Transition to Nursing Final
How does compensation occur?
*Compensation will always be from the opposing system*
Priority Actions to Take in a Fire According to the RACE Protocol
*Rescue*: Remove all pts from the vicinity of fire *Alarm*: Activate firm alarm *Contain/Confine*: Close all doors and windows *Extinguish*: Extinguish fire by using the appropriate fire extinguisher
Skills Performed by Registered Nurses
-Assessing labs -Initiating teaching -Patient assessments -Performing complex dressing changes -Feeding patients with swallowing difficulties -Administration of blood or blood products -Caring for invasive lines (central catheters) -Initial post-op assessments -IV therapy -Initial admission assessments -Discharging a patient -Planning care -Titration of meds based on patient assessment and physician order -Evaluating outcomes
Skills Performed by Nursing Assistants/UAP
-Bathing, hair care, routine oral hygiene -Routine vital signs on stable patients -Intake and output recording -Applying condom catheter -Collecting clean catch ua/uc and taking to lab -Emptying certain drainage containers (ie. foley catheters) -Ambulating patients -Applying TEDS -Performing ROM -Turning patients -Disconnect NG suction to get up to bathroom -Collecting stool specimens and taking to lab -Feeding patients
Accommodation (Conflict Management)
-Discipline may be lax if this is your primary style -Dreads conflict; wants to be liked and maintain harmony and good will -Satisfies the needs of others at expense of self but often end up feeling resentful and angry
Competing (Conflict Management)
-Force, or the use of power, is used to win their position
What could happen if the wrong type of crystalloid IV solution were infused?
-Hypotonic Solutions: Can make hypokalemia worse -Hypotonic Solutions: Can increase ICP -Hypertonic Solutions: Can further dehydrate cells -Hypertonic Solutions: Can increase fluid retention in impaired heart or kidney failure -Hypertonic Solutions: Rapid infusion can cause cerebral bleeding
How do the kidneys compensate for a blood pH change and what is the time required for compensation to begin?
-In order to maintain the pH of the blood in its normal range, the kidneys excrete or reabsorb bicarbonate (HCO3) -As the blood pH decreases, the kidneys will compensate by reabsorbing HCO3 back into the blood -As the blood pH rises, the kidneys excrete HCO3 through the urine [may take hours-days to correct the imbalance]
Collaborating (Conflict Management)
-Inappropriate to use if time is limited -Needs of both parties are taken into consideration; involves an attempt to find a solution which fully satisfies both parties
Avoiding (Conflict Management)
-May be good to use if tempers are flaring or strong anger is present -May be good to use if withdrawing from a threatening situation
Emergency Preparedness with Fires
-Need to keep environment free of clutter -Make sure the fire exits are clearly marked -Knowing the location of fire alarms, exits and fire extinguishers -Know the number to call to report a fire -Know the evacuation plan -Never use an elevator in the event of a fire -Turn off all oxygen in the area of a fire -Be prepared to offer respiratory support to ventilator patient (ambu bag) -Move all patients to a safe area as quickly as possible
Compromising (Conflict Management)
-Objective is to find an expedient, mutually acceptable solution that is acceptable to both parties but it may be a temporary solution until more options are available
How can functional illiteracy affect patients?
-Patients obtain less information from health education materials -May become overwhelmed with information, however may be too uncomfortable to ask questions -Misinformation, miscommunication, and mistakes may occur -Wrong medication doses may be taken -May be unaware of important treatment side effects or need for follow-up testing
What are factors that may interfere with patient learning?
-Physical discomfort -Environmental factors (hot/cold, excess noise) -Lack of time (must make time for teaching) -Health literacy factors (ability to understand teachings and health literacy--must be able to read at an 8th grade level or above)
Skills Performed by Licensed Practical Nurses
-Reinforcing patient teaching -Removing staples/sutures -Checking oxygen saturation using pulse oximeter -Oral suctioning -Administering respiratory treatments -Inserting/removing foley catheters -Collecting sputum specimens -Simple dressing changes -Administration of meds: po, topical, SL, eyes, ears, nasal -Vital signs prior to medications -Insert rectal tubes -Administration of ID, SQ, IM or rectal meds -Reconnect NG suction -Postmortem care -Admin of meds through NG or PEG tube -Obtaining a blood glucose reading -Caring for ostomies -Admin of enemas -Teaching from a standard plan of care (ie. simple diabetes teaching) -Assess as a part of collection of data (ie. assess breath sounds every 4 hours) -Administering tube feedings
How does triage work in mass casualty situations?
-When there are more victims of disaster than medical personnel to treat them, those who are likely to survive are treated first -When there are enough medical personnel available to treat the victims: 1st: Immediate threat to life 2nd: Non-life threatening injuries provided they are treated within the next 1-2 hours 3rd: No immediate complications and can wait several hours for treatment
Examples of Hypotonic Solutions
0.45% Saline in Water (1/2 NS)
You have been asked to administer IV fluid to a 28-year-old patient who is dehydrated after running a marathon in hot and humid weather. What IV solution will the physician order?
1. 0.9% NS 2. Lactated Ringer's
Which 2 specific IV solutions are commonly used for fluid replacement?
1. 0.9% Saline in water (NS) 2. Lactated Ringer's
Intentional Torts
1. Assualt 2. Battery 3. Invasion of privacy 4. False imprisonment 5. Libel 6. Slander
3 Different Leadership Styles
1. Authoritarian 2. Democratic 3. Laissez-Faire
What are the 5 conflict management styles?
1. Avoiding 2. Competing 3. Accommodation 4. Compromising 5. Collaborating
4 Elements that must be Present to Prove Malpractice
1. Duty 2. Breach of duty 3. Injury 4. Proximate cause
A positive Chvostek's and a positive Trousseau's sign may be seen with which two electrolyte imbalances?
1. Hypocalcemia 2. Hypomagnesemia
What 2 fluid-electrolyte imbalances have positive Chvostek's and Trousseau's signs?
1. Hypocalcemia 2. Hypomagnesemia
Contrast the 3 Different Types of Crystalloid IV Solutions
1. Hypotonic 2. Hypertonic 3. Isotonic
Explain the Steps to Analyzing ABG Results
1. Is the pH normal? 2. Is the pCO2 normal? 3. Is the HCO3 normal? 4. Match the pCO2 or the HCO3 with the pH 5. Is there compensation? 6. Are the pO2 and the O2 saturation normal?
Life-Threatening Acid-Base Imbalances
1. Respiratory Acidosis
The 6 Ethical Principles
1. Veracity 2. Justice 3. Beneficence 4. Nonmaleficence 5. Fidelity 6. Autonomy
The nurse is the first responder at the scene of a school bus accident. The nurse triages the victims from highest priority to lowest priority. Identify the order of who will be treated first, second, third and fourth. a. A child who is crying loudly and has several minor lacerations on the face, arms, and legs b. Child with a closed head wound and multiple compound fractures of the arms and legs c. Child with simple fracture of the arm d. Confused child with bright red blood pulsating from a leg wound
1. d 2. b 3. c 4. a
As explained during this course's lecture on Fluid and Electrolyte imbalances, hyponatremia can rapidly progress to seizures and comas when the sodium level drops below:
115 mmol/L
What type of IV solution may be given for a person with severe hyponatremia? Why is this solution dangerous and rarely used?
3% Sodium Chloride [It is dangerous because rapid infusion can cause cerebral bleeding. And demyelonation of the neurons in the pons may occur]
Normal Calcium Levels
8.5 - 10.5
Libel
A *written statement* about someone else that is damaging to his or her character, even if the statement is true [writing in chart "manipulative", "whiner", "drunk"]
Living Will
A document that lets people state their wishes for end-of-life medical care, in case they become unable to communicate their decisions. It has no power after death
Respondent Superior
A legal doctrine that holds an employer liable for the wrongful acts of an employee
DNR Orders
A medical order written by a doctor. It instructs health care providers not to do cardiopulmonary resuscitation (CPR) if a patient's breathing stops or if the patient's heart stops beating
Explain 72-hour-holds that may be placed on patients
A patient who is believed to be a danger to themselves and/or others is placed on a 72-hour hold within a hospital. They are unable to leave unless given consent from a psychiatrist. During the 72 hour hold, weekends do not count towards those hours.
What is hypernatremia usually caused by?
Administration of excessive amounts of NS (dehydration)
Slander
An *oral statement* about someone else that is damaging to his or her character, even if the statement is true [gossip, speaking negatively about someone]
As explained during this course's lecture on Fluid and Electrolyte imbalances, where is 99% of the body's calcium found?
Bones
Hypocalcemia
Ca2+ <8.5 CAUSES: -Hypoparathyroidism -Surgical removal/damage to parathyroid gland SIGNS/SYMPTOMS: -Severe muscle cramps -Laryngeal spasms -Diarrhea -Neuromuscular irritatbility (tremors, hyperreflexia, seizures, tetany) -Positive Chvostek's and Trosseau's signs *First sign: numbness/tingling of mouth/lips & hands/feet* TREATMENT: -Calcium chloride (works fast; need to be in ICU) -Calcium gluconate (works slower)
Hypercalcemia "Stones, bones, groans, thrones, and psychiatric overtones"
Ca2+ >10.5 (>1: medical emergency) CAUSES: -Increased release of calcium from bone -Hyperparathyroidism -Multiple myeloma -Renal disease SIGNS/SYMPTOMS: -Abdominal pain -Constipation -Polyuria/polydipsia -Deep bone pain -Renal calculi TREATMENT: -Loop diuretics -Adequate hydration -Decrease Vitamin D intake -*CALCITONIN*
Why is albumin used?
Can significantly increase the volume of blood and the effect lasts for several days
What is compensation?
Compensation occurs to maintain acid-base balance
False Imprisonment
Confining a person in some way without his or her consent *OR* Making someone wrongfully feel they cannot leave a place ["if you don't pay your bill, I will not give you your car keys back", "if you don't stay in bed, I'll have to sedate you"]
What is delegation? And who is allowed to delegate?
Delegation is the process of transferring a selected nursing task in a situation to an individual who is competent to perform that specific task -RNs are able to delegate tasks, as long as the 5 Rights are present
Beneficence
Doing good with nursing actions
Nonmaleficence
Doing no harm
Veracity
Duty to tell the truth
Democratic Leadership
Everyone participates in the decision making -Group consensus reached -High productivity -Good to use this style with daily nursing care situations, meetings, committees, review of care plans
What is hyponatremia usually caused by?
Excessive secretion of ADH; SIADH (over-hydration)
Justice
Fair treatment
You are caring for a patient with a dx of cirrhosis and ascites. Does this patient have a fluid volume excess or a fluid volume deficit? Why?
Fluid volume deficit because less in blood stream
Laissez-Faire Leadership
Focuses on people's feelings -Ignores task at hand -No structure -Good to use this style when agency goals/policies are not a consideration
Autonomy
Freedom to choose
"Stones, bones, groans, thrones, and psychiatric overtones" describes the effects of which electrolyte imbalance?
Hypercalcemia
Which one is more dangerous: hypokalemia or hyperkalemia? Why?
Hyperkalemia can lead to v-fib and cardiac arrest (both of which can kill you). The excess K+ must be removed.
Should patients receiving a hypertonic IV solution be assessed closely for hypovolemia or hypervolemia?
Hypervolemia
Your patient has the following set of electrolytes: Na 136, K 3.5, Ca 8.4, Mg 1.5. They have which electrolyte imbalance?
Hypocalcemia
What is the most common electrolyte imbalance?
Hyponatremia
What is a colloid IV solution?
IV fluids containing large proteins and molecules that tend to stay within the intravascular space (blood vessels)
No Compensation
If the opposing system is in the normal range, there is no compensation occuring
Partial Compensation
If the pH remains abnormal, the compensation is partial
Complete Compensation
If the pH returns to the normal range, the compensation is complete
What can happen if a hypotonic IV solution is given to a patient with edema and ascites?
Increased edema may occur because water would be pulled from the intravascular compartment to the interstitial compartment
What type of IV solution will be used for HHS?
Isotonic Solution
What type of crystalloid IV solution will be initially used for DKA?
Isotonic Solution
What can happen if a hypotonic IV solution is given to a patient who is at risk for increased ICP?
It can cause a sudden shift in fluid from the intravascular space to the cells. This could cause cardiovascular collapse and increased ICP in some patients. (May also exacerbate cerebral edema)
Hypokalemia
K+ <3.5 (<2.5: critical) CAUSES: -Renal loss (non-K+ sparing diuretics) -GI losses (diarrhea, vomiting) -Alkalosis -DKA SIGNS/SYMPTOMS: -Muscle cramping -Tachycardia (thread) -Postural hypertension -Lethargy -Decreased/absent reflexes -Prominent U-waves TREATMENT: -Slow administration of IV KCl 10mEq/hour -Potassium replacement by mouth -Check renal function before giving K+ (creatinine level) *Must have normal Mg2+ levels to hold onto K+*
Hyperkalemia
K+ >5.0 (>6.5: critical--usually pt on dialysis) CAUSES: -Renal failure (cannot excrete K+) -Respiratory/Metabolic Acidosis -Massive tissue injury (burns, trauma, crushing injuries) SIGNS/SYMPTOMS: -Cramping of hands and feet, arms, legs -Tall peaked T-waves -V-fib and cardiac arrest TREATMENT: -Calcium chloride -Albuterol nebulizer -D50 and insulin -Kayexelate orally or rectally (works slowly) -Lasix -Dialysis
Prioritizing Patients that Require Immediate Attention
LONG-TERM CARE PTs -Ill patients -Patients who showed signs of a problem on the previous shift HOSPITAL PTs -Most ill or unstable
Examples of Isotonic Solutions
Lactated Ringer's (LR) 0.9% Saline in Water (NS) 5% Dextrose in Water (D5W)
Advance Directives
Legal documents that allow you to spell out your decisions about end-of-life care ahead of time. They give you a way to tell your wishes to family, friends, and health care professionals and to avoid confusion later on
Fidelity
Loyal and faithful to carry out promises
A patient with pancreatitis has been receiving potassium for three days since being admitted with a serum potassium level of 2.9mEq/L. Today the potassium level is 3.1mEq/L. Which of the following lab values should the nurse check before notifying the physician of the patient's failure to respond to treatment? a. Calcium b. Magnesium c. Potassium d. Sodium
Magnesium
In order to hold onto potassium levels when you are administering potassium due to hypokalemia, what electrolyte must be in the normal range?
Magnesium
Liability of the Nurse & Other Healthcare Personnel who Perform CPR on a Patient who has a DNR Order
May be charged with battery
Hypomagnesemia
Mg2+ <1.5 SIGNS/SYMPTOMS: -Positive Chvostek's and Trosseau's signs
Hypermagnesemia
Mg2+ >2.5
Hyponatremia
Na+ <135 (125: symptomatic, <115, seizures/coma) CAUSES: -Excessive intake of water SIGNS/SYMPTOMS: -Confusion -Irritability, muscle twitching, restlessness TREATMENT: -Fluid restriction -When hypervolemic: fluid restriction and possibly a diuretic
Hypernatremia
Na+ >145 CAUSES: -Excessive sodium intake -Dehydration TREATMENT: -Requires free water replacement -Restrict sodium in diet *Rapid replacement of deficits/correction of serum sodium can result in cerebral edema
Durable Power of Attorney for Health Care
Naming a trusted person to oversee your medical care and make health care decisions for you if you are unable to do so
Normal ABG Values
Normal Blood Gas Values *pH:* 7.35 - 7.45 *pCO2:* 35 to 45 mm Hg *HCO3:* 22 to 26 mEq/L *pO2:* 80 to 100 mm Hg
What is the earliest symptom usually seen with hypocalcemia?
Numbness and tingling of the mouth/lips and hands/feet
Explain the Nurse's Role as a Patient Advocate
Nurses are advocates for the patients' safety and rights
What is usually the earliest symptom seen with hypocalcemia and what part(s) of the body is(are) affected?
Often the first symptom is numbness/tingling of the mouth and lips and also the hands and feet
Normal Acid-Base Balance
Our body fluid must maintain a balance between acidity and alkalinity in order for life to be maintained
Invasion of Privacy
Patients have a right to have their person and personal affairs kept private; to do so otherwise is an invasion of privacy [ie. photographs without consent, going through personal belongings]
Isotonic Solutions
Promote no fluid shift; no fluid flow into or out of the intravascular compartment *Close to the same osmolarity as plasma*
Hypertonic Solutions
Pull fluid and electrolytes from the intracellular and interstitial compartments into the intravascular compartment
Explain the Use of a Fire Extinguisher using PASS
Pull the pin Aim at the base of the fire Squeeze the handle Sweep the fire from side to side
Horizontal Violence
Refers to acts that occur between colleagues, where bullying is described as acts perpetrated by one in a higher level of authority and occur over time.
Normal Lab Values of Electrolytes
Sodium: 135 - 145 Potassium: 3.5 - 5.0 Calcium: 8.5 - 10.5 Magnesium: 1.5 - 2.5
What is usually the first sign seen with hyperkalemia?
Tall, peaked T-waves
What is assigning? And who is allowed to assign?
The process of giving someone a task that is already part of their job -LPNs and RNs are able to assign tasks, as long as patient safety is kept in mind
What do the lungs do in response to a blood pH change and how quickly does the compensation by the lungs begins to occur?
This triggers the lungs to either increase or decrease the rate and depth of ventilation until the appropriate amount of CO2 has been re-established
Assault
Threatening to harm someone or doing something to make the person fear that you will harm them [causing fear]
Authoritarian Leadership
Thrives on power -Involves telling someone what to do -Concerned with task -Structure/order -Good to use this style with crisis situations, code situations, emergencies
Battery
Touching someone without his or her consent, whether you caused harm or not [CPR on a DNR patient, surgery without a signed consent]
Is malpractice an intentional or unintentional tort?
Unintentional Tort
Is negligence an intentional or unintentional tort?
Unintentional Tort
Hypotonic Solutions
Water is pulled from the intravascular compartment into the interstitial compartment, which eventually moves water into the cells
Why is it dangerous to give potassium to someone who isn't urinating?
When a patient has no urinary output, most will have high levels of potassium due to retained wastes within the body
When should a patient situation or assignment be questioned?
When it places either the health care worker or patient in a position of unfamiliarity or danger
As explained during this course's lecture on Fluid and Electrolyte imbalances, where do you find 95% of the body's potassium?
Within the body's cells
Examples of Hypertonic Solutions
[3% Sodium Chloride] 50% Dextrose in Water (D50W) 5% Dextrose in 0.9% Saline (D5NS) 5% Dextrose in 0.45% Saline (D5 1/2NS) 5% Dextrose in Water in LR (D5LR)
Cognitive Learning
[Knowledge] ie. Pt. states how diet affects their BS levels
Psychomotor Learning
[Skills] ie. Pt. will demonstrate aseptic technique when giving themselves insulin
Affective Learning
[Values and Feelings] ie. Pt.'s feelings r/t giving themselves insulin
A patient who has consented to surgery tells the nurse that he now refuses that same surgery. Which is the best response by the nurse? a. "What has happened to change your mind?" b. "I will need to call your family about this." c. "You already signed the consent. I think you have to have the surgery." d. "Should I call the physician so you can talk to him?"
a. "What has happened to change your mind?"
A patient with a history of cardiac disease is scheduled for a dose of furosemide (Lasix). Which serum potassium level warrants a call to the health care provider by the nurse before administering the furosemide? a. 3.2 mEq/L b. 3.8 mEq/L c. 4.2 mEq/L d. 5.2 mEq/L
a. 3.2 mEq/L
The emergency department nurse receives a telephone call and is informed that a tornado has hit a local residential area and numerous casualties have occurred. The victims will be brought to the emergency room. Which should be the initial nursing action? a. Activate the agency emergency response plan b. Obtain additional nursing staff to assist with treating the casualties c. Obtain additional supplies from the central supply department d. Prepare the triage rooms
a. Activate the agency emergency response plan
The client's potassium level is 6.7 mEq/L. Which intervention should you assign to the student nurse you are monitoring? a. Administer Kayexalate 15g orally b. Administer spironolactone 25mg orally c. Assess ECG strip for tall peaked T waves d. Administer potassium 10mEq orally
a. Administer Kayexalate 15g orally
The nurse enters the nursing break room and discovers that a couch is on fire. The nurse activates the alarm, closes the door to the break room, and obtains the fire extinguisher to extinguish the fire. The nurse pulls the pin on the fire extinguisher. Which is the next action the nurse should perform? a. Aim at the base of the fire b. Squeeze the handle on the extinguisher c. Sweep the fire from side to side with the extinguisher d. Sweep the fire from top to bottom with the extinguisher
a. Aim at the base of the fire
While withdrawing medication from the new computerized medication administration system, you notice that the nurse ahead of you had signed out for a narcotic that was to be given to your client for pain control. In checking the chart, there was no record of the narcotic being given. Your client denied receiving anything for pain since the previous night. Which action should the nurse take first? a. Approach the nurse who had signed out the narcotic to seek clarification about the missing drug b. Notify the pharmacist that a narcotic is missing c. Notify the charge nurse/supervisor that the client did not receive the prescribed pain medication d. Notify the client that someone else received his pain medication
a. Approach the nurse who had signed out the narcotic to seek clarification about the missing drug
An anxious patient repeatedly uses the call light to get the nurse to come to the room. Finally the nurse says to the patient, "If you keep ringing, there will come a time when I won't answer your call light." This is an example of a. Assault b. Battery c. Libel d. Slander
a. Assault
An adult female ambulatory care client receiving an oral anticoagulant is given aspirin for a headache while visiting a neighbor, who is a nurse. The client subsequently has a bleeding episode because of a drug interaction. The legal nurse consultant interprets that which necessary elements of malpractice are missing from this case? Select all that apply a. Breach of duty b. Duty owed c. Injury experienced d. Causation between nurse's actions and injury e. Intent to cause harm or injury
a. Breach of duty b. Duty owed
Triage refers to the classification of injury severity during a disaster. Which of the following patients should receive priority during triage? a. Burns of the head and neck b. Contusions and lacerations of the head without loss of consciousness c. Crushing injury of the arm d. Open fractures of the tibia and fibula
a. Burns of the head and neck
A patient with COPD is admitted for respiratory acidosis. The patient informs the nurse that he does not want to be mechanically ventilated. What should the nurse do next? a. Call the physician immediately b. Consult the patient's family c. Determine the patient's competency, and then have him sign a do-not-intubate form d. Have the patient sign a do-not-intubate form
a. Call the physician immediately
A nurse enters a client's room and notes that the client's lawyer is present and the client is preparing a living will. The living will requires that the client's signature be witnessed, and the client asks the nurse to witness the signature. Which of the following is the appropriate nursing action? a. Decline from signing the will b. Sign the will as a witness to the signature only c. Call the hospital lawyer before signing the will d. Sign the will, clearly identifying credentials and employment agency
a. Decline from signing the will
When urine output is less than fluid intake, the nurse can expect the patient to a. Gain weight b. Void frequently c. Become jaundice d. Experience nausea
a. Gain weight
The nurse is in the hospital's public cafeteria and hears two nursing assistants talking about a patient in room 211. They are using her name and discussing intimate details about her illness. Which of the following actions is best for the nurse to take? a. Go over and tell the nursing assistants that their actions are inappropriate, especially in a public place b. Wait and tell the nursing assistants later that they were overheard discussing the patient. Otherwise, they might be embarrassed c. Tell the nursing assistants' supervisor about the incident. It is the supervisor's responsibility to address the issue d. Say nothing. It is not the nurse's job and the nurse is not responsible for the nursing assistants' actions
a. Go over and tell the nursing assistants that their actions are inappropriate, especially in a public place
A nurse is assessing a patient with a suspected diagnosis of hypocalcemia. Which of the following clinical manifestations would the nurse expect to note in the patient? a. Hand tremors b. Negative Trousseau's Sign c. Hypoactive bowel sounds d. Hypoactive deep tendon reflexes
a. Hand tremors
You are assigned a patient with a diagnosis of increased ICP. The doctor has ordered an IV of hypertonic solution. What is your understanding of the rationale for using this solution? a. It reduces edema of the brain b. It provides needed fluid to maintain adequate intake and output balance c. This solution causes cells to expand or increase in size d. It expands intracellular volume
a. It reduces edema of the brain
When a nurse is giving dietary instructions appropriate to a person taking ibandronate sodium (Boniva), it would be especially important to include a. Maintain adequate intake of calcium and vit D b. Increase fiber, whole grains and rhubarb c. Increase intake of vit C d. Maintain appropriate calories to avoid gaining weight
a. Maintain adequate intake of calcium and vit D
A patient with hyperparathyroidism is prone to hypercalcemia. Which nursing interventions are most appropriate to include in this patient's care plan? Select all that apply a. Monitor the patient's cardiac rhythm b. Provide a high fluid intake c. Observe for signs of muscle spasms d. Take hourly vital signs e. Assess the patient for low blood sugars f. Evaluate the patient's joints for gout
a. Monitor the patient's cardiac rhythm b. Provide a high fluid intake f. Evaluate the patient's joints for gout
Moral distress over client care issues has recently been identified as a serious problem for health care professionals, especially for nurses. Moral distress can affect the nurse both professionally and personally. Which statements describe moral distress? Select all that apply. a. Moral distress can occur when a nurse is asked to care for a client in a manner contrary to the nurse's personal or professional values b. Moral distress often causes feelings of perceived personal integrity compromise for the nurse c. Moral distress can manifest as both emotional and physical stress for the nurse d. Moral distress is an infrequent cause of nurses terminating employment on a specific unit or health care facility, and seeking employment elsewhere
a. Moral distress can occur when a nurse is asked to care for a client in a manner contrary to the nurse's personal or professional values b. Moral distress often causes feelings of perceived personal integrity compromise for the nurse c. Moral distress can manifest as both emotional and physical stress for the nurse
A patient tells the nurse about his decision to not have any life-saving measures, such as CPR, in the event he has a cardiac arrest. Which of the following would be the appropriate initial nursing action? a. Notify the physician of the patient's request b. Discuss the patient's request with the family c. Document the patient's request in the patient's record d. Conduct a patient conference to share the patient's request
a. Notify the physician of the patient's request
The pt is admitted to the hospital unit with a potassium level of 6.2. The patient with a potassium level of 6.2 would exhibit s/s of a. Peaked T waves b. U waves c. Rapid, thread pulse d. Slow and shallow respirations
a. Peaked T waves
A nurse is caring for a patient with chronic renal failure. The lab results indicate hypocalcemia. When assessing the patient, the nurse should be alert for which of the following? Select all that apply a. Positive Trousseau's sign b. Cardiac arrhythmias c. Constipation d. Drowsiness and lethargy e. Positive Chvostek's sign
a. Positive Trousseau's sign b. Cardiac arrhythmias e. Positive Chvostek's sign
An 86-year-old client will be undergoing a surgical procedure. Which change would the nurse make in the informed consent process to accommodate for age-related changes in the client? a. Providing adequate time for client to process information b. Encouraging family members to make decisions for client c. Encouraging client to sign immediately before forgetting the purpose of surgery d. Providing client with reading material about surgery and postoperative instructions
a. Providing adequate time for client to process information
The nurse assesses a patient and concludes that the patient has a fluid volume deficit. Which assessments support this conclusion? Select all that apply a. Tenting of skin b. Decreased pulse c. Sudden weight loss d. Increased blood pressure e. Longitudinal furrows in the tongue
a. Tenting of skin c. Sudden weight loss e. Longitudinal furrows in the tongue
The health care provider orders a medication in a dose that is considered toxic. The nurse administers the medication to the client, who later suffers from a cardiac arrest and dies. What consequence can the nurse expect from this situation? Select all that apply a. The health care provider can be charged with negligence, being the person who ordered the dose b. As the employing agency, only the hospital can be charged with negligence c. The nurse and physician may be terminated from employment to prevent a charge of negligence to the hospital d. Negligence will not be charged, as this event could happen to any reasonable person e. The nurse can be charged with negligence for administering the toxic dose
a. The health care provider can be charged with negligence, being the person who ordered the dose e. The nurse can be charged with negligence for administering the toxic dose
An individual has a seizure while walking down the street. During the seizure, a nurse from a physician's office is noticed driving past without stopping to assist. The individual sues the nurse for negligence but fails to win a judgment for which reason? a. The nurse had no duty to the individual b. The nurse did what most nurses would do in the same circumstance c. The nurse did not cause the client's injuries d. The nurse was off-duty at that time
a. The nurse had no duty to the individual
The nurse has moved a group of patients away from window blinds that have caught fire in a room. The next action by the nurse is to a. activate the fire alarm b. close the window in the room c. get the fire extinguisher d. unplug electrical equipment in the room
a. activate the fire alarm
A 14-month-old is receiving Digoxin and Lasix. In planning his care, the nurse should assess for which complication? a. hypokalemia b. hyperkalemia c. hypercalcemia d. hypocalcemia
a. hypokalemia
A client with a diagnosis of paranoid schizophrenia who threatened his parents with a knife was placed on a 72-hour hold by the courts and the psychiatrist. The nurse reinforces to the family that once the 72-hour hold is expired, the psychiatrist and court must determine if the client is which of the following? a. A danger to himself b. A danger to himself and others c. Agreeable to take his medications d. Willing to remain in outpatient treatment
b. A danger to himself and others
The Patient Self-Determination Act of 1990 mandates that all clients must be asked whether or not they have a(n) a. Organ donation card b. Advance directive c. Last will and testament d. Funeral home or method of burial preference
b. Advance directive
Which statements are true regarding advanced directives? Select all that apply a. Advanced directives are used as guidelines for client treatment should the client's family deem them necessary b. Advanced directives are legally binding documents c. Advanced directives should be placed in the client's medical record d. Advanced directives specify a client's wishes for health care treatment should the client become incapacitated
b. Advanced directives are legally binding documents c. Advanced directives should be placed in the client's medical record d. Advanced directives specify a client's wishes for health care treatment should the client become incapacitated
The nurse is preparing to administer medications to an adult patient and discovers that the trash can is the patient's room is on fire. Which of the following actions should the nurse take first? a. Activate the fire alarm b. Ask the patient to exit the room c. Close the door to the patient's room d. Pour a pitcher of water into the trash can
b. Ask the patient to exit the room
A pt is being started on isoniazid (INH) therapy for the tx of TB. Identify all of the following items that should be included in his discharge instruction a. Take the med with meals b. Avoid smoked fish, tuna and milk products c. Monitor BG levels regularly d. Do not drink alcohol e. Maintain follow up contact with physician f. Limit contact with others during the course of therapy
b. Avoid smoked fish, tuna and milk products d. Do not drink alcohol e. Maintain follow up contact with physician
A pt dx with metastatic cancer of the bone is exhibiting mental confusion and a BP of 160/100. Which lab value would correlate with the pts symptoms reflecting a common complication with this dx? a. Potassium 5.2 b. Calcium 13 c. Sodium 138
b. Calcium 13
A nurse is conducting dietary teaching with a patient who is hypocalcemic. The nurse encourages the patient to increase intake of which of the following foods? a. Apples b. Cheese c. Cooked pasta d. Chicken breast
b. Cheese
A client presents a Durable Power of Attorney for Health Care designating the client's niece as the person to make the health care decisions for the client should the client become incapacitated and unable to make informed health care decisions. The Durable Power of Attorney identifies the niece as the a. Legal next of kin b. Health care proxy or surrogate decision-maker for health care issues only c. Health care proxy or surrogate decision-maker for health care and financial issues d. Person responsible for the client's hospital bill
b. Health care proxy or surrogate decision-maker for health care issues only
A client with a Do Not Resuscitate/Do Not Intubate order in the medical record becomes unresponsive and a code blue is called. The code team arrives and the physician is preparing to intubate the client. What action should the nurse take regarding the DNR/DNI order? a. Prepare the client for immediate intubation. Assist the physician with the intubation procedure as needed b. Immediately inform the physician and code team of the client's DNR/DNI order in the medical record c. Assist the code team with the code blue per Advanced Care Life Support (ACLS) protocol d. Notify the physician and code team of the client's DNR/DNI order in the medical record, but the physician responding to the code blue will make the decision whether or not to intubate the client
b. Immediately inform the physician and code team of the client's DNR/DNI order in the medical record
A patient enters the ER with confusion, twitching, and had a seizure at home. The patient recently has been started on corticosteroids for arthritis. Upon assessment, the patient has flushed skin, dry mucous membranes, an elevated temperature, and poor skin turgor. The patient's serum sodium level is 162 mEq/L. Which interventions would the health care provider likely prescribe? Select all that apply a. Adminster sodium replacements, such as 3% NS b. Increase water intake orally c. Monitor intake and output d. Monitor the electrolyte levels e. Monitor vital signs f. Provide a sodium-reduced or sodium restricted diet
b. Increase water intake orally c. Monitor intake and output d. Monitor the electrolyte levels e. Monitor vital signs f. Provide a sodium-reduced or sodium restricted diet
The nurse is reviewing the medication administration record (MAR) form for an assigned patient. The nurse discovers that amitriptyline (Elavil) is written on the patient's MAR and has been given to the patient rather than the paroxetine (Paxil) as prescribed. The nurse reviews the patient's record and sees that the patient does not have a prescription for Elavil, but the patient's roommate does. Which of the following statements would be most appropriate to include on the irregular occurrence report? a. Elavil given by error b. No current prescription for Elavil c. Roommate's Elavil on wrong MAR d. Transcription error with Elavil prescription
b. No current prescription for Elavil
The pt you are caring for is on telemetry. They develop prominent U waves. Which lab should you check immediately? a. Sodium level b. Potassium level c. Magnesium level d. Calcium level
b. Potassium level
An experienced LPN reports to you that a patient's blood pressure has decreased, and when his face is assessed, one side twitches. What action should you take at this time? a. Reassess the patient's blood pressure and HR b. Review the patient's morning calcium level c. Request a neuro consult today d. Check the patient's papillary rxn to light
b. Review the patient's morning calcium level
The nurse is told in report that the patient has a positive Chvostek's sign. What data would the nurse expect to note during the data collection? Select all that apply a. Coma b. Tetany c. Diarrhea d. Possible seizure activity e. Hypoactive bowel sounds f. A positive Trousseau's sign
b. Tetany c. Diarrhea d. Possible seizure activity f. A positive Trousseau's sign
A client in the ICU is alert and oriented but loud and verbally abusive to all health care personnel who enter the client's room. Multiple staff members including the charge nurse have spoken to the client about the inappropriate behavior but all attempts have been ineffective. The client has lorazepam (Ativan) IV ordered as needed for disorientation and agitation. Which client right would be violated if the nurse were to administer the medication to the client under these circumstances? a. The client's right to self-determination b. The client's right to freedom from unreasonable restraint c. No client right is violated in this scenario d. The client's right to considerate and respectful care
b. The client's right to freedom from unreasonable restraint
Choose the correct statement a. Hypernatremia requires fluid restrictions to help bring the sodium level back to the normal range b. The higher or lower the sodium level is, the slower you need to treat or you can cause cerebral edema c. 3% sodium IV is needed to treat severe states of hypernatremia
b. The higher or lower the sodium level is, the slower you need to treat or you can cause cerebral edema
A licensed practical nurse is assigned to care for a group of patients. On review of the medical records for this group of patients, the nurse determines which patient is at risk for excess fluid volume? a. The patient on diuretics b. The patient with renal failure c. The patient with an ileostomy d. The patient who has gastrointestinal suctioning
b. The patient with renal failure
The nurse learns that a patient has an advanced directive. This document ensures that a. Only lifesaving heroic measures will be used b. The patient's right to make decisions about his death will be honored c. The physician will not attempt to dissuade the patient from any treatment plans d. The family's rights to make final decisions concerning the care of the terminally ill patient will be honored
b. The patient's right to make decisions about his death will be honored
A nurse reviews a patient's electrolyte results and notes a potassium level of 5.5. The nurse understands that a potassium value at this level would be noted with which condition? a. Diarrhea b. Traumatic burn c. Cushing's syndrome d. Overuse of laxatives
b. Traumatic burn
A nurse forgets to administer a client's diuretic and the client experiences an episode of pulmonary edema. The charge nurse would consider the medication error to constitute negligence because the situation contains which element? a. Purposeful failure to perform a health care procedure b. Unintentional failure to perform a health care procedure c. Act of substituting a different medication for the one recorded d. Failure to follow a direct order by a physician
b. Unintentional failure to perform a health care procedure
When dealing with mass casualties when there are more victims than medical personnel to care for them, who will receive care first? a. Victims who are ambulatory are treated first b. Victims who are most likely to survive are treated first c. Victims with life-threatening injuries who will not survive without medical care are treated first
b. Victims who are most likely to survive are treated first
What is the most common electrolyte imbalance? a. hypokalemia b. hyponatremia c. hyperkalemia d. hypernatremia
b. hyponatremia
When caring for a patient with hypocalcemia, the nurse should assess for: a. a decreased level of consciousness b. tetany c. bradycardia d. respiratory depression
b. tetany
A patient is experiencing diarrhea and needs to replace potassium. The nurse identifies that additional teaching is necessary when the patient says, "I should increase my intake of a. orange juice." b. warm tea." c. bananas." d. raisins."
b. warm tea."
Which of the following is an isotonic IV fluid that becomes hypotonic once it is in the body because it is rapidly metabolized leaving only the water? a. Lactated Ringer's b. 0.9% Saline in water (NS) c. 5% Dextrose in water d. 3% Sodium Chloride
c. 5% Dextrose in water
The nurse is evaluating the serum laboratory results on the following four patients. Which of the following lab results is a priority for the nurse to report first? a. A patient with osteoporosis and a calcium level of 10.6 b. A patient with renal failure and a magnesium level of 2.5 c. A patient with bulimia and a potassium level of 3.1 d. A patient with dehydration and a sodium level of 149
c. A patient with bulimia and a potassium level of 3.1
The nurse enters the patient's room and finds that the wastebasket is on fire. The nurse immediately assists the patient out of the room. Which is the next nursing action? a. Call for help b. Extinguish the fire c. Activate the fire alarm d. Confine the fire by closing the room door
c. Activate the fire alarm
A nurse is teaching a nutrition class to a group of expectant parents. Which of the following statements may indicate to the nurse that her lecture has been understood? a. Vitamins will protect my baby if I do not eat correctly b. You can never get too many vitamins and minerals c. Adequate folic acid will help prevent birth defects d. I am going to try really hard to eat a lot of veggies
c. Adequate folic acid will help prevent birth defects
A client is referred to a surgeon by the general practitioner. After meeting the surgeon, the client decides to find a different surgeon to continue treatment. The nurse supports the client's action, utilizing which ethical principle? a. Beneficence b. Veracity c. Autonomy d. Privacy
c. Autonomy
A client with cancer has decided to discontinue further treatment. Although the nurse would like the client to continue treatment, the nurse recognizes the client is competent and supports the client's decision using with ethical principle? a. Justice b. Fidelity c. Autonomy d. Confidentiality
c. Autonomy
A nurse is caring for a patient with hyperparathyroidism and notes the patient's serum calcium level is 13 mg/dL. Which medication would the nurse prepare to administer as prescribed to the patient? a. Calcium chloride b. Calcium gluconate c. Calcitonin d. Large doses of vitamin D
c. Calcitonin
The pt is admitted with a dx of hypokalemia. An IV of normal saline is infusing at 80mL/hr. The pt is also receiving an infusion of 10mEq of KCL/hr. Prior to beginning the infusion, the nurse should a. Check the sodium level b. Check the magnesium level c. Check the creatinine level d. Check the calcium level
c. Check the creatinine level
A nurse enters the client's room and finds the client sitting on the floor. The nurse checks the client thoroughly and then assists the client back into bed. The nurse completes an incident report and notifies the nursing supervisor and physician of the incident. Which of the following is the next nursing action regarding the incident? a. Place the incident report in the client's chart b. Make a copy of the incident report for the physician c. Document a complete entry in the client's record regarding the incident d. Document in the client's record that an incident report has been completed
c. Document a complete entry in the client's record regarding the incident
A patient with hyperkalemia is to receive an infusion of 250mL of 20% glucose with 20 units of regular insulin. The rationale for this therapy is: a. Potassium elimination is enhanced b. Potassium binds with the glucose and is excreted by the kidneys c. Glucose uptake by the cell drives the potassium into the cell d. Insulin lowers the potassium by lowering blood glucose
c. Glucose uptake by the cell drives the potassium into the cell
The nurse working in an acute environment would utilize which strategies to reduce the risk of malpractice litigation? Select all that apply a. Discuss any errors with the client and family in detail b. Keep incident reports on file c. Maintain expertise in practice d. Offer opinions to clients when the situation warrants e. Report unsafe staffing levels to supervisor
c. Maintain expertise in practice e. Report unsafe staffing levels to supervisor
If a pt is not urinating, it is dangerous to give a. Calcium b. Magnesium c. Potassium
c. Potassium ("No pee, No K+")
A nurse and lawyer are discussing legal issues related to their professions. The lawyer asks what the functions are of the Nurse Practice Act in that state. The nurse would include which thoughts in a response? Select all that apply a. Accredit schools of nursing b. Enforce ethical standards of behavior c. Protect the public d. Define the scope of nursing practice e. Determine liability insurance rates
c. Protect the public d. Define the scope of nursing practice
A nurse has taught a patient with hyperaldosteronism about dietary changes needed to manage the condition. The nurse determines the patient understands the information presented if the patient states a need to decrease which of the following types of foods? a. Oranges b. Red meats c. Salty snacks d. Whole grain breads
c. Salty snacks
The nurse determines that sodium polystyrene sulfonate (Kayexalate) has been effective in a patient if which laboratory result is noted? a. Serum glucose is 110 mg/dL b. Serum magnesium is 1.7 mg/dL c. Serum potassium is 4.9 mEq/L d. Serum sodium is 148 mEq/L
c. Serum potassium is 4.9 mEq/L
While working in an adolescent behavioral unit, the nurse witnesses an adolescent hitting a nursing assistant. The nurse documents the event. Which example of documentation is best? a. Became angry for no reason and an assault occurred b. Hit caregiver unexpectedly even though not provoked c. Struck nursing assistant when being helped from bed d. Attacked nursing assistant without prior warning
c. Struck nursing assistant when being helped from bed
A nurse attorney provides and education session to the nursing staff regarding patient rights. A nurse asks the attorney to describe an example that may relate to invasion of patient privacy. A nursing action that indicates violation of this right is a. Threatening to place a patient in restraints b. Performing a surgical procedure without consent c. Taking photographs of the patient without consent d. Telling the patient that he or she cannot leave the hospital
c. Taking photographs of the patient without consent
Your patient has been medicated for her surgery. The operating room (OR) nurse, when going through the patient's chart, realizes that the consent form has not been signed. Which of the following is the best action for the nurse to take? a. Assume it is emergency surgery and the consent is implied b. Give the consent form and have the patient sign it c. Tell the physician that the consent form is not signed d. Have a family member sign the consent form
c. Tell the physician that the consent form is not signed
In the health care setting, the ethical principle of "justice" refers to which aspect of client care? a. Each client's right to access their own medical records and health information b. Each client's constitutional right to health care c. The most allocation of scarce health care resources d. The right to equal health care, regardless of the client's condition
c. The most allocation of scarce health care resources
The nurse reviews electrolyte values and notes a sodium level of 130mEq/L. The nurse expects that this sodium level would be noted in a patient with which condition? a. The patient with an inadequate daily water intake b. The patient with diabetes insipidus c. The patient with the syndrome of inappropriate secretion of antidiuretic hormone d. The patient with watery diarrhea
c. The patient with the syndrome of inappropriate secretion of antidiuretic hormone
A 20 y.o. pt is taking ciprofloxacin (Cipro) for a UTI. He also take theophylline for asthma. In teaching him about his med, the nurse knows that a. Fluids should be restricted which taking Cipro b. The pt should not be started on Cipro until the culture results are obtained c. Theophylline levels may be elevated and can become toxic d. The 2 meds should be given at alternate times
c. Theophylline levels may be elevated and can become toxic
A nurse gives the wrong patient a dose of digoxin. After assessing the patient, the nurse fills out an incident report. What is the purpose of an incident report? Select all that apply a. To be stored in the nurse's personnel file b. To discipline the nurse c. To help risk management investigate existing policies and procedures d. To notify the board of nursing e. To prevent future occurrences of similar events f. To promote quality improvement
c. To help risk management investigate existing policies and procedures e. To prevent future occurrences of similar events f. To promote quality improvement
A patient is admitted for treatment of hypoparathyroidism. Based on the patient's diagnosis, the nurse would anticipate an order for: a. potassium b. magnesium c. calcium d. iron
c. calcium
A nurse is making the decision to purchase liability insurance. He or she should keep in mind that professional liability coverage a. costs the same in all health care settings b. protects the nurse from prosecution for criminal acts c. does not cover acts outside the scope of nursing practice d. provides coverage to the nurse for his or her entire professional career
c. does not cover acts outside the scope of nursing practice
The nurse is participating in a disaster drill. The nurse is advised that a fire occurred in a high rise assisted living building that has 10 floors. The nurse should understand that during a disaster drill priority should be given to the patient who a. has arm pain rated a "9" on a scale of 0-10 b. has blisters on the arms c. is coughing d. is crying uncontrollably
c. is coughing
The nurse is contributing to a staff development conference regarding legal responsibilities of health care providers. The nurse should state that the risk for a charge of battery can be minimized if a patient a. calls to schedule an appointment with the provider b. requests that a specific person complete the required care c. signs a consent form prior to treatment d. verbalizes readiness for a procedure to begin
c. signs a consent form prior to treatment
The nurse has instructed an UAP in the procedure for collecting a 24 hour urine specimen from a pt. The nurse determines that the UAP understands the directions if the UAP makes which statement a. "I need to keep the specimen at room temp." b. "I need to save the first urine specimen collected at the start time." c. "I need to discard the last voided specimen at the end of the collection time." d. "I need to ask the pt to void, discard the specimen, and note the start time."
d. "I need to ask the pt to void, discard the specimen, and note the start time."
You are preparing to discharge a client whose calcium level was low but is now just slightly within the normal range (8.5-10.5 mg/dL). Which statement by the client indicates the need for additional teaching? a. "I will call my doctor if I experience muscle twitching or seizures." b. "I will make sure to take my vitamin D with my calcium each day." c. "I will take my calcium pill every morning before breakfast." d. "I will avoid dairy products, broccoli, and spinach when I eat."
d. "I will avoid dairy products, broccoli, and spinach when I eat."
The physician orders a fluid challenge of 500 mL of IV fluid to be infused at a rapid rate, followed by the administration of a loop diuretic to sustain or improve renal function. While the IV fluid is being administered, which nursing assessment is most important? a. Check for pedal edema b. Assessing for rapid weight gain c. Monitoring specific gravity of urine d. Auscultating breath sounds
d. Auscultating breath sounds
A nurse is caring for a patient with leukemia and suspects the patient has hyponatremia. What sign would you expect to note in this patient is hyponatremia is present? a. Intense thirst b. Slow, bounding pulse c. Dry mucous membranes d. Blood pressure drop upon standing
d. Blood pressure drop upon standing
The charge nurse in a long term care facility is making assignments for the shift. In event of an emergency evacuation, the charge nurse should make sure which of the following patients are escorted from the building? a. Acute gastroenteritis b. Anemia c. Chronic bronchitis d. Dementia
d. Dementia
A client asks why a diagnostic test has been ordered and the nurse replies, "I'm unsure but will find out for you." When the nurse later returns and provides an explanation, the nurse is acting under which principle? a. Nonmaleficence b. Veracity c. Beneficence d. Fidelity
d. Fidelity
A nurse is caring for a patient with a suspected diagnosis of hypercalcemia. Which of the following signs would be an indication of this diagnosis? a. Twitching b. Positive Trousseau's Signs c. Hyperactive bowel sounds d. Generalized muscle weakness
d. Generalized muscle weakness
The nurse identifies that a patient who has a fluid intake of 500mL over 24 hours will a. Produce urine with a low specific gravity b. Urinate small amounts at each voiding c. Develop an atonic bladder d. Have dark amber urine
d. Have dark amber urine
The nurse is caring for a patient with renal failure. The lab results reveal a magnesium level of 3.7mg/dL. Which of the following signs would the nurse expect to note in the patient based on this magnesium level? a. Twitching b. Irritability c. Hyperactive reflexes d. Loss of deep tendon reflexes
d. Loss of deep tendon reflexes
During a snowstorm, the nurses scheduled to come for the next shift have not arrived by 3:30pm. The nurse should a. Notify the supervisor, give a summary of the status of his patients, and leave b. Leave, but write an incident report about the nurses' not reporting to duty c. Instruct a nursing assistant on how to care for his patients until relief nurses arrive d. Remain with his patients until relief nurses arrive
d. Remain with his patients until relief nurses arrive
While installing electrical wiring in the ICU, the workmen start an electrical fire. The nurse's first action when caring for a ventilator-dependent patient should be to a. Activate the fire alarm b. Extinguish the fire c. Notify the nursing supervisor d. Remove the patient from the room
d. Remove the patient from the room
A nurse arrives at work and is told to report (float) to the pediatric unit for the day because the unit is understaffed and needs additional nurses to care for children. The nurse has never worked in the pediatric unit. Which of the following is the appropriate nursing action? a. Call the hospital lawyer b. Call the nursing supervisor c. Refuse to float to the pediatric unit d. Report to the pediatric unit and identify tasks that can be safely performed
d. Report to the pediatric unit and identify tasks that can be safely performed
The nurse has been instructed to have a surgical consent form signed by the client who will be undergoing a surgical procedure. What is the most essential information to include in the discussion prior to the client signing the permission? a. The client's diagnosis b. Treatment proposed and the cost c. The technical aspects of the procedure d. Right to withdraw consent
d. Right to withdraw consent
You are reviewing the patient's morning lab results. Which of these results is of most concern to you? a. Serum potassium of 5.2 b. Serum sodium level of 134 c. Serum calcium level of 10.6 d. Serum magnesium level of 0.8
d. Serum magnesium level of 0.8
A new staff nurse wants to clarify responsibilities regarding delegation while working on the unit. To which document would the nurse mentor refer this nurse? a. Policy manual b. Job description c. American Nurses Association (ANA) standards of practice d. State nurse practice act
d. State nurse practice act
A 14-year-old client was admitted with a fracture to the left leg related to a sports injury. The coach of the soccer team brought the teen to the emergency room. In this case, from whom is it most appropriate to obtain the consent to perform the surgical procedure? a. The teen himself b. The client's soccer coach c. The emergency room physician d. The client's parents
d. The client's parents
The nurse is reviewing the medical records of assigned patients. The nurse should plan care knowing that which patient is at risk for a potassium deficit? a. The patient with Addison's disease b. The patient with intestinal obstruction c. The patient with metabolic acidosis d. The patient receiving nasogastric suction
d. The patient receiving nasogastric suction
An unconscious client who is bleeding profusely is brought to the emergency department after a serious accident. Surgery is required immediately to save a client's life. With regard to informed consent for the surgical procedure, which of the following is the best action? a. Call the nursing supervisor to initiate court order for the surgical procedure b. Try calling the client's spouse to obtain telephone consent before the surgical procedure c. Ask the friend who accompanied the client to the emergency department to sign the consent form d. Transport the client to the operating department immediately, as required by the physician, without obtaining an informed consent
d. Transport the client to the operating department immediately, as required by the physician, without obtaining an informed consent
A terminally ill client asks the nurse about her terminal condition. The nurse explains the disease process. The nurse is functioning under which ethical principle? a. Beneficence b. Nonmaleficence c. Justice d. Veracity
d. Veracity
The nurse is participating in a disaster drill. The nurse is advised that a fire occurred in a government building that has 7 floors. The nurse should understand that during the disaster drill priority should be given to the patient with a. a bone protruding from the foot b. a lacerated right forearm c. blood oozing from the scalp d. facial burns
d. facial burns
Following a thyroidectomy, it is most appropriate for the nurse to monitor the patient for signs of which electrolyte imbalance? a. hypokalemia b. hyponatremia c. hypomagnesemia d. hypocalcemia
d. hypocalcemia
When receiving a physician's orders by telephone, the nurse must a. write the physician's name on the order sheet b. write the patient's name, next of kin, and date on the order sheet c. repeat the orders and then write them on the physician's order sheet d. write the order as the physician gives it and repeat it back for immediate verification
d. write the order as the physician gives it and repeat it back for immediate verification
