoid personal bias. In this example, the nurse is not treating the patient in a fair and equal manner because of her personal bias about the cause of the disorder.

The patient asks, "What is an IVAC thermometer?" The nurse replies, "It is a heat-sensitive probe inserted into the sublingual area or rectal orifice. Heat transmission proceeds via an electrical system to a control center that interprets the temperature and displays it." This reply can be analyzed as a. displaying sensitivity. b. one-way communication. c. unnecessary use of jargon. d. active listening.

C This explanation is unnecessarily scientific and uses nursing jargon when a simple answer would suffice. The communication described is two-way. Active listening involves responding therapeutically rather than in a confusing manner. The nurse's response displays insensitivity.

A patient with an inoperable brain tumor says to the nurse, "I just want to die now. It's going to happen soon anyway." Which would be the most appropriate response? a. "Honey, now don't you talk like that." b. "I disagree with what you just said!" c. "Tell me why you are saying that." d. "Don't worry about that right now. It'll be OK."

C Using open-ended questions or comments gives the patient the opportunity to share freely on a subject, avoids interjection of feelings or assumptions by the nurse, and provides for patient elaboration on important topics when the nurse wants to collect a breadth of information. Giving false reassurance discounts the patient's feelings, cuts off conversation about legitimate concerns of the patient, and demonstrates a need by the nurse to "fix" something that the patient just wants to discuss. Showing agreement or disagreement discontinues patient reflection on an introduced topic, and implies a lack of value for the thoughts, feelings, or concerns of patients. Using personal terms of endearment, such as "Honey," demonstrates disrespect for the individual, diminishes the dignity of a unique patient, and may indicate that the nurse did not take the time or care enough to learn or remember the patient's name.

Which type of communication block is the nurse demonstrating when telling a depressed patient that all depressed people feel the same? A.) Chiding B.) False reassurance C.) Simple answers D.) Belittling

C With false reassurance, it is not possible to guarantee what was said to the patient. With simple answers, patients feel dismissed and misunderstood. Chiding is scolding for behavior that may be harmful to the patient. Belittling involves making fun of the patient in some way.

SBAR: Background

Client's medical and social history 2. Allergy status 3. Code status 4. If client is in isolation 5. Pain management strategies and response to interventions 6. Imaging studies 7. Lab results 8. Location of peripheral or central venous line access devices 9. Diet 10. Mobility

The nurse recognizes that starting an intravenous (IV) infusion line on a patient against his will may be classified as which wrongdoing? a. Misdemeanor b. Felony c. Assault d. Battery

D Actual physical harm caused to another person is battery. Battery may involve angry, forceful touching of people, their clothes, or anything attached to them. Performing a surgical procedure without informed consent is an example of battery. Actions much more subtle, such as inserting an intravenous catheter or urinary catheter against the will of a patient, also may be classified as battery. Assault is a threat of bodily harm or violence caused by a demonstration of force by the perpetrator. A feeling of imminent harm or feeling of immediate danger must exist for assault to be claimed. A misdemeanor is a crime of lesser consequence that is punishable by a fine or incarceration in a local or county jail for up to 1 year. A felony is a more serious crime that results in the perpetrator's being imprisoned in a state or federal facility for more than 1 year.

Leaving an unconscious patient exposed during a treatment or procedure is a violation of the ethical principle of a. justice. b. fidelity. c. nonmaleficence. d. autonomy.

D Autonomy includes the patient's right to privacy. It is assumed that an autonomous patient would reject unnecessary exposure of the body. Fidelity challenges the nurse to be faithful to the charge of acting in the patient's best interest when the capacity to make free choice is no longer available to the patient. Justice means the nurse must deliver fair and equal treatment to all patients, recognizing and avoiding personal bias. Nonmaleficence is the ethical principle of "first do no harm."

A nurse asks a patient when her pain started. This is an example of which type of question that occurs when a nurse asks a patient to provide a time for onset of pain? A.) Focused B.) Open ended C.) Affective D.) Closed-ended

D Closed-ended questions require a specific answer. This is not a type of question that would be used in affective communication. Open-ended questions allow the patient to respond in a way that is most meaningful to the patient and often begin with what, when, why, where, and how. Focused questions provide definitive information.

The nurse understands "First, do no harm" defines what ethical principle? a. Justice b. Beneficence c. Fidelity d. Nonmaleficence

D First, do no harm is the colloquial definition of nonmaleficence. Unlike beneficence, which requires actively doing good, nonmaleficence requires only the avoidance of harm. In its simplest form, beneficence can be defined as doing good. To do justice is to act fairly and equitably. Keeping promises or agreements made with others constitutes fidelity.

A nurse has been asked to care for a patient who is an inmate from a nearby prison. During shift report, the nurse asks, "Why was the man convicted and imprisoned?" Another nurse responds that this is not important since nurses are required to provide compassionate care for all people in all circumstances. The responding nurse has displayed what concept? a. Confidentiality b. Autonomy c. Advocacy d. Beneficence

D In its simplest form, beneficence can be defined as doing good. Nurses demonstrate beneficence by acting on behalf of others and placing a priority on the needs of others rather than on personal thoughts and feelings. The ethical concept of beneficence necessitates providing care for the prisoner without reproach and provide compassionate care for all people in all circumstances. Supporting or promoting the interests of others or doing so for a cause greater than ourselves defines advocacy. Confidentiality is the ethical concept that limits sharing private patient information. Autonomy, or self-determination, is the freedom to make decisions supported by knowledge and self-confidence.

The nurse is providing care to a patient experiencing pain. The nurse assesses the pain and promptly administers the ordered analgesics as promised to the patient. This nurse has applied what concept? a. Confidentiality b. Accountability c. Autonomy d. Fidelity

D Keeping promises or agreements made with others constitutes fidelity. In nursing, fidelity is essential for building trusting relationships with patients and their families. Following through on promises is a critical factor in establishing strong professional relationships with patients and their families. Autonomy, or self-determination, is the freedom to make decisions supported by knowledge and self-confidence. Accountability is the willingness to accept responsibility for one's actions. Confidentiality is the ethical concept that limits sharing private patient information.

A student nurse comes to clinical with a slightly dirty uniform and is unshaven. The patient questions the student's ability to provide safe care. Which communication method includes clothing and physical appearance? A.) One way B.) Affective C.) Two way D.) Nonverbal

D Physical appearance is part of nonverbal communication because it conveys a nonverbal message about the person. Clothing and other aspects of physical appearance can affect a patient's relationship with a nurse, which is why programs continue to have dress codes. Physical appearance is not an aspect of two-way communication, affective communication, or one-way communication.

Which statement is true about student nurses? A.) Legally, student nurses are expected to provide a different level of care from that of professional nurses. B.) Students are not members of the health care team. C.) Students in the clinical area are there to give service. D.) Students are under the supervision of clinical instructors.

D Students are members of the health care team. The clinical area is an extension of the classroom, in which the clinical instructor continues to teach the students. Students in the clinical area are there to learn, not to give service. Students are responsible for giving the same safe nursing care that professional nurses provide.

The nurse knows which statement indicates an appropriate understanding of ethical practice by the student nurse? a. "Ethics are not important as a student." b."My nurse educators are responsible for my ethical standards." c."I will not be held ethically accountable until I graduate." d."I will be held to the same ethical standards as professional nurses."

D The Code of Ethics for Nurses is "a succinct statement of the ethical obligations and duties of every individual (not just nurse educators) who enters the nursing profession," the profession's "nonnegotiable ethical standard," and "an expression of nursing's own understanding of its commitment to society." This is a powerful mandate for all nurses to communicate and act professionally to prevent inflicting physical or emotional pain on others while pursuing nursing education and engaging in nursing practice.

Which member of the health care team is responsible for initially teaching a patient about medication side effects? a. Patient care technician b. Occupational therapist c. LPN/LVN d. Registered nurse

D The RN initiates all health teaching. This would include education about medication effects and side effects. The LPN/LVN is able to initiate health teaching only for basic health habits, such as cleanliness. Occupational therapists and patient care technicians are not qualified to undertake medication teaching.

Which statement is true regarding licensed practical nurses (LPNs)? A.) The educational progress varies from 24 to 36 months. B.) LPNs are the third largest group of health care workers. C.) Upon graduation, an LPN receives a certificate. D.) LPNs do not function independently.

D The difference between RNs and LPNs is that RNs function independently whereas LPNs/LVNs have a dependent role. Upon graduation, an LPN receives a diploma. LPNs are the second-largest group of licensed health care workers. The educational program varies from 12 to 18 months of full-time study.

Which ethical principle is demonstrated when an older adult patient agrees to colon surgery for cancer after having discussed all aspects of the surgery, risks, and benefits with the surgeon? A.) Beneficence B.) Nonmaleficence C.) Fidelity D.) Autonomy

D The ethical principle described is autonomy. The patient thought through the facts, decided on surgery based on independent thinking, acted based on a personal decision, and voluntarily decided to have the surgery, which are the four components of autonomy. Fidelity refers to remaining true to the best interests of the patient. Beneficence means to do good, and nonmaleficence refers to doing no harm.

A trusting relationship with a patient can be fostered by a. seeing the patient every 5 to 7 minutes. b. identifying the patient by room number. c.making up answers when one does not know the answer. d. introducing oneself and stating one's role.

D Trust begins by gaining the patient's confidence through introducing oneself and stating one's role. Identifying the patient by room number depersonalizes the patient. Seeing the patient every 5 to 7 minutes would be excessive in most situations. Making up answers when one does not know the answer is dishonest.

Deontology vs. Utilitarianism

Deontology: the action is right or wrong Utilitarianism: some "wrong" actions can be good if they result in a good outcome for all. (hungry child stealing food for family)

informed consent

Dr. is responsible for informed consent but nurses need to make sure dr. has explained things and that the pt fully understand. Professional interpreters are needed for lang. barriers. Permission granted by a patient after discussing each of the following topics with the physician, surgeon, or advanced practice nurse who will perform the surgery or procedure: (1) exact details of the treatment, (2) necessity of the treatment, (3) all known benefits and risks involved, (4) available alternatives, and (5) risks of treatment refusal

A patient states, "I don't want to die from cancer." The nurse responds, "I heard you say you don't want to die from cancer." The nurse's response is an example of reflecting, which is an active listening behavior. (T/F)

F The nurse's response is an example of summarizing. Summarizing means briefly stating the main data gathered. For example: Nurse: "This is what I heard you say. Is that correct?"

Verbal communication refers to mood or emotion. (T/F)

F Verbal communication refers to the spoken word. "Affect" refers to mood or emotion. Affective communication is as significant as verbal and nonverbal communication.

A system of standards or moral principles that direct actions as being right or wrong is called logic. (T/F)

False Ethics is a system of standards or moral principles that direct actions as being right or wrong. Ethics is concerned with the meaning of words such as right, wrong, good, bad, ought, and duty.

The role of the LPN/LVN in the health care team is best described as independent. (T/F)

False The LPN/LVN functions interdependently by providing care according to the established plan, collecting data, and offering input to the RN about the effectiveness of care and suggestions for care improvement.

ethics committee

JCO mandates that these committees need to be on call. helps prevent unnecessary legal intervention in patient care matters.

fidelity

Keeping promises or agreements to patient. How nurses build trust. acting in patients best interest faithfully even when patient isn't able to make decision for themselves. this does not include rescuing procedures or paternalism.

Focused questions

More than a yes or no answer, but place limitations on the topic

One-way communication is

One-way communication is used to provide a command or give information without opportunity for feedback.

SBAR

S: Situation B: Background A: Assessment R: Recommendation

"Hello, my name is Mrs. Smith; I'm the charge nurse on 5N." What part of SBAR is this?

Situation

affective communication refers to mood or emotions (T/F)

True

Empathy vs. Sympathy

Understanding what it feels like vs. feeling sorry for someone

SBAR: Assessment

What is the identified problem, concern, or need?

Which of the following statements best describes team nursing as a method of delivering nursing care? a. The method is based on the level of staff skill and client need. b. Task-oriented efficiency is divided among staff across all shifts. c. The RN plans and is accountable for total client care 24 hours a day. d. This method uses scarce nursing resources in a cost-effective way.

a

Which of the following are methods of delivering nursing care in acute care agencies? (Select all that apply.) a. Primary care b. Case method c. Team method d. Functional method e. Delegation method

a b c d

end of life care

a bioethical issue. give support to pt and family. be in touch w emotions.

Confidentiality

a health professional will hold secure all info regarding a patient unless that patient has given consent to discuss. Disclosure is limited to authorized agencies. All healthcare professionals are req. by law to maintain confidentiality.

A nurse had a challenging day at work due to a difficult client assignment and coworkers that were not supportive and did not offer assistance. The nurse decided to verbalize their frustration on social media about their coworkers by calling the coworkers unfair and rude. Which areas could the nurse be considered noncompliant? Select all that apply a. The Health Insurance Portability and Accountability Act (HIPPA) b. NCSBN's A Nurse's Guide to the use of Social Media Guidelines c. Health care facility where the nurse is employed d. State law where the nurse holds a primary license e. National Student Nurses Association Code of Ethics for Student Nurses

b,c,d

"Mrs. Jones is deteriorating rapidly and needs transfer." What part of SBAR is this?

background

Utilitarianism

behaviors are judged to be right or wrong based on how they benefit the greater good/society

Which is an appropriate response to the client when the nurse identifies affectively and nonverbally the client is angry? a. Leave the room and report your observations to the team leader immediately. b. Lighten up the situation by sharing some funny e-mail jokes with the client. c. Provide observations of nonverbal behavior and encourage the client to talk about their feelings. d. Continue what you came in to do silently and leave as soon as you are through.

c

A student has arrived for their first clinical experience in the nursing home. The student wants to do everything right and feels ready because they have an elderly grandmother. Which of the following actions indicate the student's understanding of a positive interaction with a geriatric client? (Select all that apply.) a. Walk in with great enthusiasm and say, "Hi, Grandma, how are you doing?" b. Talk loudly in the resident's left ear to be sure the resident can hear her. c. Say, "Good morning. My name is....... I am a student nurse from the college. Can you confirm your name and birth date?" d. Knock on the door before entering. Take time before moving into the client's personal space. e. Quietly enter the room and touch the person's shoulder while saying "hello."

c, d

interdependent vs independent

interdependent: when RN's carry out orders of another member of the healthcare team. it's about collaboration independent: when nurses use nursing interventions. (turning patients, assessing pt's on bed rest for breathing issues. range of motion exercises. initiate referrals.

Nurse-Patient Relationship: orientation/introductory

introduces self, establishes prof. boundary. observing and assessing pt. identify needs of pt.

RN vs LVN

it is the independent role in decision making that separates RN from LVN

Essential components of communication in professional nursing: advocacy

defending right of those vulnerable and unable to make decisions for themselves.

Unconscious strategies that allow an individual to decrease or avoid unpleasant circumstances.

defense mechanisms

focused questions provide

definitive information

responsibility

dependable and reliable. nurse who is responsible adheres to professional standards of care, complies with institutional policies, meets requirements of continuing education, and follows the orders of physicians and nurse practitioners (NPs).

role of lvn

dependent in nature. assists with all phases of nursing process. identifies and reports to rn initiates health teaching for basic habits (nutrition, hygiene) assists w teaching under RN

Nurse-Patient Relationship: working

develop and implement plan of care collaboration w team enhances trust, nurse uses therapeutic communication to keep needs of pt in focus

Beneficent Paternalism

disrespectful attitude toward the client and what the client has to contribute to personal care and recovery. It is an "I know what's best for you" attitude

Non-maleficence

do no harm

durable power of attorney

document that allows an agent to represent a patient. someone can make legal decisions for pt.

Documentation errors

documentations is the legal record of care. errors: (1) omitting documentation from patient records, (2) recording assessment findings obtained by another nurse or unlicensed assistive personnel (UAP), and (3) recording care not yet provided. Nurses sometimes document that a patient has received medication before its administration. This is a serious violation of the law and becomes a medication error of omission if the nurse is distracted before administering the patient's medication.

Essential components of communication in professional nursing: assertiveness

express ideas and concerns clearly with respect. communicated w pt, pt family, and healthcare team w.out hesitation. demonstrates confidence

Blocks to communication

false reassurance probing judging belittling giving advice simple answers

student nurse role in team

give same care as practicing nurses. expected to assist other team members. and perform clinical assignment

giving advice

implies that the nurse knows what is best for client and that client is incapable of any self-direction. avoid giving advice, ask "what ideas do you have?" then summarize what they've said, go over evidence to assist w decision making

advance directives

includes 3 things: living will, durable power of attorney, and health care proxy.

Advocacy

informing clients of the plan of care. Supporting or promoting the interests of others.

communication w visual impaired

typically have heightened olfactory and auditory senses. communication is anticipatory-alert pt to obstacles. gentle physical contact

SBAR: Recommendation

what actions or interventions should be applied to alleviate problem?

SBAR: Situation

what is happening right now? What the problem is (briefly), when it started, and how severe it is admission date, chief complaint, and diagnosis

Abandonment

withdrawing medical care from a patient without providing sufficient notice to the patient. getting an emergency call and leaving your pt isn't allowed. this is a legal issue.