Managed Care

An employee health nurse is assisting a stressed working mother with value clarification. Which of the following best defines value clarification? a) A belief about the worth of something, about what matters, that acts as a standard to guide one's behavior. b) A systematic inquiry into principles of right and wrong conduct, of virtue and vice, and of good and evil, as they relate to conduct. c) An organization of values in which each is ranked along a continuum of importance, often leading to a personal code of conduct. d) A process by which people come to understand their own values and value systems.

A process by which people come to understand their own values and value systems.

A nurse who is a practicing Jehovah's Witness is asked by a client whether or not to consent to having a blood transfusion. Which of the following would be the appropriate response by the nurse in this situation? a) "It is not part of my job to discuss blood transfusions. I will call your doctor." b) "You should not have a blood transfusion. I can share with you why I am against them." c) "I should not talk about transfusions. But I will ask another nurse to speak to you." d) "It is your opinion that is important. How do you feel about the transfusion?"

"It is your opinion that is important. How do you feel about the transfusion?"

During a taped shift report, the evening nurse reports that a client has been "annoying all evening, and has been demanding and on the call bell constantly." The nurse manager of the unit overhears this part of the report. Which of the following statements represents the best response by the nurse manager to the evening nurse? a) "Your report was too long. You need to learn to condense the important information." b) "Your report was accurate. Some of the other nurses have had similar problems." c) "Your report was informative and should help the nurses taking over the care." d) "Your report was subjective and did not address the cause of the behavior."

"Your report was subjective and did not address the cause of the behavior."

The nurse on the postpartum unit is caring for four couplets. There will be a new admission in 30 minutes. The new client is a G4 P4, Spanish-speaking-only client with an infant who is in the special care nursery (SCN) for fetal distress. The nurse should place the new client in a room with which of the following clients? a) A G1 P1 who is a non-English speaking client with infant in SCN for fetal distress. b) A G4 P4 who is 2 days postpartum with infant, Spanish speaking only. c) A G1 P1 who is 1 day postpartum with an infant in the SCN. d) A G6 P6 who gave birth 4 hours ago by C/S for fetal distress, infant at bedside.

A G4 P4 who is 2 days postpartum with infant, Spanish speaking only.

The nurse-manager has noticed a sharp increase in medication errors associated with I.V. antibiotic administration over the past 2 months. The nurse should discuss the situation with each nurse involved and then: a) Report them to the supervisor. b) Report the incidents to the hospital attorney. c) Ask them to attend inservice training for administration of I.V. medications. d) Document it on their evaluation.

Ask them to attend inservice training for administration of I.V. medications.

A child with a nut allergy is admitted with a severe reaction for the third time in three months. The parent says, "I am having trouble with the food labels." The nurse should first:

Assess the parent's ability to read.

A nurse is finishing her shift on the pediatric unit. Because her shift is ending, which intervention takes top priority?

Documenting the care provided during the shift

A public health nurse is working in a community immunization clinic. Client information gathered at the clinic is stored and transported to the health unit on a portable memory device. Which of the following must the nurse do to protect the confidentiality of the information? a) Ensure that the information on the memory device is protected. b) Make sure the nurse's computer is password protected. c) Have a backup copy on a portable computer. d) Lock the memory device at all times.

Ensure that the information on the memory device is protected.

A client's membranes have just ruptured, and the amniotic fluid is clear. Her medical history includes testing positive for human immunodeficiency virus (HIV). The client inquires about having the fetal scalp electrode placed because she's worried about her baby. Which response by a nurse is best? a) Explain to the client that fetal scalp electrode application increases the risk of maternal-fetal HIV transmission. b) Inform the client that the fetal scalp electrode helps monitor fetal heart rate and assists with shortening the first stage of labor. c) The fetal scalp electrode is a small device that looks like a corkscrew. It's applied quickly after the baby's scalp is carefully palpated. d) Inform the client that she'll have to remain on bedrest after the fetal scalp electrode is applied.

Explain to the client that fetal scalp electrode application increases the risk of maternal-fetal HIV transmission.

A client being treated for complications of chronic obstructive pulmonary disease needs to be intubated. The client has previously discussed his wish to not be intubated with his girlfriend of 5 years, whom he's designated as his health care power of attorney. The client's children want their father to be intubated. A nurse caring for this client knows that:

clients commonly confer health care power of attorney on someone who shares their personal values and beliefs.

(see full question) While providing care for a hospitalized infant, a nurse is summoned to the phone. The caller requests information about the infant's condition. The nurse should:

determine the caller's identity before responding

When a client wants to read the chart, the nurse should: a) Ask the client what he wants to know and answer those questions without giving him the chart. b) Call the health care provider to obtain permission. c) Tell the client that he can read the chart when the health care provider makes rounds. d) Give the client the chart and answer questions for him.

Give the client the chart and answer questions for him.

A nurse is caring for a client who was admitted with pneumonia, has a history of falls, and has skin lesions resulting from scratching. The priority nursing diagnosis for this client should be: a) Risk for falls. b) Ineffective airway clearance. c) Impaired tissue integrity. d) Ineffective breathing pattern.

Ineffective airway clearance

While caring for a client who has a dual diagnosis of bipolar disorder and alcohol dependency, which of the following areas is the priority for daily assessment? a) Eating habits. b) Self-care ability. c) Mental status. d) Sleep pattern.

Mental status

A nurse is caring for a client with multiple sclerosis. The client informs the nurse that a lawyer is coming to prepare a living will and requests the nurse to sign as witness. Which of the following actions should the nurse take? a) Note that the nurse caring for the client cannot be a witness. b) Inform the physician about the living will. c) State that the physician will be a witness. d) Arrange for other colleagues to sign as a witness.

Note that the nurse caring for the client cannot be a witness.

A client with terminal cancer tells the nurse that she is not afraid to die and she is thinking about how to plan her funeral. The most appropriate referral the nurse could suggest would be to the: a) Pastoral care department. b) Psychologist. c) Home health care service. d) Social worker.

Pastoral care department

The nurse is preparing to assist with the removal of a chest tube. Which of the following is appropriate at the site from which the chest tube is removed? a) No dressing is necessary. b) Petroleum gauze. c) Adhesive strip. d) 4 x 4 gauze with antibiotic ointment.

Petroleum gauze.

A primigravid client at about 36 weeks' gestation in active labor has had no prenatal care and admits to cocaine use during the pregnancy. Which of the following persons must the nurse notify? a) Primary care provider who will attend the birth of the infant. b) Chaplain in case the fetus dies in utero. c) Head of the hospital's security department. d) Nursing unit manager so appropriate agencies can be notified.

Primary care provider who will attend the birth of the infant.

A nurse-manager works for a nonprofit health care corporation whose revenues have significantly exceeded annual expenses. The nurse-manager has been told to anticipate which action? a) Receiving a portion of the revenue to improve client services on the unit b) Reducing operating expenses to help the organization pay taxes on the revenue c) Identifying revenue as profit d) Dividing revenue among stockholders as dividends

Receiving a portion of the revenue to improve client services on the unit

While giving report to the oncoming night shift, the charge nurse smells alcohol on the breath of one of the nurses. The charge nurse should: a) Ask the nurse if she has been drinking. b) Report this to the head nurse when she arrives in the morning. c) Assess the nurse's behavior for signs of intoxication. d) Report this to the nursing supervisor immediately.

Report this to the nursing supervisor immediately.

(see full question) A 42-year-old client was admitted from a homeless shelter with a diagnosis of tuberculosis and alcoholism. It is essential that which of the following health care team members attend the care conference to discuss discharge planning and community resources?

Social worker.

The nurse applies which ethical principle when telling the truth to a client about the prognosis? a) Fidelity b) Nonmaleficence c) Beneficence d) Veracity

Veracity

vA nurse-manager recognizes that infiltration commonly occurs during I.V. infusions for infants on the hospital's inpatient unit. The nurse-manager should: a) obtain data about the infiltrations to study common threads. b) develop a team with expertise in infant infusions for the hospital. c) provide nursing staff with in-service education about infusing infants. d) change the hospital policy that recommends changing IV sites every 72 hours to every 48 hours.

obtain data about the infiltrations to study common threads.

The charge nurse in the newborn nursery has an unlicensed assistive personnel (UAP) with her for the shift. Under their care are 8 babies rooming in with their Moms, and 1 infant in the nursery for the night on tube feedings. There is a new client whose infant will be brought to the nursery in 15 minutes. Which tasks would the RN assign to the UAP? Select all that apply. a) Newborn admission. b) Record voids/stools. c) Tube feeding. d) Vital signs on all stable infants. e) Document feedings of infants. f) Bath and initial feeding for new admission.

• Record voids/stools. • Vital signs on all stable infants. • Document feedings of infants.

A 1-month-old infant in the neonatal intensive care unit is dying. His parents request that a nurse give the infant an opioid analgesic. The infant's heart rate is 68 beats/minute and his respiratory rate is 18 breaths/minute. He is on room air; oxygen saturation is 92%. The nurse's response to the parents' request should be based on the fact that: a) providing an analgesic during the last days and hours is an ethically appropriate nursing action. b) administering an analgesic during the last days and hours is the parents' ethical decision. c) withholding the opioid analgesic during the last days and hours is an ethical duty; administering it would represent assisted suicide. d) withholding the opioid analgesic is clinically appropriate because administering it would hasten the infant's death.

providing an analgesic during the last days and hours is an ethically appropriate nursing action.