Week 1 - Clinical Judgment

11 A group of nurses is discussing the advantages of using computerized provider order entry (CPOE). Which of the following statements indicates that the nurses understand the major advantage of using CPOE? 1 "CPOE reduces transcription errors." 2 "CPOE reduces the time necessary for health care providers to write orders." 3 "Health care providers can write orders from any computer that has Internet access." 4 "CPOE reduces the time nurses use to communicate with health care providers."

1 "CPOE reduces transcription errors."

7 During a home health visit the nurse prepares to instruct a patient in how to perform range-of-motion (ROM) exercises for an injured shoulder. The nurse verifies that the patient took an analgesic 30 minutes before arrival at the patient's home. After discussing the purpose for the exercises and demonstrating each one, the nurse has the patient perform them. After two attempts with only the second of three exercises, the patient stops and says, "This hurts too much. I don't see why I have to do this so many times." The nurse applies the critical thinking attitude of integrity in which of the following actions?" 1 "I understand your reluctance, but the exercises are necessary for you to regain function in your shoulder. Let's go a bit more slowly and try to relax." 2 "I see that you're uncomfortable. I'll call your doctor to decide the next step." 3 "Show me exactly where your pain is and rate it for me on a scale of 0 to 10." 4 "Is anything else bothering you? Other than the pain, is there any other reason you might not want to do the exercises?"

1 "I understand your reluctance, but the exercises are necessary for you to regain function in your shoulder. Let's go a bit more slowly and try to relax."1

13 A nurse is working with a nursing assistive personnel (NAP) on a busy oncology unit. The nurse has instructed the NAP on the tasks that need to be performed, including getting patient A out of bed, collecting a urine specimen from patient B, and checking vital signs on patient C, who is scheduled to go home. Which of the following represent(s) successful delegation? (Select all that apply.) 1 A nurse explains to the NAP the approach to use in getting the patient up and why the patient has activity limitations. 2 A nurse is asked by a patient to help her to the bathroom; the nurse leaves the room and directs the NAP to assist the patient instead. 3 The nurse sees the NAP preparing to help a patient out of bed, goes to assist, and thanks the NAP for her efforts to get the patient up early. 4 The nurse is in patient B's room to check an intravenous (IV) line and collects the urine specimen while in the room. 5 The nurse offers support to the NAP when needed but allows her to complete patient care tasks without constant oversight.

1 A nurse explains to the NAP the approach to use in getting the patient up and why the patient has activity limitations. 3 The nurse sees the NAP preparing to help a patient out of bed, goes to assist, and thanks the NAP for her efforts to get the patient up early. 4 The nurse is in patient B's room to check an intravenous (IV) line and collects the urine specimen while in the room.

14 A nurse working on a medicine nursing unit is assigned to a 78-year-old patient who just entered the hospital with symptoms of H1N1 flu. The nurse finds the patient to be short of breath with an increased respiratory rate of 30 breaths/min. He lost his wife just a month ago. The nurse's knowledge about this patient results in which of the following assessment approaches at this time? (Select all that apply.) 1 A problem-focused approach 2 A structured comprehensive approach 3 Using multiple visits to gather a complete database 4 Focusing on the functional health pattern of role-relationship

1 A problem-focused approach 3 Using multiple visits to gather a complete database

4 What technique(s) best encourage(s) a patient to tell his or her full story? (Select all that apply.) 1 Active listening 2 Back channeling 3 Validating 4 Use of open-ended questions 5 Use of closed-ended questions

1 Active listening 2 Back channeling 4 Use of open-ended questions

12 Identify behaviors that foster the development of trust. (Select all that apply.) 1 Answer the call light promptly. 2 Call the patient by first name unless requested otherwise. 3 Do all the care as quickly as possible and leave the room so the patient can rest. 4 Answer questions honestly. 5 Demonstrate competence when doing treatments.

1 Answer the call light promptly. 4 Answer questions honestly. 5 Demonstrate competence when doing treatments.

7 Contemporary nursing requires that the nurse has knowledge and skills for a variety of professional roles and responsibilities. Which of the following are examples? (Select all that apply.) 1 Caregiver 2 Autonomy and accountability 3 Patient advocate 4 Health promotion 5 Lobbyist

1 Caregiver 2 Autonomy and accountability 3 Patient advocate 4 Health promotion

5 A nurse who is working on a surgical unit is caring for four different patients. Patient A will be discharged home and is in need of instruction about wound care. Patients B and C have returned from the operating room within an hour of each other, and both require vital signs and monitoring of their intravenous (IV) lines. Patient D is resting following a visit by physical therapy. Which of the following activities by the nurse represent(s) use of clinical decision making for groups of patients? (Select all that apply.) 1 Consider how to involve patient A in deciding whether to involve the family caregiver in wound care instruction. 2 Think about past experience with patients who develop postoperative complications. 3 Decide which activities can be combined for patients B and C. 4 Carefully gather any assessment information and identify patient problems.

1 Consider how to involve patient A in deciding whether to involve the family caregiver in wound care instruction. 3 Decide which activities can be combined for patients B and C.

2 The nurse sits down to talk with a patient who lost her sister 2 weeks ago. The patient reports she is unable to sleep, feels very fatigued during the day, and is having trouble at work. The nurse asks her to clarify the type of trouble. The patient explains she can't concentrate or even solve simple problems. The nurse records the results of the assessment, describing the patient as having ineffective coping. This is an example of: 1 Diagnostic reasoning. 2 Competency. 3 Inference. 4 Problem solving.

1 Diagnostic reasoning.

10 You are supervising a beginning nursing student who is documenting patient care. Which of the following actions requires you to intervene? The nursing student: 1 Documented medication given by another nursing student. 2 Included the date and time of all entries in the chart. 3 Stood with his back against the wall while documenting on the computer. 4 Signed all documentation electronically.

1 Documented medication given by another nursing student.

4 When a nurse assesses a patient for pain and offers a plan to manage the pain, which principal is used to encourage the nurse to monitor the patient's response to the pain? 1 Fidelity 2 Beneficence 3 Nonmaleficence 4 Respect for autonomy

1 Fidelity

8 Advanced practice registered nurses generally: 1 Function independently 2 Function as unit directors 3 Work in acute care settings 4 Work in the university setting.

1 Function independently

8 A patient who visits the allergy clinic tells the nurse practitioner that he is not getting relief from shortness of breath when he uses his inhaler. The nurse decides to ask the patient to explain how he uses the inhaler, when he should take a dose of medication, and what he does when he gets no relief. On the basis of Gordon's functional health patterns, which pattern does the nurse assess? 1 Health perception-health management pattern 2 Value-belief pattern 3 Cognitive-perceptual pattern 4 Coping-stress tolerance pattern

1 Health perception-health management pattern

9 A nurse researcher decides to complete a study to evaluate how Florence Nightingale improved patient outcomes in the Crimean War. This is an example of what type of research? 1 Historical 2 Evaluation 3 Exploratory 4 Experimental

1 Historical

8 The nurses on a medical unit have seen an increase in the number of pressure ulcers that develop in their patients. They decide to initiate a quality improvement project using the PDSA model. Which of the following is an example of "Do" from that model? 1 Implement the new skin care protocol on all medicine units. 2 Review the data collected on patients cared for using the protocol. 3 Review the QI reports on the six patients who developed ulcers over the last 3 months. 4 Based on findings from patients who developed ulcers, implement an evidence-based skin care protocol.

1 Implement the new skin care protocol on all medicine units.

9 Health care reform will bring changes in the emphasis of care. Which of the following models is expected from health care reform? 1 Moving from an acute illness to a health promotion, illness prevention model 2 Moving from illness prevention to a health promotion model 3 Moving from an acute illness to a disease management model 4 Moving from a chronic care to an illness prevention model

1 Moving from an acute illness to a health promotion, illness prevention model

10 Which of the following are examples of data validation? (Select all that apply.) 1 The nurse assesses the patient's heart rate and compares the value with the last value entered in the medical record. 2 The nurse asks the patient if he is having pain and then asks the patient to rate the severity. 3 The nurse observes a patient reading a teaching booklet and asks the patient if he has questions about its content. 4 The nurse obtains a blood pressure value that is abnormal and asks the charge nurse to repeat the measurement. 5 The nurse asks the patient to describe a symptom by saying, "Go on."

1 The nurse assesses the patient's heart rate and compares the value with the last value entered in the medical record. 4 The nurse obtains a blood pressure value that is abnormal and asks the charge nurse to repeat the measurement.

9 You are giving a hand-off report to another nurse who will be caring for your patient at the end of your shift. Which of the following pieces of information do you include in the report? (Select all that apply.) 1 The patient's name, age, and admitting diagnosis 2 Allergies to food and medications 3 Your evaluation that the patient is "needy" 4 How much the patient ate for breakfast 5 That the patient's pain rating went from 8 to 2 on a scale of 1 to 10 after receiving 650 mg of Tylenol

1 The patient's name, age, and admitting diagnosis 2 Allergies to food and medications 5 That the patient's pain rating went from 8 to 2 on a scale of 1 to 10 after receiving 650 mg of Tylenol

5 A nurse gathers the following assessment data. Which of the following cues form(s) a pattern suggesting a problem? (Select all that apply.) 1 The skin around the wound is tender to touch. 2 Fluid intake for 8 hours is 800 mL. 3 Patient has a heart rate of 78 and regular. 4 Patient has drainage from surgical wound. 5 Body temperature is 101° F (38.3° C). 6 Patient asks, "I'm worried that I won't return to work when I planned."

1 The skin around the wound is tender to touch. 4 Patient has drainage from surgical wound. 5 Body temperature is 101° F (38.3° C).

6 Successful ethical discussion depends on people who have a clear sense of personal values. When a group of people share many of the same values, it may be possible to refer for guidance to philosophical principals of utilitarianism. This philosophy proposes which of the following? 1 The value of something is determined by its usefulness to society. 2 People's values are determined by religious leaders. 3 The decision to perform a liver transplant depends on a measure of the moral life that the patient has led so far. 4 The best way to determine the solution to an ethical dilemma is to refer the case to the attending physician or health care provider.

1 The value of something is determined by its usefulness to society.

12 Resolution of an ethical dilemma involves discussion with the patient, the patient's family, and participants from all health care disciplines. Which of the following describes the role of the nurse in the resolution of ethical dilemmas? 1 To articulate his or her unique point of view, including knowledge based on clinical and psychosocial observations 2 To await new clinical orders from the physician 3 To limit discussions about ethical principals 4 To allow the patient and the physician to resolve the dilemma without regard to personally held values or opinions regarding the ethical issues

1 To articulate his or her unique point of view, including knowledge based on clinical and psychosocial observations

7 Match the correct entry with the appropriate SOAP (Subjective—Objective—Assessment—Plan) category. 1. S, 2.O, 3.A, 4.P a. Repositioned patient on right side. Encouraged patient to use patient-controlled analgesia (PCA) device. b. "The pain increases every time I try to turn on my left side." c. Acute pain related to tissue injury from surgical incision. d. Left lower abdominal surgical incision, 3 inches in length, closed, sutures intact, no drainage. Pain noted on mild palpation.

1. S - b. "The pain increases every time I try to turn on my left side." 2. O - d. Left lower abdominal surgical incision, 3 inches in length, closed, sutures intact, no drainage. Pain noted on mild palpation. 3. A - c. Acute pain related to tissue injury from surgical incision. 4. P - a. Repositioned patient on right side. Encouraged patient to use patient-controlled analgesia (PCA) device.

8 You ask another nurse how to collect a laboratory specimen. The nurse raises her eyebrows and asks, "Why don't you figure it out?" What would be the best response? 1 Say nothing and walk away. Find a different nurse to help you. 2 "When you brush me off like that, it takes me even longer to do my job." 3 "Why do you always put me down like that?" 4 "I guess I just enjoy having you make fun of me."

2 "When you brush me off like that, it takes me even longer to do my job."

6 Which of the following statements would be most likely to block communication? 1 "You look kind of tired today." 2 "Why do you always put so much salt on your food?" 3 "It sounds like this has been a hard time for you." 4 "If you use your oxygen when you walk, you may be able to walk farther."

2 "Why do you always put so much salt on your food?"

4 A nurse is caring for a patient with end-stage lung disease. The patient wants to go home on oxygen and be comfortable. The family wants the patient to have a new surgical procedure. The nurse explains the risk and benefits of the surgery to the family and discusses the patient's wishes with the family. The nurse is acting as the patient's: 1 Educator 2 Advocate 3 Caregiver 4 Case manager

2 Advocate

5 Arrange the following steps of evidence-based practice (EBP) in the appropriate order: 1 Integrate the evidence. 2 Ask the burning clinical question. 3 Evaluate the practice decision or change. 4 Share the results with others. 5 Critically appraise the evidence you gather. 6 Collect the most relevant and best evidence.

2 Ask the burning clinical question. 6 Collect the most relevant and best evidence. 5 Critically appraise the evidence you gather. 1 Integrate the evidence. 3 Evaluate the practice decision or change. 4 Share the results with others.

3 A child's immunization may cause discomfort during administration, but the benefits of protection from disease, both for the individual and society, outweigh the temporary discomforts. Which principle is involved in this situation? 1 Fidelity 2 Beneficence 3 Nonmaleficence 4 Respect for autonomy

2 Beneficence

5 The nurse states, "When you tell me that you're having a hard time living up to expectations, are you talking about your family's expectations?" The nurse is using which therapeutic communication technique? 1 Providing information 2 Clarifying 3 Focusing 4 Paraphrasing

2 Clarifying

2 Mrs. Jones states that she gets anxious when she thinks about giving herself insulin. How do you use your understanding of intrapersonal communication to help with this? 1 Provide her the opportunity to practice drawing up insulin 2 Coach her to give herself positive messages about her ability to do this 3 Bring her written material that clearly describes the steps of insulin administration 4 Use therapeutic communication to help her express her feeling about giving herself an injection

2 Coach her to give herself positive messages about her ability to do this

13 A precise definition for the word quality is difficult to articulate when it comes to quality of life. Why? (Select all that apply.) 1 Quality of life is measured by potential income, and average income varies in different regions of the country. 2 Community values are subject to change, and communities influence definitions of "quality." 3 Individual experiences influence perceptions of quality in potentially different ways, making consensus difficult. 4 Placing measurable value on elusive elements such as cognitive skills, ability to perform meaningful work, and relationship to family is challenging.

2 Community values are subject to change, and communities influence definitions of "quality." 3 Individual experiences influence perceptions of quality in potentially different ways, making consensus difficult. 4 Placing measurable value on elusive elements such as cognitive skills, ability to perform meaningful work, and relationship to family is challenging.

8 The nurse cared for a 14-year-old with renal failure who died near the end of the work shift. The health care team tried for 45 minutes to resuscitate the child with no success. The family was devastated by the loss, and, when the nurse tried to talk with them, the mother said, "You can't make me feel better; you don't know what it's like to lose a child." Which of the following examples of journal entries might best help the nurse reflect and think about this clinical experience? (Select all that apply.) 1 Data entry of time of day, who was present, and condition of the child 2 Description of the efforts to restore the child's blood pressure, what was used, and questions about the child's response 3 The meaning the experience had for the nurse with respect to her understanding of dealing with a patient's death 4 A description of what the nurse said to the mother, the mother's response, and how the nurse might approach the situation differently in the future

2 Description of the efforts to restore the child's blood pressure, what was used, and questions about the child's response 3 The meaning the experience had for the nurse with respect to her understanding of dealing with a patient's death 4 A description of what the nurse said to the mother, the mother's response, and how the nurse might approach the situation differently in the future

15 A nurse researcher is developing a research proposal and is in the process of selecting an instrument to measure anxiety. In which part of the research process is this nurse? 1 Analyzing the data 2 Designing the study 3 Conducting the study 4 Identifying the problem

2 Designing the study

8 On the nursing unit you are able to access a patient's medical record and review the education that other nurses provided to the patient during an initial hospitalization and three subsequent clinic visits. This type of feature is most common in what type of record system? 1 Information technology. 2 Electronic health record. 3 Personal health information. 4 Administrative information system.

2 Electronic health record.

10 A patient had hip surgery 16 hours ago. During the previous shift the patient had 40 mL of drainage in the surgical drainage collection device for an 8-hour period. The nurse refers to the written plan of care, noting that the health care provider is to be notified when drainage in the device exceeds 100 mL for the day. On entering the room, the nurse looks at the device and carefully notes the amount of drainage currently in it. This is an example of: 1 Planning. 2 Evaluation. 3 Intervention. 4 Diagnosis.

2 Evaluation.

9 Ethical dilemmas often arise over a conflict of opinion. What is the critical first step in negotiating the difference of opinion? 1 Consult a professional ethicist to ensure that the steps of the process occur in full. 2 Gather all relevant information regarding the clinical, social, and spiritual aspects of the dilemma. 3 Ensure that the attending physician or health care provider has written an order for an ethics consultation to support the ethics process. 4 List the ethical principles that inform the dilemma so negotiations agree on the language of the discussion.

2 Gather all relevant information regarding the clinical, social, and spiritual aspects of the dilemma.

2 A new graduate nurse is providing a telephone report to a patient's health care provider and accepting telephone orders from the provider. Which of the following actions requires the new nurse's preceptor to intervene? The new nurse: 1 Uses SBAR (Situation-Background-Assessment-Recommendation) as a format when providing the report. 2 Gives a newly ordered medication before entering the order in the patient's medical record. 3 Reads the orders back to the health care provider after receiving them and verifies their accuracy. 4 Asks the preceptor to listen in on the phone conversation.

2 Gives a newly ordered medication before entering the order in the patient's medical record.

5 A patient asks for a copy of her medical record. The best response by the nurse is to: 1 State that only her family may read the record. 2 Indicate that she has the right to read her record. 3 Tell her that she is not allowed to read her record. 4 Explain that only health care workers have access to her record.

2 Indicate that she has the right to read her record.

15 A 58-year-old patient with nerve deafness has come to his doctor's office for a routine examination. The patient wears two hearing aids. The advanced practice nurse who is conducting the assessment uses which of the following approaches while conducting the interview with this patient? (Select all that apply.) 1 Maintain a neutral facial expression 2 Lean forward when interacting with the patient 3 Acknowledge the patient's answers through head nodding 4 Limit direct eye contact

2 Lean forward when interacting with the patient 3 Acknowledge the patient's answers through head nodding

11 When an ethical dilemma occurs on your unit, can you resolve the dilemma by taking a vote? 1 Yes because ethics is essentially a democratic process, with all participants sharing an equal voice 2 No because an ethical dilemma involves the resolution of conflicting values and principals rather than simply the identification of what people want to do 3 Yes because ethical dilemmas otherwise take up time and energy that is better spent at the bedside performing direct patient care 4 No because most ethical dilemmas are resolved by deferring to the medical director of the ethics department

2 No because an ethical dilemma involves the resolution of conflicting values and principals rather than simply the identification of what people want to do

10 Which of the following nursing roles may have prescriptive authority in their practice? (Select all that apply.) 1 Critical care nurse 2 Nurse practitioner 3 Certified clinical nurse specialist 4 Charge nurse

2 Nurse practitioner 3 Certified clinical nurse specialist

7 A nurse checks a patient's intravenous (IV) line in his right arm and sees inflammation where the catheter enters the skin. She uses her finger to apply light pressure (i.e., palpation) just above the IV site. The patient tells her the area is tender. The nurse checks to see if the IV line is running at the correct rate. This is an example of what type of assessment? 1 Agenda setting 2 Problem-focused 3 Objective 4 Use of a structured database format

2 Problem-focused

14 Your patient has just been told that she has cancer, and she is crying. Which actions facilitate therapeutic communication? (Select all that apply.) 1 Turning on the television to her favorite show 2 Pulling the curtain to provide privacy 3 Offering to discuss information about her condition 4 Asking her why she is crying 5 Sitting quietly by her bed and hold her hand

2 Pulling the curtain to provide privacy 3 Offering to discuss information about her condition 5 Sitting quietly by her bed and hold her hand

13 A group of staff educators are reading a research study together at a journal club meeting. While reviewing the study, one of the nurses states that it evaluates if newly graduated nurses progress through orientation more effectively when they participate in patient simulation exercises. Which part of the research process is reflected in this nurse's statement? 1 Introduction 2 Purpose statement 3 Methods 4 Results

2 Purpose statement

1 A nurse researcher interviews parents of children who have diabetes and asks them to describe how they deal with their child's illness. The analysis of the interviews yields common themes and stories describing the parents' coping strategies. This is an example of which type of study? 1 Historical 2 Qualitative 3 Correlational 4 Experimental

2 Qualitative

14 Which of the following explain how health care reform is an ethical issue? (Select all that apply.) 1 Access to care is an issue of beneficence, a fundamental principal in health care ethics. 2 Reforms promote the principle of beneficence, a hallmark of health care ethics. 3 Purchasing health care insurance may become an obligation rather than a choice, a potential conflict between autonomy and beneficence. 4 Lack of access to affordable health care causes harm, and nonmaleficence is a basic principal of health care ethics.

2 Reforms promote the principle of beneficence, a hallmark of health care ethics. 3 Purchasing health care insurance may become an obligation rather than a choice, a potential conflict between autonomy and beneficence. 4 Lack of access to affordable health care causes harm, and nonmaleficence is a basic principal of health care ethics.

7 The philosophy sometimes called the ethics of care suggests that ethical dilemmas can best be solved by attention to which of the following? 1 Patients 2 Relationships 3 Ethical principles 4 Code of ethics for nurses

2 Relationships

12 A nurse is caring for an older-adult couple in a community-based assisted living facility. During the family assessment he notes that the couple has many expired medications and multiple medications for their respective chronic illnesses. They note that they go to two different health care providers. The nurse begins to work with the couple to determine what they know about their medications and helps them decide on one care provider rather than two. This is an example of which Quality and Safety in the Education of Nurses (QSEN) competency? 1 Patient-centered care 2 Safety 3 Teamwork and collaboration 4 Informatics

2 Safety

4 A group of nurses have implemented an evidence-based practice (EBP) change and have evaluated the effectiveness of the change. Their next step is to: 1 Conduct a literature review. 2 Share the findings with others. 3 Conduct a statistical analysis. 4 Create a well-defined PICOT question.

2 Share the findings with others.

14 While reviewing the pulmonary section of a patient's electronic chart, the physician notices blank spaces since the initial assessment the previous day when the nurse documented that the lung assessment was within normal limits. There also are no progress notes about the patient's respiratory status in the nurse's notes. The most likely reason for this is because: 1 The nurses forgot to document on the pulmonary system. 2 The nurses were charting by exception. 3 The computer is not working correctly. 4 The physician does not have authorization to view the nursing assessment.

2 The nurses were charting by exception.

12 You are helping to design a new patient discharge teaching sheet that will go home with patients who are discharged to home from your unit. Which of the following do you need to remember when designing the teaching sheet? 1 The new federal laws require that teaching sheets be e-mailed to patients after they are discharged. 2 You need to use words the patients can understand when writing the directions. 3 The form needs to be given to patients in a sealed envelope to protect their health information. 4 The names of everyone who cared for the patient in the hospital need to be included on the form in case the patient has questions at home.

2 You need to use words the patients can understand when writing the directions.

9 When the nurse takes the patient's nursing history, he or she sits: 1 Next to the patient. 2 4 to 12 feet from the patient. 3 18 inches to 4 feet from the patient. 4 12 inches to 3 feet from the patient.

3 18 inches to 4 feet from the patient.

5 Evidence-based practice is defined as: 1 Nursing care based on tradition 2 Scholarly inquiry of nursing and biomedical research literature 3 A problem-solving approach that integrates best current evidence with clinical practice 4 Quality nursing care provided in an efficient and economically sound manner

3 A problem-solving approach that integrates best current evidence with clinical practice

4 A nurse has worked on an oncology unit for 3 years. One patient has become visibly weaker and states, "I feel funny." The nurse knows how patients often have behavior changes before developing sepsis when they have cancer. The nurse asks the patient questions to assess thinking skills and notices the patient shivering. The nurse goes to the phone, calls the physician, and begins the conversation by saying, "I believe that your patient is developing sepsis. I want to report symptoms I'm seeing." What examples of critical thinking concepts does the nurse show? (Select all that apply.) 1 Experience 2 Ethical 3 Analyticity 4 Self-confidence 5 Risk taking

3 Analyticity

2 An 18-year-old woman is in the emergency department with fever and cough. The nurse obtains her vital signs, auscultates her lung sounds, listens to her heart sounds, determines her level of comfort, and collects blood and sputum samples for analysis. Which standard of practice is performed? 1 Diagnosis 2 Evaluation 3 Assessment 4 Implementation

3 Assessment

9 A nurse has been working on a surgical unit for 3 weeks. A patient requires a Foley catheter to be inserted, so the nurse reads the procedure manual for the institution to review how to insert it. The level of critical thinking the nurse is using is: 1 Commitment. 2 Scientific method. 3 Basic critical thinking. 4 Complex critical thinking.

3 Basic critical thinking.

13 A nurse caring for a patient on a ventilator electronically documents the head of bed elevated at 20 degrees. Suddenly an alert warning appears on the screen warning the nurse that this patient is at a high risk for aspiration because the head of the bed is not elevated high enough. This warning is known as what type of system? 1 Electronic health record 2 Clinical documentation 3 Clinical decision support system 4 Computerized physician order entry

3 Clinical decision support system

3 What type of interview techniques does the nurse use when asking these questions, "Do you have pain or cramping?" "Does the pain get worse when you walk?" (Select all that apply.) 1 Active listening 2 Open-ended questioning 3 Closed-ended questioning 4 Problem-oriented questioning

3 Closed-ended questioning 4 Problem-oriented questioning

2 The nurse asks a patient, "Describe for me your typical diet over a 24-hour day. What foods do you prefer? Have you noticed a change in your weight recently?" This series of questions would likely occur during which phase of a patient-centered interview? 1 Setting the stage 2 Gathering information about the patient's chief concerns 3 Collecting the assessment 4 Termination

3 Collecting the assessment

3 A patient on a surgical unit develops sudden shortness of breath and a drop in blood pressure. The staff respond, but the patient dies 30 minutes later. The manager on the nursing unit calls the staff involved in the emergency response together. The staff discusses what occurred over the 30-minute time frame, the actions taken, and whether other steps should have been implemented. The nurses in this situation are: 1 Problem solving. 2 Showing humility. 3 Conducting reflective practice. 4 Exercising responsibility.

3 Conducting reflective practice.

6 The surgical unit has initiated the use of a pain-rating scale to assess patients' pain severity during their postoperative recovery. The registered nurse (RN) looks at the pain flow sheet to see the pain scores recorded for a patient over the last 24 hours. Use of the pain scale is an example of which intellectual standard? 1 Deep 2 Relevant 3 Consistent 4 Significant

3 Consistent

15 Mr. Sakda emigrated from Thailand. When taking care of him, you note that he looks relaxed and smiles but seldom looks at you directly. How do you respond? 1 Use therapeutic communication to assess for increased anxiety 2 Sit down and position yourself closer so you are at eye level 3 Deflect your eyes downward to show respect 4 Continue to maintain eye contact

3 Deflect your eyes downward to show respect

4 You are reviewing Health Insurance Portability and Accountability Act (HIPAA) regulations with your patient during the admission process. The patient states, "I've heard a lot about these HIPAA regulations in the news lately. How will they affect my care?" Which of the following is the best response? 1 HIPAA allows all hospital staff access to your medical record. 2 HIPAA limits the information that is documented in your medical record. 3 HIPAA provides you with greater control over your personal health care information. 4 HIPAA enables health care institutions to release all of your personal information to improve continuity of care.

3 HIPAA provides you with greater control over your personal health care information.

15 Nurses at a community hospital are in an education program to learn how to use a new pressure-relieving device for patients at risk for pressure ulcers. This is which type of education? 1 Continuing education 2 Graduate education 3 In-service education 4 Professional Registered Nurse Education

3 In-service education

15 Which is the best method of negotiating or processing difficult ethical situations? 1 Ethical issues arise between dissenting providers and can be best resolved by deference to an independent arbitrator such a chaplain. 2 Since ethical issues usually affect policy and procedure, a legal expert is the best consultant to help resolve disputes. 3 Institutional ethics committees help to ensure that all participants involved in the ethical dilemma get a fair hearing and an opportunity to express values, feelings, and opinions as a way to find consensus. 4 Medical experts are best able to resolve conflicts about outcome predictions.

3 Institutional ethics committees help to ensure that all participants involved in the ethical dilemma get a fair hearing and an opportunity to express values, feelings, and opinions as a way to find consensus.

11 A patient tells the nurse during a visit to the clinic that he has been sick to his stomach for 3 days and he vomited twice yesterday. Which of the following responses by the nurse is an example of probing? 1 So you've had an upset stomach and began vomiting—correct? 2 Have you taken anything for your stomach? 3 Is anything else bothering you? 4 Have you taken any medication for your vomiting?

3 Is anything else bothering you?

12 The nurse asks a patient how she feels about her impending surgery for breast cancer. Before the discussion the nurse reviewed the description of loss and grief and therapeutic communication principles in his textbook. The critical thinking component involved in the nurse's review of the literature is: 1 Experience. 2 Problem solving. 3 Knowledge application. 4 Clinical decision making.

3 Knowledge application.

7 You are caring for an 80-year-old woman, and you ask her a question while you are across the room washing your hands. She does not answer. What is your next action? 1 Leave the room quietly since she evidently does not want to be bothered right now 2 Repeat the question in a loud voice, speaking very slowly 3 Move to her bedside, get her attention, and repeat the question while facing her 4 Bring her a communication board so she can express her needs

3 Move to her bedside, get her attention, and repeat the question while facing her

10 The ANA code of nursing ethics articulates that the nurse "promotes, advocates for, and strives to protect the health, safety, and rights of the patient." This includes the protection of patient privacy. On the basis of this principal, if you participate in a public online social network such as Facebook, could you post images of a patient's x-ray film if you deleted all patient identifiers? 1 Yes because patient privacy would not be violated as long as the patient identifiers were removed 2 Yes because respect for autonomy implies that you have the autonomy to decide what constitutes privacy 3 No because, even though patient identifiers are removed, someone could identify the patient based on other comments that you make online about his or her condition and your place of work 4 No because the principal of justice requires you to allocate resources fairly

3 No because, even though patient identifiers are removed, someone could identify the patient based on other comments that you make online about his or her condition and your place of work

2 The point of the ethical principal to "do no harm" is an agreement to reassure the public that in all ways the health care team not only works to heal patients but agree to do this in the least painful and harmful way possible. Which principle describes this agreement? 1 Beneficence 2 Accountability 3 Nonmaleficence 4 Respect for autonomy

3 Nonmaleficence

10 A group of nurses on the research council of a local hospital are measuring nursing-sensitive outcomes. Which of the following is a nursing-sensitive outcome that the nurses need to consider measuring? 1 Incidence of asthma among children of parents who smoke 2 Frequency of low blood sugar episodes in children at a local school 3 Number of patients who fall and experience subsequent injury on the evening shift 4 Number of sexually active adolescent girls who attend the community-based clinic for birth control

3 Number of patients who fall and experience subsequent injury on the evening shift

8 In most ethical dilemmas in health care, the solution to the dilemma requires negotiation among members of the health care team. Why is the nurse's point of view valuable? 1 Nurses understand the principle of autonomy to guide respect for patient's self-worth. 2 Nurses have a scope of practice that encourages their presence during ethical discussions. 3 Nurses develop a relationship to the patient that is unique among all professional health care providers. 4 The nurse's code of ethics recommends that a nurse be present at any ethical discussion about patient care.

3 Nurses develop a relationship to the patient that is unique among all professional health care providers.

13 A patient with limited English proficiency is going to be discharged on new medication. How does the nurse complete the discharge teaching? 1 Uses a dictionary to give directions for medication administration 2 Explains the directions to the patient's 14-year-old daughter 3 Obtains an interpreter to facilitate communication of medication information 4 Uses a picture board and visual aids to communicate medication administration information

3 Obtains an interpreter to facilitate communication of medication information

2 A nurse who works in a newborn nursery asks, "I wonder if the moms who breastfeed their babies would be able to breastfeed more successfully if we played peaceful music while they were breastfeeding." In this example of a PICOT question, the I is: 1 Breastfeeding moms. 2 Infants. 3 Peaceful music. 4 The nursery.

3 Peaceful music.

13 During the review of systems in a nursing history, a nurse learns that the patient has been coughing mucus. Which of the following nursing assessments would be best for the nurse to use to confirm a lung problem? (Select all that apply.) 1 Family report 2 Chest x-ray film 3 Physical examination with auscultation of the lungs 4 Medical record summary of x-ray film findings

3 Physical examination with auscultation of the lungs 4 Medical record summary of x-ray film findings

15 What is an appropriate way for a nurse to dispose of printed patient information? 1 Rip several times and place in a standard trash can 2 Place in the patient's paper-based chart 3 Place in a secure canister marked for shredding 4 Burn the documents

3 Place in a secure canister marked for shredding

11 A group of staff nurses notice an increased incidence of medication errors on their unit. After further investigation it is determined that the nurses are not consistently identifying the patient correctly. A change is needed quickly. What type of quality improvement method would be most appropriate? 1 PDSA 2 Six Sigma 3 Rapid-improvement event 4 A randomized controlled trial

3 Rapid-improvement event

10 When working with an older adult, the nurse remembers to avoid: 1 Touching the patient. 2 Allowing the patient to reminisce. 3 Shifting quickly from subject to subject. 4 Asking the patient how he or she feels.

3 Shifting quickly from subject to subject.

6 The nurse makes the following statement during a change of shift report to another nurse. "I assessed Mr. Diaz, my 61-year-old patient from Chile. He fell at home and hurt his back 3 days ago. He has some difficulty turning in bed, and he says that he has pain that radiates down his leg. He rates his pain at a 6, but I don't think it's that severe. You know that back patients often have chronic pain. He seems fine when talking with his family. Have you cared for him before?" What does the nurse's conclusion suggest? 1 The nurse is making an accurate clinical inference. 2 The nurse has gathered cues to identify a potential problem area. 3 The nurse has allowed stereotyping to influence her assessment. 4 The nurse wants to validate her information with the other nurse.

3 The nurse has allowed stereotyping to influence her assessment.

3 The nurse has a patient who is short of breath and calls the health care provider using SBAR (Situation-Background-Assessment-Recommendation) to help with the communication. What does the nurse first address? 1 The respiratory rate is 28. 2 The patient has a history of lung cancer. 3 The patient is short of breath. 4 He or she requests an order for a breathing treatment.

3 The patient is short of breath.

14 A research study is investigating the following research question: What is the effect of the diagnosis of breast cancer on the roles of the family? In this study "the diagnosis of breast cancer" and "family roles" are examples of: 1 Surveys 2 The sample 3 Variables 4 Data collection points

3 Variables

12 The nurse is assessing the character of a patient's migraine headache and asks, "Do you feel nauseated when you have a headache?" The patient's response is "yes." In this case the finding of nausea is which of the following? 1 An objective finding 2 A clinical inference 3 A validation 4 A concomitant symptom

4 A concomitant symptom

14 Which of the following is unique to the commitment level of critical thinking? 1 Weighs benefits and risks when making a decision. 2 Analyzes and examine choices more independently. 3 Concrete thinking. 4 Anticipates when to make choices without others' assistance.

4 Anticipates when to make choices without others' assistance.

5 What is the best example of the nurse practicing patient advocacy? 1 Seek out the nursing supervisor in conflicting procedural situations 2 Document all clinical changes in the medical record in a timely manner 3 Work to understand the law as it applies to an error in following standards of care 4 Assess the patient's point of view and prepare to articulate it

4 Assess the patient's point of view and prepare to articulate it

12 A nurse is providing care to a patient who is experiencing major abdominal trauma following a car accident. The patient is losing blood quickly and needs a blood transfusion. The nurse finds out that the patient is a Jehovah's Witness and cannot have blood transfusions because of religious beliefs. He or she notifies the patient's health care provider and receives an order to give the patient an alternative to blood products. This is an example of: 1 A quality improvement study. 2 An evidence-based practice change. 3 A time when calling the hospital's ethics committee is essential. 4 Considering the patient's preferences and values while providing care.

4 Considering the patient's preferences and values while providing care.

1 You are participating in a clinical care coordination conference for a patient with terminal cancer. You talk with your colleagues about using the nursing code of ethics for professional registered nurses to guide care decisions. A nonnursing colleague asks about this code. Which of the following statements best describes this code? 1 Improves self-health care 2 Protects the patient's confidentiality 3 Ensures identical care to all patients 4 Defines the principles of right and wrong to provide patient care

4 Defines the principles of right and wrong to provide patient care

1 A manager who is reviewing the nurses' notes in a patient's medical record finds the following entry, "Patient is difficult to care for, refuses suggestion for improving appetite." Which of the following directions does the manager give to the staff nurse who entered the note? 1 Avoid rushing when charting an entry. 2 Use correction fluid to remove the entry. 3 Draw a single line through the statement and initial it. 4 Enter only objective and factual information about the patient.

4 Enter only objective and factual information about the patient.

1 The nurse summarizes the conversation with the patient to determine if the patient has understood him or her. This is what element of the communication process? 1 Referent 2 Channel 3 Environment 4 Feedback

4 Feedback

1 A nurse assesses a patient who comes to the pulmonary clinic. "I see that it's been over 6 months since you've been in, but your appointment was for every 2 months. Tell me about that. Also I see from your last visit that the doctor recommended routine exercise. Can you tell me how successful you have been following his plan?" The nurse's assessment covers which of Gordon's functional health patterns? 1 Value-belief pattern 2 Cognitive-perceptual pattern 3 Coping-stress-tolerance pattern 4 Health perception-health management pattern

4 Health perception-health management pattern

3 A patient in the emergency department has developed wheezing and shortness of breath. The nurse gives the ordered medicated nebulizer treatment now and in 4 hours. Which standard of practice is performed? 1 Planning 2 Evaluation 3 Assessment 4 Implementation

4 Implementation

11 A critical care nurse is using a computerized decision support system to correctly position her ventilated patients to reduce pneumonia caused by accumulated respiratory secretions. This is an example of which Quality and Safety in the Education of Nurses (QSEN) competency? 1 Patient-centered care 2 Safety 3 Teamwork and collaboration 4 Informatics

4 Informatics

6 When recruiting subjects to participate in a study about the effects of an exercise program on balance, the researcher provides full and complete information about the purpose of the study and gives the subjects the choice to participate or not participate in the study. This is an example of: 1 Bias. 2 Anonymity. 3 Confidentiality. 4 Informed consent.

4 Informed consent.

1 The patient for whom you are caring needs a liver transplant to survive. This patient has been out of work for several months and doesn't have health insurance or enough cash. What principles would be a priority in a discussion about ethics? 1 Accountability because you as the nurse are accountable for the well-being of this patient 2 Respect for autonomy because this patient's autonomy will be violated if he does not receive the liver transplant 3 Ethics of care because the caring thing that a nurse could provide this patient is resources for a liver transplant 4 Justice because the first and greatest question in this situation is how to determine the just distribution of resources

4 Justice because the first and greatest question in this situation is how to determine the just distribution of resources

7 Nurses on a pediatric nursing unit are discussing ways to improve patient care. One nurse asks a colleague, "I wonder how best to measure pain in a child who has sickle cell disease?" This question is an example of a/an: 1 Hypothesis. 2 PICOT question. 3 Problem-focused trigger. 4 Knowledge-focused trigger.

4 Knowledge-focused trigger.

14 The nurses on an acute care medical floor notice an increase in pressure ulcer formation in their patients. A nurse consultant decides to compare two types of treatment. The first is the procedure currently used to assess for pressure ulcer risk. The second uses a new assessment instrument to identify at-risk patients. Given this information, the nurse consultant exemplifies which career? 1 Clinical nurse specialist 2 Nurse administrator 3 Nurse educator 4 Nurse researcher

4 Nurse researcher

6 Which of the following charting entries is most accurate? 1 Patient walked up and down hallway with assistance, tolerated well. 2 Patient up, out of bed, walked down hallway and back to room, tolerated well. 3 Patient up, walked 50 feet and back down hallway with assistance from nurse. Spouse also accompanied patient during the walk. 4 Patient walked 50 feet and back down hallway with assistance from nurse; HR 88 and regular before exercise, 94 and regular following exercise.

4 Patient walked 50 feet and back down hallway with assistance from nurse; HR 88 and regular before exercise, 94 and regular following exercise.

1 While assessing a patient, the nurse observes that the patient's intravenous (IV) line is not infusing at the ordered rate. The nurse assesses the patient for pain at the IV site, checks the flow regulator on the tubing, looks to see if the patient is lying on the tubing, checks the point of connection between the tubing and the IV catheter, and then checks the condition of the site where the intravenous catheter enters the patient's skin. After the nurse readjusts the flow rate, the infusion begins at the correct rate. This is an example of: 1 Inference. 2 Diagnostic reasoning. 3 Competency. 4 Problem solving.

4 Problem solving.

6 The examination for registered nurse licensure is exactly the same in every state in the United States. This examination: 1 Guarantees safe nursing care for all patients 2 Ensures standard nursing care for all patients 3 Ensures that honest and ethical care is provided 4 Provides a minimal standard of knowledge for a registered nurse in practice

4 Provides a minimal standard of knowledge for a registered nurse in practice

3 A nurse researcher conducts a study that randomly assigns 100 patients who smoke and attend a wellness clinic into two groups. One group receives the standard smoking cessation handouts; the other group takes part in a new educational program that includes a smoking cessation support group. The nurse plans to compare the effectiveness of the standard treatment with the educational program. What type of a research study is this? 1 Qualitative 2 Descriptive 3 Correlational 4 Randomized controlled trial

4 Randomized controlled trial

4 You are caring for Mr. Smith, who is facing amputation of his leg. During the orientation phase of the relationship, what would you do? 1 Summarize what you have talked about in the previous sessions 2 Review his medical record and talk to other nurses about how he is reacting 3 Explore his feelings about losing his leg 4 Talk with him about his favorite hobbies

4 Talk with him about his favorite hobbies

15 In which of the following examples is the nurse not applying critical thinking skills in practice? 1 The nurse considers personnel experience in performing intravenous (IV) line insertion and ways to improve performance. 2 The nurse uses a fall risk inventory scale to determine a patient's fall risk. 3 The nurse observes a change in a patient's behavior and considers which problem is likely developing. 4 The nurse explains the procedure for giving a tube feeding to a second nurse who has floated to the unit to assist with care.

4 The nurse explains the procedure for giving a tube feeding to a second nurse who has floated to the unit to assist with care.

3 As you enter the patient's room, you notice that he is anxious to say something. He quickly states, "I don't know what's going on; I can't get an explanation from my doctor about my test results. I want something done about this." Which of the following is the most appropriate documentation of the patient's emotional status? 1 The patient has a defiant attitude and is demanding his test results. 2 The patient appears to be upset with his nurse because he wants his test results immediately. 3 The patient is demanding and complains frequently about his doctor. 4 The patient stated that he felt frustrated by the lack of information he received regarding his tests.

4 The patient stated that he felt frustrated by the lack of information he received regarding his tests.

11 The statement that best explains the role of collaboration with others for the patient's plan of care is which of the following? 1 The professional nurse consults the health care provider for direction in establishing goals for patients. 2 The professional nurse depends on the latest literature to complete an excellent plan of care for patients. 3 The professional nurse works independently to plan and deliver care and does not depend on other staff for assistance. 4 The professional nurse works with colleagues and the patient's family to provide combined expertise in planning care.

4 The professional nurse works with colleagues and the patient's family to provide combined expertise in planning care.

9 A nurse is conducting a patient-centered interview. Place the statements from the interview in the correct order. 1 "You say you've lost weight. Tell me how much weight you have lost in the last month." 2 "My name is Todd. I'll be the nurse taking care of you today. I'm going to ask you a series of questions to gather your health history." 3 "I have no further questions. Thank you for your patience." 4 "Tell me what brought you to the hospital." 5 "So, to summarize, you've lost about 6 pounds in the last month, and your appetite has been poor—correct?"

9. 2, 4, 1, 5, 3; 2 "My name is Todd. I'll be the nurse taking care of you today. I'm going to ask you a series of questions to gather your health history." 4 "Tell me what brought you to the hospital." 1 "You say you've lost weight. Tell me how much weight you have lost in the last month." 5 "So, to summarize, you've lost about 6 pounds in the last month, and your appetite has been poor—correct?" 3 "I have no further questions. Thank you for your patience."

11 A 67-year-old patient will be discharged from the hospital in the morning. The health care provider has ordered three new medications for her. Place the following steps of the nursing process in the correct order. ____ 1 The nurse returns to the patient's room and asks her to describe the medicines she will be taking at home. ____ 2 The nurse talks with the patient and family about who will be available if the patient has difficulty taking medicines and considers consulting with the health care provider about a home health visit. ____ 3 The nurse asks the patient if she is in pain, feels tired, and is willing to spend the next few minutes learning about her new medicines. ____ 4 The nurse brings the containers of medicines and information leaflets to the bedside and discusses each medication with her. ____ 5 The nurse considers what she learns from the patient and identifies the patient's nursing diagnosis.

____ 3 The nurse asks the patient if she is in pain, feels tired, and is willing to spend the next few minutes learning about her new medicines. ____ 5 The nurse considers what she learns from the patient and identifies the patient's nursing diagnosis. ____ 2 The nurse talks with the patient and family about who will be available if the patient has difficulty taking medicines and considers consulting with the health care provider about a home health visit. ____ 4 The nurse brings the containers of medicines and information leaflets to the bedside and discusses each medication with her. ____ 1 The nurse returns to the patient's room and asks her to describe the medicines she will be taking at home.