Professional Nursing: End of Chapter Questions Exam #3

A woman has severe life-threatening injuries, is unresponsive, 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? 1. Obtain a court order to give the blood. 2. Convince the husband to allow the nurse to give the blood. 3. Call security and have the husband removed from the hospital. 4. Gather more information about the wife's preferences and determine whether the husband has her power of attorney for health care.

4

A patient states, "I don't have confidence in my doctor. She looks so young." What is the nurse's therapeutic response? 1. Tell me more about your concern. 2. You have nothing to worry about. Your doctor is perfectly competent. 3. You can go online and see how others have rated your doctor. I do that. 4. You should ask your doctor to tell you her background.

1

Resolution of an ethical problem involves discussion with the patient, the patient's family, and participants from appropriate health care disciplines. Which statement best describes the role of the nurse in the resolution of ethical problems? 1. To articulate the nurse's unique point of view, including knowledge based on clinical and psychosocial observations 2. To study the literature on current research about the possible clinical interventions available for the patient in question 3. To hold a point of view but realize that respect for the authority of administrators and health care providers takes precedence over personal views 4. To allow the patient and the health care provider private time to resolve the dilemma on the basis of ethical principles

1

The nurse is caring for a patient who needs a liver transplant to survive. This patient has been out of work for several months, does not have health insurance, and cannot afford the procedure. Which of the following statements speaks to the ethical elements of this case? 1. The health care team should select a plan that considers the principle of justice as it pertains to the distribution of health care resources. 2. The patient should enroll in a clinical trial of a new technology that can do the work of the liver, similar to the way dialysis treats kidney disease. 3. The social worker should look into enrolling the patient in Medicaid, since many states offer expanded coverage. 4. A family meeting should take place in which the details of the patient's poor prognosis are made clear to his family so that they can adopt a palliative approach.

1

You are working on a patient care unit and observe several other nurses who are not following the agency's policy when preparing and administering medications. When you ask them to explain why they are doing this, they state the new medication administration technology installed on the unit takes too much time to use, so they are using workarounds to get their patient medications administered on time. Which is the best action to take first? 1. Discuss the situation with the nursing manager. 2. Call a colleague who works at another institution to talk about the problem. 3. Look for a position on a different nursing unit. 4. Say nothing and begin your work.

1

A new nurse graduate is in orientation on a surgical unit and is being mentored by an experienced nurse. Which action completed by the new nurse graduate requires intervention by the experienced nurse? (Select all that apply.) 1. The new nurse stops documenting about a dressing change to take a patient some water. 2. The new nurse gathered the medications for two different patients at the same time. 3. The new nurse asked an AP to help transfer a patient from the bed to a wheelchair before discharge. 4. The new nurse educates a patient about pain management when administering a pain medication to a patient. 5. The new nurse gathers all equipment necessary to start a new IV site before entering a patient's room.

1, 2

Which of the following statements indicate that the new nursing graduate understands ways to remain involved professionally? (Select all that apply.) 1. "I am thinking about joining the health committee at my church." 2. "I need to read newspapers, watch news broadcasts, and search the Internet for information related to health." 3. "I will join nursing committees at the hospital after I have completed orientation and better understand the issues affecting nursing." 4. "Nurses do not have very much voice in legislation in Washington, DC, because of the nursing shortage." 5. "I will go back to school as soon as I finish orientation."

1, 2, 3

A nurse asks an AP to help the patient in Room 418 walk to the bathroom right now. The nurse tells the AP that the patient needs the assistance of one person and the use of a walker. The nurse also tells the AP that the patient's oxygen can be removed while he goes to the bathroom but to make sure that when it is put back on, the flowmeter is still at 2 L. The nurse also instructs the AP to make sure the side rails are up and the bed alarm is reset after the patient gets back in bed. Which of the following components of the "Five Rights of Delegation" were used by the nurse? (Select all that apply.) 1. Right task 2. Right circumstance 3. Right person 4. Right directions and communication 5. Right supervision and evaluation

1, 2, 3, 4

The nurse manager from the surgical unit was awarded the nursing leadership award for practice of transformational leadership. Which of the following are characteristics or traits of transformational leadership displayed by the award winner? (Select all that apply.) 1. The nurse manager regularly rounds on staff to gather input on unit decisions. 2. The nurse manager sends thank-you notes to staff in recognition of a job well done. 3. The nurse manager sends memos to staff about decisions that the manager has made regarding unit policies. 4. The nurse manager has an "innovation idea box" to which staff are encouraged to submit ideas for unit improvements. 5. The nurse manager develops a philosophy of care for the staff.

1, 2, 4

Which statements properly apply an ethical principle to justify access to health care? (Select all that apply.) 1. Access to health care reflects the commitment of society to principles of beneficence and justice. 2. If low income compromises access to care, respect for autonomy is compromised. 3. Access to health care is a privilege in the United States, not a right. 4. Poor access to affordable health care causes harm that is ethically troubling because nonmaleficence is a basic principle of health care ethics. 5. If a new drug is discovered that cures a disease but at great cost per patient, the principle of justice suggests that the drug should be made available to those who can afford it.

1, 2, 4

Which statements reflect the difficulty that can occur for agreement on a common definition of the word quality when it comes to quality of life? (Select all that apply.) 1. Community values influence definitions of quality, and they are subject to change over time 2. Individual experiences influence perceptions of quality in different ways, making consensus difficult 3. The value of elements such as cognitive skills, ability to perform meaningful work, and relationship to family is difficult to quantify using objective measures 4. Statistical analysis is difficult to apply when the outcome cannot be quantified 5. Whether a person has a job is an objective measure, but it does not play a role in understanding quality of life

1, 2, 4

A nurse is teaching an older-adult patient about ways to detect a melanoma. Which of the following are age-appropriate teaching techniques for this patient? (Select all that apply.) 1. Speak in a low tone. 2. Begin and end the session with the most important information regarding melanoma. 3. Provide a pamphlet about melanoma with large font in blues and greens. 4. Use basic one- or two-syllable medical terms. 5. Provide specific information in frequent, small amounts. 6. Speak quickly so that you do not take up much of the patient's time.

1, 2, 5

The nurse transferring a patient to an acute rehab center must fax EHR information. Which of the following actions are appropriate for the nurse to take to maintain privacy and confidentiality of the patient's information when faxing this information? (SATA) 1. Confirm that the fax number for the acute rehabilitation center is correct before sending the fax. 2. Use the encryption feature on the fax machine to encode the information and make it impossible for staff at the acute rehabilitation center to read the information unless they have the encryption key. 3. Fax the patient's information without a cover sheet so that the person receiving the information at the acute rehabilitation center can identify it more quickly. 4. After sending the fax, place the information that was printed out in a standard trash can after ripping it into several pieces. 5. After sending the fax, place the information that was printed out

1, 2, 5

Which social media uses can be implemented with patients and families without violating confidentiality? (Select all that apply.) 1. Social media can be used to provide supportive information. 2. Results such as x-ray results can easily be sent via social media. 3. Family and friends who cannot be present can connect with the patient. 4. All health information can be shared on social media. 5. Social media should never be used with patients and families.

1, 3

Which strategies should a nurse use to facilitate a safe transition of care during a patient's transfer from the hospital to a skilled nursing facility? (Select all that apply.) 1. Collaboration between staff members from sending and receiving departments 2. Requiring that the patient visit the facility before a transfer is arranged 3. Using a standardized transfer policy and transfer tool 4. Arranging all patient transfers during the same time each day 5. Relying on family members to share information with the new facility

1, 3

The ethics of care suggests that ethical dilemmas can best be solved by attention to relationships. How does this differ from other approaches to ethical problems? (Select all that apply.) Ethics of care: 1. pays attention to the context in which caring occurs. 2. is used only by nurses because it is part of the Nursing Code of Ethics. 3. requires understanding the relationships between involved parties. 4. considers the decision maker's relationships with other involved parties. 5. is an approach that suggests a greater commitment to patient care. 6. considers the decision maker to be in a detached position outside the ethical problem

1, 3, 4

When working with an older adult who is hearing-impaired, the use of which techniques would improve communication? (Select all that apply.) 1. Check for needed adaptive equipment. 2. Exaggerate lip movements to help the patient lip-read. 3. Give the patient time to respond to questions. 4. Keep communication short and to the point. 5. Communicate only through written information.

1, 3, 4

You are a RN working in an agency that recently implemented a EHR. Which of the following are acceptable practices for maintaining the security and confidentiality of EHR info? (SATA) 1. Using a strong password and changing your password frequently according to agency policy 2. Allowing a temporary staff member to use your computer username and password to access the electronic record 3. Ensuring that work lists (and any other data that must be printed from the EHR) are protected throughout the shift and disposed of in a locked receptacle designated for documents that are to be shredded when no longer needed 4. Ensuring that the patient information that is displayed on the computer monitor that you are using is not visible to visitors and other health care providers who are not involved in that patient's care 5. Remaining logged into a computer to save time if you only need to step away to administer a medication

1, 3, 4

A nurse is using motivational interviewing with a patient. What outcomes does the nurse expect? (Select all that apply.) 1. Gain an understanding of the patient's health goals. 2. Direct the patient to avoid poor health choices. 3. Recognize the patient's strengths and support the patient's efforts. 4. Provide assessment data that can be shared with families to promote change. 5. Identify differences in patient's health outcomes and current behaviors.

1, 3, 5

Which of the following actions, if performed by an RN, could result in both criminal and administrative law sanctions against the nurse? (Select all that apply.) 1. Reviewing the EHR of a family member who is a patient in the same hospital on a different unit 2. Refusing to provide health care information to an older adult's child 3. Reporting suspected abuse and neglect of children 4. Applying physical restraints without a written order 5. Completing an occurrence report on the unit

1, 4

A pt is in skeletal traction and has a plaster cast due to a fractured femur. The pt experiences decreased sensation & cold feeling in the toes of the affected leg. The nurse observes that the pt's toes have become pale & cold but forgets to document & report this to the health care provider because 1 of the nurse's other patients experienced cardiac arrest at the same time. Two days later the pt in skeletal traction has an elevated temperature, & 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? (SATA) 1. Failure to document a change in assessment data 2. Failure to provide discharge instructions 3. Failure to provide patient education about cast care 4. Failure to use proper medical equipment ordered for patient monitoring 5. Failure to notify a health care provider about a change in the patient's condition

1, 5

A patient's cultural background affects the motivation for learning. Using the ACCESS model, match the nursing approach with the correct model component. Access Model Component __1.Assessment __2.Communication __3.Cultural __4.Establishment __5.Sensitivity __6.Safety Nursing Approach A. Help patients feel culturally secure and able to maintain their cultural identity. B. Remain aware of verbal and nonverbal responses. C. Be aware of how patients from diverse backgrounds perceive their care needs. D. Become aware of your patient's culture and your own cultural biases. E. Learn about the patient's health beliefs and practices. F. Show respect by creating a caring rapport.

1E, 2B, 3D, 4F, 5C, 6A

Match the following actions (1 through 4) with the terms (a through d) listed below: ___1. You see an open medical record on the computer and close it so that 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 provider and your nurse manager 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 patient's 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 contacts the health care provider about a change in a patient's condition and receives several new orders for the patient over the phone. When documenting telephone orders in the EHR, what should the nurse do? 1. Print out a copy of all telephone orders entered into the EHR in order to keep them in personal records for legal purposes. 2. "Read back" all telephone orders to the health care provider over the phone to verify all orders were heard, understood, and transcribed correctly before entering the orders in the EHR. 3. Record telephone orders in the EHR but wait to implement the order(s) until they are electronically signed by the health care provider who gave them. 4. Implement telephone order(s) immediately but insist that the health care provider come to the patient care unit to personally enter the order(s) into the EHR within the next 24 hours.

2

A nurse is planning care for a patient going to surgery. Who is responsible for informing the patient about the surgery along with possible risks, complications, and benefits? 1. Family member 2. Surgeon 3. Nurse 4. Nurse manager

2

A nurse received change-of-shift reports on these four patients and starts rounding. Which patient does the nurse need to focus on as a priority? 1. A patient who had abdominal surgery 2 days ago and is requesting pain medication 2. A patient admitted yesterday with atrial fibrillation who now has a decreased level of consciousness 3. A patient with a wound drain who needs teaching before discharge in the early afternoon 4. A patient going to surgery for a mastectomy in 3 hours who has a question about the surgery

2

A patient suddenly experienced a severe headache with numbness and decreased movement in the left arm. An emergency brain scan confirmed a cerebral vessel clot. With a stroke confirmed, the emergency room physician consults with a neurosurgeon to schedule an emergent angiogram to remove the clot. Which teaching approach is most appropriate for explaining to the patient what to expect from the procedure? 1. Selling approach 2. Telling approach 3. Entrusting approach 4. Participating approach

2

The nurse works at an agency where military time is used for documentation and needs to document that a patient was medicated for pain after midnight. Identify the correct military time to document medication administered at 12:05 a.m. 'clock shows timings form 1300 to 2400 in increments of 100' 1. 2405 2. 0005 3. 2205 4. 1205

2

When designing a plan for pain management for a patient following surgery, 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. If the nurse's actions are driven by respect for autonomy, what aspect of this scenario best demonstrates this action? 1. Assessing the patient's pain on a numeric scale every 2 hours 2. Asking the patient to establish the goal for pain control 3. Using alternative measures such as distraction or repositioning to relieve the pain 4. Monitoring the patient for oversedation as a side effect of his pain medication

2

A nurse sends a text message to the oncoming nurse that states, "Mr. Kodro in room 3348-1 refused to take his sertraline hydrochloride as ordered this morning because he said he was feeling better." What should the oncoming nurse do? (Select all that apply.) 1. Add this information to the board hanging at the patient's bedside. 2. Tell the nurse who sent the text that the text is a HIPAA violation. 3. Inform the nursing supervisor. 4. Forward the text to the charge nurse. 5. Thank the nurse for sending the information.

2, 3

A patient has gone through a number of treatment changes during a shift of care. During the hand-off report, the nurse plans to communicate effectively with the nurse who will be caring next for the patient for which of the following reasons? (Select all that apply.) 1. To improve the nurse's status with the health team members 2. To reduce the risk of errors to the patient 3. To provide an optimum level of patient care 4. To improve patient outcomes 5. To prevent issues that need to be reported to outside agencies

2, 3, 4

Which techniques demonstrate a therapeutic response to an adult patient who is anxious? (Select all that apply.) 1. Matching the rate of speech to be the same as that of the patient 2. Providing good eye contact 3. Demonstrating a calm presence 4. Spending time attentively with the patient 5. Assuring the patient that all will be well

2, 3, 4

A nurse calls a patient's HCP about Ms. Ducote's blood transfusion issue. Arrange in SBAR order. 1. I think she might need a diuretic ordered. Is it possible for you to come see her soon? Is there anything else you would like for me to do right now? 2. This is JoAnn. I'm caring for Ms. Ducote. She has labored breathing, an increased HR, and is on her 2nd unit of blood. She reports trouble catching her breath. 3. Ms. Ducote had surgery earlier yesterday to remove a tumor in the colon. Her hemoglobin was 9.6 grams/dL, and her hematocrit was 33.6% this morning. Her first ordered unit of packed RBCs infused over 90 mins, & she is 30 mins into receiving her 2nd unit of blood now. She states she takes furosemide 20 mg q.a.m at home. She does not currently have an order for furosemide 4. Pt denies pain, & her VS are: B/P 150/98 mm Hg; pulse 118; rr 28; temp 98.8° F. I think she is showing signs of fluid volume overload.

2, 3, 4, 1

At 1300 the registered nurse (RN) says to the assistive personnel (AP), "You did a good job transferring Mr. Harvey into his chair this morning at 0830. I saw that you recorded how long he stayed in his chair. I saw that Mr. Harvey did not have any shoes or nonslip slippers on, though. For safety, the next time you transfer a patient into a chair, you need to make sure that the patient wears slippers or shoes. Please get Mr. Harvey up in his chair again by 1500." Which characteristics of positive feedback did the RN use when talking to the AP? (Select all that apply.) 1. Feedback is given immediately. 2. Feedback focuses on one issue. 3. Feedback offers concrete details. 4. Feedback identifies ways to improve. 5. Feedback focuses on changeable things. 6. Feedback is specific about what is done incorrectly only.

2, 3, 4, 5

An RN at an outpatient chemo infusion center cares for a 56-year-old male on his first visit for colon cancer treatment. The medical record notes prior chemo education but lacks the patient's response. The Dr makes a quick visit & tells the pt, "We will get your treatment started today & we will be checking ur blood each week for any problems." The DR leaves & the pt asks the RN, "What are the blood tests for?" To determine this patient's learning needs, what should the nurse assess? (SATA) 1. Medical record summary of the stage of the cancer 2. The patient's behavior as the nurse interacts with him 3. The patient's level of knowledge about chemotherapy effects 4. The number of treatments the patient will be receiving 5. The patient's health literacy 6. The patient's self-description of severity of his cancer 7. The date of the medical record note describing patient instruction

2, 3, 5, 6

Which of the following scenarios demonstrate that patient learning has taken place? (Select all that apply.) 1. A patient listens to a nurse's review of the warning signs of a stroke. 2. A patient describes how to set up a pill organizer for newly ordered medicines. 3. A patient attends a spinal cord injury support group. 4. A patient demonstrates how to take his blood pressure at home. 5. A patient reviews written information about resources for cancer survivors.

2, 4

A nurse works with a patient using therapeutic communication during all phases of the therapeutic relationship. Place the nurse's statements in order according to these phases. 1. The nurse states, "Let's work on learning injection techniques." 2. The nurse is mindful of biases and knowledge in working with the patient with B12 deficiency. 3. The nurse summarizes progress made during the nursing relationship. 4. After providing introductions, the nurse defines the scope and purpose of the nurse-patient relationship.

2, 4, 1, 3

A home health nurse notices significant bruising on a 2-year-old patient's head, 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? 1. Document her findings and treat the patient. 2. Instruct the mother on safe handling of a 2-year-old child. 3. Contact a child abuse hotline. 4. Discuss this story with a colleague.

3

A nurse is preparing to teach a patient who has sleep apnea how to use a continuous positive airway pressure (CPAP) machine at night. Which action is most appropriate for the nurse to perform first? 1. Allow patient to manipulate machine and look at parts. 2. Provide a teach-back session. 3. Set mutual goals for the education session. 4. Discuss the purpose of the machine and how it works.

3

A nurse received a bedside report at the change of shift with the night-shift nurse and the patient. The nursing student assigned to the patient asks to review the patient's medical record. The nurse lists patients' medical diagnoses on the message boards in the patients' rooms. 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 HIPAA? 1. Discussing patient conditions at the bedside at the change of shift 2. Allowing the nursing student to review the assigned patient's chart before providing care during the clinical experience 3. Posting medical information about the patient on a message board in the patient's room 4. Releasing patient information regarding terminal illness to family when the patient has given permission for information to be shared

3

A patient recovering from open heart surgery is taught how to cough and deep breathe using a pillow to support or splint the chest incision. Following the teaching session, which of the following is the best way for the nurse to evaluate whether learning has taken place? 1. Verbalization of steps to use in splinting 2. Selecting from a series of flash cards the images showing the correct technique 3. Return demonstration 4. REALM test

3

An RN at an outpatient chemo infusion center cares for a 56-year-old male on his first visit for colon cancer treatment. The medical record notes prior chemo education but lacks the patient's response. The nurse's assessment reveals that the patient is motivated to learn more about his chemotherapy and is alert and currently feeling well. The nurse has prepared the first infusion, regulated it, and now takes time to begin instruction. Which teaching approaches are best suited for this situation? 1. Use an entrusting approach in explaining how to monitor for side effects of chemotherapy. 2. Bring the patient together with two other patients in the clinic and conduct a group discussion. 3. Provide verbal one-on-one instruction, with the patient participating in selection of content. 4. Present the patient with a problem situation involving a serious side effect and have the patient decide what to do.

3

The application of deontology does not always resolve an ethical problem. Which of the following statements best explains one of the limitations of deontology? 1. The emphasis on relationships feels uncomfortable to decision makers who want more structure in deciding the best action. 2. The single focus on power imbalances does not apply to all situations in which ethical problems occur. 3. In a diverse community it can be difficult to find agreement on which principles or rules are most important. 4. The focus on consequences rather than on the "goodness" of an action makes decision makers uncomfortable.

3

The nurse is administering a dose of metoprolol to a patient and is completing the steps of bar-code medication administration within the EHR. As the bar-code information on the medication is scanned, an alert that states, "Do not administer dose if apical heart rate (HR) is <60 beats/min or systolic blood pressure (SBP) is <90 mm Hg" appears on the computer screen. The alert that appeared on the computer screen is an example of what type of system? 1. Electronic health record (EHR) 2. Charting by exception 3. Clinical decision support system (CDSS) 4. Computerized provider order entry (CPOE)

3

What outcome demonstrates the effective use of silence as a therapeutic communication technique? 1. The nurse feels like there was enough time to be therapeutic when communicating with the patient. 2. The patient states a preference to talk with another staff member. 3. The patient perceives having gained insight into the issue after the conversation. 4. The patient was able to drift off to sleep more easily.

3

When documenting an assessment of a patient's cardiac system in an EHR, the nurse uses the computer mouse to select the "WNL" statement to document the following findings: "Heart sounds S1 & S2 auscultated. Heart rate between 80 and 100 beats/min, and regular. Denies chest pain." This is an example of using which of the following documentation formats? 1. Focus charting incorporating data, action, and response (DAR) 2. Problem-intervention-evaluation (PIE) 3. Charting by exception (CBE) 4. Narrative documentation

3

Which example demonstrates a nurse performing the skill of evaluation? 1. The nurse explains the side effects of the new blood pressure medication ordered for the patient. 2. The nurse asks a patient to rate pain on a scale of 0 to 10 before administering a pain medication. 3. After completing a teaching session, the nurse observes a patient drawing up and administering an insulin injection. 4. The nurse changes a patient's leg ulcer dressing using aseptic technique.

3

While administering medications, a nurse realizes that a prescribed dose of a medication was not given. The nurse acts by completing an incident report and notifying the patient's health care provider. Which of the following is the nurse exercising? 1. Authority 2. Responsibility 3. Accountability 4. Decision making

3

A nurse performs the following four steps in delegating a task to an AP. Place the steps in the correct order of appropriate delegation. 1. Do you have any questions about walking with Mr. Malone? 2. Before you take him for his walk to the end of the hallway and back, please take and record his pulse rate. 3. In the next 30 minutes please assist Mr. Malone in Room 418 with his afternoon walk. 4. I will make sure that I check with you in about 40 minutes to see how the patient did.

3, 2, 4, 1

A 26-year-old patient visits a medical clinic and asks a nurse to provide instruction on how to perform a breast self-examination. "My mom had cancer so I want to learn how." Which domains are required to learn this skill? (Select all that apply.) 1. Affective domain 2. Sensory domain 3. Cognitive domain 4. Attentional domain 5. Psychomotor domain

3, 5

A 55-year-old man has been in the hospital for over a week following surgical complications. The patient has had limited activity but is now ordered to begin a mobility program. The patient just returned from several diagnostic tests and tells the nurse he is feeling fatigued. The nurse prepares to instruct the patient on the mobility program protocol. Which of the following learning principles will likely be affected by this patient's condition? 1. Motivation to learn 2. Developmental stage 3. Stage of grief 4. Readiness to learn

4

A man who is homeless enters the emergency department seeking health care. The health care provider indicates that the patient needs to be transferred to the city hospital for care before assessing the patient. This action is most likely a violation of which of the following laws? 1. Health Insurance Portability and Accountability Act (HIPAA) 2. Americans With Disabilities Act (ADA) 3. Patient Self-Determination Act (PSDA) 4. Emergency Medical Treatment and Active Labor Act (EMTALA)

4

The RN assesses a midline incision dressing change and notes changes from the previous documentation. After recording the current wound assessment, the nurse calls the surgeon to report concerns. Which of the following illustrates the most appropriate way for the nurse to document this conversation? 1. Health care provider notified about change in assessment of abdominal incision. T. Wright, RN 2. 09-3-21: Notified the surgeon by phone that there is a new area of redness around the patient's incision. T. Wright, RN 3. 1015: Contacted the surgeon and notified about changes in abdominal incision. T. Wright, RN 4. 09-3-21 (1015): Surgeon contacted by phone. Notified about new area of bright red erythema extending approximately 1 inch around circumference of midline abdominal incision and oral temperature of 101.5 F. No orders received. T. Wright, RN

4

The nurse is discussing the advantages of using CPOE with a nursing colleague. Which statement best describes the major advantage of a CPOE system within an EHR? 1. CPOE reduces the time necessary for health care providers to write orders. 2. CPOE reduces the time needed for nurses to communicate with health care providers. 3. Nurses do not need to acknowledge orders entered by CPOE in an EHR. 4. CPOE improves patient safety by reducing transcription errors.

4

The nurse is reviewing health care provider orders that were handwritten on paper when all computers were down during a system upgrade. Which of the following orders contains an inappropriate abbreviation included on TJC's "do not use" list and should be clarified with the health care provider? 1. Change open midline abdominal incision daily using wet-to-moist normal saline and gauze. 2. Lorazepam 0.5 mg PO every 4 hours prn anxiety 3. Morphine sulfate 1 mg IVP every 2 hours prn severe pain 4. Insulin aspart 8u SQ every morning before breakfast

4

Which task is appropriate for a registered nurse (RN) to delegate to an AP? 1. Determining whether the patient understands the preoperative preparation required before the surgery in the morning 2. Administering the ordered antibiotic to the patient before surgery 3. Obtaining the patient's signature on the surgical informed consent 4. Helping the patient to the bathroom before leaving for the operating room

4

The nurse applying effective communication skills throughout the nursing process should: (Place the following interventions in the correct order.) 1. Validate health care needs through verbal discussion with the patient. 2. Compare actual and expected patient care outcomes with the patient. 3. Provide support through therapeutic communication techniques. 4. Complete a nursing history using verbal communication techniques.

4, 1, 3, 2

A nurse prepares to contact a patient's health care provider about a change in the patient's condition. Put the following statements in the correct order using SBAR (Situation, Background, Assessment, and Recommendation) communication. 1. "She is a 53-year-old woman who was admitted 2 days ago with pneumonia and was started on levofloxacin at 5 p.m. yesterday. She states she has a poor appetite; her weight has remained stable over the past 2 days." 2. "The patient reported feeling very nauseated after her dose of levofloxacin an hour ago." 3. "Is it possible to make a change in antibiotics, or could we give her a nutritional supplement before her medication?" 4. "The patient started to complain of nausea yesterday evening and vomited several times during the night."

4S, 1B, 2A, 3R

The following are steps in the process to help resolve an ethical problem. What is the best order of these steps to achieve resolution? 1. List all the possible actions that could be taken to resolve the problem. 2. Articulate a statement of the problem or dilemma that you are trying to resolve. 3. Develop and implement a plan to address the problem. 4. Gather all relevant information regarding the clinical, social, and spiritual aspects of the problem. 5. Take time to clarify values and identify the ethical elements, such as principles and key relationships involved. 6. Recognize that the problem requires ethics.

6, 4, 5, 2, 1, 3

The nurse is writing a narrative progress note. Identify each of the following statements as subjective data (S) or objective data (O): 1. April 24, 2021 (0900) 2. Repositioned patient on left side. 3. Medicated with hydrocodone-acetaminophen 5/325 mg, 2 tablets PO. 4. "The pain in my incision increases every time I try to turn on my right side." 5. S. Eastman, RN 6. Surgical incision right lower quadrant, 3 inches in length, well approximated, sutures intact, no drainage. 7. Rates pain 7/10 at location of surgical incision.

O: 1, 2, 3, 5, 6, 7; S: 4