Exam 6 Study Questions
"Why do you always complain about the night nurse? She is a nice woman and a fine nurse and has five kids to support. You're wrong when you say she is noisy and uncaring." This example reflects which nontherapeutic technique? a.Requesting an explanation b.Defending c.Disagreeing d.Advising
B
A client is in the mild stage of dementia due to Alzheimer's disease. Which intervention would be most appropriate? A. Suggesting new activities for the client and family to do together B. Providing emotional support and gentle reminders C. Offering nourishing finger foods to help maintain the client's nutritional status D. Advocating for the client to be transitioned to a care home
B
A female client comes to an urgent care clinic and says, "I've just been raped." What should the nurse do? a.Allow the client to express whatever she wants. b.Ask the client if staff can call a friend or family member for her. c.Offer the client coffee, tea, or whatever she likes to drink. d.Get the examination completed quickly to decrease trauma to the client. e.Provide the client privacy; let her go to a room to make phone calls. f.Stay with the client until someone else arrives to be with her.
A,B,F
Which actions would indicate an increased suicidal risk? a.An abrupt improvement in mood b.Calling family members to make amends c.Crying when discussing sadness d.Feeling overwhelmed by simple daily tasks e.Statements such as "I'm such a burden for everyone" f.Statements such as "Everything will be better soon"
A,B,F
Confidentiality means respecting the client's right to keep his or her information private. When can the nurse share information about the client? a.The client threatens to harm a family member. b.Sharing the information is in the client's best interest. c.The client gives written permission. d.The client's legal guardian asks for information. e.The client is discharged to the parent's care. f.The client admits to domestic abuse.
A,C,D
A client with delirium is attempting to remove the IV tubing from his arm, saying to the nurse, "Get off me! Go away!" What is the client experiencing? a.Delusions b.Hallucinations c.Illusions d.Disorientation
B
The advantages of assertive communication are a.all persons' rights are respected. b.it gains approval from others. c.it protects the speaker from being exploited. d.the speaker can say no to another person's request. e.the speaker can safely express thoughts and feelings. f.the speaker will get his or her needs met.
A,C,D,E
A nurse decides to become a home health care nurse. Which personal qualities are key to being successful as a community-based nurse? Select all that apply. A. Making accurate assessments B. Researching new treatments for chronic diseases C. Communicating effectively D. Delegating tasks appropriately E. Performing clinical skills effectively F. Making independent decisions
A,C,E,F
Nursing interventions that are helpful for the grieving client include a.allowing denial when it is useful. b.assuring the client that it will get better. c.correcting faulty assumptions. d.discouraging negative, pessimistic conversation. e.providing attentive presence. f.reviewing past coping behaviors.
A,C,E,F
A nurse caring for patients in an institutional setting expresses a commitment to social justice. What action best exemplifies this attribute? A. Providing honest information to patients and the public B. Promoting universal access to health care C. Planning care in partnership with patients D. Documenting care accurately and honestly
B
A nurse is caring for patients in a primary care center. What is the most likely role of this nurse based on the setting? A. Assisting with major surgery B. Performing a health assessment C. Maintaining patients' function and independence D .Keeping student immunization records up to date
B
A student nurse begins a clinical rotation in a long-term care facility and quickly realizes that certain residents have unmet needs. The student wants to advocate for these residents. Which statements accurately describe this concept? Select all that apply. A. Advocacy is the protection and support of another's rights. B. Patient advocacy is primarily performed by nurses. C. Patients with special advocacy needs include the very young and the older adult, those who are seriously ill, and those with disabilities. D. Nurse advocates make good health care decisions for patients and residents. E. Nurse advocates do whatever patients and residents want. F. Effective advocacy may entail becoming politically active.
A,C,F
Interventions for clients with dementia that follow the psychosocial model of care include a.asking the clients about the places where they were born. b.correcting the any misperceptions or delusion. c.finding activities that engage the clients' attention. d.introducing new topics of discussion at dinner. e. processing behavioral problems to improve coping skills. f. providing unrelated distractions when clients are agitated.
A,C,F
interventions for clients with dementia that follow the psychosocial model of care include a.asking the clients about the places where they were born. b.correcting the any misperceptions or delusion. c.finding activities that engage the clients' attention. d.introducing new topics of discussion at dinner. e.processing behavioral problems to improve coping skills. f.providing unrelated distractions when clients are agitated.
A,C,F
Newly hired nurses in a busy suburban hospital are required to read the state nurse practice act as part of their training. Which topics are covered by this act? Select all that apply. A. Violations that may result in disciplinary action B. Clinical procedures C. Medication administration D. Scope of practice E. Delegation policies F. Medicare reimbursement
A,D
A nurse in a NICU fails to monitor a premature newborn according to the protocols in place, and is charged with malpractice. What is the term for those bringing the charges against the nurse? A. Appellates B. Defendants C. Plaintiffs D. Attorneys
C
A nurse is caring for a patient who has complications related to type 2 diabetes mellitus. The nurse researches new procedures to care for foot ulcers when developing a care plan for this patient. Which QSEN competency does this action represent? A. Patient-centered care B. Evidence-based practice C. Quality improvement D. Informatics
C
Which of the following interventions is most appropriate in helping a client with early-stage dementia complete ADLs? a.Allow enough time for the client to complete ADLs as independently as possible. b.Provide the client with a written list of all the steps needed to complete ADLs. c.Plan to provide step-by-step prompting to complete the ADLs. d.Tell the client to finish ADLs before breakfast or the nursing assistant will do them.
A
Which of the following is a concrete message? a."Help me put this pile of books on Marsha's desk." b."Get this out of here." c."When is she coming home?" d."They said it is too early to get in."
A
A patient is being transferred from the ICU to a regular hospital room. What must the ICU nurse be prepared to do as part of this transfer? A. Provide a verbal report to the nurse on the new unit. B. Provide a detailed written report to the unit secretary. C. Delegate the responsibility for providing information. D. Make a copy of the patient's medical record.
C
A nurse working in a rehabilitation facility focuses on the goal of restoring health for patients. Which examples of nursing interventions reflect this goal? Select all that apply. A. A nurse counsels adolescents in a drug rehabilitation program B. A nurse performs range-of-motion exercises for a patient on bedrest C. A nurse shows a diabetic patient how to inject insulin D. A nurse recommends a yoga class for a busy executive E. A nurse provides hospice care for a patient with end-stage cancer F. A nurse teaches a nutrition class at a local high school
A,B,C
A caregiver asks a nurse to explain respite care. How would the nurse respond? A."Respite care is a service that allows time away for caregivers." B. "Respite care is a special service for the terminally ill and their family." C. "Respite care is direct care provided to people in a long-term care facility." D. "Respite care provides living units for people without regular shelter."
A
A client comes to day treatment intoxicated but says he is not. The nurse identifies that the client is exhibiting symptoms of a.denial. b.reaction formation. c.projection. d.transference.
A
A client with late moderate-stage dementia has been admitted to a long-term care facility. Which nursing intervention will help the client maintain optimal cognitive function? a.Discuss pictures of children and grandchildren with the client. b.Do word games or crossword puzzles with the client. c.Provide the client with a written list of daily activities. d.Watch and discuss the evening news with the client
A
A hospice nurse is caring for a patient with end-stage cancer. What action demonstrates this nurse's commitment to the principle of autonomy? A. The nurse helps the patient prepare a durable power of attorney document. B. The nurse gives the patient undivided attention when listening to concerns. C. The nurse keeps a promise to provide a counselor for the patient. D. The nurse competently administers pain medication to the patient.
A
A nurse is assessing a patient who is diagnosed with anorexia. Following the assessment, the nurse recommends that the patient meet with a nutritionist. This action best exemplifies the use of: A. Clinical judgment B. Clinical reasoning C. Critical thinking D. Blended competencies
A
A nurse is using time management techniques when planning activities for patients. Which nursing action reflects effective time management? A. The nurse asks patients to prioritize what they want to accomplish each day B. The nurse includes a "nice to do" for every "need to do" task on the list C. The nurse "front loads" the schedule with "must do" priorities D. The nurse avoids helping other nurses if scheduling does not permit it
A
A student nurse is on a clinical rotation at a busy hospital unit. The RN in charge tells the student to change a surgical dressing on a patient while she takes care of other patients. The student has not changed dressings before and does not feel confident performing the procedure. What would be the student's best response? A. Tell the RN that he or she lacks the technical competencies to change the dressing independently. B. Assemble the equipment for the procedure and follow the steps in the procedure manual. C. Ask another student nurse to work collaboratively with him or her to change the dressing. D. Report the RN to his or her instructor for delegating a task that should not be assigned to student nurses.
A
An attorney is representing a patient's family who is suing a nurse for wrongful death. The attorney calls the nurse and asks to talk about the case to obtain a better understanding of the nurse's actions. How should the nurse respond? A. "I'm sorry, but I can't talk with you; you will have to contact my attorney." B. "I will answer your questions so you'll understand how the situation occurred. C. "I hope I won't be blamed for the death because it was so busy that day." D. "First tell me why you are doing this to me. This could ruin my career!"
A
An older adult client develops delirium secondary to an infection. Which would be the most likely cause? A. Pneumonia B. Appendicitis C. Cellulitis D. Low platelet count
A
An older nurse asks a younger coworker why the new generation of nurses just aren't ethical anymore. Which reply reflects the BEST understanding of moral development? A. "Behaving ethically develops gradually from childhood; maybe my generation doesn't value this enough to develop an ethical code." B. "I don't agree that nurses were more ethical in the past. It's a new age and the ethics are new!" C. "Ethics is genetically determined...it's like having blue or brown eyes. Maybe we're evolving out of the ethical sense your generation had." D. "I agree! It's impossible to be ethical when working in a practice setting like this!"
A
Nursing in the United States is regulated by the state nurse practice act. What is a common element of each state's nurse practice act? A. Defining the legal scope of nursing practice B. Providing continuing education programs C. Determining the content covered in the NCLEX examination D. Creating institutional policies for health care practices
A
The client who believes everyone is out to get him or her is experiencing a(n) a.delusion. b.hallucination. c.idea of reference. d.loose association.
A
The diagnosis of delirium is supported when the nurse notes what about the client? A. The client reports seeing "hundreds of bugs" and is not always oriented to time and place B. The client spends much of the day sleeping in the dayroom and usually denies being hungry C. The client responds to most assessment questions with "I don't know" and appears apathetic D. The client repeatedly asks where the client is and attempts to drink the water in a flower vase
A
The nurse uses blended competencies when caring for patients in a rehabilitation facility. Which examples of interventions involve cognitive skills? Select all that apply. A. The nurse uses critical thinking skills to plan care for a patient. B. The nurse correctly administers IV saline to a patient who is dehydrated. C. The nurse assists a patient to fill out an informed consent form. D. The nurse learns the correct dosages for patient pain medications. E. The nurse comforts a mother whose baby was born with Down syndrome. F. The nurse uses the proper procedure to catheterize a female patient.
A,D
Nurses provide care to patients as collaborative members of the health care team. Which roles may be performed by the advanced practice registered nurse? Select all that apply. A. Primary care provider B. Hospitalist C. Physical therapist D. Anesthetist E. Midwife F. Pharmacist
A,D,E
A nurse researcher keeps current on the trends to watch in health care delivery. What trends are likely included? Select all that apply. A. Globalization of the economy and society B. Slowdown in technology development C. Decreasing diversity D. Increasing complexity of patient care E. Changing demographics F. Shortages of key health care professionals and educators
A,D,E,F
Assessment of suicidal risk includes which? a.Intent to die b.Judgment c.Insight d.Method e.Plan f.Reason
A,D,E,F
Examples of child maltreatment include a.calling the child stupid for climbing on a fence and getting injured. b.giving the child a time-out for misbehaving by hitting a sibling. c.failing to buy a desired toy for Christmas. d.spanking an infant who won't stop crying. e.watching pornographic movies in a child's presence. f.withholding meals as punishment for disobedience.
A,D,E,F
A nurse manager who is attempting to institute the SBAR process to communicate with health care providers and transfer patient information to other nurses is meeting staff resistance to the change. Which action would be most effective in approaching this resistance? A. Containing the anxiety in a small group and moving forward with the initiative B. Explaining the change and listing the advantages to the person and the organization C. Reprimanding those who oppose the new initiative and praising those who willingly accept the change D. Introducing the change quickly and involving the staff in the implementation of the change
B
A nurse wants to call an ethics consult to clarify treatment goals for a patient no longer able to speak for himself. The nurse believes his dying is being prolonged painfully. The patient's doctor threatens the nurse with firing if the nurse raises questions about the patient's care or calls the consult. What ethical conflict is this nurse experiencing? A. Ethical uncertainty B. Ethical distress C. Ethical dilemma D. Ethical residue
B
A nursing student asks the charge nurse about legal liability when performing clinical practice. Which statement regarding liability is true? A. Students are not responsible for their acts of negligence resulting in patient injury. B. Student nurses are held to the same standard of care that would be used to evaluate the actions of a registered nurse. C. Hospitals are exempt from liability for student negligence if the student nurse is properly supervised by an instructor. D. Most nursing programs carry group professional liability making student personal professional liability insurance unnecessary.
B
Assessment data about the client's speech patterns are categorized in which of the following areas? a.History b.General appearance and motor behavior c.Sensorium and intellectual processes d.Self-concept
B
Review of a patient's record revealed that no one obtained informed consent for the heart surgery that was performed on the patient. Which intentional tort has been committed? A. Assault B. Battery C. Invasion of privacy D. False imprisonment
B
The client tells the nurse "I never do anything right. I make a mess of everything. Ask anyone; they'll tell you the same thing." The nurse recognizes these statements as examples of a. emotional issues. b. negative thinking. c. poor problem-solving. d. relationship difficulties
B
The nurse is talking with a woman who is worried that her mother has Alzheimer disease. The nurse knows that the first sign of dementia is a.disorientation to person, place, or time. b.memory loss that is more than ordinary forgetfulness. c.inability to perform self-care tasks without assistance. d.variable with different people.
B
The nurse observes a client muttering to himself and pounding his fist in his other hand while pacing in the hallway. Which principle should guide the nurse's action? a.Only one nurse should approach an upset client to avoid threatening the client. b.Clients who can verbalize angry feelings are less likely to become physically aggressive. c.Talking to a client with delusions is not helpful, because the client has no ability to reason. d.Verbally aggressive clients often calm down on their own if staff members don't bother them.
B
When teaching a client about memantine (Namenda), the nurse will include which information? a.Lab tests to monitor the client's liver function are needed. b.Namenda can cause elevated blood pressure. c.Taking Namenda will improve the client's cognitive functioning. d.The most common side effect of Namenda is gastrointestinal bleeding.
B
When the nurse is assessing whether the client's ideas are logical and make sense, the nurse is examining which of the following areas? a.Thought content b.Thought process c.Memory d.Sensorium
B
Which behaviors would indicate stimulant intoxication? a.Slurred speech, unsteady gait, impaired concentration b.Hyperactivity, talkativeness, euphoria c.Relaxed inhibitions, increased appetite, distorted perceptions d.Depersonalization, dilated pupils, visual hallucinations
B
Which is an example of an open-ended question? a.Who is the current president of the United States? b.What concerns you most about your health? c.What is your address? d.Have you lost any weight recently?
B
Which is an example of assertive communication? a."I wish you would stop making me angry." b."I feel angry when you walk away when I'm talking." c."You never listen to me when I'm talking." d."You make me angry when you interrupt me."
B
Which of the following give cues to the nurse that a client may be grieving for a loss? a.Sad affect, anger, anxiety, and sudden changes in mood b.Thoughts, feelings, behavior, and physiologic complaints c.Hallucinations, panic level of anxiety, and sense of impending doom d.Complaints of abdominal pain, diarrhea, and loss of appetite
B
Which statement about anger is true? a.Expressing anger openly and directly usually leads to arguments. b.Anger results from being frustrated, hurt, or afraid. c.Suppressing anger is a sign of maturity. d.Angry feelings are a negative response to a situation.
B
Which type of drugs requires cautious use with potentially aggressive clients? a.Antipsychotic medications b.Benzodiazepines c.Mood stabilizers d.Lithium
B
A nurse caring for patients in the intensive care unit develops values from experience to form a personal code of ethics. Which statements best describe this process? Select all that apply. A. People are born with values. B. Values act as standards to guide behavior. C. Values are ranked on a continuum of importance. D. Values influence beliefs about health and illness. E. Value systems are not related to personal codes of conduct. F. Nurses should not let their values influence patient care.
B,C,D
A nurse answers a patient's call light and finds the patient on the floor by the bathroom door. After calling for assistance and examining the patient for injury, the nurse helps the patient back to bed and then fills out an incident report. Which statements accurately describe steps of this procedure and why it is performed? Select all that apply. A. An incident report is used as disciplinary action against staff members. B. An incident report is used as a means of identifying risks. C. An incident report is used for quality control. D. The facility manager completes the incident report. E. An incident report makes facts available in case litigation occurs. F. Filing of an incident report should be documented in the patient record.
B,C,E
A nurse uses critical thinking skills to focus on the care plan of an older adult who has dementia and needs placement in a long-term care facility. Which statements describe characteristics of this type of critical thinking applied to clinical reasoning? Select all that apply. A. It functions independently of nursing standards, ethics, and state practice acts. B. It is based on the principles of the nursing process, problem solving, and the scientific method. C. It is driven by patient, family, and community needs as well as nurses' needs to give competent, efficient care. D. It is not designed to compensate for problems created by human nature, such as medication errors. E. It is constantly re-evaluating, self-correcting, and striving for improvement. F. It focuses on the big picture rather than identifying the key problems, issues, and risks involved with patient care.
B,C,E
Which conditions would the nurse recognize as signs of alcohol withdrawal? a.Blackouts b.Diaphoresis c.Elevated blood pressure d.Lethargy e.Nausea f.Tremulousness
B,C,E,F
A nurse is providing health care to patients in a health care facility. Which of these patients are receiving secondary health care? Select all that apply. A. A patient enters a community clinic with signs of strep throat. B. A patient is admitted to the hospital following a myocardial infarction. C. A mother brings her son to the emergency department following a seizure. D. A patient with osteogenesis imperfecta is being treated in a medical center. E. A mother brings her son to a specialist to correct a congenital heart defect. F. A woman has a hernia repair in an ambulatory care center.
B,C,F
When assessing a client with delirium, the nurse will expect to see a.aphasia. b.confusion. c.impaired level of consciousness. d.long-term memory impairment. e.mood fluctuations. f.rapid onset of symptoms.
B,C,F
A nurse who is working in a hospital setting uses value clarification to help understand the values that motivate patient behavior. Which examples denote "prizing" in the process of values clarification? Select all that apply. A. A patient decides to quit smoking following a diagnosis of lung cancer. B. A patient shows off a new outfit that she is wearing after losing 20 pounds. C. A patient chooses to work fewer hours following a stress-related myocardial infarction. D. A patient incorporates a new low-cholesterol diet into his daily routine. E. A patient joins a gym and schedules classes throughout the year. F. A patient proudly displays his certificate for completing a marathon.
B,F
An RN working on a busy hospital unit delegates patient care to UAPs. Which patient care could the nurse most likely delegate to a UAP safely? Select all that apply. A. Performing the initial patient assessments B. Making patient beds C. Giving patients bed baths D. Administering patient medications E. Ambulating patients F. Assisting patients with meals
B<C<E<F
A client is pacing in the hallway with clenched fists and a flushed face. She is yelling and swearing. In which phase of the aggression cycle is she? a.Anger b.Triggering c.Escalation d.Crisis
C
A nurse cares for dying patients by providing physical, psychological, social, and spiritual care for the patients, their families, and other loved ones. What type of care is the nurse providing? A. Respite care B. Palliative care C. Hospice care D. Extended care
C
A nurse develops a detailed care plan for a 16-year-old patient who is a new single mother of a premature infant. The plan includes collaborative care measures and home health care visits. When presented with the plan, the patient states, "We will be fine on our own. I don't need any more care." What would be the nurse's best response? A. "You know your personal situation better than I do, so I will respect your wishes." B. "If you don't accept these services, your baby's health will suffer." C. "Let's take a look at the plan again and see if we can adjust it to fit your needs." D. "I'm going to assign your case to a social worker who can explain the services better."
C
An RN on a surgical unit is behind schedule administering medications. Which of the RN's other tasks can be safely delegated to a UAP? A. The assessment of a patient who has just arrived on the unit B. Teaching a patient with newly diagnosed diabetes about foot care C. Documentation of a patient's I & O on the flow chart D. Helping a patient who has recently undergone surgery out of bed for the first time
C
Client: "I had an accident." Nurse: "Tell me about your accident." This is an example of which therapeutic communication technique? a.Making observations b.Offering self c.General lead d.Reflection
C
The nurse assesses a client who has received a tentative diagnosis of delirium and explains to the family about the major cause of the client's condition. Which statement by the nurse would be most appropriate? A. "Your report of gradually developing confusion over time was the basis for the diagnosis." B. "The client's exposure to an infectious agent led us to determine the diagnosis." C. "The client's diagnosis is primarily based on the rapid onset of the change in consciousness." D. "Basically, this diagnosis is based on the client's inability to talk normally."
C
The nurse documents that a client diagnosed with dementia of the Alzheimer's type is exhibiting agnosia when the client is observed being unable to ... A. open juice and insert a straw into the container. B. identify a picture of a car. C. find words to describe the client's daughter's appearance. D.button a blouse.
C
The nurse practices using critical thinking indicators (CTIs) when caring for patients in the hospital setting. The best description of CTIs is: A. Evidence-based descriptions of behaviors that demonstrate the knowledge that promotes critical thinking in clinical practice B. Evidence-based descriptions of behaviors that demonstrate the knowledge and skills that promote critical thinking in clinical practice C. Evidence-based descriptions of behaviors that demonstrate the knowledge, characteristics, and skills that promote critical thinking in clinical practice D. Evidence-based descriptions of behaviors that demonstrate the knowledge, characteristics, standards, and skills that promote critical thinking in clinical practice
C
To assess the client's ability to concentrate, the nurse would instruct the client to do which? a.Explain what "a rolling stone gathers no moss" means. b.Name the last three presidents. c.Repeat the days of the week backward. d.Talk about what a typical day is like.
C
Which statement by the caregiver of a client newly diagnosed with dementia requires further intervention by the nurse? a."I will remind Mother of things she has forgotten." b."I will keep Mother busy with favorite activities as long as she can participate." c."I will try to find new and different things to do every day." d."I will encourage Mother to talk about her friends and family."
C
Which statement indicates the caregiver's accurate knowledge about the needs of a parent at the onset of the moderate stage of dementia? a."I need to give my parent a bath at the same time every day." b."I need to postpone any vacations for 5 years." c."I need to spend time with my parent doing things we both enjoy." d."I need to stay with my parent 24 hours a day for supervision."
C
A nurse practicing in a primary care center uses the ANA's Nursing's Social Policy Statement as a guideline for practice. Which purposes of nursing are outlined in this document? Select all that apply. A. A description of the nurse as a dependent caregiver B. The provision of standards for nursing educational programs C. A definition of the scope of nursing practice D. The establishment of a knowledge base for nursing practice E. A description of nursing's social responsibility F. The regulation of nursing research
C,D,E
A nurse instructor outlines the criteria establishing nursing as a profession. What teaching point correctly describes this criteria? Select all that apply. A. Nursing is composed of a well-defined body of general knowledge B. Nursing interventions are dependent upon medical practice C. Nursing is a recognized authority by a professional group D. Nursing is regulated by the medical industry E. Nursing has a code of ethics F. Nursing is influenced by ongoing research
C,E,F
Nursing students are reviewing information about health care delivery systems in preparation for a quiz the next day. Which statements describe current U.S. health care delivery practices? Select all that apply. A. Access to care depends only on the ability to pay, not the availability of services. B. The Patient Protection and Affordable Care Act provides private health care insurance to underserved populations. C. Every health insurance plan in the Health Insurance Marketplace offers comprehensive coverage, from doctors to medications to hospital visits. D. The uninsured pay for more than one third of their care out of pocket and are usually charged lower amounts for their care than the insured pay. E. Fifty years ago, half of the doctors in the United States practiced primary care, but today fewer than one in three do. F. Quality of care can be defined as the right care for the right person at the right time.
C,E,F
Which are specific tasks of the working phase of a therapeutic relationship? a.Begin planning for termination. b.Build trust. c.Encourage expression of feelings. d.Establish a nurse-client contract. e.Facilitate behavior change. f.Promote self-esteem.
C,E,F
A nurse performs nurse-initiated nursing actions when caring for patients in a skilled nursing facility. Which are examples of these types of interventions? Select all that apply. A. A nurse administers 500 mg of ciprofloxacin to a patient with pneumonia. B. A nurse consults with a psychiatrist for a patient who abuses pain killers. C. A nurse checks the skin of bedridden patients for skin breakdown. D. A nurse orders a kosher meal for an orthodox Jewish patient. E. A nurse records the I&O of a patient as prescribed by his health care provider. F. A nurse prepares a patient for minor surgery according to facility protocol.
C<D<F
A nurse administers the wrong medication to a patient and the patient is harmed. The health care provider who ordered the medication did not read the documentation that the patient was allergic to the drug. Which statement is true regarding liability for the administration of the wrong medication? A. The nurse is not responsible, because the nurse was following the doctor's orders. B. Only the nurse is responsible, because the nurse actually administered the medication. C. Only the health care provider is responsible, because the health care provider actually ordered the drug. D. Both the nurse and the health care provider are responsible for their respective actions.
D
A nurse incorporates the "five values that epitomize the caring professional nurse" (identified by the American Association of Colleges of Nursing) into a home health care nursing practice. Which attribute is best described as acting in accordance with an appropriate code of ethics and accepted standards of practice? A. Altruism B. Autonomy C. Human dignity D. Integrity
D
A nurse is counseling an older woman who has been hospitalized for dehydration secondary to a urinary tract infection. The patient tells the nurse: "I don't like being in the hospital. There are too many bad bugs in here. I'll probably go home sicker than I came in." She also insists that she is going to get dressed and go home. She has the capacity to make these decisions. What is the legal responsibility of the nurse in this situation? A. To inform the patient that only the primary health care provider can authorize discharge from a hospital B. To collect the patient's belongings and prepare the paperwork for the patient's discharge C. To request a psychiatric consult for the patient and inform her PCP of the results D. To explain that the choice carries a risk for increased complications and make sure that the patient has signed a release form
D
A nurse manager of a busy cardiac unit observes disagreements between the RNs and the LPNs related to schedules and nursing responsibilities. At a staff meeting, the manager compliments all the nurses on a job well done and points out that expected goals and outcomes for the month have been met. The nurse concludes the meeting without addressing the disagreements between the two groups of nurses. Which conflict resolution strategy is being employed by this manager? A. Collaborating B. Competing C. Compromising D. Smoothing
D
A pediatric nurse is assessing a 5-year-old boy who has dietary modifications related to his diabetes. His parents tell the nurse that they want him to value good nutritional habits, so they decide to deprive him of a favorite TV program when he becomes angry after they deny him foods not on his diet. This is an example of what mode of value transmission? A. Modeling B. Moralizing C. Laissez-faire D. Rewarding and punishing
D
A state attorney decides to charge a nurse with manslaughter for allegedly administering a lethal medication. This is an example of what type of law? A. Public law B. Private law C. Civil law D. Criminal law
D
A student nurse is organizing clinical responsibilities for a patient who is diabetic and is being treated for foot ulcers. The patient tells the student, "I need to have my hair washed before I can do anything else today; I'm ashamed of the way I look." The patient's needs include diagnostic testing, dressing changes, meal planning and counseling, and assistance with hygiene. How would the nurse best prioritize this patient's care? A. Explain to the patient that there is not enough time to wash her hair today because of her busy schedule. B. Schedule the testing and meal planning first and complete hygiene as time permits. C. Perform the dressing changes first, schedule the testing and counseling, and complete hygiene last. D. Arrange to wash the patient's hair first, perform hygiene, and schedule diagnostic testing and counseling.
D
An 82-year-old client with a diagnosis of vascular dementia has been admitted to the geriatric psychiatry unit of the hospital. In planning the care of this client, which outcome should the nurse prioritize? A. The client will identify life areas that require alterations due to illness. B. The client will demonstrate decreased agitation. C. The client will demonstrate increased feelings of self-worth. D. The client will remain free from injury.
D
Nurses today complete a nursing education program, and practice nursing that identifies the personal needs of the patient and the role of the nurse in meeting those needs. Which nursing pioneer is MOST instrumental in this birth of modern nursing? A. Clara Barton B. Lilian Wald C. Lavinia Dock D. Florence Nightingale
D
The nurse has been teaching a caregiver about donepezil (Aricept). The nurse knows that teaching has been effective when the caregiver makes which statement? a."Let's hope this medication will stop the Alzheimer disease from progressing any further." b."It is important to take this medication on an empty stomach." c."I'll be eager to see if this medication makes any improvement in concentration." d."This medication will slow the progress of Alzheimer disease temporarily."
D
The nurse observes that a client with bipolar disorder is pacing in the hall, talking loudly and rapidly, and using elaborate hand gestures. The nurse concludes that the client is demonstrating which? a.Aggression b.Anger c.Anxiety d.Psychomotor agitation
D
The nurse should consider the intervention referred to as "going along with" when managing the care of which client? A. the adolescent who is hitting and biting because he or she was given time out for disobeying unit rules B. the middle-aged adult who is convinced that the electrical cords are really snakes C. the young adult who is expressing concern about the "police being aliens" D. the older widower who is worried about his wife not being able to visit because of the snow
D
Which is an example of a closed-ended question? a.How have you been feeling lately? b.How is your relationship with your wife? c.Have you had any health problems recently? d.Where are you employed?
D
Which nursing diagnosis would be the priority for the client experiencing acute delirium? A. Fall precautions related to acute confusion B. Acute confusion related to delirium of known/unknown etiology C. Risk for self-mutilation related to confusion and cognitive deficits D.Risk for injury related to confusion and cognitive deficits
D
nurse working in a long-term care facility bases patient care on five caring processes: knowing, being with, doing for, enabling, and maintaining belief. This approach to patient care best describes whose theory? A.Travelbee's B.Watson's C. Benner's D. Swanson's
D
A home health nurse performs a careful safety assessment of the home of a frail older adult to prevent harm to the patient. The nurse's action reflects which principle of bioethics? A. Autonomy B. Beneficence C. Justice D. Fidelity E. Nonmaleficence
E
A nurse writes the following outcome for a patient who is trying to lose weight: "The patient can explain the relationship between weight loss, increased exercise, and decreased calorie intake." This is an example of what type of outcome? a. Cognitive b. Psychomotor c.Affective d. Physical changes
a
A nurse is using the implementation step of the nursing process to provide care for patients in a busy hospital setting. Which nursing actions best represent this step? Select all that apply. A. The nurse carefully removes the bandages from a burn victim's arm. B. The nurse assesses a patient to check nutritional status. C. The nurse formulates a nursing diagnosis for a patient with epilepsy. D. The nurse turns a patient in bed every 2 hours to prevent pressure injuries. E. The nurse checks a patient's insurance coverage at the initial interview. F. The nurse checks for community resources for a patient with dementia.
a,d,f
A new RN is being oriented to a nursing unit that is currently understaffed and is told that the UAPs have been trained to obtain the initial nursing assessment. What is the best response of the new RN? A. Allow the UAPs to do the admission assessment and report the findings to the RN. B. Do his or her own admission assessments but don't interfere with the practice if other professional RNs seem comfortable with the practice. C. Tell the charge nurse that he or she chooses not to delegate the admission assessment until further clarification is received from administration. D. Contact his or her labor representative to report this practice to the state board of nursing.
c
A nurse is collecting evaluative data for a patient who is finished receiving chemotherapy for an osteosarcoma. Which nursing action represents this step of the nursing process? a. The nurse collects data to identify health problems. b. The nurse collects data to identify patient strengths. c. The nurse collects data to justify terminating the care plan. d. The nurse collects data to measure outcome achievement.
d
Behaviors observed during the recovery phase of the aggression cycle include a.angry feelings. b.anxiety. c.apologizing to staff. d.decreased muscle tension. e.lowered voice volume. f.rational communication
d,e,f
