week (1-3) lecture - prep U

Which would be included as a responsibility of the scrub nurse? -Obtaining and opening wrapped sterile equipment -Keeping all records and adjusting lights -Handing instruments to the surgeon and assistants -Coordinating activities of other personnel

Handing instruments to the surgeon and assistants

The nurse observes a nursing assistant leave the room of client diagnosed with Clostridium difficile infection without washing hands. Which is the priority action by the nurse? a.Report the nursing assistant to the nurse manager. b.Have the nursing assistant wash hands with soap and water. c.Provide written documentation about the incident. d.Teach the nursing assistant about the chain of infection.

Have the nursing assistant wash hands with soap and water.

A nurse reports to the charge nurse that a client medication due at 9 am was omitted. Which principle is the nurse demonstrating? a.Altruism b.Social justice c.Integrity d.Autonomy

Integrity

What is the nurse accountable for, according to state nurse practice acts? -Managing the care team effectively -Making nursing diagnoses -Prescribing PRN (as needed) medications -Mentoring other nurses

Making nursing diagnoses

A client has a prescription for amoxicillin 500 mg P.O. every 8 hours. The nurse administers the medication via the intravenous route. Based on the nurse's action, the client develops complications and has an increased length of stay. The client files a lawsuit against the facility and the nurse. Which legal action has the nurse's attorney identified that meets the criteria for the client's lawsuit? Negligence Malpractice Assault Battery

Malpractice

The nurse is reviewing a medication prescription for a client prior to administration and observes that the route of administration is not present in the prescription. What is the appropriate action by the nurse to address this omission? -Add the route to the prescription and administer the medication since the nurse is familiar with the drug. -Notify the health care provider to add the route and then administer the medication when complete. -Call to ask the pharmacy how the drug should be administered. -Omit the administration of the medication since it was written incorrectly.

Notify the health care provider to add the route and then administer the medication when complete.

The nurse is reviewing a medication prescription for a client prior to administration and observes that the route of administration is not present in the prescription. What is the appropriate action by the nurse to address this omission? a.Add the route to the prescription and administer the medication since the nurse is familiar with the drug. b.Notify the health care provider to add the route and then administer the medication when complete. c.Call to ask the pharmacy how the drug should be administered. d.Omit the administration of the medication since it was written incorrectly.

Notify the health care provider to add the route and then administer the medication when complete.

A nurse reporting for the scheduled shift finds an assignment that includes the nurse's aunt, who was admitted during the night with a fractured hip. What should the nurse do in response to the client assignment? -Accept the assignment and not disclose the relationship with the client. -Notify the supervisor and provide care until another nurse can be assigned to the client. -Notify the supervisor that this is a relative but the relationship will not be a conflict. -Ask the aunt if she would like the nurse to take care of her while in the hospital.

Notify the supervisor and provide care until another nurse can be assigned to the client.

A nurse reporting for the scheduled shift finds an assignment that includes the nurse's aunt, who was admitted during the night with a fractured hip. What should the nurse do in response to the client assignment? a.Accept the assignment and not disclose the relationship with the client. b.Notify the supervisor and provide care until another nurse can be assigned to the client. c.Notify the supervisor that this is a relative but the relationship will not be a conflict. d.Ask the aunt if she would like the nurse to take care of her while in the hospital.

Notify the supervisor and provide care until another nurse can be assigned to the client.

The nurse observes bloody drainage on the surgical dressing of the client who has just arrived on the nursing unit. Which intervention should the nurse plan to do next? -Make the client NPO and order a stat hemoglobin and hematocrit. -Remove the dressing, assess the wound, and apply a new sterile dressing. -Outline the drainage with a pen and record the date and time next to the drainage. -Take the client's vital signs and call the surgeon.

Outline the drainage with a pen and record the date and time next to the drainage.

In preparing to administer a drug to a client, the nurse has pierced a multi-use vial of medication. What is the appropriate nursing action? -Discard the remaining drug. -Place the date on the vial and retain for future use. -Draw up the remaining medication to give at the next time of administration. -Send the vial with the remaining drug back to the pharmacy.

Place the date on the vial and retain for future use.

A client on the mental health unit is granted a weekend pass. The physician writes an order for the nurse to provide the client with enough medication to cover the weekend. What would be the most appropriate action by the nurse? -Send the order to the pharmacy for processing of weekend medications only. -Prepare labeled containers with medication taken from the client's existing medications. -Refuse to comply with this order because it is considered "dispensing." -Ask the physician to prepare the weekend medication for the client.

Prepare labeled containers with medication taken from the client's existing medications.

A 6-year-old child will be hospitalized for a surgical procedure. How can the nurse best ease the stress of hospitalization for this child? a.Tell the parents to bring toys for the child from home. b.Prepare the child for hospitalization by explaining what to expect and showing him or her around the hospital. c.There is no way to adequately prepare a child for an impending hospitalization. d.Have another child talk with the child to be hospitalized.

Prepare the child for hospitalization by explaining what to expect and showing him or her around the hospital.

A nurse is employed in an operative setting. Which of these roles is within the registered nurse (RN) scope of practice? Select all that apply. -administering inhalation anesthetics -positioning the client on the operating table -administering regional nerve blocks -counting sponges before and after surgery -monitoring the client's vital signs

-positioning the client on the operating table -counting sponges before and after surgery -monitoring the client's vital signs

When providing care to a client, a new graduate nurse develops a therapeutic nurse-client relationship, incorporating the client's beliefs and values into the client's plan of care and demonstrating empathy for the client, advocating for the client when necessary. When providing client education, the nurse ensures that any teaching materials match the client's health literacy level. The nurse also uses a mechanical lift and asks for assistance from other team members when moving and transferring the client. The new graduate nurse is demonstrating competency in which area(s)? Select all that apply. person-centered care quality and safety malpractice diagnosis and treatment professionalism

-quality and safety -person centered care -professionalism

A client is received into the emergency department after getting shot in the chest. The client is hemorrhaging profusely and is in hypovolemic shock. The nurse calls a code blue. What type of leadership style will be most effective during the management of the code? Autocratic leadership Laissez-faire leadership Democratic leadership Transactional leadership

Autocratic leadership

The charge nurse on a unit receives a report that a licensed practical nurse (LPN) is taking clients' opioids and hiding them in the nurses' lounge. The charge nurse disregards the report and continues to work on a scheduled task. Which conflict resolution style is the charge nurse using? Avoiding Collaborating Compromising Accommodating

Avoiding

A nurse working as part of a genetics counseling team is preparing a presentation for a career day discussion at a local college of nursing. When describing the genomic framework for nursing, which of the following would the nurse include as being most important? -Having a thorough understanding of the various technologies available -Experiencing first-hand providing care for a wide range of genetic conditions -Obtaining in-depth knowledge about the variety of cultural beliefs related to the causes of illness -Being keenly aware of one's own attitudes and assumptions about genetics and genomics

Being keenly aware of one's own attitudes and assumptions about genetics and genomics

A nurse working as part of a genetics counseling team is preparing a presentation for a career day discussion at a local college of nursing. When describing the genomic framework for nursing, which of the following would the nurse include as being most important? a.Having a thorough understanding of the various technologies available b.Experiencing first-hand providing care for a wide range of genetic conditions c.Obtaining in-depth knowledge about the variety of cultural beliefs related to the causes of illness d.Being keenly aware of one's own attitudes and assumptions about genetics and genomics

Being keenly aware of one's own attitudes and assumptions about genetics and genomics

The nurse is teaching a prenatal class illustrating the steps that are used to keep families safe. The nurse determines the session is successful when the parents correctly choose which precaution to follow after the birth of their infant? a.Send a family member to accompany the infant when leaving the room. b.Check the name on the baby's identification bracelet. c.Provide a list of approved visitors who came spend time with the infant. d.Check the identification badge of any health care worker before releasing baby from room.

Check the identification badge of any health care worker before releasing baby from room.

A patient is in the operating room for surgery. Which individual would be responsible for ensuring that procedure and site verification occurs and is documented?

Circulating

The OR personnel responsible for maintaining the safety of the client and the surgical environment is the: -Anesthesiologist -Circulating nurse -Scrub nurse -Surgeon

Circulating nurse

The nurse is reviewing the physician's order written for a postmenopausal client: "calcitonin salmon nasal spray 200 IU, one spray every day." What is the appropriate action to be taken by the nurse regarding this order? -Clarify with the physician that the spray should be given in only one nostril per day. -Inform the physician that the medication is not a nasally applied medication. -Ask the physician why this medication was ordered for a postmenopausal client. -Remind the physician that this medication can be purchased over-the-counter.

Clarify with the physician that the spray should be given in only one nostril per day.

A nurse observes a physician providing care to an infectious client without the use of personal protective equipment. What should the nurse do first? -Notify the unit manager. -Complete an incident report. -Discuss the breach of practice with the physician. -Ask the nurse educator to in-service the physician.

Discuss the breach of practice with the physician.

A nurse observes a second nurse documenting a peripheral blood glucose level that the second nurse did not actually collect from a client with diabetes. What is the priority action by the nurse observing this situation? a.Discuss the observation with the other nurse. b.Document the nurse's behavior on the client's chart. c.Strike through the entry that the nurse documented. d.Do the blood glucose level on the client for the other nurse.

Discuss the observation with the other nurse.

Two nurses are working the night shift on a medical unit. The first nurse completes an initial shift assessment on assigned clients. One hour later, the second nurse finds the first nurse asleep in the lounge. The first nurse remains asleep for the next 4 hours and then wakes up to do client rounds. What should the second nurse do in this situation? a.Cover by assessing the first nurse's patients hourly. b.Nothing; the first nurse's patients did not call for assistance. c.Discuss the situation with the first nurse, including the safety implications of sleeping on the job. c.Ask the nurse on the day shift to report the situation to the nurse manager.

Discuss the situation with the first nurse, including the safety implications of sleeping on the job.

The nurse is providing care to a client whose condition has progressively declined. The nurse assesses and makes appropriate interventions as well as notifies the health care provider. Despite the nurse's efforts, the client expires. What element of liability has the nurse demonstrated? -Duty -Breach of duty -Causation -Damages

Duty

A nurse is providing care to a client and is preparing the client for breakfast. The nurse assists the client out of bed to the chair and then helps the client open the items on the breakfast tray. The client begins to eat breakfast. The nurse tells the client, "I'll be back in about 10 minutes to check on you. In the meantime, here is your call light in case you need me." About 10 minutes later, the nurse returns to check on the client. The nurse is demonstrating which ethical principle? Fidelity Nonmaleficence Autonomy Justice

Fidelity

The nurse is admitting a client to the hospital. The nurse gives the client information about patient rights while in the hospital. Which statement by the client indicates that more teaching is needed? a."I can get a copy of my medical record if I want to read it." b."You can not give any information to anyone unless I agree." c."The doctor can copy my information and send it to my son." d."You can not tell a caller that I am in the hospital."

"The doctor can copy my information and send it to my son."

The nursing student is having difficulty obtaining a mobile computer for the purpose of administering medications using the electronic medical record. The student has been reprimanded for delivering medications late in the past and wants to ensure timely administration. What action should the student take? -Print a copy of the medication record at the nurse's station to use at the bedside in order to administer the medications on time. -Use the medication dispensing terminal to prepare the medications, and print a dispensing receipt to use for patient identification at the beside. -Speak to the instructor about the unavailability of mobile computers for medication administration, and request assistance in obtaining one. -Wait for a mobile computer to become available, and explain to the instructor that the reason for late administration was related to adhering to safety policy.

Speak to the instructor about the unavailability of mobile computers for medication administration, and request assistance in obtaining one.

The nurse begins a shift and finds that the wrong medication has been administered to a client. After completing a safety event report, what should the nurse do next? a.File the safety event report in the appropriate file and document in the nurse's notes the date and time that it was filed. b.Make a copy of the safety event report for the client. c.Place the safety event report in the client's medical record for future reference. d.Submit the safety report to the appropriate department within the facility so that it can be reviewed.

Submit the safety report to the appropriate department within the facility so that it can be reviewed.

A client is admitted to the emergency department with a ruptured abdominal aortic aneurysm. No family members are present, and the surgeon instructs the nurse to take the client to the operating room immediately. Which action should the nurse take regarding informed consent? a.Ask the nursing supervisor to contact the hospital lawyer. b.Keep the client in the emergency department until the family is contacted. c.Take the client to the operating room for surgery without informed consent. d.Contact the hospital chaplain to sign the consent on the client's behalf

Take the client to the operating room for surgery without informed consent.

A nurse gives a client the wrong medication. After assessing the client, the nurse completes an incident report. Which statement describes what will happen next? -The facility will report the incident to the state board of nursing for disciplinary action. -The incident will be documented in the nurse's personnel file. -The nurse will be suspended and, possibly, terminated from employment at the facility. -The incident report will provide a basis for promoting quality care and risk management.

The incident report will provide a basis for promoting quality care and risk management.

A nurse caring for a client with a respiratory condition notices the client's breathing pattern is getting more irregular and the rate has greatly increased from 18 to 32 breaths per minute. The nurse notes that this client's vital signs are assessed once every shift, but believes the assessment should be done more frequently. Who is responsible for increasing the frequency of this client's assessments? -The health care provider -The nurse -The case manager -The nursing supervisor

The nurse

A nurse caring for a client with a respiratory condition notices the client's breathing pattern is getting more irregular and the rate has greatly increased from 18 to 32 breaths per minute. The nurse notes that this client's vital signs are assessed once every shift, but believes the assessment should be done more frequently. Who is responsible for increasing the frequency of this client's assessments? a.The health care provider b.The nurse c.The case manager d.The nursing supervisor

The nurse

The nurse-manager of a 20-bed coronary care unit is not on duty when a staff nurse makes a serious medication error that results in a client's overdose. The client nearly dies. Which statement accurately reflects the accountability of the nurse-manager? -The nurse-manager would receive a call at home from the on-duty nursing supervisor, apprising the nurse-manager of the problem as soon as possible. -Because the nurse-manager is off duty and not accountable for incidents that occur in their absence, the nurse-manager need not be notified. -The nurse-manager only needs to be informed of the incident when the nurse-manager reports to work on the next scheduled day. -Although the nurse-manager is off duty and not responsible for what happened, the nursing supervisor would call the nurse-manager only if time permits.

The nurse-manager would receive a call at home from the on-duty nursing supervisor, apprising the nurse-manager of the problem as soon as possible.

The pediatric nurse is preparing to administer ibuprofen to an 8-month-old infant. The infant's weight is listed in the computer as 15 kg (33 lb) and the medication is prescribed to be given 10 mg/kg. The nurse notices that the dose of 150 mg seems high for an infant. The nurse clarifies the prescription with the healthcare provider, who states that it is the correct dose. What should the nurse do? -Administer the medication as prescribed because the healthcare provider said it is correct. -Verify child's weight is accurate and, if it is correct, give the medication. -Notify the healthcare provider's superior about the medication prescription. -Document the healthcare provider's response on the medical record.

Verify child's weight is accurate and, if it is correct, give the medication.

A client is brought to the operating room for an elective surgery. What is the priority action by the circulating nurse? -Verify consent. -Document the start of surgery. -Acquire ordered blood products. -Count sponges and syringes.

Verify consent.

A nurse would perform handwashing instead of using an alcohol-based product for which situation? a.Before putting on sterile gloves for inserting a urinary catheter b.After taking a client's vital signs c.When hands are visibly soiled from client care d.During client care when moving from a contaminated body site to a clean one

When hands are visibly soiled from client care

A client has been prescribed an opioid and the nurse is convinced that the dose prescribed will create a serious risk for respiratory depression, What is the nurse's best initial action? a.Administer the medication as prescribed and document the concerns in the patient record b.Administer the medication and monitor the client's respiratory status continually c.Withhold the medication and speak with the care provider d.Do not administer the medication and then complete an incident report

Withhold the medication and speak with the care provider

The client was admitted to the hospital with the diagnosis of iron overload. Over time, an excess of iron can damage the liver and cause heart problems. Which medication does the nurse anticipate the healthcare provider to order? montelukast ramipril flurazepam deferoxamine

deferoxamine

A nurse manager reviews an employee's contribution to the nursing division annually. This process is: -interpreting quality indicators. -employee's job satisfaction survey. -performance appraisal. -reward and development survey.

performance appraisal.

As a circulating nurse caring for a 45-year-old man undergoing left knee arthroscopic exploratory surgery, which task ensures that the team is on the same page and will perform the procedure on the right client and at the right site? -operative site marking -preoperative checklist -procedural pause (time-out) -informed consent

procedural pause (time-out)

A nurse is working as a registered nurse first assistant as defined by the state's nurse practice act. This nurse practices under the direct supervision of which surgical team member? -Surgeon -Circulating nurse -Scrub nurse -Anesthetist

surgeon

A client who is in her third trimester presents at the labor and delivery triage area with a history of a fall. She has bruising on her back and arms. There is no vaginal bleeding and the fetal heart rate (FHR) shows accelerations. A completed Abuse Assessment Screen indicates the possibility of abuse. The nurse should refer this client to -the physician on call. -the social worker on call. -Women in Distress (local provincial/territorial, regional or aboriginal shelter). -a lawyer.

the social worker on call.

A client is received into the emergency department after getting shot in the chest. The client is hemorrhaging profusely and is in hypovolemic shock. The nurse calls a code blue. What type of leadership style will be most effective during the management of the code? -Autocratic leadership -Laissez-faire leadership -Democratic leadership -Transactional leadership

Autocratic leadership

Several nurses from the medical unit access the electronic medical record of a well-known public official who was admitted to the emergency department. How should the nurse manager respond to the nurses regarding this situation? a."It is understandable that you would be interested in the official's medical status." b."Accessing the official's medical record is a breach of confidentiality." c."You must not share the information you learn with others outside this unit." d."We must maintain the official's confidentiality by denying that the official is a client here."

"Accessing the official's medical record is a breach of confidentiality."

A newly hired psychiatric-mental health nurse has learned about the suicide risk assessment. Which statement made by the nurse would indicate a need for further teaching? -"it's okay that I feel uncomfortable asking clients about suicidal thoughts." -"Asking clients if they are having suicidal thoughts may put that idea into their head." -"It is our responsibility to keep all clients safe on the unit; therefore, we have to assess for suicidal risk." -"A suicide risk assessment is part of our comprehensive assessment."

"Asking clients if they are having suicidal thoughts may put that idea into their head."

A nurse administers morphine sulfate as ordered for pain. The client experiences nausea and vomiting and a decrease in respiratory rate. When documenting this event in the health record, which data would be considered subjective data? a."Client vomited 250 mL of yellow liquid." b."Client's respiratory rate was 8 and labored." c."Client seems very nauseated." d."Promethazine 25 mg IM is administered."

"Client seems very nauseated."

When questioning a 15-year-old about his health history, what would be an appropriate way for the nurse to ask about the child's drug history? -"Have you smoked crack before?" -"Have you had alcohol at parties before?" -"Have you heard that some teens like to smoke? Have you tried this?" -"Have you smoked cigarettes?"

"Have you heard that some teens like to smoke? Have you tried this?"

A nurse working in a blood conservation program is being mentored by a supervising nurse. A client asks for information about iron supplements and epoetin alfa as alternatives to a blood transfusion. Which response by the nurse causes the supervising nurse to plan a review of professional and ethical standards? -"You should take the unit of blood. It will help you feel better." -"Do you have all the information you need for informed consent?" -"Do you have any questions that I can clarify for you?" -"Tell me how the nurse educator explained the procedure."

"You should take the unit of blood. It will help you feel better."

A community nurse arrives at the home of a client. The client is in soiled clothes due to the inability to make it to the bathroom in time. The nurse overhears the unregulated care provider (UCP) scolding the client for the soiled clothes. What is the most appropriate response by the nurse to the UCP? -"Your behavior in this situation is considered verbal abuse." -"You need to have more training in therapeutic communication." -"I'm sure you didn't mean to hurt the client's feelings, but you did." -"Why weren't you there to help the client get to the bathroom?"

"Your behavior in this situation is considered verbal abuse."

A nurse reports to the charge nurse that a client medication due at 9 am was omitted. Which principle is the nurse demonstrating? -Altruism -Social justice -Integrity -Autonomy

-Integrity

When administering insulin to a client with type 1 diabetes, which of the following would be most important for the nurse to keep in mind? -Duration of the insulin -Accuracy of the dosage -Area for insulin injection -Technique for injecting

Accuracy of the dosage

When a relief charge nurse posts assignments, a nurse notes that they are no longer assigned to a client whom the nurse has cared for the previous 2 nights. How should the nurse respond to this assignment? -Tell the charge nurse that the nurse would like to continue with the same assignment. -Ask the nurse if there's a reason there was a change to the assignment. -Accept the assignment and discuss the situation with the charge nurse at a later time. -Tell the charge nurse that the nurse feels they are the best person to care for this particular client.

Ask the nurse if there's a reason there was a change to the assignment.

A nurse working in the emergency department receives an order from an orthopedic surgeon to obtain written consent from a client for the surgical repair of a fractured forearm. The surgeon has not seen the client but has reviewed the radiographs in the operating room between cases. Which would be the most appropriate response by the nurse to the surgeon? -"It is your responsibility to obtain informed consent from the client." -"I will get the consent signed right away and attach it to the chart." -"I'll have the client sign, but you must explain the procedure before surgery." -"I will explain the procedure and call you back if the client won't sign the consent."

"It is your responsibility to obtain informed consent from the client."

The unlicensed assistive personnel (UAP) has taken vital signs on a newly admitted client. The client asks the nurse how this information is recorded in the chart, since the UAP is not licensed. Which response by the nurse is best? -"The UAP will tell me what the vital signs are, and I will record them in the record so the health care provider can review them." -"Vital signs do not need to be recorded unless they are abnormal." -"The UAP logs in under my name and documents the vital signs." -"The UAP is able to log in and enter the information so all members of the health care team can see it."

"The UAP is able to log in and enter the information so all members of the health care team can see it."

A community nurse arrives at the home of a client. The client is in soiled clothes due to the inability to make it to the bathroom in time. The nurse overhears the unregulated care provider (UCP) scolding the client for the soiled clothes. What is the most appropriate response by the nurse to the UCP? a."Your behavior in this situation is considered verbal abuse." b."You need to have more training in therapeutic communication." c."I'm sure you didn't mean to hurt the client's feelings, but you did." d."Why weren't you there to help the client get to the bathroom?"

"Your behavior in this situation is considered verbal abuse."

Which statements made by a nurse would indicate to a nurse manager that the nurse requires further training? Select all that apply. -"If I make a mistake, I will not tell anyone." -"When I document, I make sure it is factual, accurate, complete, and timely." -"I will have the supervisor fill out the incident report when I make an error." -"I am accountable for any task that I delegate." -"The nursing plan of care must be accurate and must be followed. It is part of the client's permanent record."

-"I will have the supervisor fill out the incident report when I make an error." -"If I make a mistake, I will not tell anyone."

A nurse is interacting with a client in the outpatient surgical unit intraoperatively. What is the nurse's priority responsibility? -Educating the client about postoperative protocols -Establishing a nurse-client rapport -Client safety -Providing emotional support for the client and family

-Client safety

Which qualities are essential for a community-based nurse? Select all that apply. -Strong knowledge foundation -Effective communication skills -Keen physical assessment skills -Ability to delegate client care tasks to unlicensed assistive personnel -Competence in assisting with minor surgical procedures

-Keen physical assessment skills -Effective communication skills -Strong knowledge foundation

Which style of leadership is rarely used in a hospital setting because of the difficulty of task achievement by independent nurses? -Democratic -Autocratic -Laissez-faire -Transformational

-Laissez-faire

When the electrocardiogram (ECG) of a client in the emergency department indicates an ST elevation myocardial infarction (STEMI) in progress, the physician orders a beta-adrenergic blocker. Which factors in the client's history will cause the nurse to withhold medication pending discussion with physician? Select all that apply. Myocardial infarction caused by cocaine use Third-degree heart block Hypertension Shock Cerebrovascular accident

-Shock -Third-degree heart block -Myocardial infarction caused by cocaine use

When providing care to a client, a new graduate nurse develops a therapeutic nurse-client relationship, incorporating the client's beliefs and values into the client's plan of care and demonstrating empathy for the client, advocating for the client when necessary. When providing client education, the nurse ensures that any teaching materials match the client's health literacy level. The nurse also uses a mechanical lift and asks for assistance from other team members when moving and transferring the client. The new graduate nurse is demonstrating competency in which area(s)? Select all that apply. -person-centered care -quality and safety -malpractice -diagnosis and treatment -professionalism

-quality and safety -professionalism -person-centered care

A staffing agency is assigning a licensed practical/vocational nurse (LPN/VN) to cover a shift on a pediatric unit. Because the unit manager is unfamiliar with the nurse's skill level, what assignment is best for the LPN/VN? -8-year-old child admitted that morning with suspected meningitis -9-year-old child receiving subcutaneous insulin for diabetes mellitus 1-0-year-old child who had a tonsillectomy that morning -9-year-old child with Legg-Calve'-Perthes disease

9-year-old child receiving subcutaneous insulin for diabetes mellitus

Which is an example of an unintentional tort? -Nurses discuss a client's laboratory values in the elevator. -A nurse tells a client that the client cannot leave the hospital until the client pays the bill. -A nurse threatens to restrain a client if the client does not stop talking. -A nurse gives the client a medication, and the client has an adverse reaction to it.

A nurse gives the client a medication, and the client has an adverse reaction to it.

Which is an example of an unintentional tort? a.Nurses discuss a client's laboratory values in the elevator. b.A nurse tells a client that the client cannot leave the hospital until the client pays the bill. c.A nurse threatens to restrain a client if the client does not stop talking. d.A nurse gives the client a medication, and the client has an adverse reaction to it.

A nurse gives the client a medication, and the client has an adverse reaction to it.

The nurse delegates vital signs to be taken and recorded by the unlicensed assistive personnel (UAP). The UAP reports a blood pressure of 191/110 mm Hg on a client. Which is the nurse's priority action? a.Direct the UAP to take the blood pressure in the other arm with a large cuff. b.Notify the health care provider of the blood pressure result. c.Review the client's medication list and notify the nursing supervisor. d.Assess the client and re-evaluate the vital signs.

Assess the client and re-evaluate the vital signs.

The nurse is preparing to administer regular insulin to a nonverbal pediatric client. Which action will the nurse perform prior to administering the medication? -Check the full name and birth date on the client's wristband with the medication administration record. -Check the full name and room number on the client's wristband with the medication administration record. -Check the birth date and full name on the client's wristband with the medication administration record and have another nurse verify. -Check the full name and age on the client's wristband with the medication administration record and have the parent verbally confirm.

Check the full name and birth date on the client's wristband with the medication administration record.

The nurse is preparing to administer regular insulin to a nonverbal pediatric client. Which action will the nurse perform prior to administering the medication? a.Check the full name and birth date on the client's wristband with the medication administration record. b.Check the full name and room number on the client's wristband with the medication administration record. c.Check the birth date and full name on the client's wristband with the medication administration record and have another nurse verify. d.Check the full name and age on the client's wristband with the medication administration record and have the parent verbally confirm.

Check the full name and birth date on the client's wristband with the medication administration record.

The healthy adult client is given an opioid prior to a surgical procedure. The nurse is completing the chart and notices the consent form was not signed by the client. Which of the following should the nurse do first? -Immediately have the client sign the consent form. -Have the client's family member sign the consent form. -Ask the client if he still wants to proceed with the procedure. -Notify the health care provider of the oversight. TAKE ANOTHER QUIZ

Notify the health care provider of the oversight.

The nurse is reading a medication prescription for a drug that is routinely administered every 12 hours. The prescription does not state the frequency of administration. What is the appropriate nursing action and accompanying rationale that guides the nurse's action? -Contact the health care provider to clarify the prescription. Assumptions cannot be made about medication administration and the nurse must practice within the state's nurse practice act and the organization's policies and procedures concerning medication administration. -Ask the client how often this drug is taken at home, because this is not an assumption and is within the state's nurse practice act and the organization's policies and procedures concerning medication administration. -Review medication literature and request that another nurse validate the frequency as every 12 hours. As long as two nurses verify the missing information contacting the health care provider is not necessary. -Input the prescription into the electronic health record (EHR) to show that the drug is given every 12 hours because EHRs are able to detect an incorrect frequency and will warn the nurse if it is an error.

Contact the health care provider to clarify the prescription. Assumptions cannot be made about medication administration and the nurse must practice within the state's nurse practice act and the organization's policies and procedures concerning medication administration.

A charge nurse asks a group of staff nurses to cover part of the next shift because a nurse called off. A staff nurse states, "40 hours a week of nursing is all I can manage. I won't volunteer for overtime." The charge nurse tells the unit's nurse manager, "You should adjust her schedule to make her wish she'd volunteered." How should the nurse manager respond? a.Ignore the comment because the charge nurse made the statement under stress. b.Report the charge nurse to the nursing administration. c.Counsel the charge nurse about her comment. d.Tell the staff nurse what the charge nurse said about her.

Counsel the charge nurse about her comment.

A nurse is providing care to a client and is preparing the client for breakfast. The nurse assists the client out of bed to the chair and then helps the client open the items on the breakfast tray. The client begins to eat breakfast. The nurse tells the client, "I'll be back in about 10 minutes to check on you. In the meantime, here is your call light in case you need me." About 10 minutes later, the nurse returns to check on the client. The nurse is demonstrating which ethical principle? a.Fidelity b.Nonmaleficence c.Autonomy d.Justice

Fidelity

A nurse is administering evening medications and notices that a medication was omitted during the day shift. Which statement demonstrates the principle of accountability? a.Administering the medication with the other evening medications b.Telling the client that the medication will be given the following morning c.Filling out an occurrence report and notifying the healthcare provider d.Documenting in the chart a narrative note about the occurrence

Filling out an occurrence report and notifying the healthcare provider

The health care provider (HCP) has prescribed hydrocodone/APAP 1 tablet by mouth every 4 to 6 hours as needed for pain for a client who underwent right total knee replacement. When the nurse reassesses pain following administration, the client reports pain is still a 9 on a 10-point scale. When the nurse informs the HCP, the HCP states that one hydrocodone/APAP tablet should be sufficient and refuses to issue a new prescription. Which measure should the nurse select to act as an advocate for the client? a.Follow the chain of command to obtain adequate pain relief for the client. b.Document that the HCP was notified of the client's pain and continue to administer hydrocodone/APAP as prescribed. c.Give the client 1 hydrocodone/APAP tablet every 3 hours. d.Give the client 2 hydrocodone/APAP tablets every 4 hours.

Follow the chain of command to obtain adequate pain relief for the client.

The registered nurse (RN) and unlicensed assistive personnel (UAP) are working together to admit a pediatric client to a nursing unit. Which task would be inappropriate for the RN to delegate to the UAP? a.Initiating intravenous therapy b.Securing the client on a papoose board c.Soothing the client during the procedure d.Gathering equipment needed for intravenous therapy

Initiating intravenous therapy

A nurse suspects that a coworker is self-administering illegal drugs during work hours. What is the first action the nurse should take? a.Notify the nurse manager and document the situation. b.Determine whether this is a breach of any hospital policy. c.Report the nurse to the governing body of nursing. d.Discuss the concerns with one of the physicians.

Notify the nurse manager and document the situation.

The nurse is preparing to administer prescribed intravenous antibiotics to a client. While assessing the medication lock, the nurse notes that there is resistance when administering the saline flush solution. What would be the best action by the nurse? a.Call the health care provider to request oral antibiotics. b.Flush the lock with heparin solution. c.Administer the prescribed antibiotics as prescribed. d.Insert a new IV medication lock and remove the old one.

Insert a new IV medication lock and remove the old one.

A home care nurse is planning to visit a 60-year-old client diagnosed with heart failure for the first time. Which of the following would be most appropriate for the nurse to do? -Contact the client to say that the nurse is coming out to visit. -Telephone the client to obtain permission to visit. -Ask the client if he lives alone or with someone else. -Obtain information about the client's health insurance.

Telephone the client to obtain permission to visit.

A family member of a resident in a long-term care facility reports to the nurse that her mother's diamond ring is missing. Another resident reported a day earlier that a twenty-dollar bill was missing from his/her night table. What should the nurse do in this situation? a.Report the incidents to the facility's lawyer. b.Remind the residents and family members not to leave valuables unattended. c.Pass the information on to the doctor and the next shift staff. d.Notify the supervisor and call the police.

Notify the supervisor and call the police.

A nurse realizes that data has been entered on the wrong client's written health record. Which step should the nurse take to correct this documentation error? a.Use liquid paper to cover over the incorrect entry. b.Use a black marker to cross over the incorrect entry. c.Put a line through the entry, leaving the content visible, and initial. d.Tear out the page, and recopy the other entries on the page.

Put a line through the entry, leaving the content visible, and initial.

A nurse arriving for duty notes that an unlicensed assistive personnel (UAP) has been assigned to a complex client with treatments involving sterile technique. What is the responsibility of the nurse regarding the assignment of the UAP? -Make sure the UAP has practiced sterile technique on at least one other occasion. -Reassign the UAP to a client requiring basic tasks that the UAP has mastered. -Supervise the UAP during the treatments involving sterile technique. -Provide the UAP with a list of resources to guide the implementation of care.

Reassign the UAP to a client requiring basic tasks that the UAP has mastered.

A nurse arriving for duty notes that an unlicensed assistive personnel (UAP) has been assigned to a complex client with treatments involving sterile technique. What is the responsibility of the nurse regarding the assignment of the UAP? a.Make sure the UAP has practiced sterile technique on at least one other occasion. b.Reassign the UAP to a client requiring basic tasks that the UAP has mastered. c.Supervise the UAP during the treatments involving sterile technique. c.Provide the UAP with a list of resources to guide the implementation of care.

Reassign the UAP to a client requiring basic tasks that the UAP has mastered.

A client continually reports of pain after the administration of an oral analgesic. The physician writes an order for the nurse to administer a placebo to the client the next time the client reports of pain. The doctor states, "Tell the client it is a stronger analgesic." What would be the appropriate action by the nurse? -Give the placebo as ordered by the physician. -Give the placebo but do not tell the client it is a stronger medication. -Refuse to administer the placebo to the client. -Consult with the pharmacist to discuss the dosage of the placebo.

Refuse to administer the placebo to the client.

While reviewing the day's charts, a nurse who's been under a great deal of personal stress realizes that the nurse forgot to administer insulin to client with diabetes mellitus. The nurse has made numerous errors in the past few weeks and is now afraid this job is in jeopardy. What is the best course of action? a.Administer the medication immediately and chart it as given on time. b.Report the error and request a private meeting with the unit manager. c.Report the error, complete the proper paperwork, and meet with the unit manager. d.Contact the physician and follow their instructions.

Report the error, complete the proper paperwork, and meet with the unit manager.

A toddler is hospitalized with multiple injuries. Although the parent states that the child fell down the stairs, the child's history and physical findings suggest abuse as the cause of the injuries. What is the nurse's first responsibility in caring for this child? -Document all the areas of injuries. -Report the incident to the proper authorities. -Place the child in a monitored room. -Restrict the parent from the child's room.

Report the incident to the proper authorities.

The nurse is caring for a client with a PICC line that requires flushing. The nurse has not previously performed this skill. What is the most appropriate action by the nurse to ensure safe care? a.Contact the nurse educator for the unit to help guide the nurse through the skill. b.Attempt to flush the PICC line in the same fashion as a peripheral line. c.Request a different client assignment and arrange a session on the care of a PICC line. d.Defer the flushing to a more experienced nurse on the oncoming shift.

Request a different client assignment and arrange a session on the care of a PICC line.

The anesthesiologist will use moderate (conscious) sedation during the client's surgical procedure. The circulating nurse will expect the client to: a.Respond verbally during the procedure b.Need an endotracheal tube c.Be anxious throughout the procedure d.Need pain control throughout the procedure

Respond verbally during the procedure

A nurse is working as a registered nurse first assistant as defined by the state's nurse practice act. This nurse practices under the direct supervision of which surgical team member? a.Surgeon b.Circulating nurse c.Scrub nurse d.Anesthetist

Surgeon

The registered nurse (RN) has received orders to perform an unsafe practice on a client. The RN voices concern with the health care provider who gave the order, but the health care provider refuses to change the order. Whom should the nurse consult next regarding the order? -The client -The charge nurse -The nurse manager -The licensed practice nurse (LPN)

The charge nurse

The registered nurse (RN) wants to delegate measuring a client's urinary output to an unlicensed assistive personnel (UAP). Which factors should the nurse consider before delegating the task?

The stability of the client's condition, potential for harm, and complexity of the activity

A student nurse is assisting an older adult client to ambulate following hip replacement surgery when the client falls and reinjures the hip. Who is potentially responsible for the injury to this client? a.The student nurse b.The nurse instructor c.The hospital d.The student nurse, the nurse instructor, and the hospital

The student nurse, the nurse instructor, and the hospital

A client was admitted to a postoperative nursing unit after undergoing abdominal surgery. During this time, the nurse failed to recognize the significance of abdominal swelling, which significantly increased during the next 6 hours. Later, the client had to undergo emergency surgery. The lack of action on the nurse's part is liable for action. Which legal term describes the case? a.Misdemeanor b.Felony c.Tort d.Fraud

Tort

A nurse manager of the pediatric unit discovers that she is overbudget on supplies. How could each nurse assigned to the unit help with cost containment? -Order only brand-name supplies instead of the generic equivalent. -Use the supply closet at work to stock personal medicine cabinets because the supplies are free. -Order supplies that are soon to be expired. -Use care pathways to specify care and identify daily outcomes.

Use care pathways to specify care and identify daily outcomes.

The pediatric nurse is preparing to administer ibuprofen to an 8-month-old infant. The infant's weight is listed in the computer as 15 kg (33 lb) and the medication is prescribed to be given 10 mg/kg. The nurse notices that the dose of 150 mg seems high for an infant. The nurse clarifies the prescription with the healthcare provider, who states that it is the correct dose. What should the nurse do? a.Administer the medication as prescribed because the healthcare provider said it is correct. b.Verify child's weight is accurate and, if it is correct, give the medication. c.Notify the healthcare provider's superior about the medication prescription. c.Document the healthcare provider's response on the medical record.

Verify child's weight is accurate and, if it is correct, give the medication.

The nurse is caring for a client after having various diagnostic tests. The client discusses a proxy being in attendance for the health care provider's diagnosis. The nurse requests a copy for the file, and allows the proxy to be in attendance with what type of document? -durable power of attorney -living will -patient rights -informed consent

durable power of attorney

When the indication for surgery is without delay, the nurse recognizes that the surgery will be classified as -emergency. -urgent. -required. -elective.

emergency