Fundamentals Chapters 15-20 NClex Review

The Joint Commission is conducting an accreditation visit at the hospital. What is the focus of the evaluation being conducted? a) Quality assurance b) Peer review c) Magnet status d) Quality improvement

A) Quality assurance

Why are quality assurance programs important in nursing? a) They enable nursing to be accountable for the quality of care b) They specify how resources are used or not used c) They allow increased retention of qualified nurses d) They facilitate increased enrollment in educational programs

A) They enable nursing to be accountable for the quality of care

A new graduate is working at her first job. Which of the following statements is most important for the new nurse to follow? A) Use abbreviations approved by the facility B) Only document changes in the client's status C) Document lengthy entries using complete sentences D) Use PIE Charting even if it is not the institution's charting method

A) Use abbreviations approved by the facility

The administrators of a community hospital have determined that the number of client falls increased over the last year. Nurse managers are invited from each hospital unit to evaluate falls-risk assessment tools for use on their units. What step does this represent in the performance improvement process? a) Planning a strategy using indicators b) Assessing the change c) Implementing a change d) Discovery of the problem

A--

Which expected client outcome is an example of a psychomotor outcome? Select all that apply a) Accurately drawing up insulin b) Identifying signs and symptoms of infection c) Rating pain as a 2 on a 10 point scale d) Safely ambulating using a walker e) Reporting increased confidence in testing blood sugar

A--Accurately drawing up insulin and D--Safely ambulating using a walker

When the nurse prepares to discharge a client, and subsequently evaluate the effectiveness of the nursing care, the nurse should determine whether the.... a) Client's goals have been achieved b) Documentation is thorough c) Critical pathways are completed d) Physician orders have been completed

A--client's goals have been achieved

The nurse is collecting data on a client presenting to the medical short-stay unit for a colonoscopy. A client reports to the nurse that he quit smoking six months ago, after being diagnosed with lung cancer. The nurse recognizes this change in behavior is which type of outcome? a) Cognitive outcome b) Affective outcome c) Physiologic outcome d) Psychomotor outcome

B--Affective Outcome

The nurse manager on an orthopedic unit has determined that the nurses are not keeping the nursing diagnoses up to date on client care plans and, in turn, the nurses are not using the plan of care. What is a feasible approach to correcting this problem? a) Provide an in-service on interviewing and physical assessment skills; discuss the importance of these skills with the staff b) Develop a process for periodic review of care plans that focuses on deleting and updating the nursing diagnoses c) Request that a staff development nurse instruct the nurses on concept mapping to use instead of care planning d) Delegate the updating of nursing diagnoses for all clients on the unit to one nurse for each shift

B--Develop a process for periodic review of care plans that focuses on deleting and updating the nursing diagnoses

The nursing staff on a hospital unit are using peer review to improve professional performance. Who performs the review? a) Visitors b) Nurses c) Unit manager d) Clients

B--Nurses

The client identifies three strategies for minimizing leakage of an ileostomy bag. This is an example of what type of outcome? a) Psychomotor outcome b) Physiologic outcome c) Cognitive outcome d) Affective outcome

C--Cognitive outcome

How does the nurse researcher obtain information from a client record? a) Interview nursing staff b) Audit discharge records c) Study client records d) Examine institutional procedures

C--Study client records

Which nurse is using criteria to determine expected standards of performance? a) The nurse seeks information from the unlicensed nursing personnel regarding the family's response to the nurse's education b) The nurse manager provides the staff nurse feedback regarding job performance for the previous year c) The new graduate nurse consults the policies and procedures of the institution prior to skill implementation d) The nurse preceptor provides feedback to the new graduate nurse after six weeks of orientation

C--The new graduate nurse consults the policies and procedures of the institution prior to skill implementation

A nurse is caring for a client diagnosed with an MI. A person identifying himself as the client's friend asks the nurse for the client's records, but the nurse refuses. The nurse's refusal is based on the understanding that which of the following people would be entitled to access of the client's records? a) Any family member of the client b) Health care professionals of the facility c) Those directly involved in the client's care d) Close friends of the client

C--Those directly involved in the client's care

One of the outcomes that has been identified in the care of a client with a new suprapubic catheter is that he will demonstrate the correct technique for cleaning his insertion site and changing his catheter prior to discharge. When should this outcome be evaluated? a) During his first home health care visit b) Once the primary care physician has written a discharge order c) When the client is discharged d) Throughout the client's hospital admission

D--throughout the client's hospital admission

Which of the following information about the patient would a nurse include as a part of a minimum data set when using electronic medical records? Select all that apply: a) Sex/gender b) Insurance c) Admission date d) Physical assessment e) Health history

a) Sex/gender b) Insurance c) Admission date

The nurse has administered one unit of glucose to the client as per order. What is the correct documentation of this information? a) 1 bottle of glucose b) 1 Unit of glucose c) One U of glucose d) 1 U of glucose

b) 1 Unit of glucose

Besides using the medical records, which form of communication should the nurse use to provide client details to the health care team coming on duty in the next shift? a) Client assignments b) Change of shift reports c) Telephone calls d) Team conferences

b) Change of shift reports

Which client outcome is an example of a cognitive outcome? a) The client demonstrates how to take a radial pulse b) The client's pulse ranges from 60 to 100 beats per minute c) The client's finger stick blood sugar is greater than 70 and less than 110 d) The client identifies three strategies for minimizing leakage of an ileostomy bag

d) The client identifies three strategies for minimizing leakage of an ileostomy bag

Which example may illustrate a breach of confidentiality and security of client information? a) The nurse informs a colleague that she should not be discussing client information in the hospital cafeteria b) The nurse accesses client information on the computer at the nurse's station, then logs off before answering a client's call bell c) The nurse provides information to a professional caregiver involved in the care of the client d) The nurse provides information over the phone to the client's family member who lives in a neighboring state

d) The nurse provides information over the phone to the client's family member who lives in a neighboring state

Which statement related to the evaluation of outcome attainment for a client is correct? a) Collecting data related to outcome attainment requires the nurse to know when to collect the data based upon established time criteria b) Celebrating outcome achievement with a client often interferes with attainment of future goals c) The nurse should initially evaluate the plan of care at the time of the client's discharge d) Evaluation of the client's attainment of outcome goals is determined by the nurse and physician

A--Collecting data related to outcome attainment requires the nurse to know when to collect the data based upon established time criteria

The focus of a hospital's current quality assurance program is a comparison between the health status of clients upon admission and at the time of discharge. This form of quality assurance is characteristic of what? a) Outcome evaluation b) Process evaluation c) Structure evaluation d) Nursing audit

A--Outcome evaluation

Which nursing action reflects the evaluation stage? Select all that apply a) The nurse documents the client's response to suctioning b) The nurse identifies that the client has developed a pressure ulcer c) The nurse sets an anxiety level of 3 or less with the client d) The nurse performs a tracheostomy care using sterile technique e) The nurse determines the client did not lose the expected two pounds

A--The nurse documents the client's response to suctioning and E--The nurse determines the client did not lose the expected two pounds

The health care team has convened to discuss the care of an end-of-life client who is not able to achieve an acceptable level of comfort. The physician asks for the nurse's perspective of the situation. Which standard for establishing and sustaining healthy work environments does this action represent? a) True collaboration b) Appropriate staffing c) Effective decision making d) Skilled communication

A--True collaboration

Which client outcome is a cognitive outcome? Select all that apply a) The client correctly ambulates with a walker b) The client identifies signs and symptoms of hypoglycemia c) The client lists the side effects of digoxin d) The client describes how to perform progressive muscle relaxation e) The client reports cycling 30 minutes three times each week

B--The client identifies signs and symptoms of hypoglycemia, C--The client lists the side effects of digoxin, and D--The client describes how to perform progressive muscle relaxation

The nurse observes a nursing colleague enter an isolation room without appropriate PPE. According to the study, Silence Kills: The Seven Crucial Conversations for Healthcare, of which type of crucial conversation category is this an example? a) Poor teamwork b) Mistakes c) Incompetence d) Broken Rules

D--Broken Rules

The nurse manager is holding a staff meeting and indicated that the unit is looking at a 3% budget cut for the coming year. The nurse manager asks the staff what they see as priorities for the unit and solicits suggestions from the staff as to what budget areas might be reduced. Which standard for establishing and sustaining healthy work environments does this action represent? a) Appropriate staffing b) Meaningful recognition c) True collaboration d) Effective decision making

D--Effective decision making

A health care facility plans to evaluate and revise the plan of care for a client based on the client's medical records. The physician, dietician, and the nurse involved in the client's care are required to collate all of the information for easy access. Which style do you think the agency is following in order to record the client's details? a) Focus charting b) Narrative charting c) PIE charting d) SOAP charting

D--SOAP Charting

The American Nurses Association defines components of quality care: structure evaluation, process evaluation and outcome evaluation. Which of the following best defines structure evaluation? A) Demonstrable changes in a client's health status that consider the environment for care and the nursing actions provided B) The nature and sequence of activities carried out by nurses implementing the nursing process C) Measurable changes in the health status of the client or the end results of the nursing care provided D) Standards that describe physical facilities and equipment; organizational characteristics, policies, and procedures; fiscal resources; and personnel resources

D--Standards that describe physical facilities and equipment; organizational characteristics, policies, and procedures; fiscal resources; and personnel resources

A male client has recently been diagnosed with diabetes after receiving emergency treatment for a hyperglycemic episode. Which of the client's actions indicates that he has achieved a cognitive outcome in the management of his new health problem? a) The client can demonstrate the correct technique for using his new glucometer b) The client expresses a desire to change the way that he eats and the amount of exercise he performs c) The client's blood sugars have been maintained within acceptable range in the days prior to discharge d) The client is able to explain when and why he needs to check his blood sugar?

D--The client is able to explain when and why he needs to check his blood sugar?

Which of the following best summarizes the evaluating step of the nursing process? a) The nurse and client identify nursing diagnoses and appropriate interventions b) The client and family have met health care goals and no longer need care c) The nurse completes a health assessment to establish a database d) The nurse and client measure achievement of planned outcomes of care

D--The nurse and client measure achievement of planned outcomes of care

A physician suggests that the nurse use the computer terminal that is available at the point of care of at the client's bedside. What is the probable reason for the physician's suggestion? a) It keeps the nurse close to the source of the data b) The client needs to check the entry as well c) There are limited computer modules available d) It solves the space constraint in the hospital

a) It keeps the nurse close to the source of the data

A group of nurses has established a focus group and pilot study to examine the potential application of personal data assistants (PDAs) in bedside care. This study is a tangible application of what? a) Nursing informatics b) Electronic medical records c) Telemedicine d) Computerized documentation

a) Nursing informatics

A hospital is changing the format for documentation in an attempt to decrease the amount of time the nurses are spending on charting. The new type of charting will require that the nurses document the significant findings as a narrative note, in a shorthand method using well-defined standards of practice. Which of the following best defines this type of charting? a) Problem, Intervention, Evaluation (PIE) charting b) Charting by exception c) Focus charting d) Variance charting

b) Charting by exception

A client will be transferred from the surgical unit to the rehabilitation unit for further care. Which of the following would the nurse expect to include when preparing the verbal handoff report? a) Client's intake for previous meal b) Current client assessment c) Client's family members d) Client's admission number

b) Current client assessment

When maintaining medical records fora client, the nurse knows that a medical record also serves as a legal document of evidence. What should the nurse do to ensure legal defensible charting? a) Record all facts and subjective interpretations b) Ensure that they client's name appears on all pages c) Use abbreviations whenever possible d) Leave spaces between entries and signature

b) Ensure that they client's name appears on all pages

The student nurse is reviewing physician orders written on a client's chart. Which entry is written incorrectly because is is on the "do not use" list of the Joint Commission on Accreditation of Healthcare Organizations (JCAHO)? a) Tylenol 650 mg po every 4 hours for fever greater than 102 degrees F b) Epogen 6500 U SQ daily c) Valium 5 mg po on-call to the OR d) Synthroid 0.125 po daily

b) Epogen 6500 U SQ daily

A hospital is switching to computerized charting. The nurse recognizes that one advantage to an electronic client chart is what? a) It is less costly to maintain b) Retrieval of information is more efficient c) Access is open to anyone d) No other charting method is necessary

b) Retrieval of information is more efficient

Which of the following clinical situations is addressed by the provisions of the Health Insurance Portability and Accountability Act (HIPAA)? a) A client who resides in Indiana has required hospitalization during a vacation in Hawaii b) A client has asked for a second opinion regarding treatment options for her diagnosis of ovarian cancer c) A client has asked a nurse if he can read the documentation that his physician wrote in his chart d) A client wishes to appear her insurance company's refusal to reimburse for a diagnostic test

c) A client has asked a nurse if he can read the documentation that his physician wrote in his chart

A nurse is part of a team that will be working in a new orthopedic unit to determine the most appropriate method for documentation. The team agrees to initiate the practice of an abbreviated form of documentation that requires less nursing time and readily detects changes in client status. Which documentation method would the group most likely suggest? a) FOCUS data, action, and response note b) Narrative notes c) Charting by exception d) Problem, intervention, and evaluation note

c) Charting by exception

A nurse caring for a client at a health care facility has to maintain a medical record for the client. Which of the following is a use of the medical record? a) To inform family and others concerned about the client's care b) To transmit health records between insurance companies c) To investigate the quality of care in the agency d) To release the entire health record for research

c) To investigate the quality of care in the agency

The nurse should utilize ISBARR communication (Introduction, Situation, Background, Assessment, Recommendation, Read Back) during which of the following clinical situations? a) When reporting to a client's family member or significant other b) When providing a change-of-shift report to a colleague c) When communicating a client's change in addition to the client's physician d) When documenting the care that was provided to a client whose condition recently deteriorated

c) When communicating a client's change in addition to the client's physician

A community health nurse provides information to a client with newly diagnosed multiple sclerosis about a support group at the local hospital for patients diagnosed with multiple sclerosis, and their families. Providing this information is an example of which of the following? a) Conferring b) Reporting c) A consultation d) A referral

d) A referral

A nurse on a night shift entered an older adult client's room during a scheduled check and discovered the client on the floor beside her bed, the result of falling when trying to ambulate to the washroom. After assessing the client and assisting her into bed, the nurse has completed an incident report. What is the primary purpose of this particular type of documentation? a) Protecting the nurse and the hospital from litigation b) Following up the incident with other members of the care team c) Gauging the nurse's professional performance over time d) Identifying risks and ensuring future safety for clients

d) Identifying risks and ensuring future safety for clients

When documenting the care of a client, the nurse is aware of the need to use abbreviations conscientiously and safely. This includes: a) Ensuring that abbreviations are understandable to clients who may seek access to their health records b) Using only those abbreviations that are defined in full at another location in the client's chart c) Using only abbreviations whose meaning is self-evident to an educated health professional d) Limiting abbreviations to those approved for use by the institution

d) Limiting abbreviations to those approved for use by the institution

When taking a telephone order from a physician, the nurse verifies that he or she understands the order by..... a) faxing the written order to the physician's office b) Asking the physician to summarize the orders given c) Confirming the order with the nurse manager d) Repeating the order back to the physician

d) Repeating the order back to the physician

When recording data regarding the client's health record, the nurse mentions the analysis of the subjective and objective data, in addition to detailing the plan for care of the client. Which of the following styles of documentation is the nursing implementing? a) Narrative charting b) PIE charting c) Focus charting d) SOAP Charting

d) SOAP Charting

When documenting information in a client's medical record, which of the following should the nurse do consistently for each entry? a) Obtain a signature from the physician b) Provide the day of the week on the entry c) Report each observation to the physician d) Sign each entry by name and title

d) Sign each entry by name and title