NP1 Exam 1 Review Questions
Which of the following properly applies an ethical principle to justify access to health care? (Select all that apply) a. access to health care reflects the commitment of society to principles of beneficence and justice b. if low income compromises access to care, respect for autonomy is compromised c. access to health care is a privilege in the US, not a right d. poor access to affordable health care causes harm that is ethically troubling because nonmaleficence is a basic principle of health care ethics e. providers are exempt from fidelity to people with drug addiction because addiction reflects a lack of personal accountability f. if a new drug is discovered that cures a disease but a great cost per patient, the principle of justice suggests that the drug should be made available to those who can afford it
A, B, D
Which of the following are examples of a nurse participating in primary care activities? (Select all that apply) a. providing prenatal teaching on nutrition to a pregnant woman during the first trimester b. assessing the nutritional status of older adults who come to the community center for lunch c. working with patients in a cardiac rehabilitation program d. providing home wound care to a patient e. teaching a class to parents at the local grade school about the importance of immunizations
A, B, and E
The nurse is caring for a patient who is taking nitrofurantoin. Which nursing interventions are appropriate for this patient? (Select all that apply) a. Monitor urinary output and urine specific gravity b. Monitor the patient for peripheral neuropathy c. Advise the patient to take the medication on an empty stomach to enhance absorption d. Warn the patient to avoid excess exposure to sunlight e. Inform the patient that urine may turn a harmless brown color
A, B,E
The American Dental Association suggests that patient who are at risk for poor hygiene use the following interventions for oral care: (Select all that apply): a. Use antimicrobial toothpaste b. Brush teeth 4 times daily c. Use 0.12% chlorhexidine gluconate (CHG) oral rinses d. Use a soft toothbrush for oral care e. Avoid cleaning the gums and tongue
A, C, D
What should the nurse teach a young women with a history of urinary tract infections (UTIs) about UTI prevention? (Select all that apply) a. keep the bowels regular b. limit water intake to 1 to 2 glasses a day c. wear cotton underwear d. cleanse the perineum from front to back e. practice pelvic muscle exercise (Kegel) daily
A, C, D
An ambulatory elderly woman with dementia is incontinent of urine. She has poor short-term memory and has not been sen toileting independently. What is the best nursing intervention for this patient? a. recommend that she be evaluated for an overactive bladder (OAB) medication b. start a scheduled toileting program c. recommend that she be evaluated for an indwelling catheter d. start a bladder-retraining program
B
The patient is taking tolterodine. The nurse plans to teach the patient to report which condition? a. Alkaline urine b. Urinary retention c. Excessive tearing d. Reddish orange urine
B
The nurse observes an adult Middle Eastern patient attempting to bathe himself with only his left hand. The nurse recognizes that this behavior likely relates to: a. Obsessive compulsive behavior b. Personal preferences c. The patient's cultural norm d. Controlling behaviors
C
A critical care nurse is using a computerized decision support system to correctly position her ventilated patients to reduce pneumonia caused by accumulated respiratory secretions. This is an example of which Quality and Safety in the Education of Nurses (QSEN) competency? a. patient-centered care b. safety c. teamwork and collaboration d. informatics
D
Which if the following statements indicate that the new nursing graduate understands ways to remain involved professionally? (Select all that apply) a. "I am thinking about joining the health committee at my church" b. "I need to read newspapers, watch news broadcasts, and search the Internet for information related to health" c. "I will join nursing committees at the hospital after I have completed orientation and better understand the issues affecting nursing" d. "Nurses do not have very much voice in legislation in Washington DC, because of the nursing shortage" e. "I will go back to school as soon as I finish orientation"
A, B, C
Contemporary nursing requires that the nurse has knowledge and skills for a variety of professional roles and responsibilities. Which of the following are examples? (Select all that apply.) A. Caregiver B. Autonomy and accountability C. Patient advocate D. Health promotion E. Lobbyist
A, B, C, D
The nursing staff is developing a quality program. Which of the following are nursing-sensitive indicators from the National Database of Nursing Quality Indicators (NDNQI) that the nurses can use to measure patient safety and quality for the unit? (Select all that apply) a. use of physical restraints b. pain assessment, intervention, and reassessment c. patient satisfaction with food preparation d. registered nurse (RN) education and certification e. number of outpatient surgical cases per year
A, B, D
An 88 year old patient comes to the medical clinic regularly. During a recent visit the nurse noticed that the patient had lost 10 pounds in 6 weeks without being on a special diet. The patient tells the nurse that he has had trouble chewing his food. Which of the following factors are normal aging changes that can affect an older adult's oral health? (Select all that apply) a. Dentures do not always fit properly b. Most older adults have an increase in saliva secretions c. With aging the peridontal membrane becomes tighter and painful d. Many older adults are edentulous, and remaining teeth are often decayed e. The teeth of elderly patients are more sensitive to hot and cold
A, D
Which of the following actions, if performed by a registered nurse, would result in both criminal and administrative law sanctions against the nurse? (Select all that apply) a. taking or selling controlled substances b. refusing to provide health care information to a patient's child c. reporting suspected abuse and neglect of children d. applying physical restraints without a written physician's order e. completing an occurrence report on the unit
A, D
The nursing assistive personnel (NAP) reports to the nurse that a patient's catheter drainage bag has been empty for 4 hours. What is a priority nursing intervention? a. implement the "as-needed" order to irrigate the catheter b. assess the catheter and drainage tubing for obvious occlusion c. notify the health care provider immediately d. assess the vital signs and intake and output record
B
What are the correct steps to resolve an ethical dilemma on a clinical unit? Place the steps in correct order. a. clarify values b. ask the question, is this an ethical dilemma c. verbalize the problem d. gather information e. identify course of action f. evaluate the plan g. negotiate a plan
B, D, A, C, E, G, F
A patient tells a nurse that she is enrolled in a preferred provider organization (PPO) but does not understand what this is. What is the nurse's best explanation of a PPO? a. this health plan is for people who cannot afford their own health insurance b. this health plan is operated by the government to provide healthcare to older adults c. this health plan gives you a list of physicians and hospital from which you can choose d. this is a fee-for-service plan in which you can choose any physician or hospital
C
An 18-year old woman is in the emergency department with fever and cough. The nurse obtains her vital signs, listens to her lung and heart sounds, determines her level of comfort, and collects blood and sputum samples for analysis. Which standard of practice is performed? a. diagnosis b. evaluation c. assessment d. implementation
C
In most ethical dilemmas in health care, the solution to the dilemma requires negotiation among members of the health care team. Why is the nurse's point of view valuable? a. nurses understand the principle of autonomy to guide respect for a patient's self-worth b. nurses have a scope of practice that encourages their presence during ethical discussions c. nurses develop a relationship with the patient that is unique among all professional healthcare providers d. the nurse's code of ethics recommends that a nurse be present at any ethical discussion about patient care
C
Nurses in an acute care hospital are attending a unit based education program to learn how to use a new pressure-relieving device for patients at risk for pressure ulcers. This is which type of education? a. continuing education b. graduate education c. in-service education d. professional registered nurse education
C
The ANA code of nursing ethics articulates that the nurse "promotes, advocates for, and strives to protect the health, safety, and rights of the patients." This includes the protection of patient privacy. ON the basis of this principle, if you participate in a public online social network such as Facebook, could you post images of a patient's x-ray film if you obscured or deleted all patient identifiers? a. yes, because patient privacy would not be violated since patient identifiers were removed b. yes, because respect for autonomy implies that you have the autonomy to decide what constitutes privacy c. no, because, even though patient identifiers are removed, someone could identify the patient on the basis of other comments that you make online about his or her condition and your place of work d. no, because the principle of justice requires you to allocate resources fairly
C
What is a critical step when inserting an indwelling catheter into a male patient? a. slowly inflate the catheter balloon with sterile saline b. secure the catheter drainage tubing to the bed side c. advance the catheter to the bifurcation of the drainage and balloon parts d. advance the catheter until urine flows, then insert it 1/4 inch more
C
When you are assigned to a patient who has a reduced level of consciousness and requires mouth care, which physical assessment techniques should you perform before the procedure? (Select all that apply) a. oxygen saturation b. heart rate c. respiration d. gag reflex e. response to painful stimulation
C, D
Which of the following nursing activities is provided in a secondary health care environment? a. conducting blood pressure screenings for older adults at the Senior Center b. teaching a clinic patient with chronic obstructive pulmonary disease purse-lipped breathing techniques c. changing the postoperative dressing for a patient on a medical surgical unit d. doing endotracheal suctioning for a patient on a ventilator in the medical intensive care unit
C, D
A homeless man enters the emergency department seeking health care. The heath care provider indicates that the patient needs to be transferred to the City Hospital for care. This action is most likely a violation of which of the following laws? a. Health Insurance Portability and Accountability Act (HIPAA) b. Americans with Disabilities Act (ADA) c. Patient Self-Determination Act (PSDA) d. Emergency Medical Treatment and Active Labor Act (EMTALA) without triage completed
D
A patient complains about a burning sensation and pain when urinating. Which urinary analgesic does the nurse suspect will be ordered? a. Tolterodine b. Oxybutynin c. Bethanechol d. Phenazopyridine
D
A woman has sever-life threatening injuries and is hemorrhaging following a car accident. The health care provider ordered 2 units of packed red blood cells to treat the woman's anemia. The woman's husband refuses to allow the nurse to give his wife the blood for religious reasons. What is the nurse's responsibility? a. obtain a court order to give the blood b. coerce the husband into giving the blood c. call security and have the husband removed from the hospital d. more information is needed about the wife's preference and if the husband has her medical power of attorney
D
The examination for registered nurse (RN) licensure is exactly the same in every state in the United States. This examination: a. guarantees safe nursing for all patients b. ensures standard nursing care for patients c. ensures that honest and ethical care is provided d. provides a minimal standard of knowledge for an RN in practice
D
The nurses on a medical unit have seen an increase in the number of pressure ulcers that develop in their patients. They decide to initiate a quality improvement project using the Plan-Do-Study-Act (PDSA) model. Which of the following is an example of "Do" from that model? a. implementing the new skin care protocol on all medicine units b. reviewing the data collected on patients cared for using the protocol c. reviewing the quality improvement reports on the six patients who developed ulcers over the last 3 months d. based on findings from patients who developed ulcers, implementing an evidence-based skin care protocol
D
When a nurse delegates hygiene care for a male patient to a nursing assistive personnel, the NAP must use an electric razor to shave the patient with the following diagnosis: a. Congestive heart failure b. Pneumonia c. Arthritis d. Thrombocytopenia
D
The patient for whom you are caring needs a liver transplant to survive. This patient has been out of work for several months and doesn't have health insurance or enough cash. Even though several ethical principles are at work in this case, list the principles from highest to lowest priority. a. accountability: you as the nurse are accountable for the well-being of this patient b. respect for autonomy: this patient's autonomy will be violated if he does not receive the liver transplant c. ethics of care: the caring thing that a nurse could provide this patient is resources for a liver transplant d. justice: the greatest in this situation is how to determine the just distribution of resources
D, B, C, A
Match the advanced practice nurse specialty with the statement about the role. 1. Clinical nurse specialist 2. Nurse anesthetist 3. Nurse practitioner 4. Nurse-midwife a. Provides independent care, including pregnancy and gynecological services b. Expert clinician in a specialized area of practice such as adult diabetes care c. Provides comprehensive care, usually in a primary care setting, directly managing the medical care of patients who are healthy or have chronic conditions d. Provides care and services under the supervision of an anesthesiologist
1B, 2D, 3C, 4A
When designing a plan for pain management for a postoperative patient. the nurse assesses that the patient's priority is to be as free of pain as possible. The nurse and patient work together to identify a plan to manage the pain. The nurse continually reviews the plan with the patient to ensure that the patient's priority is met. Which principle is used to encourage the nurse to monitor the patient's response to the pain? a. fidelity b. beneficence c. nonmaleficence d. respect for autonomy
A
You are floated to work on a nursing unit where you are given an assignment that is beyond your capability. Which is the best nursing action to take first? a. call the nursing supervisor to discuss the situation b. discuss the problem with a colleague c. leave the nursing unit and go home d. say nothing and begin your work
A
The nurse delegates needed hygiene care for an elderly stroke patient. Which intervention would be appropriate for the nursing assistive personnel to accomplish during the bath? a. Checking distal pulse b. Providing range of motion (ROM) exercises to extremities c. Determining type of treatment for stage 1 pressure ulcer d. Changing the dressing over an intravenous site
B
There is no urine when a catheter is inserted 3 inches into a female's urethra. What should the nurse do next? a. Remove the catheter and start all over with a new kit and catheter b. Leave the catheter there and start over with a new catheter c. Pull the catheter back and reinsert at a different angle d. Ask the patient to bear down and insert the catheter further
B
Which nursing intervention decreases the risk for catheter-associated urinary tract infection (CAUTI)? a. cleansing the urinary meatus 3 to 4 times daily with antiseptic solution b. hanging the urinary drainage bag below the level of the bladder c. emptying the urinary drainage bag daily d. irrigating the urinary catheter with sterile water
B
Which of the following Internet resources can help consumers compare quality care measures? (Select all that apply) a. WebMD b. Hospital Compare c. Magnet Recognition Program d. Hospital Consumer Assessment of Healthcare e. The American Hospital Association's webpage
B and D
What is the proper position to use for an unresponsive patient during oral care to prevent aspiration? (Select all that apply) a. Prone's position b. Sim's position c. Semi-Fowler's position with head to side d. Trendelenburg position e. Supine position
B, C
The student nurse is teaching a family member the importance of foot care for his or her mother, who has diabetes. Which safety precautions are important for the family member to know to prevent infection? (Select all that apply) a. Cut nails frequently b. Assess skin for redness, abrasions, and open areas daily c. Soak feet in water at least 10 minutes before nail care d. Apply lotion to feet daily e. Clean between toes after bathing
B, D, E
A patient with a malignant brain tumor requires oral care. The patient's level of consciousness has declined, with the patient only being able to respond to voice commands. Place the following steps in the correct order for administration of oral care. a. If patient is uncooperative or having difficulty keeping mouth open, insert an oral airway b. Raise bed, lower side rail, and position patient close to side of bed with head of bed raised up to 30 degrees c. Using a brush moistened with chlorhexidine paste, clean chewing and inner tooth surfaces first d. For patients without teeth, use a toothette moistened in chlorhexidine rinse to clean oral cavity e. Remove partial plate or dentures if present f. Gently brush tongue but avoid stimulating gag reflex
B, E, A, C, F, D
A nurse stops to help in an emergency at the scene of an accident. The injured party files a suit and the nurse's employing institution insurance does not cover the nurse. What would probably cover the nurse in this situation? a. The nurse's auto insurance b. The nurse's homeowner's insurance c. The Good Samaritan laws, which grant immunity from suit if there is no gross negligence. d. The Patient Care Partnership, which may grant immunity from suit if the injured party contends.
C
A nurses notes that the health care unit keeps a listing of the patient names at the front desk in easy view for health care providers to more efficiently locate the patient. The nurse talks with the nurse manager because this action is a violation of which act? a. patient protection and affordable care act (PPACA) b. patient self-determination act (PSDA) c. health insurance portability and accountability act (HIPAA) d. emergency medical treatment and active labor act
C
A patient receiving chemotherapy experiences stomatitus. The nurse advises the patient to use: a. Community mouthwash b. Alcohol-based mouth rinse c. Normal saline rinses d. Firm toothbrush
C
The nurse received a hand-off report at the change of shift in the conference room from the night shift nurse. The nursing student assigned to the nurse asks to the nurse review the medical records of the patients assigned to them. The nurse begins assessing the assigned patients and lists the nursing care information for each patient on each individual patient's message board in the patient rooms. The nurse also lists the patients' medical diagnoses on the message board. Later in the day the nurse discusses the plan of care for a patient who is dying with the patient's family. Which of these actions describes a violation of the Health Insurance Portability and Accountability Act (HIPPA)? a. discussing patient conditions in the nursing report room at the change of shift b. allowing nursing students to review patient charts before caring for patients to whom they are assigned c. posting medical information about the patient on a message board in the patient's room d. releasing [patient information regarding terminal illness to family when the patient has given permission for information to be shared
C
While planning morning care, which of the following patients would have the highest priority to receive his or her bath first? a. A patient who just returned to the nursing unit from a diagnostic test b. A patient who prefers a bath in the evening when his wife visits and can help him c. A patient who is frequently incontinent diarrheal stools and urine d. A patient who has been awake all nights because of pain 8/10
C
A nurse is using the Plan-Do-Study-Act (PDSA) strategy to do a quality improvement project to decrease patient falls on a nursing unit. Place the steps in the correct sequence for PDSA. a. bedside change of shift report is piloted on tow medical surgical units b. patient satisfaction levels after implementation of the bedside report are compared to patient satisfaction levels before the change c. the nursing council develops a strategy for bedside change of shift report d. After modifications are made in the shift report elements, bedside shift report is implemented on all nursing units
C, A, B, D
Integrity of the oral mucosa depends on salivary secretion. Which of the following factors impairs salivary secretion? (Select all that apply) a. use of cough drops b. immunosupression c. radiation therapy d. dehydration e. presence of oral airway
C, D
Which activity performed by a nurse is related to maintaining competency in nursing practice? a. asking another nurse about how to change the settings on a medication pump b. regularly attending unit staff meetings c. participating as a member of the professional nursing council d. attending a review course in preparation for a certification examination
D
Which of the following statements is true regarding Magnet status recognition for a hospital? a. nursing is run by a Magnet manager who makes decisions for the nursing units b. nurses in Magnet hospitals make all of the decisions on the clinical units c. Magnet is a term that is used to describe hospitals that are able to hire the nurses they need d. Magnet is a special designation for hospitals that achieve excellence in nursing practice
D
A nurse is planning care for a patient going into surgery. Who is responsible for informing the patient about the surgery along with possible risks, complications, and benefits? a. family member b. surgeon c. nurse d. nurse manager
B
Which nursing interventions should a nurse implement when removing an indwelling urinary catheter in an adult patient? (Select all that apply) a. attach a 3 mL syringe to the inflation port b. allow the balloon to drain into the syringe by gravity c. initiate a voiding record/bladder diary d. pull the catheter quickly e. clamp the catheter before removal
B, C
A nurse is sued for negligence due to failure to monitor a patient appropriately after a procedure. Which of the following statements are correct about this lawsuit? (Select all that apply) a. the nurse does not need any representation b. the patient must prove injury, damage, or loss occurred c. the person filing the lawsuit has to show a compensable damage, such as lost wages, occurred d. the patient must prove that a breach in the prevailing standard of care caused an injury e. the burden of proof is always the responsibility of the nurse
B, C, D
Match the examples with the professional nursing code of ethics: 1. You see an open medical record on the computer and close it so no one else can read the record without proper access. 2.You administer a once a day cardiac medication at the wrong time, but nobody sees it. However, you contact the primary care provider and your head nurse and follow agency procedure. 3. A patient at the end of life wants to go home to die, but the family wants every care possible. The nurse contacts the primary care provider about the patients request. 4.You tell your patient that you will return in 30 minutes to give him his next pain medication. a. advocacy b. responsibility c. accountability d. confidentiality
1D, 2C, 3A, 4B
A nurse is listening to a student provide instruction to a patient who is having difficulty with activities needed to care for soft contact lenses. Which of the following statements by the nursing student might require some correction by the nurse? a. use tap water to clean soft lenses b. follow recommendations for lens manufacturer when inserting the lenses c. keep lenses moist or wet not worn d. use fresh solution daily when storing and disinfecting lenses.
A
A nurse is providing restorative care to a patient following an extended hospitalization for an acute illness. Which of the following is an appropriate goal for restorative care? a. patient will be able to walk 200 feet without shortness of breath b. wound will heal without signs of infection c. patient will express concerns related to return home d. patient will identify strategies to improve sleep habits
A
A nurse is using data collected from the unit to monitor the incidence of falls after the unit implemented a new fall protocol. The nurse is working in which area? a. Quality improvement (QI) b. health care patient system c. nursing informatics d. computerized nursing network
A
A nurse uses long firm, strokes distal to proximal while bathing a patient's legs because: a. It promotes venous circulation b. It covers a larger area of the leg c. it completes care in a timely fashion d. it prevents blood clots in legs
A
A patient who has constipation is prescribed as bisacodyl suppository. Which explanation will the nurse use to explain the action of bisacodyl? a. Acts on smooth intestinal muscle to gently increase perstalsis b. Absorbs water into the intestines to increase bulk and peristalsis c. Lowers surface tension and increases water accumulation in the intestines d. Pulls salts into the colon and increases water in the feces to increase bulk
A
Healthcare reform will bring changes in the emphasis of care. Which of the following models is expected from health care reform? a. moving from an acute illness to a health promotion, illness prevention model b. moving from an illness prevention to a health promotion model c. moving from an acute illness to a disease management model d. moving from a chronic care to an illness prevention model
A
Nurses on a nursing unit are discussing the processes that led up to a near-miss error on the clinical unit. They are outlining strategies that will prevent this in the future. This is an example of nurses working on what issue in the health care system? a. patient safety b. evidence-based practice c. patient satisfaction d. maintenance of competency
A
Resolution of an ethical dilemma involves discussion with the patient, the patient's family, and participants from all health care disciplines. Which of the following describes the role of the nurse in the resolution of ethical dilemmas? A. To articulate his or her unique point of view, including knowledge based on clinical and psychosocial observations B. To await new clinical orders from the physician C. To limit discussions about ethical principals D. To allow the patient and the physician to resolve the dilemma without regard to personally held values or opinions regarding the ethical issues
A
The nurse spends time with the patient and family reviewing the dressing change procedure for the patient's wound. The patient's spouse demonstrates how to change the dressing. The nurse is acting in which professional role? a. educator b. advocate c. caregiver d. case manager
A
What best describes measurement of postvoid residual (PVR)? a. bladder scan the patient immediately after voiding b. catheterize the patient 30 minutes after voiding c. bladder scan the patient when he or she reports a strong urge to void d. catheterize the patient with a 16 Fr/10 mL catheter
A
The ethics of care suggests that ethical dilemmas can best be solved by attention to relationships. How does this differ from other ethical practices? (Select all that apply.) a. Ethics of care pays attention to the environment in which caring occurs. b. Ethics of care pays attention to the stories of the people involved in the ethical issue. c. Ethics of care is used only in nursing practice. d. Ethics of care focuses only on the code of ethics for nurses e. Ethics of care focuses only on understanding relationships.
A, B, E
A patient is scheduled to have an intravenous pyelogram (IVP) the next morning. Which nursing measures should be implemented before the test. (Select all that apply) a. ask the patient about any allergies and reactions b. instruct the patient that a full bladder is required for the test c. instruct the patient to save all urine in a special container d. ensure that informed consent has been obtained e. explain that the test includes instrumentation of the urinary tract
A, D
Which of the following are characteristics of managed care systems? (Select all that apply) a. provider receives a predetermined payment for each patient in the program b. payment is based on a set fee for each service provided c. system includes a voluntary prescription drug program for an additional cost d. system tried to reduce costs while keeping patients healthy e. focus of care is on prevention and early intervention
A, D, E
A patient has a fractured femur that is placed in skeletal traction with a fresh plaster cast applied. The patient experiences decreased sensation and a cold feeling in the toes of the affected leg. The nurse observes that the patient's toes have become pale and cold but forgets to document this because one of the nurse's other patients experienced cardiac arrest at the same time. Two days later the patient in skeletal traction has an elevated temperature, and he is prepared for surgery to amputate the leg below the knee. Which of the following statements regarding a breach of duty apply to this situation? (Select all that apply) a. failure to document a change in assessment data b. failure to provide discharge instructions c. failure to follow the six rights of medication administration d. failure to use proper medical equipment ordered for patient monitoring e. failure to notify a health care provider about a change in the patient's condition
A, E
A child's immunization may cause discomfort during administration, but the benefits, of protection of disease, both for the individual and society, outweigh the temporary discomforts. Which principle is involved in this situation? a. fidelity b. beneficence c. nonmaleficence d. respect for autonomy
B
A community center is presenting a nurse-led program on the Patient Protection and Affordable Care Act. Which statement made by a participate indicates a need for the further teaching? a. "my small company will now have to offer the 75 employees health insurance or pay a penalty" b. "as long as my son is a full-time student in college, I will be able to keep him on my health insurance until he is 26 year olds" c. "I signed up for the state health insurance exchange before the designated deadline to make sure I had health insurance" d. "since I have now been diagnosed with diabetes, my health insurance plan cannot charge me higher premiums"
B
A nurse is caring for a patient with end-stage lung disease. The patient wants to go home on oxygen and be comfortable. The family wants the patient to have a new surgical procedure. The nurse explains the risk and benefits of the surgery to the family and discusses the patient's wishes with them. The nurse is acting as the patient's: a. educator b. advocate c. caregiver d. case manager
B
A nurse note that an advance directive is on a patient's medical record. Which statement represents the best description of an advance directive guideline that the nurse will follow? a. a living will allows an appointed person to make health care decisions when the patient is in an incapacitated state b. a living will is invoked only when the patient has a terminal condition or is in a persistent vegetative state c. the patient cannot make changes in the advance directive once admitted to the hospital d. a durable power of attorney for health care is invoked only when the patient has a terminal condition or is in a persistent vegetative state
B
A nursing is presenting information to a management class of nursing students on the topic of financial reimbursement for achievement of established, measurable patient outcomes. The nurse is presenting information on the class on which topic? a. prospective payment system b. pay for performance c. capitation payment system d. managed care systems
B
A patient complains of constipation and requires a laxative. In providing teaching for this patient, the nurse reviews the common causes of constipation, including which cause? a. Motion sickness b. Poor dietary habits c. Food intolerance d. Bacteria (E. coli)
B
A patient with nausea is taking ondansetron. She asks the nurse how this drug works. The nurse is aware that his medication has which action? a. Enhances histamine1 receptor sites b. Blocks serotonin receptors in the chemoreceptor trigger zone c. Blocks dopamine receptors in the chemoreceptor trigger zone d. Stimulates anticholinergic receptor sites
B
A postoperative patient with a three-way indwelling urinary catheter and continuous bladder irrigation (CBI) complains of lower abdominal pain and distention. What should be the nurse's initial intervention? a. increase the rate of the CBI b. assess the intake and output from system c. decrease the rate of the I d. assess vital signs
B
The application of utilitarianism does not always resolve an ethical dilemma. Which of the following statements best explains why? a. utilitarianism refers to usefulness and therefore eliminates the need to talk about spiritual values b. in a diverse community it can be difficult to find agreement on a definition of usefulness, the focus of utilitarianism c. even when agreement about a definition of usefulness exists in a community, laws prohibit an application of utilitarianism d. difficult ethical decisions cannot be resolved by talking about the usefulness of a procedure
B
A nurse is caring for a patient who recently had coronary bypass surgery and now is on the postoperative unit. Which are legal sources of standards of care that the nurse uses to deliver safe health care? (Select all that apply) a. information provided by the head nurse b. policies and procedures of the employing hospital c. state nurse practice act d. regulations identified in The Joint Commission manual e. The Amerian Nurses Association standards of nursing practice
B, C, D, E
It can be difficult to agree on a common definition of the word quality when it comes to quality of life. Why? (Select all that apply) a. average income varies in different regions of the country b. community values influence definitions of quality, and they are subject to change over time c. individual experiences influence perceptions of quality in different ways, making consensus difficult d. the value of elements such as cognitive skills, ability to perform meaningful work, and relationship to family is difficult to quantify using objective measures e. statistical analysis is difficult to apply when the outcome cannot be quantified f. whether or not a person has a job is an objective measure, but it does not play a tole in understanding quality of life
B, C, D, E
A group of staff nurses notice an increased incidence of medication errors on their unit. After further investigation it is determined that the nurses are not consistently identifying the patient correctly. A change is needed quickly. What type of quality improvement method would be most appropriate? a. PDSA b. Six Sigma c. Rapid-improvement event (RIE) d. A randomized controlled trial
C
A home health nurse notices significant bruising on a 2-year-old patient's heard, arms, abdomen, and legs. The patient's mother describes the patient's frequent falls. What is the best nursing action for the home health nurse to take? a. document her findings and treat the patient b. instruct the mother on safe handling of a 2-year-old child c. contact a child abuse hotline d. discuss this story with a colleague
C
A nurse meets with the registered dietician and physical therapist to develop a plan of care that focuses on improving nutrition and mobility for a patient. This is an example of which Quality and Safety in the Education of Nurses (QSEN) competency? a. patient-centered care b. safety c. teamwork and collaboration d. informatics
C
A patient is taking nitrofurantoin? What will the nurse teach the patient? a. Expect the urine to turn blue b. Keep the urine acidic by drinking milk c. Rinse the mouth after taking oral nitrofurantoin to avoid staining the teeth d. take an antacid with oral nitrofurantoin to avoid gastrointestinal distress
C
When assessing a patient's first voided urine of the day, which finding should be reported to the health care provider? a. pale yellow urine b. slightly cloudy urine c. light pink urine d. dark amber urine
C
When metoclopramide (Reglan) is given for nausea, the nurse plans to caution the patient to avoid which substance? a. milk b. coffee c. alcohol d. carbonated beverages
C
Which instructions should the nurse five the nursing assistive personnel (NAP) concerning the patient who has had an indwelling urinary catheter removed that day? a. limit oral fluid intake to avoid possible urinary incontinence b. expect patient complaints of suprapubic fullness and discomfort c. report the time and amount of first voiding d. instruct patient to stay in bed and use a urinal or bedpan
C
Which nursing assessment question would best indicate that an incontinent man with a history of prostate enlargement might not be emptying his bladder adequately? a. do you leak urine when you cough or sneeze? b. do you need help getting to the toilet? c. do you dribble urine constantly? d. does it burn when you pass your urine?
C
Which nursing intervention minimizes the risk for trauma and infection when applying an external/condom catheter? a. leaving a gap of 3 to 5 inches between the tip of the penis and drainage tube b. shaving the pubic area so hair does not adhere c. washing with soap and water before applying the condom-type catheter d. applying tape to the condom sheath to keep it securely placed
C
A nurse is assigned to care for the following patients. Which of the patients is most at risk for developing skin problems and thus requiring thorough bathing and skin care? a. A 44 year old female who has had removal of a breast lesion and is having her menstrual cycle. b. A 56 year old male patient who is homelesss and admitted to the emergency department with malnutrition and dehydration and who has an intravenous line. c. A 60 year old female who experienced a stroke with right-sided paralysis and has an orthopedic brace applied to the left leg. d. A 70 year old patient who has diabetes and dementia and has been incontinent of stool.
D
A patient in the emergency department has developed wheezing and shortness of breath. The nurse gives the ordered medicated nebulizer treatment now and in 4 hours. Which standard of practice is performed? a. planning b. evaluation c. assessment d. implementation
D
A patient is admitted to a medical unit. The patient is fearful of hospitals. The nurse carefully assesses the patient to determine the exact fears and then establishes interventions designed to reduce these fears. In this setting how is the nurse practicing patient advocacy? a. seeking out the nursing supervisor to talk with the patient b. documenting patient fears in the medical record in a timely manner c. working to change the hospital environment d. assessing the patient's point of view and preparing to articulate it
D
A patient is receiving solifenacin succinate. The nurse knows that this drug is used to treat which condition? a. Chronic Cystitus b. Urinary tract stones c. Urinary tract infections d. Overactive bladder
D
A patient is taking the urinary aseptic methenamine for a urinary tract infection (UTI). The nurse understands that this drug should not be given concurrently with which other drug to avoid crystalluria? a. Ertapenem b. Ciprofloxacin c. Fosfomycin d. Trimethoprim-sulfamethoxale
D
A patient is using scoplamine to prevent motion sickness. About which common side effect should the nurse teach the patient? a. Diarrhea b. Vomiting c. Insomnia d. Dry mouth
D
The nurses on an acute care medical floor notice an increase in pressure ulcer formation in their patients. A nurse consultant decides to compare two types of treatment. The first is the procedure currently used to assess for pressure ulcer risk. The second uses a new assessment instrument to identify at-risk patients. Given this information, the nurse consultant exemplifies which career? a. clinical nurse specialist b. nurse administrator c. nurse educator d. nurse researcher
D
You are preparing presentation for you classmates regarding the clinical care coordination conference for a patient with terminal cancer. As part of the preparation you have your classmates read the Nursing Code of Ethics for Professional Registered Nurses. Your instructor asks the class why this document is important. Which of the following statements best describes this code? a. improves self-health care b. protects the patient's confidentiality c. ensures identical care to all patients d. defines the principles of right and wrong to provide patient care
D
Your are the night shift nurse caring for a newly admitted patient who appears to be confused. The family asks to see the patient's medical record. What is the priority nursing action? a. give the family the record b. discuss the issues that concern the family with them c. calling the nursing supervisor d. determine from the medical record if the family has been granted permission by the patient to access his or her medical information
D
Ethical dilemmas often arise over a conflict of opinion. Reliance on a predictable series of steps can help people in conflict find common ground. All of the following actions in order to promote the resolution of an ethical dilemma? a. list the actions that could be taken to resolve the dilemma b. agree on a statement of the problem or dilemma that you are trying to resolve c. agree on a plan to evaluate the action over time d. gather all relevant information regarding the clinical, social, and spiritual aspects of the dilemma e. take time to clarify values and distinguish between facts and opinions-your own and those of others involved d. negotiate a plan
D, E, B, A, F, C
Place the following steps for insertion of an indwelling catheter in a female patient in appropriate order. a. insert and advance catheter b. lubricate catheter c. inflate catheter balloon d. cleanse urethral meatus with antiseptic solution e. drape patient with the sterile square and demonstrated drapes f. when urine appears, advance another 2.5 to 5 cm g. prepare sterile fields and supplies h. gently pull catheter until resistance is felt i. attach drainage tubing
E, G, B, D, A, F, C, H, I
Fill in the Blank. The point of the ethical practice is an agreement to reassure the public that in all ways the health care team not only works to heal patients but agrees to do this in the least painful and harmful way possible. This principle is commonly called the principle of ________?
Maleficence
