Professionalism Exam #1

2-9. A nurse's significant other undergoes exploratory surgery at the hospital where the nurse is an employee. Which practice is most appropriate? A. The nurse is an employee; therefore, access to the chart is permissible. B. Access to the chart requires a signed release form. C. The relationship with the client provides the nurse special access to the chart. D. The nurse can ask the surgeon to discuss the outcome of the surgery.

B. Access to the chart requires a signed release form. Being an employee does not give permission to access the chart. Unless the significant other has authorized any access to information, the only people entitled to information without written consent are the client and those providing direct care. The patient still needs to give consent. The surgeon cannot discuss the patient's health without consent from the patient.

2-3. Health Insurance Portability and Accountability Act (HIPAA) regulations guard confidentiality. In several situations, confidentiality can be breached and information can be reported to other entities. Which of the following meet these criteria? Select all that apply. A. The patient is from a correctional institution. B. The situation involves child abuse. C. An injury occurred from a firearm. D. The patient is a physician. E. The breach of information was unintentional.

B. The situation involves child abuse. C. An injury occurred from a firearm. The health information of incarcerated patients is still protected under the Health Insurance Portability and Accountability Act (HIPAA). Although HIPAA provides protections for patient privacy, there are some cases in which health-care providers can disclose patient information to other providers and caregivers. These exceptions typically include care related to criminal acts, such as child or elder abuse, or when a patient is injured because of a firearm or some other weapon. Individual occupations and vocations are protected. Any breach of information, intentional or unintentional, violates HIPAA.

3-5. An RN sees an older woman fall in the mall. The RN helps the woman. The woman later complains that she twisted and sprained her ankle. The RN is protected from litigation under: A. Hospital malpractice insurance B. Good faith agreement C. Good Samaritan law D. Personal professional insurance

C. Good Samaritan law The incident occurred outside of the hospital. A good-faith agreement implies that a contract exists. The Good Samaritan law protects persons who assist at an accident scene if they act in good faith. Professional insurance is not in effect because the actions were not performed while on duty. Professional liability insurance does not necessarily cover this type of litigation.

3-6. An RN has asked a licensed practical nurse (LPN) to trim the toenails of a diabetic patient. The LPN trims them too short, which results in a toe amputation from infection. The patient files a lawsuit against the hospital, the RN, and the LPN. What might all three be found guilty of? A. Unintentional tort B. Intentional tort C. Negligence D. Malpractice

D. Malpractice Although this was performed without malice and is considered an unintentional tort, harm occurred, making the action malpractice. The licensed practical nurse (LPN) did not intend to hurt the patient. Negligence falls in the category of an unintentional tort. Malpractice occurs when an unintentional tort causes an injury to a client.

1-6. Nurses at a community hospital are in an 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. In-service education Continuing education furthers knowledge and skills within the professional domain. Graduate education leads to a higher level degree such as a master's or doctorate. In-service education takes place within an institution or agency. It is usually directed at teaching nurses who work in the institution about a new policy, standard, or type of equipment. Professional registered nurse education is the basic nursing education to sit for licensure.

6-5. A nurse is assigned to care for the following patients. Which patient should the nurse assess first? A. A 60-year-old patient on a ventilator for whom a sterile sputum specimen must be sent to the laboratory B. A 55-year-old with COPD and a pulse oximetry reading from the previous shift of 90% saturation C. A 70-year-old with pneumonia who needs to be started on IV antibiotics D. A 50-year-old with asthma who complains of shortness of breath after using a bronchodilator

D. A 50-year-old with asthma who complains of shortness of breath after using a bronchodilator This patient's needs are not urgent or emergent. In chronic obstructive pulmonary disease (COPD), patients' pulse oximetry oxygen saturations of more than 90% are acceptable. The IV needs to be started; however, there is not an indication that the patient is in an urgent or emergent situation. The patient with asthma did not achieve relief from shortness of breath after using the bronchodilator and is at risk for respiratory complications. This patient's needs are urgent.

6-6. A respiratory therapist performs suctioning on a patient with a closed head injury who has a tracheostomy. Afterward, the NAP obtains vital signs. The nurse should communicate that the NAP needs to report which vital sign value or values immediately? Select all that apply. A. Heart rate of 96 beats/min B. Respiratory rate of 24 breaths/min C. Pulse oximetry of 95% D. Tympanic temperature of 101.4°F (38.6°C)

D. Tympanic temperature of 101.4°F (38.6°C) Suctioning will increase the heart rate. This needs reporting and reassessment and may be related to the increased temperature. Respiratory rate is often increased with a fever. Pulse oximetry of 95% is acceptable. The patient has a tracheostomy and is at risk for infection. A tympanic temperature of 101.4°F (38.6°C) indicates an infection and needs to be reported immediately.

2-8. Which of the following demonstrates a nurse as advocating for a patient? The nurse A. calls a nursing supervisor in conflicting situations. B. reviews and understands the law as it applies to the client's clinical condition. C. documents all clinical changes in the medical record in a timely manner. D. assesses the client's point of view and prepares to articulate this point of view.

D. assesses the client's point of view and prepares to articulate this point of view. Calling the supervisor does not demonstrate speaking or advocating for the patient. Values and ethics are beliefs. Documenting clinical changes is important; however, this is not advocating. Nurses strengthen their ability to advocate for a client when nurses are able to identify personal values and then accurately identify the values of the client and articulate the client's point of view.

6-7. An experienced LPN is working under the supervision of the RN. The LPN is providing nursing care for a patient who has a respiratory problem. Which activities should the RN delegate to the experienced LPN? Select all that apply. A. Auscultate breath sounds. B. Administer medications via metered-dose inhaler (MDI). C. Complete in-depth admission assessment. D. Initiate the nursing care plan. E. Evaluate the patient's technique for using MDIs.

A. Auscultate breath sounds. B. Administer medications via metered-dose inhaler (MDI). The experienced licensed practical nurse (LPN) is capable of gathering data and making observations, including noting breath sounds and performing pulse oximetry. Administering medications, such as those delivered via metered dose inhalers (MDIs), is within the scope of practice of the LPN. Independently completing the admission assessment is within the scope of practice of the professional registered nurse (RN). Initiating the nursing care plan is within the scope of practice of the professional RN. Evaluating a patient's abilities requires additional education and skills. These actions are within the scope of practice of the professional RN.

1-5. APRNs generally: Select all that apply. A. Function independently B. Function as unit directors C. Work in acute care settings D. Work in the university setting E. Hold advanced degrees

A. Function independently E. Hold advanced degrees Although advanced practice nurses (APNs) work in a variety of settings, they all: Function independently as guided by the nurse practice acts of the individual states. Are educated to provide higher level patient care. May work in acute care settings. May work in university settings. Are educated at the master's level or higher.

1-7. Which of the following is unique to a professional standard of decision making? Select all that apply. A. Weighs benefits and risks when making a decision B. Analyzes and examines choices more independently C. Concrete thinking D. Anticipates when to make choices without others' assistance

A. Weighs benefits and risks when making a decision B. Analyzes and examines choices more independently Professionals look at risks and benefits before making a decision. They analyze choices in order to make sound decisions. Concrete thinking is literal and focuses on the physical world. Professional decision making occurs independently.

2-5. Which best describes the difference between patient privacy and patient confidentiality? A. Confidentiality occurs between persons who are close, whereas privacy can affect anyone. B. Privacy is the right to be free from intrusion into personal matters, whereas confidentiality is protection from sharing a person's information. C. Confidentiality involves the use of technology for protection, whereas privacy uses physical components of protection. D. Privacy involves protection from being watched, whereas confidentiality involves protection from verbal exchanges.

B. Privacy is the right to be free from intrusion into personal matters, whereas confidentiality is protection from sharing a person's information. Confidentiality is an expectation of anyone who is under treatment. Privacy is the condition of being free from being observed or disturbed by other people. Confidentiality has to do with the sharing of someone else's information. Technology often causes breaches in confidentiality. Confidentiality goes beyond verbal exchanges; breaches can occur electronically or in writing.

3-4. An RN new to the emergency department documented that "the patient was intoxicated and acted in a crazy manner." The team leader told the RN that this type of documentation can lead to: A. Assault B. Wrongful publication C. Defamation of character D. Slander

C. Defamation of character Assault is a threat to do harm. Wrongful publication refers to erroneous information in writing. Charting or saying unsupported defamatory statements can lead to tort litigation. Slander is making an untrue statement that causes harm to someone's reputation.

3-2. The health-care facility has sponsored a continuing education offering on emergency management of pandemic influenza. At lunch, a nurse is overheard saying, "I'm not going to take care of anyone who might have that flu. I have kids to think about." What is true of this statement? Select all that apply. A. The nurse has a greater obligation than a layperson to care for the sick or injured in an emergency. B. This statement reflects defamation and may result in legal action against the nurse. C. This statement is a breach of the Code of Ethics for Nurses. D. The nurse has this right as no nurse-patient contract has been established.

A. The nurse has a greater obligation than a layperson to care for the sick or injured in an emergency. C. This statement is a breach of the Code of Ethics for Nurses. Because nurses have greater ability to provide care, their obligation to provide care is higher than that of laypersons. The nurse has not made an inflammatory or false statement. According to the Code of Ethics, nurses need to care for patients without judgment. Caring for a patient is an expectation of the role. Nurses do not establish contracts with patients to deliver care.

2-10. A nurse is providing care to a patient whose family has previously brought suit against another hospital and two physicians. Under which ethical principle should the nurse practice? A. Justice B. Veracity C. Autonomy D. Nonmaleficence

A. Justice All patients are entitled to the best possible care regardless of their socioeconomic status, culture, or situations. Veracity refers to truthfulness. Autonomy is the right to make one's own decisions. Nonmaleficience means to do no harm.

6-9. The nursing assistant tells a nurse that a patient who is receiving oxygen at a flow rate of 6 L/min by nasal cannula is complaining of nasal passage discomfort. What intervention should the nurse suggest to improve the patient's comfort for this problem? A. Suggest that the patient's oxygen be humidified. B. Suggest that a simple face mask be used instead of a nasal cannula. C. Suggest that the patient be provided with an extra pillow. D. Suggest that the patient sit up in a chair at the bedside.

A. Suggest that the patient's oxygen be humidified. When the oxygen flow rate is higher than 4 L/min, the mucous membranes can be dried out. The best treatment is to add humidification to the oxygen delivery system. Application of a water-soluble jelly to the nares can also help decrease mucosal irritation.

3-3. After 3 years of uneventful employment, the nurse made a medication error that resulted in patient injury. What hospital response to this event is ethical? A. The hospital was supportive and assistive as the nurse coped with this event. B. The nurse was dismissed for incompetence. C. The hospital quality department advised the nurse not to tell the patient about the error. D. The nurse was reassigned to an area in which there is no direct patient care responsibility.

A. The hospital was supportive and assistive as the nurse coped with this event. Nurses must be held accountable for errors but should be treated in a professional and assistive manner. Dismissal for incompetence fails to demonstrate ethical or supportive behavior. Advising a professional not to discuss the error is unethical. Reassigning is punitive.

1-9. Which of the following represent the knowledge and skills expected of the professional nurse? Select all that apply. A. Accountability B. Advocacy C. Autonomy D. Social networking E. Participation in nursing blogs

A. Accountability B. Advocacy C. Autonomy Professional behaviors include: Accountability for one's work and responsibilities. Advocating for patients and families. Autonomy in making decisions within the scope of practice. Social networking is not considered a knowledge or skill unique to professional nursing. Participation in nursing blogs is not considered a knowledge or skill unique to professional nursing.

6-3. A nurse is caring for a patient who has chronic obstructive pulmonary disease (COPD) and is 2 days postoperative after a laparoscopic cholecystectomy. Which intervention for airway management should the nurse delegate to an NAP? A. Assisting the patient to sit up on the side of the bed B. Instructing the patient to cough effectively C. Teaching the patient to use incentive spirometry D. Auscultating breath sounds every 4 hours

A. Assisting the patient to sit up on the side of the bed Assisting patients with positioning and activities of daily living is within the educational preparation and scope of practice of a nursing assistant. Instructing requires additional education and skills and is more appropriate for a licensed nurse. Teaching patients requires additional education and skills and is more appropriate for a licensed nurse. Assessing patients requires additional education and skills and is more appropriate for a licensed nurse.

6-10. The patient with COPD has a nursing diagnosis of Ineffective Breathing Pattern. Which is an appropriate action to delegate to the experienced LPN under your supervision? A. Observe how well the patient performs pursed-lip breathing. B. Plan a nursing care regimen that gradually increases activity intolerance. C. Assist the patient with basic activities of daily living. D. Consult with the physical therapy department about reconditioning exercises.

A. Observe how well the patient performs pursed-lip breathing. Experienced licensed practical nurses (LPNs) and licensed vocational nurses (LVNS) can use observation of patients to gather data regarding how well patients perform interventions that have already been taught. Planning requires additional education and skills, appropriate to a registered nurse (RN). Assisting patients with activities of daily living (ADLs) is more appropriately delegated to a nursing assistant. Consulting requires additional education and skills, appropriate to an RN.

2-2. The ANA Code of Ethics With Interpretive Statements guides nurses in ethical behaviors. Provision 3 of the ANA Code of Ethics says: "The nurse promotes, advocates for, and strives to protect the health, safety, and rights of the patient." Which of the following best describes an example of this provision? A. Respecting the patient's privacy and confidentiality when caring for him B. Serving on a committee that will improve the environment of patient care C. Maintaining professional boundaries when working with a patient D. Caring for oneself before trying to care for another person

A. Respecting the patient's privacy and confidentiality when caring for him The ANA Code of Ethics is designed to guide nurses toward quality, ethical care of patients. There may be times when it is difficult to discern the most ethical action, particularly when the lines are blurred as to the correct decision. The Code of Ethics provides some guidance that nurses can follow as part of the profession of nursing to uphold standards of ethical care. Improving care environments is important but does not address the ANA Code. Maintaining professional boundaries comes under professional behaviors. Caring for self is important; however, it does not address quality and ethical care.

6-1. A nurse is helping an NAP provide a bed bath to a comatose patient who is incontinent. Which of the following actions requires the nurse to intervene? A. The nursing assistant answers the phone while wearing gloves. B. The nursing assistant log-rolls the client to provide back care. C. The nursing assistant places an incontinence diaper under the client. D. The nursing assistant positions the client on the left side, head elevated.

A. The nursing assistant answers the phone while wearing gloves. The gloves are contaminated and should be removed before answering the phone. Log rolling is an appropriate action. Using an incontinence diaper is an appropriate action. Keeping the head elevated is an appropriate action.

1-10. Professional accountability serves the following purpose: Select all that apply. A. To provide a basis for ethical decision making B. To respect the decision of the client C. To maintain standards of health D. To evaluate new professional practices and reassess existing ones E. To belong to a professional organization

A. To provide a basis for ethical decision making B. To respect the decision of the client C. To maintain standards of health D. To evaluate new professional practices and reassess existing ones To provide a basis for ethical decision making is a characteristic of professional accountability. To respect the decision of the client is a characteristic of professional accountability. To maintain standards of health is a characteristic of professional accountability. To evaluate new professional practices and reassess existing ones is a characteristic of professional accountability. Belonging to a professional organization demonstrates commitment to the profession, not necessarily accountability.

6-2. A nurse is caring for a patient who has a pulmonary embolus. The patient is receiving anticoagulation with IV heparin. What instructions should the nurse give the NAP who will help the patient with activities of daily living? Select all that apply. A. Use a lift sheet when moving and positioning the patient in bed. B. Use an electric razor when shaving the patient each day. C. Use a soft-bristled toothbrush or tooth sponge for oral care. D. Use a rectal thermometer to obtain a more accurate body temperature. E. Be sure the patient's footwear has a non-slip sole when the patient ambulates.

A. Use a lift sheet when moving and positioning the patient in bed. B. Use an electric razor when shaving the patient each day. C. Use a soft-bristled toothbrush or tooth sponge for oral care. E. Be sure the patient's footwear has a non-slip sole when the patient ambulates. D. This is inappropriate. Although a patient is receiving anticoagulation therapy, it is important to avoid trauma to the rectal tissue, which could cause bleeding (e.g., avoid rectal thermometers and enemas). A, B, C, and E. These are appropriate to the care of a patient receiving anticoagulants.

2-4. A patient asks a nurse if he has to agree to the health provider's treatment plan. The nurse asks the patient about his concerns. Which ethical principle is the nurse applying in this situation? Select all that apply. A. Beneficence B. Autonomy C. Veracity D. Justice

B. Autonomy Beneficence is to do good. The principle of autonomy indicates that the client has independence to make decisions and take action for himself or herself. When the nurse asks the patient about his concerns, the nurse is exploring the reasons and allowing the patient to make his own decision. Veracity is to be truthful. Justice is to treat all patients equally.

2-6. A nurse is working on an ethics committee to determine the best course of action for a patient who is dying. The nurse considers the positive and negative outcomes of the decision to assist with choices. Which best describes the distinction of using a list when making an ethical decision? A. The nurse can back up her reasons for why she has decided to provide a certain type of care. B. The nurse can compare the benefits of one choice over another. C. The nurse can communicate the best choice of action to the interdisciplinary team. D. The nurse can provide care based on developed policies and standards.

B. The nurse can compare the benefits of one choice over another. Although important to be able to support reasons, lists do not help with this. Creating a list of positives and negatives helps when difficult choices need to be made. The list outlines the positive and negative aspects of a decision. It allows the nurse to compare the benefits of making a choice versus the potential disadvantages. When compared side by side, it could help the nurse to make a difficult decision through an easier method. Communicating the choice occurs after the list is created. Providing care should always be based on policies and standards.

2-7. A nurse is caring for a patient who feels that life should not be prolonged when hope is gone. She has decided that she does not want extraordinary measures taken when her life is at its end. She has discussed her feelings with her family and health-care provider. The nurse realizes that this is an example of: A. Affirming a value B. Choosing a value C. Prizing a value D. Reflecting a value

C. Prizing a value To affirm means to strongly state a fact, not indicating satisfaction with the choice. Choosing is to decide what is important. Prizing a value means being satisfied with a choice and being willing to declare the choice to others. The patient made her choice clear to her family and provider. Reflecting a value means considering it.

6-4. A nurse is caring for a patient who is diagnosed with coronary artery disease and sleep apnea. Which action should the nurse delegate to the NAP? A. Discuss weight-loss strategies such as diet and exercise with the patient. B. Teach the patient how to set up the CPAP machine before sleeping. C. Remind the patient to sleep on his side instead of his back. D. Administer modafinil (Provigil) to promote daytime wakefulness.

C. Remind the patient to sleep on his side instead of his back. Discussing weight-loss strategies requires additional education and training. Teaching requires additional education and training. These actions are within the scope of practice of the registered nurse (RN). The nursing assistant can remind patients about actions that have already been taught by the nurse and are part patient's plan of care. of the The RN can delegate the administration of medication to a licensed practical nurse (LPN) or licensed vocational nurse (LVN).

6-8. An assistant nurse manager is making assignments for the next shift. Which patient should the assistant nurse manager assign to a nurse with 6 months of experience and who has been floated from the surgical unit to the medical unit? A. A 58-year-old on airborne precautions for tuberculosis (TB) biopsy B. A 68-year-old who just returned from bronchoscopy and C. A 69-year-old with COPD who is ventilator dependent D. A 72-year-old who needs teaching about the use of incentive spirometry

D. A 72-year-old who needs teaching about the use of incentive spirometry To care for the patient with tuberculosis (TB) in isolation, the nurse must be fitted for a high-efficiency particulate air (HEPA) respirator mask. The bronchoscopy patient needs specialized procedure care and a more experienced nurse. The ventilator-dependent patient needs a nurse who is familiar with ventilator care. Many surgical patients are taught about coughing, deep breathing, and the use of incentive spirometry preoperatively.

1-3. You are participating in a clinical care coordination conference for a patient with terminal cancer. You talk with your colleagues about using the nursing code of ethics for professional registered nurses to guide care decisions. A non-nursing colleague asks about this code. Which of the following statements best describes this code? A. Improves communication between the nurse and the patient B. Protects the patient's right of autonomy C. Ensures identical care to all patients D. Acts as a guide for professional behaviors in giving patient care

D. Acts as a guide for professional behaviors in giving patient care Although good communication is expected, it is not considered an "ethical code." Protecting autonomy is part of the ethical code. All individuals are entitled to equitable care; however, nursing care is patient centered, so care, although equitable, may not be identical. Codes of ethics provide guidelines for appropriate professional behaviors and guide practice.

1-4. The NCLEX for nurses is exactly the same in every state in the United States. The examination: A. Guarantees safe nursing care for all patients B. Ensures standard nursing care for all patients C. Ensures that honest and ethical care is provided D. Provides a minimal standard of knowledge for a registered nurse in practice

D. Provides a minimal standard of knowledge for a registered nurse in practice The NCLEX exam ensures that the registered nurse has achieved the minimum knowledge and skills necessary to enter practice. The exam ensures minimally safe practice. Standards of care are designated by evidence-based practice. Honest and ethical care is expected and guided by the Code of Ethics.