Mod A/B health promotions
A nurse is teaching a group of newly licensed nurses about professional values. Which of the following statements by a newly licensed nurse demonstrates an understanding of social justice?
"Health care should be a right for everyone."
A nurse and an assistive personnel (AP) disagree about how to move a client from the bed to a stretcher. Which of the following statements should the nurse make to promote conflict resolution?
"Let's discuss how we can work together."
A nurse is teaching a client about advance directives. Which of the following client statements indicates an understanding of the teaching?
"My health care surrogate will make health care decisions for me if I am unable."
A charge nurse is providing teaching to a group of nurses about the collaborative teamwork skill of situation monitoring. Which of the following statements by a nurse indicates an understanding of the teaching?
"Situation monitoring focuses on the awareness of the team's performance on client outcomes."
A newly licensed nurse is talking about their day with another nurse. Which statement by the newly licensed nurse demonstrates incivility?
"The charge nurse called me stupid in front of the team."
A nurse is using the introduction, situation, background, assessment, recommendation, and readback (I-SBAR-R) communication tool when contacting a provider about a client who has COPD. Which of the following statements by the nurse should be included in the assessment component?
"The client has a respiratory rate of 38/min."
A nurse is using the introduction, situation, background, assessment, recommendation, and readback (I-SBAR-R) communication tool when contacting a provider about a client who has Parkinson's disease. Which of the following statements by the nurse should be included in the situation component?
"The client is coughing while eating."
A nurse is teaching a client who has end-stage kidney disease and a new sacral pressure injury. The client's provider has requested a plastic surgery consultation. Which of the following statements by the client indicates an understanding of the consultation?
"The plastic surgeon might change my wound care treatment."
A nurse is teaching about change-of-shift report with a newly licensed nurse. Which of the following statements should the nurse make?
"Using I-SBAR-R during change-of-shift report decreases the risk of missing information."
A nurse is caring for a client who asks, "Why do I have to talk to so many people before I can go home? Don't these people communicate?" Which of the following statements should the nurse make?
"Your health care team works together so you can safely go home."
A nurse is caring for a client who is nearing the end of life. Which of the following responses by the nurse supports the client's dignity? (Select all)
1. "What would you like to know about your medications?" is correct. The nurse should provide the client with accurate information about their care and medications. 2. "What can I do to help you feel more independent?" is correct. The nurse should support the client's dignity by demonstrating caring behaviors.
A nurse is teaching a client about hospice care. Which of the following information should the nurse include? (select all that apply. )
1. "You must have a terminal illness," is correct. Diagnosis of a terminal illness is an admission criterion for hospice care. 2. "You accept palliative care for comfort," is correct. The Centers for Medicare and Medicaid Services (CMS) have specific criteria that must be met for a client to be eligible for hospice services, including that a hospice provider and the primary care provider must officially state the client is terminally ill and the client must agree to palliative care as opposed to curing their illness. 3. "The health care provider must officially state that you are terminally ill," is correct. The Centers for Medicare and Medicaid Services (CMS) have specific criteria that must be met for a client to be eligible for hospice services, including that a hospice provider and the primary care provider must officially state the client is terminally ill and the client must agree to palliative care as opposed to curing their illness.
A nurse is caring for a client who asks why they chose the nursing profession. The nurse states that it was because they wanted to help others. The nurse is referring to which of the following professional values?
Altruism
A nurse is caring for a client who is scheduled for surgery. Before the client has signed the informed consent form, the client states, "I didn't really understand what the doctor said." Which of the following actions should the nurse take?
Ask the provider to discuss the procedure with the client
A nurse is discussing types of communication styles with a group of staff nurses. Which of the following information should the nurse include
Assertive communicators are confident in their communications.
A hospice nurse is caring for a client who is hallucinating and talking to someone who is not there. Which of the following actions should the nurse take?
Ensure client safety and prevent injury. (The nurse should ensure the client's safety and the prevention of client injury.)
A nurse is speaking to a client who smokes tobacco and has a child living in the home. The nurse should identify that the child's exposure to second-hand smoke is an example of which of the following types of risk factors?
Environmental
A nurse is teaching a class about nutrients. The nurse should include that which of the following is a function of fats?
Facilitates the absorption of vitamins
A nurse at the end of their shift realizes they forgot to give a client their scheduled vitamins. The nurse decides to document that the vitamins were administered. Which of the following describes the nurse's action?
Falsification of records
A nurse stops at the side of the road to provide care to a person involved in a motor-vehicle crash. Which of the following protects the nurse from liability when administering care at the scene of an accident?
Good Samaritan Laws
A nurse is teaching a client about the benefits of a healthy diet and regular exercise to achieve weight loss. Which of the following topics is the nurse teaching to the client?
Health Promotion
A nurse is reviewing hospice care services with a group of newly hired nurses. Which of the following information should the nurse include?
Hospice care is an interdisciplinary team effort. (Hospice care is an interdisciplinary team effort. The interdisciplinary team is made up of providers, nurses, assistive personnel, social workers, spiritual leaders, and other health care professional services required to meet client needs.)
A nurse is providing privacy for a client who has incontience. The nurse is demonstrating which of the following professional values?
Human dignity
A nurse is teaching a client about the International Self-Care Foundation's seven pillars of self-care. Which of the following client statements indicates an understanding of the teaching?
I will perform moderate exercise several times each week.
A nurse is teaching a client about the benefits of exercise. Which of the following information should the nurse include?
Improves sleep Decreases stress Increases mood
A nurse is teaching a newly licensed nurse about what to include in a medication reconciliation form for a client who is being transferred to a new facility. Which of the following instructions should the nurse include?
Include medications the client took at home.
A nurse who has been working 12-hr shifts on a busy unit is experiencing nurse fatigue. Which of the following effects can result from nurse fatigue?
Increase in medication error
A nurse notifies their supervisor that they accidentally administered the wrong medication to a client. The nurse is demonstrating which of the following professional values?
Integrity
A nurse is discussing culturally competent care with another nurse. Which of the following information should the nurse include?
It is culturally insensitive to talk about impending death in some cultures. (In some cultures, it is culturally insensitive to talk about impending death. The nurse should understand the cultural beliefs of the individual before discussing a poor prognosis with a client and their family.)
A nurse is providing equal care to a group of clients who have varying economic statuses. Which of the following ethical principles is the nurse demonstrating?
Justice
A home health nurse is visiting a client who lives in an older home and is concerned about their child's exposure to lead paint in the house. The nurse should identify that which of the following is a potential health risk from exposure to lead paint?
Learning disabilities
Educating client who has experiencing sleep disturbances and desires to decrease caffeine intake which of the following beverages should the nurse recommend
Lemon-lime soda
A nurse is creating a list of challenges that nurses experience when using electronic charting. Which of the following should the nurse include?
Less time for direct client care
A nurse at a hospital is interviewing a newly admitted client. The client tells the nurse they would like to adhere to their cultural beliefs during their hospitalization. Which of the following actions should the nurse take to provide the client with culturally competent care? (Select all that apply.)
Listen to the client's request with respect and compassion. Reassure the client that they can practice their cultural beliefs if safe to self and others. Provide resources to meet the client's culture needs.
A nurse is caring for a client who is actively dying. The client's caregivers state they are interested in donating the client's organs. Which of the following actions should the nurse take?
Make a referral to an organ procurement organization. (Health care professionals who have completed a course provided or endorsed by an organ procurement organization are responsible for discussing organ donation.)
A nurse is completing a SOAP note in a client's chart. In which of the following sections should the client's vital signs be documented
Objective
A nurse is teaching a class about the physiology of sleep. The nurse should include that which of the following occurs as a result of sleep?
Transfer of memory from short-term to long-term
The nurse is providing oral care for a client who is immobile. Which of the following actions should the nurse take?
Turn the client on his side before starting oral care.
A nurse is teaching a class about barriers to interprofessional collaboration between health care professionals. The nurse should include that which of the following is a barrier?
Unresolved conflicts between team members
A nurse truthfully answers a client's questions about their laboratory results. The nurse is demonstrating which of the following ethical principles?
Veracity
A nurse is assisting an older adult client who is Sedetary plan and new exercise regimen which of the following activities should the nurse recommend
Walking
A nurse is providing post mortem care for a client. Which of the following actions should the nurse take? (select all)
1.Document where the body is being moved is correct. The nurse should document where the body is being moved, such as to a funeral home. 2.Include the name of anyone notified in the medical record is correct. The nurse should document the name of anyone notified of the client's death in the medical record. 3.Document the date and time of death is correct. The nurse should document the date and time of the client's death. 4.Ensure the client's belongings are accounted for is correct. The nurse should ensure the client's belongings are accounted for.
A nurse is caring for a client who is actively dying. the client's caregiver asks the nurse about the client's noisy respirations. Which of the following information should the nurse include? (Select all)
1.They can be an indication of approaching death. (Noisy respirations are caused by retention of secretions in the respiratory tract, also known as "death rattle" and Cheyne-Stokes respirations.) 2.Turning the client's head to the side can assist with drainage. (Turning the client's head to the side can assist with drainage of the secretions from the throat and lungs. ) 3.Medications can be administered to help dry up the secretions. (Medications such as oral atropine drops or scopolamine patches are used to assist with drying up the oral secretions.) 4.The client is unable to clear the secretions themselves. (The accumulation of secretions in the lungs and throat causes congestion and a "rattling" sound as the secretions become trapped. The sound of "rattling" caused the family members to become upset. The nurse should tell the family that this is not an indication that the client is experiencing any discomfort.)
A nurse is establishing Health promotion goals for a female client who smokes cigarettes, has hypertension, and has a BMI of 26 which of the following goals should the nurse include
A client will walk for 30 min 5 days a week
A nurse is teaching a newly licensed nurse about health literacy. Which of the following information should the nurse include?
A client's comprehension of education can be affected by low health literacy.
A nurse is caring for a client who is actively dying and is discussing pain management with the client's caregiver. Which of the following information should the nurse include?
A combination of approaches is suggested to manage pain symptoms. (Pharmacological treatment of pain includes the use of both nonopioids and opioids. A combination of approaches is suggested to manage pain symptoms. This includes pharmacological treatment of pain, which includes the use of non-opioids, opioids, as well as nonpharmacological interventions.)
A nurse at a health fair is assessing the weight status of four clients which of the four clients are classified as overweight.
A male client who has a body mass index of 29
A nurse is teaching class about advocacy. The nurse should include which of the following as an example of client advocacy
A nurse communicates the clients wishes to their provider
A nurse is reviewing standards of care with a group of newly hired nurses. The nurse should include which of the following incidents as an example of breach of standards of care?
A nurse did not read back a verbal medication prescription to a provider
A nurse is teaching a newly licensed nurse about ethical principles. The nurse should include that which of the following situations is an example of fidelity?
A nurse keeps a promise to a client not to tell their family about their diagnosis
A nurse is teaching a newly licensed nurse about professional values. The nurse should include that which of the following is an example of autonomy?
A nurse respects a client's which to discontinue a treatment
A nurse in an emergency department is caring for four clients. Which of the following clients requires mandatory reporting?
A young adult client who is positive for tuberculosis
A nurse is caring for a client who is at the end of life and is experiencing dyspnea. Which of the following actions should the nurse take?
Administer an opioid narcotic to the client
A nurse is providing teaching to a newly licensed nurse about the purpose of documentation in the client's health record. Which of the following information should the nurse include?
Allows health care team members to document client care
A nurse is caring for a client who has a terminal illness and reports feeling isolated from family and friends. Which of the following actions should the nurse take?
Assist in scheduling friends and family to visit. (The nurse should assist the client with scheduling visitors to promote a sense of belonging.)
A nurse is teaching a newly licensed nurse about ethical principles. The nurse should include that client who has chosen to sign a blood product refusal form is an example of which of the following ethical principles?
Autonomy
A nurse is caring for a client who is alone & has just received a serious diagnosis. The client asks the nurse if they can pray together, & the nurse agrees. The nurse is demonstrating which of the following ethical principles?
Beneficence
A nurse is teaching an in-service about zero-tolerance for bullying and incivility in the health care facility. Which of the following information should the nurse include?
Bullying can result in an increase in nursing turnover.
A nursing is preparing to give a handoff report to the oncoming nurse. In which of the following areas should the nurse provide report to the oncoming nurse?
Client's bedside
A nurse is caring for a client who is at the end of life and is unresponsive. Which of the following actions should the nurse take?
Continue to talk to the client as if they are awake
A charge nurse is providing an in-service on documentation with a group of staff nurses. Which of the following should the nurse include as a component of an electronic health record?
Demographic data
A nurse is caring for a client who has a terminal illness and states that they want to experience a "good death". Which of the following actions should the nurse take?
Determine the client's definition of a "good death" (The nurse should determine the client's definition of a "good death" because clients can have varying definitions and expectations of what constitutes a "good death." A "good death" is individualistic and is influenced by the client's perception.)
A nurse is preparing an advocacy plan of care for a client. Which of the following actions should the nurse plan to take first?
Determine the client's needs.
In nurses providing postmortem care for an adult client which of the following actions should the nurse take
Determine whether the client will have an autopsy Cover the body with a clean sheet and place the arms outside of the sheet Give the client's personal belongings to the family.
A nurse is preparing a discharge plan for a client following a bilateral below-the-knee amputation. Which of the following interventions is the priority?
Determine whether the client's home is wheelchair accessible.
A nurse is preparing to administer an influenza vaccine to a client. The client states that they understand being immunized will help protect them against the influenza virus. Which of the following concepts is the nurse demonstrating by administering the vaccine?
Disease prevention
A nurse is preparing to administer a PRN pain medication to a client but withholds the medication because the client is sleeping. Which of the following actions should the nurse take to provide the expected standard of care?
Document that the medication was not administered
A nurse is teaching a client about the sleep-wake cycle. The nurse should include that which of the following factors can interfere with the sleep-wake cycle?
Drinking caffeinated beverages in the evening Emotional stress A bright light
A nurse is caring for a client who is actively dying. Which of the following actions should the nurse take for alterations in breathing pattern?
Educate the family about the expected respiratory changes. (As the client approaches the end of life, common physiological changes include shortness of breath, retention of secretions in the respiratory tract, and an irregular respiratory rate fluctuating between several quick breaths and periods of apnea. The nurse should provide education to family members and caregivers that many of the physiological respiratory changes are predictable as the client is dying.)
A charge nurse is providing an in-service to a group of nurses about benefits of an interprofessional team. Which of the following information should the nurse include?
Efficiency in client-care services
A nurse is preparing an in-service about communication for a group of staff nurses. Which of the following information should the nurse include when discussing the electronic mode of communication?
Electronic communication includes video conference calls with clients.
A nurse is providing change-of-shift report to another nurse for a client using the Introduction, Situation, Background, Assessment and Recommendation (ISBARR) communication tool. Which of the following information should the nurse include as part of the situation component of this communication tool?
Medical condition
A nurse is caring for a client who is actively dying and notes the client's feet are purple and marbled. Which of the following findings should the nurse expect?
Mottling is visible on the client's legs. (The nurse should expect to see mottling on the client's legs. It often begins in the feet, then travels up the legs.)
A nurse is discussing factors that influence communication with a group of newly licensed nurses. Which of the following information should the nurse include?
Nurses might focus on a client's physiological needs over psychosocial needs when communicating during care.
A nurse is discussing hospice care services with the caregiver of a client who is terminally ill. Which of the following information should the nurse include?
Nursing support will be provided in meeting the client's daily needs, including the administration of medications. (The nurse will support the caregiver in meeting the client's daily needs, including the administration of medications and activities of daily living. The hospice nurse supports the family's and caregiver's needs by assisting them to anticipate changes as the client's condition deteriorates, including measures to meet the changing needs of their loved one.)
A nurse is delegating care for a group of four clients. Which of the following tasks should the nurse delegate to an assistive personnel (AP)?
Obtain a daily weight on a client who has heart failure.
A nurse is discussing the benefits of palliative care with a newly licensed nurse. Which of the following information should the nurse include?
Palliative care improves the client's quality of life. (Palliative care has been shown to improve a client's quality of life, reduce hospitalization times, and improve client satisfaction. Palliative care services can be provided long before a client has been diagnosed with a terminal illness. Any client who has a life-limiting disease, regardless of projected life expectancy or prognosis, is eligible to receive palliative care.)
A nurse is discussing palliative care with a client who has colon cancer. Which of the following information should the nurse include?
Palliative care uses a holistic approach. (Palliative care uses a holistic approach, caring for the client as a whole person and providing treatment of physical and psychosocial needs. It uses an interprofessional team approach with providers, nurses, and other associated health care personnel to meet the needs of the client.)
A nurse is grieving following the death of a client who had a terminal illness and is having difficulty sleeping and concentrating. Which of the following actions should the nurse take?
Participate in an exercise program. (Self-care activities such as exercising, eating a healthy diet, and setting boundaries are initial steps the nurse can take to help with the grieving process.)
A nurse is teaching a newly licensed nurse about receiving and transcribing verbal prescriptions. Which of the following instructions should the nurse include?
Read back the prescription to the provider after transcribing.
A nurse is receiving a telephone prescription for a client from a provider. Which of the following actions should the nurse take when transcribing the prescription?
Read back the prescription to the provider.
A nurse is caring for a client who has diabetes mellitus and does not adhere to the prescribed diet. Which of the following interventions by the nurse demonstrates collaborative health care?
Requesting a referral to a dietitian to work with the client
A nurse at a clinic is providing free blood pressure screenings for clients. Which of the following levels of health prevention is the nurse demonstrating?
Secondary prevention
A nurse is discussing the concept of spirituality with a newly licensed nurse. Which of the following information should then nurse include?
Spirituality focuses on the significance and purpose of life.
A nurse is teaching a client who has a prescription for home oxygen therapy. Which of the following instructions should the nurse include?
Store oxygen tanks upright.
A nurse is teaching a group of guardians about primary prevention techniques. Which of the following topics should the nurse include as an example of primary prevention?
Taking measures to decrease the risk of childhood injuries within the home.
A nurse suspects their coworker might be under the influence of a chemical substance. Which of the following actions should the nurse take?
Tell the charge nurse that the coworker might be impaired
A nurse is teaching a client who has a new prescription for an antihypertensive medication.
Tertiary prevention
A nurse in an emergency department overhears a provider say they will not accept any more clients who do not have health insurance. Which of the following is the provider violating?
The Emergency Medical Treatment and Labor Act (EMTALA)
A nurse is teaching a group of clients about the HIPAA Enforcement Rule. Which of the following information should the nurse include?
The Enforcement Rule covers the administration of financial penalties.
A Hospice nurse is caring for her terminal cancer and takes PO morphine for pain and relief. the client reports that he had to increase the dose of morphine this week to obtain pain relief. which of the following scenarios should the nurse document as the explanation for this situation?
The client developed a tolerance to the medication.
A nurse is assigned to care for a client. The client's provider is known to become angry and yell at the nurse. Which of the following actions by the nurse demonstrates the use of cognitive rehearsal?
The nurse mentally practices in advance what to say to the provider.
A nurse is discussing the Healthy People initiative with a newly licensed nurse. Which of the following information should nurse include?
The program focuses on providing goals and data for improved public health.
A nurse is teaching a client about modifiable risk factors to their health. Which of the following should the nurse include as an example of a modifiable risk factor?
Tobacco use
A nurse is planning care for a client who is terminally ill and speaks a different language than the nurse. Which of the following actions should the nurse take?
Use the health care facility's interpreter services. (Use the health care facility's interpreter services is correct. The nurse is legally obligated to use a qualified interpreter when providing care for a client who speaks a different language than the nurse.)
A nurse is caring for a client who reports an improved diet, exercising 30 min a day for 5 days a week, and an overall sense of improved health. The nurse should identify that the client is describing a positive state of health known as which of the following?
Wellness
A nurse is teaching about foods that are included on a clear liquid diet which of the following foods choices made by the client indicates the need for further teaching
Yogurt