module 5

MATCHING A nurse is using AIDET to communicate with patients and families. Match the letters of the acronym to the behavior a nurse will use. a. Nurse describes procedures and tests. b. Nurse lets the patient know how long the procedure will last. c. Nurse recognizes the person with a positive attitude. d. Nurse thanks the patient. e. Nurse tells the patient "I am an RN and will be managing your care." 1. A 2. I 3. D 4. E 5. T

1. ANS: C DIF: Apply (application) REF: 325 OBJ: Demonstrate qualities, behaviors, and communication techniques of professional communication while interacting with patients. TOP: Implementation MSC: Management of Care 2. ANS: E DIF: Apply (application) REF: 325 OBJ: Demonstrate qualities, behaviors, and communication techniques of professional communication while interacting with patients. TOP: Implementation MSC: Management of Care 3. ANS: B DIF: Apply (application) REF: 325 OBJ: Demonstrate qualities, behaviors, and communication techniques of professional communication while interacting with patients. TOP: Implementation MSC: Management of Care 4. ANS: A DIF: Apply (application) REF: 325 OBJ: Demonstrate qualities, behaviors, and communication techniques of professional communication while interacting with patients. TOP: Implementation MSC: Management of Care 5. ANS: D DIF: Apply (application) REF: 325 OBJ: Demonstrate qualities, behaviors, and communication techniques of professional communication while interacting with patients. TOP: Implementation MSC: Management of Care

15. A patient with an indwelling urinary catheter has been given a bed bath by a new nursing assistive personnel. The nurse evaluating the cleanliness of the patient notices crusting at the urinary meatus. Which action should the nurse take next? a. Ask the nursing assistive personnel to observe while the nurse performs catheter care. b. Leave the room and ask the nursing assistive personnel to go back and perform proper catheter care. c. Tell the nursing assistive personnel that catheter care is sloppy. d. Remove the catheter.

ANS: A If the staff member's performance is not satisfactory, give constructive and appropriate feedback. You may discover the need to review a procedure with staff and offer demonstration. Because the nursing assistant is new, it is best for the nurse to perform catheter care while the assistant observes. This action will ensure that the assistant has been shown the proper way to perform the task and fosters collaboration rather than leaving the room just to tell the assistant to come back. Telling that catheter care is sloppy does not correct the problem. The catheter does not need to be removed.

18. A nurse is assigned to care for the following patients who all need vital signs taken right now. Which patient is most appropriate for the nurse to delegate vital sign measurement to the nursing assistive personnel (NAP)? a. Patient scheduled for a procedure in the nuclear medicine department b. Patient transferring from the intensive care unit (ICU) c. Patient returning from a cardiac catheterization d. Patient returning from hip replacement surgery

ANS: A The nurse does not assign vital sign measurement or other tasks to NAP when patients are experiencing a change in level of care. The patient awaiting the procedure in nuclear medicine is the only patient who has not experienced a change in level of care. According to the rights of delegation, tasks that are repetitive, require little supervision, are relatively noninvasive, have results that are predictable, and have minimal risk can be delegated to assistive personnel. The patient in this question with the most predictable condition is the patient awaiting the nuclear medicine procedure. Once the nurse determines that the other patients are stable, the nurse could delegate their future vital sign measurement to the NAP. However, it is important for the nurse to assess patients coming from the ICU, the cardiac cath lab, and surgery when they first arrive on the unit.

8. A nurse manager sent one of the staff nurses on the unit to a conference about new, evidence-based wound care techniques. The nurse manager asks the staff nurse to prepare a poster to present at the next unit meeting, which will be mandatory for all nursing staff on the unit. Which type of opportunity is the nurse manager providing for the staff? a. Staff education b. Interprofessional collaboration c. Providing a professional shared governance council d. Establishing a nursing practice committee

ANS: A The nurse manager is planning a staff education opportunity. Staff education is one way the nurse manager supports staff involvement in a shared decision-making model. Interprofessional collaboration between nurses and health care providers (e.g., MD, PT, TR, etc.) is critical to the delivery of quality, safe patient care and the creation of a positive work culture for practitioners. The question does not state that the nurse is establishing a practice committee or a professional shared governance council. Chaired by senior clinical staff nurses, these groups establish and maintain care standards for nursing practice on their work unit.

9. A nurse is making a home visit and discovers that a patient's wound infection has gotten worse. The nurse cleans and redresses the wound. What should the nurse do next? a. Notify the health care provider of the findings before leaving the home. b. Ask the home health facility nurse manager to contact the health care provider. c. Document the findings and confirm with the patient the date of the next home visit. d. Tell the patient that the health care provider will be notified before the next home visit.

ANS: A The nurse should notify the health care provider before leaving the home. Regardless of the setting, an enriching professional environment is one in which staff members respect one another's ideas, share information, and keep one another informed. The manager should avoid taking care of problems for staff. The staff nurse needs to learn how to professionally communicate with other members of the health care team and demonstrate interprofessional collaboration.

A nurse writes the following PICOT question: How do patients with breast cancer rate their quality of life? How should the nurse evaluate this question? a. A true PICOT question regardless of the number of elements b. A true PICOT question because the intervention comes before the control c. Not a true PICOT question because the comparison comes after the intervention d. Not a true PICOT question because the time is not designated

ANS: A A meaningful PICOT question can contain only a P and O: How do patients with breast cancer (P) rate their quality of life (O)? Note that a well-designed PICOT question does not have to follow the sequence of P, I, C, O, and T. The aim is to ask a question that contains as many of the PICOT elements as possible.

11. A patient with sepsis as a result of long-term leukemia dies 25 hours after admission to the hospital. A full code was conducted without success. The patient had a urinary catheter, an intravenous line, an oxygen cannula, and a nasogastric tube. Which question is the priority for the nurse to ask the family before beginning postmortem care? a. "Is an autopsy going to be done?" b. "Which funeral home do you want to use?" c. "Would you like to assist in bathing your loved one?" d. "Do you want me to remove the lines and tubes before you see your loved one?"

ANS: A An autopsy or postmortem examination may be requested by the patient or the patient's family, as part of an institutional policy, or if required by law. Because the patient's death occurred as a result of long-term illness and not under suspicious circumstances, whether to conduct a postmortem examination would be decided by the family, and consent would have to be obtained from the family. The nurse needs to know if the lines can be removed or not depending upon the family's response to the question. Asking about bathing the deceased patient is a valid question but is not a priority, because the nurse needs to know the protocol to follow if an autopsy is to be done. Finding out which funeral home the deceased patient is to be transported to is valid but is not a priority, because other actions must be taken before the deceased patient is transported from the hospital. Asking about removing the lines may not be an option depending on the response of the family to an autopsy.

5. A nurse performs cardiopulmonary resuscitation (CPR) on a 92-year-old with brittle bones and breaks a rib during the procedure, which then punctures a lung. The patient recovers completely without any residual problems and sues the nurse for pain and suffering and for malpractice. Which key point will the prosecution attempt to prove against the nurse? a. The CPR procedure was done incorrectly. b. The patient would have died if nothing was done. c. The patient was resuscitated according to the policy. d. The older patient with brittle bones might sustain fractures when chest compressions are done.

ANS: A Certain criteria are necessary to establish nursing malpractice. The prosecution would try to prove that a breach of duty had occurred (CPR done incorrectly), which had caused injury. The defense team, not the prosecution, would explain the correlation between brittle bones and rib fractures during CPR and that the patient was resuscitated according to policy. In this situation, although harm was caused, it was not because of failure of the nurse to perform a duty according to standards, the way other nurses would have performed in the same situation. The fact that the patient sustained injury as a result of age and physical status does not mean the nurse breached any duty to the patient. The nurse would need to make sure the defense attorney knew that the cardiopulmonary resuscitation (CPR) was done correctly. Without intervention, the patient most likely would not have survived.

A nurse uses evidence-based practice (EBP) to provide nursing care. What is the best rationale for the nurse's behavior? a. EBP is a guide for nurses in making clinical decisions. b. EBP is based on the latest textbook information. c. EBP is easily attained at the bedside. d. EBP is always right for all situations.

ANS: A Evidence-based practice (EBP) is a guide for nurses to structure how to make appropriate, timely, and effective clinical decisions. A textbook relies on the scientific literature, which may be outdated by the time the book is published. Unfortunately, much of the best evidence never reaches the bedside. EBP is not to be blindly applied without using good judgment and critical thinking skills.

12. A nurse needs to begin discharge planning for a patient admitted with pneumonia and a congested cough. When is the best time the nurse should start discharge planning for this patient? a. Upon admission b. Right before discharge c. After the congestion is treated d. When the primary care provider writes the order

ANS: A Ideally, discharge planning begins at admission. Right before discharge is too late for discharge planning. After the congestion is treated is also too late for discharge planning. Usually the primary care provider writes the order too close to discharge, and nurses do not need an order to begin the teaching that will be needed for discharge. By identifying discharge needs early, nursing and other health care professionals begin planning for discharge to the appropriate level of care, which sometimes includes support services such as home care and equipment needs.

17. A nurse is using SOLER to facilitate active listening. Which technique should the nurse use for R? a. Relax b. Respect c. Reminisce d. Reassure

ANS: A In SOLER, the R stands for relax. It is important to communicate a sense of being relaxed and comfortable with the patient. Active listening enhances trust because the nurse communicates acceptance and respect for the patient, but it is not the R in SOLER. Reminisce is a therapeutic communication technique, especially when used with the elderly. Reassuring can be therapeutic if the nurse reassures patients that there are many kinds of hope and that meaning and personal growth can come from illness experiences. However, false reassurance can block communication. DIF: Understand (comprehension) REF: 327-328 OBJ: Demonstrate qualities, behaviors, and communication techniques of professional communication while interacting with patients. TOP: Implementation MSC: Psychosocial Integrity

3. A 17-year-old patient, dying of heart failure, wants to have organs removed for transplantation after death. Which action by the nurse is correct? a. Instruct the patient to talk with parents about the desire to donate organs. b. Notify the health care provider about the patient's desire to donate organs. c. Prepare the organ donation form for the patient to sign while still oriented. d. Contact the United Network for Organ Sharing after talking with the patient.

ANS: A In this situation, the parents would need to sign the form because the teenager is under age 18. An individual who is at least 18 may sign the form allowing organ donation upon death. The nurse cannot allow the patient to sign the organ donation document because the patient is younger than age 18. The health care provider will be notified about the patient's wishes after the parents agree to donate the organs. The United Network for Organ Sharing (UNOS) has a contract with the federal government and sets policies and guidelines for the procurement of organs.

A nurse has collected several research findings for evidence-based practice. Which article will be the best for the nurse to use? a. An article that uses randomized controlled trials (RCT) b. An article that is an opinion of expert committees c. An article that uses qualitative research d. An article that is peer-reviewed

ANS: A Individual RCTs are the highest level of evidence or "gold standard" for research. A peer-reviewed article means that a panel of experts has reviewed the article; this is not a research method. Qualitative research is valuable in identifying information about how patients cope with or manage various health problems and their perceptions of illness. It does not usually have the robustness of an RCT. Expert opinion is on the bottom of the hierarchical pyramid of evidence.

16. A nurse is taking a history on a patient who cannot speak English. Which action will the nurse take? a. Obtain an interpreter. b. Refer to a speech therapist. c. Let a close family member talk. d. Find a mental health nurse specialist.

ANS: A Interpreters are often necessary for patients who speak a foreign language. Using a family member can lead to legal issues, speech therapists help patients with aphasia, and mental health nurse specialists help angry or highly anxious patients to communicate more effectively. DIF: Understand (comprehension) REF: 320 | 326 | 332 OBJ: Implement nursing care measures for patients with special communication needs. TOP: Implementation MSC: Management of Care

A nurse is trying to decrease the rate of falls on the unit. After reviewing the literature, a strategy is implemented on the unit. After 3 months, the nurse finds that the falls have decreased. Which process did the nurse institute? a. Performance improvement b. Peer-reviewed project c. Generalizability study d. Qualitative research

ANS: A Performance improvement focuses on performance issues like falls or pressure ulcer incidence. A peer-reviewed article is reviewed for accuracy, validity, and rigor and approved for publication by experts before it is published. Generalizability is not a study/research; it is if the results of a study can be compared to other patients with similar experiences. This is a quantitative study, not a qualitative study.

3. A nurse wants to present information about flu immunizations to the older adults in the community. Which type of communication should the nurse use? a. Public b. Small group c. Interpersonal d. Intrapersonal

ANS: A Public communication is interaction with an audience. Nurses have opportunities to speak with groups of consumers about health-related topics, present scholarly work to colleagues at conferences, or lead classroom discussions with peers or students. When nurses work on committees or participate in patient care conferences, they use a small group communication process. Interpersonal communication is one-on-one interaction between a nurse and another person that often occurs face to face. Intrapersonal communication is a powerful form of communication that you use as a professional nurse. This level of communication is also called self-talk. DIF: Apply (application) REF: 318 OBJ: Utilize the five levels of communication with patients. TOP: Communication and Documentation MSC: Health Promotion and Maintenance

7. A nurse is charting on a patient's record. Which action will the nurse take that is accurate legally? a. Charts legibly b. States the patient is belligerent c. Writes entry for another nurse d. Uses correction fluid to correct error

ANS: A Record all entries legibly. Do not write personal opinions (belligerent). Enter only objective and factual observations of patient's behavior; quote all patient comments. Do not erase, apply correction fluid, or scratch out errors made while recording. Chart only for yourself.

3. A nurse is auditing and monitoring patients' health records. Which action is the nurse taking? a. Determining the degree to which standards of care are met by reviewing patients' health records b. Realizing that care not documented in patients' health records still qualifies as care provided c. Basing reimbursement upon the diagnosis-related groups documented in patients' records d. Comparing data in patients' records to determine whether a new treatment had better outcomes than the standard treatment

ANS: A The auditing and monitoring of patients' health records involve nurses periodically auditing records to determine the degree to which standards of care are met and identifying areas needing improvement and staff development. The mistakes in documentation that commonly result in malpractice include failing to record nursing actions; this is the aspect of legal documentation. The financial billing or reimbursement purpose involves diagnosis-related groups (DRGs) as the basis for establishing reimbursement for patient care. For research purposes, the researcher compares the patient's recorded findings to determine whether the new method was more effective than the standard protocol. Data analysis contributes to evidence-based nursing practice and quality health care.

A nurse is reviewing literature for an evidence-based practice study. Which study should the nurse use for the most reliable level of evidence that uses statistics to show effectiveness? a. Meta-analysis b. Systematic review c. Single random controlled trial d. Control trial without randomization

ANS: A The main difference is that in a meta-analysis the researcher uses statistics to show the effect of an intervention on an outcome. In a systematic review no statistics are used to draw conclusions about the evidence. A single random controlled trial (RCT) is not as conclusive as a review of several RCTs on the same question. Control trials without randomization may involve bias in how the study is conducted.

9. A home health nurse notices that a patient's preschool children are often playing on the sidewalk and in the street unsupervised and repeatedly takes them back to the home and talks with the patient, but the situation continues. Which immediate action by the nurse is mandated by law? a. Contact the appropriate community child protection facility. b. Tell the parents that the authorities will be contacted shortly. c. Take pictures of the children to support the overt child abuse. d. Discuss with both parents about the safety needs of their children.

ANS: A The nurse has a duty to report this situation to protect the children. Any health care professional who does not report suspected child abuse or neglect may be liable for civil or criminal legal action. Talking with both parents is not mandated by law. There is no obligation to tell the parents that they will be reported to authorities. There is no obligation for the nurse to take pictures of the children.

1. A nurse uses the five rights of delegation when providing care. Which "rights" did the nurse use? (Select all that apply.) a. Right task b. Right person c. Right direction d. Right supervision e. Right circumstances f. Right cost-effectiveness

ANS: A, B, C, D, E The five rights of delegation are right task, circumstances, person, direction, and supervision. Cost-effectiveness is not a right.

20. Which situation will cause the nurse to intervene and follow up on the nursing assistive personnel's (NAP) behavior? a. The nursing assistive personnel is calling the older-adult patient "honey." b. The nursing assistive personnel is facing the older-adult patient when talking. c. The nursing assistive personnel cleans the older-adult patient's glasses gently. d. The nursing assistive personnel allows time for the older-adult patient to respond.

ANS: A The nurse needs to intervene to correct the use of "honey." Avoid terms of endearment such as "honey," "dear," "grandma," or "sweetheart." Communicate with older adults on an adult level, and avoid patronizing or speaking in a condescending manner. Facing an older-adult patient, making sure the older adult has clean glasses, and allowing time to respond facilitate communication with older-adult patients and should be encouraged, not stopped. DIF: Apply (application) REF: 324 OBJ: Engage in effective communication techniques for older patients. TOP: Implementation MSC: Management of Care

A nurse is using the research process. Place in order the sequence that the nurse will follow. 1. Analyze results. 2. Conduct the study. 3. Identify clinical problem. 4. Develop research question. 5. Determine how study will be conducted. a. 3, 4, 5, 2, 1 b. 4, 3, 5, 2, 1 c. 3, 5, 4, 2, 1 d. 4, 5, 3, 2, 1

ANS: A The steps of the research process are as follows: (1) Identify area of interest or clinical problem, (2) develop research question(s)/hypotheses, (3) determine how study will be conducted, (4) conduct the study, and (5) analyze results of the study.

10. Before meeting the patient, a nurse talks to other caregivers about the patient. Which phase of the helping relationship is the nurse in with this patient? a. Preinteraction b. Orientation c. Working d. Termination

ANS: A The time before the nurse meets the patient is called the preinteraction phase. This phase can involve things such as reviewing available data, including the medical and nursing history, talking to other caregivers who have information about the patient, or anticipating health concerns or issues that can arise. The orientation phase occurs when the nurse and the patient meet and get to know one another. This phase can involve things such as setting the tone for the relationship by adopting a warm, empathetic, caring manner. The working phase occurs when the nurse and the patient work together to solve problems and accomplish goals. The termination phase occurs during the ending of the relationship. This phase can involve things such as reminding the patient that termination is near. DIF: Understand (comprehension) REF: 322 OBJ: Identify a nurse's communication approaches within the four phases of a nurse-patient helping relationship. TOP: Assessment MSC: Management of Care

24. A patient is aphasic, and the nurse notices that the patient's hands shake intermittently. Which nursing action is most appropriate to facilitate communication? a. Use a picture board. b. Use pen and paper. c. Use an interpreter. d. Use a hearing aid.

ANS: A Using a pen and paper can be frustrating for a nonverbal (aphasic) patient whose handwriting is shaky; the nurse can revise the care plan to include use of a picture board instead. An interpreter is used for a patient who speaks a foreign language. A hearing aid is used for the hard of hearing, not for an aphasic patient. DIF: Apply (application) REF: 331-332 OBJ: Offer alternative communication devices when appropriate to promote communication with patients who have impaired communication. TOP: Implementation MSC: Psychosocial Integrity

The nurse uses a PICOT question to develop an evidence-based change in protocol for a certain nursing procedure. However, to make these changes throughout the entire institution would require more evidence than is available at this time. What is the nurse's best option? a. Conduct a pilot study to investigate findings. b. Drop the idea of making the change at this time. c. Insist that management hire the needed staff to facilitate the change. d. Seek employment in another institution that may have the staff needed.

ANS: A When evidence is not strong enough to apply in practice, the next option is to conduct a pilot study to investigate the PICOT question. Dropping the idea would be counterproductive; insisting that management hire staff could be seen as a mandate and could produce negative results. Seeking employment at another institution most likely would not be the answer because most institutions operate under similar established guidelines.

A nurse is implementing an evidence-based practice project regarding infection rates. After reviewing research literature, which other evidence should the nurse review? a. Quality improvement data b. Inductive reasoning data c. Informed consent data d. Biased data

ANS: A When implementing an evidence-based practice project, it is important to first review evidence from appropriate research and quality improvement data. Inductive reasoning is used to develop generalizations or theories from specific observations; this study needs specifics. Informed consent is not data but a process and form that subjects must sign before participating in research projects/studies. Biased data is based on opinions; facts are needed for this study.

2. A nurse exchanges information with the oncoming nurse about a patient's care. Which action did the nurse complete? a. A verbal report b. An electronic record entry c. A referral d. An acuity rating

ANS: A Whether the transfer of patient information occurs through verbal reports, electronic or written documents, you need to follow some basic principles. Reports are exchanges of information among caregivers. A patient's electronic medical record or chart is a confidential, permanent legal documentation of information relevant to a patient's health care. Nurses document referrals (arrangements for the services of another care provider). Nurses use acuity ratings to determine the hours of care and number of staff required for a given group of patients every shift or every 24 hours.

Before conducting any study with human subjects, the nurse researcher must obtain informed consent. What must the nurse researcher ensure to obtain informed consent? (Select all that apply.) a. Gives complete information about the purpose b. Allows free choice to participate or withdraw c. Understands how confidentiality is maintained d. Identifies risks and benefits of participation e. Ensures that subjects complete the study

ANS: A, B, C, D Informed consent means that research subjects (1) are given full and complete information about the purpose of a study, procedures, data collection, potential harm and benefits, and alternative methods of treatment; (2) are capable of fully understanding the research and the implications of participation; (3) have the power of free choice to voluntarily consent or decline participation in the research; and (4) understand how the researcher maintains confidentiality or anonymity. Completion of the study is not needed for informed consent.

2. A nurse is implementing nursing care measures for patients with challenging communication issues. Which types of patients will need these nursing care measures? (Select all that apply.) a. A child who is developmentally delayed b. An older-adult patient who is demanding c. A female patient who is outgoing and flirty d. A male patient who is cooperative with treatments e. An older-adult patient who can clearly see small print f. A teenager frightened by the prospect of impending surgery

ANS: A, B, C, F Challenging communication situations include patients who are flirtatious, demanding, frightened, or developmentally delayed. A child who has received little environmental stimulation possibly is behind in language development, thus making communication more challenging. Patients who are cooperative and have good eyesight (see small print) do not cause challenging communication situations. DIF: Understand (comprehension) REF: 318 OBJ: Implement nursing care measures for patients with special communication needs. TOP: Caring MSC: Management of Care

The nurse is preparing to conduct research that will allow precise measurement of a phenomenon. Which methods will provide the nurse with the right kind of data? (Select all that apply.) a. Surveys b. Phenomenology c. Grounded theory d. Evaluation research e. Nonexperimental research

ANS: A, D, E Experimental research, nonexperimental research, surveys, and evaluation research are all forms of quantitative research that allow for precise measurement. Phenomenology and grounded theory are forms of qualitative research.

6. A staff member verbalizes satisfaction in working on a particular nursing unit because of the freedom of choice and responsibility for the choices. This nurse highly values which element of shared decision making? a. Authority b. Autonomy c. Responsibility d. Accountability

ANS: B Autonomy is freedom of choice and responsibility for the choices. Authority refers to legitimate power to give commands and make final decisions specific to a given position. Responsibility refers to the duties and activities that an individual is employed to perform. Accountability refers to individuals being answerable for their actions.

17. A nursing assistive personnel (NAP) reports seeing a reddened area on the patient's hip while bathing the patient. Which action should the nurse take? a. Request a wound nurse consult. b. Go to the patient's room to assess the patient's skin. c. Document the finding per the NAP's report. d. Ask the NAP to apply a dressing over the reddened area.

ANS: B The nurse needs to assess the patient's skin. Assessment should not be delegated; it is the responsibility of the licensed registered nurse. The nurse needs to document the assessment findings objectively, not subjectively, per the nursing assistive personnel. Before requesting a consult or determining treatment, the nurse needs to assess the skin.

3. A nurse is working in an intensive care unit (critical care). Which type of nursing care delivery model will this nurse most likely use? a. Team nursing b. Total patient care c. Primary nursing d. Case-management

ANS: B Total patient care is found primarily in critical care areas. Total patient care involves an RN being responsible for all aspects of care for one or more patients. In the team nursing care model, the RN assumes the role of group or team leader and leads a team made up of other RNs, practical nurses, and nursing assistive personnel. The primary nursing model of care delivery was developed to place RNs at the bedside and improve the accountability of nursing for patient outcomes and the professional relationships among staff members. Case-management is a care approach that coordinates and links health care services to patients and families while streamlining costs.

15. A patient just received a diagnosis of cancer. Which statement by the nurse demonstrates empathy? a. "Tomorrow will be better." b. "This must be hard news to hear." c. "What's your biggest fear about this diagnosis?" d. "I believe you can overcome this because I've seen how strong you are."

ANS: B "This must be hard" is an example of empathy. Empathy is the ability to understand and accept another person's reality, accurately perceive feelings, and communicate this understanding to the other. An example of false reassurance is "Tomorrow will be better." "I believe you can overcome this" is an example of sharing hope. "What is your biggest fear?" is an open-ended question that allows patients to take the conversational lead and introduces pertinent information about a topic. DIF: Analyze (analysis) REF: 328 OBJ: Identify opportunities to improve communication with patients while giving care. TOP: Communication and Documentation MSC: Psychosocial Integrity

9. A nurse has taught the patient how to use crutches. The patient went up and down the stairs using crutches with no difficulties. Which information will the nurse use for the "I" in PIE charting? a. Patient went up and down stairs b. Demonstrated use of crutches c. Used crutches with no difficulties d. Deficient knowledge related to never using crutches

ANS: B A second progress note method is the PIE format. The narrative note includes P—Nursing diagnosis, I—Intervention, and E—Evaluation. The intervention is "Demonstrated use of crutches." "Patient went up and down stairs" and "Used crutches with no difficulties" are examples of E. "Deficient knowledge regarding crutches" is P.

21. A confused older-adult patient is wearing thick glasses and a hearing aid. Which intervention is the priority to facilitate communication? a. Focus on tasks to be completed. b. Allow time for the patient to respond. c. Limit conversations with the patient. d. Use gestures and other nonverbal cues.

ANS: B Allowing time for patients to respond will facilitate communication, especially for a confused, older patient. Focusing on tasks to be completed and limiting conversations do not facilitate communication; in fact, they block communication. Using gestures and other nonverbal cues is not effective for visually impaired (thick glasses) patients or for patients who are confused. DIF: Apply (application) REF: 326 | 332 OBJ: Engage in effective communication techniques for older patients. TOP: Implementation MSC: Psychosocial Integrity

The nurse is reviewing nursing research literature related to a potential practice problem on the nursing unit. What is the rationale for the nurse's action? (Select all that apply.) a. Nursing research ensures the nurse's promotion. b. Nursing research identifies new knowledge. c. Nursing research improves professional practice. d. Nursing research enhances effective use of resources. e. Nursing research leads to decreases in budget expenditures.

ANS: B, C, D Nursing research is a way to identify new knowledge, improve professional education and practice, and use resources effectively. Nursing research itself does not lead to a decrease in budget expenditures; however it does lead to using health care resources effectively. A promotion is not a direct result of nursing research.

13. A nursing student has been written up several times for being late with providing patient care and for omitting aspects of patient care and not knowing basic procedures that were taught in the skills course one term earlier. The nursing student says, "I don't understand what the big deal is. As my instructor, you are there to protect me and make sure I don't make mistakes." What is the best response from the nursing instructor? a. "You are practicing under the license of the hospital's insurance." b. "You are expected to perform at the level of a professional nurse." c. "You are expected to perform at the level of a prudent nursing student." d. "You are practicing under the license of the nurse assigned to the patient."

ANS: B Although nursing students are not employees of the health care facility where they are having their clinical experience, they are expected to perform as professional nurses would in providing safe patient care. Different levels of standards do not apply. No standard is used for nursing students other than that they must meet the standards of a professional nurse. Student nurses do not practice under anybody's license; nursing students are liable if their actions exceed their scope of practice or cause harm to patients.

6. A recent immigrant who does not speak English is alert and requires hospitalization. What is the initial action that the nurse must take to enable informed consent to be obtained? a. Ask a family member to translate what the nurse is saying. b. Request an official interpreter to explain the terms of consent. c. Notify the nursing manager that the patient doesn't speak English. d. Use hand gestures and medical equipment while explaining in English.

ANS: B An official interpreter must be present to explain the terms of consent if a patient speaks only a foreign language. A family member or acquaintance who speaks a patient's language should not interpret health information. Family members can tell those caring for the patient what the patient is saying, but privacy regarding the patient's condition, assessment, etc., must be protected. A nurse can take care of requesting an interpreter, and the nurse manager is not needed. Using hand gestures and medical equipment is inappropriate when communicating with a patient who does not understand the language spoken. Certain hand gestures may be acceptable in one culture and not appropriate in another. The medical equipment may be unknown and frightening to the patient, and the patient still doesn't understand what is being said.

8. While recovering from a severe illness, a hospitalized patient wants to change a living will, which was signed 9 months ago. Which response by the nurse is most appropriate? a. "Check with your admitting health care provider whether a copy is on your chart." b. "Let me check with someone here in the hospital who can assist you." c. "You are not allowed to ever change a living will after signing it." d. "Your living will can be changed only once each calendar year."

ANS: B As long as the patient is not declared legally incompetent or lacks the capacity to make decisions, living wills can be changed. It is the nurse's responsibility to find an appropriate person in the facility to assist the patient. Checking with the health care provider about the presence of a living will on the chart has nothing to do with the patient's desire to change the living will. The question states that the patient wants to change a living will. A living will can be changed whenever the patient decides to change it, as long as the patient is competent.

26. A patient says, "You are the worst nurse I have ever had." Which response by the nurse is most assertive? a. "I think you've had a hard day." b. "I feel uncomfortable hearing that statement." c. "I don't think you should say things like that. It is not right." d. "I have been checking on you regularly. How can you say that?"

ANS: B Assertive responses contain "I" messages such as "I want," "I need," "I think," or "I feel." While all of these start with "I," the only one that is the most assertive is "I feel uncomfortable hearing that statement." An assertive nurse communicates self-assurance; communicates feelings; takes responsibility for choices; and is respectful of others' feelings, ideas, and choices. "I think you've had a hard day" is not addressing the problem. Arguing ("How can you say that?") is not assertive or therapeutic. Showing disapproval (using words like right) is not assertive or therapeutic. DIF: Analyze (analysis) REF: 325 OBJ: Demonstrate qualities, behaviors, and communication techniques of professional communication while interacting with patients. TOP: Communication and Documentation MSC: Psychosocial Integrity

6. A preceptor is working with a new nurse on documentation. Which situation will cause the preceptor to follow up? a. The new nurse documents only for self. b. The new nurse charts consecutively on every other line. c. The new nurse ends each entry with signature and title. d. The new nurse keeps the password secure.

ANS: B Chart consecutively, line by line (not every other line); every other line is incorrect and must be corrected by the preceptor. If space is left, draw a line horizontally through it, and place your signature and credentials at the end. Every other line should not be left blank. All the other behaviors are correct and need no follow-up. Documenting only for yourself is an appropriate behavior. End each entry with signature and title/credentials. For computer documentation, keep your password to yourself.

In conducting a research study, the nurse researcher guarantees the subject no information will be reported in any manner that will identify the subject and only the research team will have access to the information. Which concept is the nurse researcher fulfilling? a. Bias b. Confidentiality c. Informed consent d. The research process

ANS: B Confidentiality guarantees that any information the subject provides will not be reported in any manner that identifies the subject and will not be accessible to people outside the research team. Biases are opinions that may influence the results of research. Informed consent means that research subjects (1) are given full and complete information about the purpose of the study, procedures, data collection, potential harm and benefits, and alternative methods of treatment; (2) are capable of fully understanding the research; (3) have the power to voluntarily consent or decline participation; and (4) understand how confidentiality or anonymity is maintained. The research process is a broader concept that provides an orderly series of steps that allow the researcher to move from asking a question to finding the answer.

13. A patient is being discharged home. Which information should the nurse include? a. Acuity level b. Community resources c. Standardized care plan d. Signature for verbal order

ANS: B Discharge documentation includes medications, diet, community resources, follow-up care, and who to contact in case of an emergency or for questions. A patient's acuity level, usually determined by a computer program, is based on the types and numbers of nursing interventions (e.g., intravenous [IV] therapy, wound care, or ambulation assistance) required over a 24-hour period. Many computerized documentation systems include standardized care plans or clinical practice guidelines (CPGs) to facilitate the creation and documentation of a nursing and or interprofessional plan of care. Each CPG facilitates safe and consistent care for an identified problem by describing or listing institutional standards and evidence-based guidelines that are easily accessed and included in a patient's electronic health record. Verbal orders occur when a health care provider gives therapeutic orders to a registered nurse while they are standing in proximity to one another.

The nurse researcher is preparing to publish the findings and is preparing to add the limitations to the manuscript. Which area of the manuscript will the nurse researcher add this information? a. Abstract b. Conclusion c. Study design d. Clinical implications

ANS: B During results or conclusions, the researcher interprets the findings of the study, including limitations. An abstract summarizes the purpose of the article with major findings. Study design involves selection of research methods and type of study conducted. The researcher explains how to apply findings in a practice setting for the type of subjects studied in the clinical implications section.

22. The staff is having a hard time getting an older-adult patient to communicate. Which technique should the nurse suggest the staff use? a. Try changing topics often. b. Allow the patient to reminisce. c. Ask the patient for explanations. d. Involve only the patient in conversations.

ANS: B Encouraging older adults to share life stories and reminisce about the past has a therapeutic effect and increases their sense of well-being. Avoid sudden shifts from subject to subject. It is helpful to include the patient's family and friends and to become familiar with the patient's favorite topics for conversation. Asking for explanations is a nontherapeutic technique. DIF: Apply (application) REF: 331 OBJ: Engage in effective communication techniques for older patients. TOP: Planning MSC: Management of Care

12. Conjoined twins are in the neonatal department of the community hospital until transfer to the closest medical center. A photographer from the local newspaper gets off the elevator on the neonatal floor and wants to take pictures of the infants. Which initial action should the nurse take? a. Escort the cameraman to the neonatal unit while a few pictures are taken quietly. b. Tell the cameraman where the hospital's public relations department is located. c. Have the cameraman wait for permission from the health care provider. d. Ask the cameraman how the pictures are to be used in the newspaper.

ANS: B In some cases, information about a scientific discovery or a major medical breakthrough or an unusual situation is newsworthy. In this case, anyone seeking information needs to contact the hospital's public relations department to ensure that invasion of privacy does not occur. It is not the nurse's responsibility to decide independently the legality of disclosing information. The nurse does not have the right to allow the cameraman access to the neonatal unit. This would constitute invasion of privacy. The health care provider has no responsibility regarding this situation and cannot allow the cameraman on the unit. It is not the nurse's responsibility to find out how the pictures are to be used. This is a task for the public relations department.

11. During the initial home visit, a home health nurse lets the patient know that the visits are expected to end in about a month. Which phase of the helping relationship is the nurse in with this patient? a. Preinteraction b. Orientation c. Working d. Termination

ANS: B Letting the patient know when to expect the relationship to be terminated occurs in the orientation phase. Preinteraction occurs before the nurse meets the patient. Working occurs when the nurse and the patient work together to solve problems and accomplish goals. Termination occurs during the ending of the relationship. DIF: Apply (application) REF: 322 OBJ: Identify a nurse's communication approaches within the four phases of a nurse-patient helping relationship. TOP: Assessment MSC: Management of Care

14. A nurse works full time on the oncology unit at the hospital and works part time on weekends giving immunizations at the local pharmacy. While giving an injection on a weekend, the nurse caused injury to the patient's arm and is now being sued. How will the hospital's malpractice insurance provide coverage for this nurse? a. It will provide coverage as long as the nurse followed all procedures, protocols, and policies correctly. b. The hospital's malpractice insurance covers this nurse only during the time the nurse is working at the hospital. c. As long as the nurse has never been sued before this incident, the hospital's malpractice insurance will cover the nurse. d. The hospital's malpractice insurance will provide approximately 50% of the coverage the nurse will need.

ANS: B Malpractice insurance provided by the employing institution covers nurses only while they are working within the scope of their employment. It is always wise to find out if malpractice insurance is provided by a secondary place of employment, in this case, the pharmacy, or the nurse should carry an individual malpractice policy to cover situations such as this. The hospital policy would not provide coverage even if the nurse followed all procedures and policies or had never been sued. It will not provide 50% of coverage.

1. Which types of nurses make the best communicators with patients? a. Those who learn effective psychomotor skills b. Those who develop critical thinking skills c. Those who like different kinds of people d. Those who maintain perceptual biases

ANS: B Nurses who develop critical thinking skills make the best communicators. Just liking people does not make an effective communicator because it is important to apply critical thinking standards to ensure sound effective communication. Just learning psychomotor skills does not ensure that the nurse will use those techniques, and communication involves more than psychomotor skills. Critical thinking helps the nurse overcome perceptual biases or human tendencies that interfere with accurately perceiving and interpreting messages from others. Nurses who maintain perceptual biases do not make good communicators. DIF: Understand (comprehension) REF: 317 OBJ: Identify ways to apply critical thinking to the communication process. TOP: Communication and Documentation MSC: Psychosocial Integrity

6. A nurse is sitting at the patient's bedside taking a nursing history. Which zone of personal space is the nurse using? a. Socio-consultative b. Personal c. Intimate d. Public

ANS: B Personal space is 18 inches to 4 feet and involves things such as sitting at a patient's bedside, taking a patient's nursing history, or teaching an individual patient. Intimate space is 0 to 18 inches and involves things such as performing a physical assessment, bathing, grooming, dressing, feeding, and toileting a patient. The socio-consultative zone is 9 to 12 feet and involves things such as giving directions to visitors in the hallway and giving verbal report to a group of nurses. The public zone is 12 feet and greater and involves things such as speaking at a community forum, testifying at a legislative hearing, or lecturing. DIF: Understand (comprehension) REF: 322 OBJ: Identify a nurse's communication approaches within the four phases of a nurse-patient helping relationship. TOP: Assessment MSC: Psychosocial Integrity

A nurse is developing a care delivery outcomes research project. Which population will the nurse study? a. Nurses b. Patients c. Administrators d. Health care providers

ANS: B Similar to the expected outcomes you develop in a plan of care, a care delivery outcome focuses on the recipients of service (e.g., patient, family, or community) and not the providers (e.g., nurse or physician/health care provider). Administrators are not recipients of service.

7. A pediatric oncology nurse floats to an orthopedic trauma unit. Which action should the nurse manager of the orthopedic unit take to enable safe care to be given by this nurse? a. Provide a complete orientation to the functioning of the entire unit. b. Determine patient acuity and care the nurse can safely provide. c. Allow the nurse to choose which mealtime works best. d. Assign nursing assistive personnel to assist with care.

ANS: B Supervisors are liable if they give staff nurses an assignment that they cannot safely handle. Nurses who float must inform the supervisor of any lack of experience in caring for the types of patients on the nursing unit. They should request and receive an orientation to the unit. A basic orientation is needed, whereas a complete orientation of the functioning of the entire unit would take a period of time that would exceed what the nurse has to spend on orientation. Allowing nurses to choose which mealtime they would like is a nice gesture of thanks for the nurse, but it does not enable safe care. Having nursing assistive personnel may help the nurse complete basic tasks such as hygiene and turning, but it does not enable safe nursing care that the nurse and manager are ultimately responsible for.

2. A new nurse notes that the health care unit keeps a listing of patient names in a closed book behind the front desk of the nursing station so patients can be located easily. Which action is most appropriate for the nurse to take? a. Talk with the nurse manager about the listing being a violation of the Health Insurance Portability and Accountability Act (HIPAA). b. Use the book as needed while keeping it away from individuals not involved in patient care. c. Move the book to the upper ledge of the nursing station for easier access. d. Ask the nurse manager to move the book to a more secluded area.

ANS: B The book is located where only staff would have access so the nurse can use the book as needed. The privacy section of the HIPAA provides standards regarding accountability in the health care setting. These rules include patient rights to consent to the use and disclosure of their protected health information, to inspect and copy their medical record, and to amend mistaken or incomplete information. It is not the responsibility of the new nurse to move items used by others on the patient unit. The listing is protected as long as it is used appropriately as needed to provide care. There is no need to move the book to a more secluded area.

The nurse is reviewing a research article on a patient care topic. Which area should entice the nurse to read the article? a. Literature review b. Introduction c. Methods d. Results

ANS: B The introduction contains information about its purpose and the importance of the topic to the audience who reads the article. The literature review or background offers a detailed background of the level of science or clinical information about the topic of the article. The methods or design section explains how a research study was organized and conducted. The results or conclusion section details the results of the study and explains whether a hypothesis is supported.

8. The nurse asks a patient where the pain is, and the patient responds by pointing to the area of pain. Which form of communication did the patient use? a. Verbal b. Nonverbal c. Intonation d. Vocabulary

ANS: B The patient gestured (pointed), which is a type of nonverbal communication. Gestures emphasize, punctuate, and clarify the spoken word. Pointing to an area of pain is sometimes more accurate than describing its location. Verbal is the spoken word or message. Intonation or tone of voice dramatically affects the meaning of a message. Vocabulary consists of words used for verbal communication. DIF: Understand (comprehension) REF: 320-321 OBJ: Demonstrate qualities, behaviors, and communication techniques of professional communication while interacting with patients. TOP: Assessment MSC: Basic Care and Comfort

8. A nurse wants to find all the pertinent patient information in one record, regardless of the number of times the patient entered the health care system. Which record should the nurse find? a. Electronic medical record b. Electronic health record c. Electronic charting record d. Electronic problem record

ANS: B The term electronic health record/EHR is increasingly used to refer to a longitudinal (lifetime) record of all health care encounters for an individual patient by linking all patient data from previous health encounters. An electronic medical record (EMR) is the legal record that describes a single encounter or visit created in hospitals and outpatient health care settings that is the source of data for the EHR. There are no such terms as electronic charting record or electronic problem record that record the lifetime information of a patient.

18. An older-adult patient is wearing a hearing aid. Which technique should the nurse use to facilitate communication? a. Chew gum. b. Turn off the television. c. Speak clearly and loudly. d. Use at least 14-point print.

ANS: B Turning off the television will facilitate communication. Patients who are hearing impaired benefit when the following techniques are used: check for hearing aids and glasses, reduce environmental noise, get the patient's attention before speaking, do not chew gum, and speak at normal volume—do not shout. Using at least 14-point print is for sight/visually impaired, not hearing impaired. DIF: Apply (application) REF: 326 | 332 OBJ: Engage in effective communication techniques for older patients. TOP: Implementation MSC: Psychosocial Integrity

MULTIPLE RESPONSE 1. Which behaviors indicate the nurse is using critical thinking standards when communicating with patients? (Select all that apply.) a. Instills faith b. Uses humility c. Portrays self-confidence d. Exhibits supportiveness e. Demonstrates independent attitude

ANS: B, C, E A self-confident attitude is important because the nurse who conveys confidence and comfort while communicating more readily establishes an interpersonal helping-trusting relationship. In addition, an independent attitude encourages the nurse to communicate with colleagues and share ideas about nursing interventions. An attitude of humility is necessary to recognize and communicate the need for more information before making a decision. Faith and supportiveness are attributes of caring, not critical thinking standards. DIF: Understand (comprehension) REF: 317 OBJ: Identify ways to apply critical thinking to the communication process. TOP: Evaluation MSC: Management of Care

19. Which staff member does the nurse assign to provide morning care for an older-adult patient who requires assistance with activities of daily living? a. Licensed practical nurse b. Cardiac monitor technician c. Nursing assistive personnel (NAP) d. Another registered nurse on the floor

ANS: C The NAP is capable of caring for this patient and is the most cost-effective choice. The cardiac monitor technician's role is to watch the cardiac monitors for patients on the floor. The nurse and the licensed practical nurse are not the most cost-effective options in this case, even though each could assist with activities of daily living. These nurses would be better used to administer medications, perform assessments, etc.

12. Which approach will be most appropriate for a nurse to take when faced with the challenge of performing many tasks in one shift? a. Do as much as possible by oneself before seeking assistance from others. b. Evaluate the effectiveness of all tasks when all tasks are completed. c. Complete one task before starting another task. d. Delegate tasks the nurse does not like doing.

ANS: C The appropriate clinical care coordination skill in these options is to complete one task before starting another task. Good time management involves setting goals to help the nurse complete one task before starting another task. Evaluation is ongoing and should not be completed just at the end of task completion. The nurse should not delegate tasks simply because the nurse does not like doing them. The nurse should use delegation skills and time-management skills instead of trying to do as much as possible with no help.

11. A new nurse expresses frustration at not being to complete all interventions for a group of patients in a timely manner. The nurse leaves the rounds report sheets at the nurse's station when caring for patients and reports having to go back and forth between rooms for equipment and supplies. Which type of skill does the nurse need? a. Interpersonal communication b. Clinical decision making c. Organizational d. Evaluation

ANS: C The clinical care coordination skill this nurse needs to improve on is organization. This nurse needs to keep the patient report sheets in hand to anticipate what equipment and supplies a patient is going to need. Then the nurse may not have to leave the room so often; this will save time. The nurse is not having a problem communicating with others (interpersonal communication). The nurse is not having a problem using the nursing process for clinical decisions. The nurse is not having a problem comparing actual patient outcomes with expected outcomes (evaluation).

5. A nurse is working in a facility that has fewer directors with managers and staff able to make shared decisions. In which type of organizational structure is the nurse employed? a. Delegation b. Research-based c. Decentralization d. Philosophy of care

ANS: C The decentralized management structure often has fewer directors, and managers and staff are able to make shared decisions. The American Nurses Association defines delegation as transferring responsibility for the performance of an activity or task while retaining accountability for the outcome. Research-based means care is based upon evidence. A philosophy of care includes the professional nursing staff's values and concerns for the way they view and care for patients. For example, a philosophy addresses the purpose of the nursing unit, how staff works with patients and families, and the standards of care for the work unit.

11. A nurse is a member of an interdisciplinary team that uses critical pathways. According to the critical pathway, on day 2 of the hospital stay, the patient should be sitting in the chair. It is day 3, and the patient cannot sit in the chair. What should the nurse do? a. Add this data to the problem list. b. Focus chart using the DAR format. c. Document the variance in the patient's record. d. Report a positive variance in the next interdisciplinary team meeting.

ANS: C A variance occurs when the activities on the critical pathway are not completed as predicted or the patient does not meet expected outcomes. An example of a negative variance is when a patient develops pulmonary complications after surgery, requiring oxygen therapy and monitoring with pulse oximetry. A positive variance occurs when a patient progresses more rapidly than expected (e.g., use of a Foley catheter may be discontinued a day early). When a nurse is using the problem-oriented medical record, after analyzing data, health care team members identify problems and make a single problem list. A third format used for notes within a POMR is focus charting. It involves the use of DAR notes, which include D—Data (both subjective and objective), A—Action or nursing intervention, and R—Response of the patient (i.e., evaluation of effectiveness).

7. A smiling patient angrily states, "I will not cough and deep breathe." How will the nurse interpret this finding? a. The patient's denotative meaning is wrong. b. The patient's personal space was violated. c. The patient's affect is inappropriate. d. The patient's vocabulary is poor.

ANS: C An inappropriate affect is a facial expression that does not match the content of a verbal message (e.g., smiling when describing a sad situation). The patient is smiling but is angry, which indicates an inappropriate affect. The patient's personal space was not violated. The patient's vocabulary is not poor. Individuals who use a common language share denotative meaning: baseball has the same meaning for everyone who speaks English, but code denotes cardiac arrest primarily to health care providers. The patient's denotative meaning is correct for cough and deep breathe. DIF: Apply (application) REF: 321 OBJ: Demonstrate qualities, behaviors, and communication techniques of professional communication while interacting with patients. TOP: Communication and Documentation MSC: Psychosocial Integrity

4. An obstetric nurse comes across an automobile accident. The driver seems to have a crushed upper airway, and while waiting for emergency medical services to arrive, the nurse makes a cut in the trachea and inserts a straw from a purse to provide an airway. The patient survives and has a permanent problem with vocal cords, making it difficult to talk. Which statement is true regarding the nurse's performance? a. The nurse acted appropriately and saved the patient's life. b. The nurse stayed within the guidelines of the Good Samaritan Law. c. The nurse took actions beyond those that are standard and appropriate. d. The nurse should have just stayed with the patient and waited for help.

ANS: C An obstetric nurse would not have been trained in performing a tracheostomy (cut in the trachea), and doing so would be beyond what the nurse has been trained or educated to do. If you perform a procedure exceeding your scope of practice and for which you have no training, you are liable for injury that may result from that act. You should only provide care that is consistent with your level of expertise. The nurse did not act appropriately. The nurse is not protected by the Good Samaritan Law because the nurse acted outside the scope of practice and training. The nurse should have acted within what was trained and educated to do in this circumstance, not just stay with the patient.

A nurse develops the following PICOT question: Do patients who listen to music achieve better control of their anxiety and pain after surgery when compared with patients who receive standard nursing care following surgery? Which information will the nurse use as the "C"? a. After surgery b. Who listen to music c. Who receive standard nursing care d. Achieve better control of their anxiety and pain

ANS: C Do patients (P) who listen to music (I) achieve better control of their anxiety and pain (O) after surgery (T) when compared with patients who receive standard nursing care following surgery (C)?

2. A nurse believes that the nurse-patient relationship is a partnership and that both are equal participants. Which term should the nurse use to describe this belief? a. Critical thinking b. Authentic c. Mutuality d. Attend

ANS: C Effective interpersonal communication requires a sense of mutuality, a belief that the nurse-patient relationship is a partnership and that both are equal participants. Critical thinking in nursing, based on established standards of nursing care and ethical standards, promotes effective communication and uses standards such as humility, self-confidence, independent attitude, and fairness. To be authentic (one's self) and to respond appropriately to the other person are important for interpersonal relationships but do not mean mutuality. Attending is giving all of your attention to the patient. DIF: Understand (comprehension) REF: 317 OBJ: Incorporate features of a helping relationship when interacting with patients. TOP: Caring MSC: Management of Care

4. A nurse is using therapeutic communication with a patient. Which technique will the nurse use to ensure effective communication? a. Interpersonal communication to change negative self-talk to positive self-talk b. Small group communication to present information to an audience c. Electronic communication to assess a patient in another city d. Intrapersonal communication to build strong teams

ANS: C Electronic communication is the use of technology to create ongoing relationships with patients and their health care team. Intrapersonal communication is self-talk. Interpersonal communication is one-on-one interaction between a nurse and another person that often occurs face to face. Public communication is used to present information to an audience. Small group communication is interaction that occurs when a small number of persons meet. When nurses work on committees or participate in patient care conferences, they use a small group communication process. DIF: Analyze (analysis) REF: 319 OBJ: Utilize the five levels of communication with patients. TOP: Communication and Documentation MSC: Management of Care

In caring for patients, what must the nurse remember about evidence-based practice (EBP)? a. EBP is the only valid source of knowledge that should be used. b. EBP is secondary to traditional or convenient care knowledge. c. EBP is dependent on patient values and expectations. d. EBP is not shown to provide better patient outcomes.

ANS: C Even when the best evidence available is used, application and outcomes will differ based on patient values, preferences, concerns, and/or expectations. Nurses often care for patients on the basis of tradition or convenience. Although these sources have value, it is important to learn to rely more on research evidence than on nonresearch evidence. Evidence-based care improves quality, safety, patient outcomes, and nurse satisfaction while reducing costs.

9. A patient has been admitted to the hospital numerous times. The nurse asks the patient to share a personal story about the care that has been received. Which interaction is the nurse using? a. Nonjudgmental b. Socializing c. Narrative d. SBAR

ANS: C In a therapeutic relationship, nurses often encourage patients to share personal stories. Sharing stories is called narrative interaction. Socializing is an important initial component of interpersonal communication. It helps people get to know one another and relax. It is easy, superficial, and not deeply personal. Nonjudgmental acceptance of the patient is an important characteristic of the relationship. Acceptance conveys a willingness to hear a message or acknowledge feelings; it is not a technique that involves personal stories. SBAR is a popular communication tool that helps standardize communication among health care providers. SBAR stands for Situation, Background, Assessment, and Recommendation. DIF: Understand (comprehension) REF: 323 OBJ: Incorporate features of a helping relationship when interacting with patients. TOP: Communication and Documentation MSC: Psychosocial Integrity

The nurse is trying to identify common general themes relative to the effectiveness of cardiac rehabilitation from patients who have had heart attacks and have gone through cardiac rehabilitation programs. The nurse conducts interviews and focus groups. Which type of research is the nurse conducting? a. Nonexperimental research b. Experimental research c. Qualitative research d. Evaluation research

ANS: C Qualitative research involves using inductive reasoning to develop generalizations or theories from specific observations or interviews. Evaluation and experimental research are forms of quantitative research. Nonexperimental descriptive studies describe, explain, or predict phenomena such as factors that lead to an adolescent's decision to smoke cigarettes.

10. A confused patient with a urinary catheter, nasogastric tube, and intravenous line keeps touching these needed items for care. The nurse has tried to explain to the patient that these lines should not be touched, but the patient continues. Which is the best action by the nurse at this time? a. Apply restraints loosely on the patient's dominant wrist. b. Notify the health care provider that restraints are needed immediately. c. Try other approaches to prevent the patient from touching these care items. d. Allow the patient to pull out lines to prove that the patient needs to be restrained.

ANS: C Restraints can be used when less restrictive interventions are not successful. The nurse must try other approaches than just telling. The situation states that the patient is touching the items, not trying to pull them out. At this time, the patient's well-being is not at risk so restraints cannot be used at this time nor does the health care provider need to be notified. Allowing the patient to pull out any of these items to prove the patient needs to be restrained is not acceptable.

14. A patient was admitted 2 days ago with pneumonia and a history of angina. The patient is now having chest pain with a pulse rate of 108. Which piece of data will the nurse use for "B" when using SBAR? a. Having chest pain b. Pulse rate of 108 c. History of angina d. Oxygen is needed

ANS: C The B in SBAR stands for background information. The background information in this situation is the history of angina. Having chest pain is the Situation (S). Pulse rate of 108 is the Assessment (A). Oxygen is needed is the Recommendation (R). DIF: Apply (application) REF: 323 OBJ: Identify desired outcomes of nurse-health care team member relationships. TOP: Implementation MSC: Management of Care

A nurse wants to change a patient procedure. Which action will the nurse take to easily find research evidence to support this change? a. Read all the articles found on the Internet. b. Make a general search of the Internet. c. Use a PICOT format for the search. d. Start with a broad question.

ANS: C The more focused the question is, the easier it becomes to search for evidence in the scientific literature. The PICO format allows the nurse to ask focused questions that are intervention based. Inappropriately formed questions (general search or broad question) will likely lead to irrelevant sources of information. It is not beneficial to read hundreds of articles. It is more beneficial to read the best four to six articles that specifically address the question.

12. A nurse and a patient work on strategies to reduce weight. Which phase of the helping relationship is the nurse in with this patient? a. Preinteraction b. Orientation c. Working d. Termination

ANS: C The working phase occurs when the nurse and the patient work together to solve problems and accomplish goals. Preinteraction occurs before the nurse meets the patient. Orientation occurs when the nurse and the patient meet and get to know each other. Termination occurs during the ending of the relationship. DIF: Apply (application) REF: 322 OBJ: Identify a nurse's communication approaches within the four phases of a nurse-patient helping relationship. TOP: Implementation MSC: Health Promotion and Maintenance

5. A nurse has provided care to a patient. Which entry should the nurse document in the patient's record? a. Status unchanged, doing well b. Patient seems to be in pain and states, "I feel uncomfortable." c. Left knee incision 1 inch in length without redness, drainage, or edema d. Patient is hard to care for and refuses all treatments and medications. Family is present.

ANS: C Use of exact measurements establishes accuracy. Charting that an abdominal wound is "approximated, 5 cm in length without redness, drainage, or edema," is more descriptive than "large abdominal incision healing well." Include objective data to support subjective data, so your charting is as descriptive as possible. Avoid using generalized, empty phrases such as "status unchanged" or "had good day." It is essential to avoid the use of unnecessary words and irrelevant details or personal opinions. "Patient is hard to care for" is a personal opinion and should be avoided. It is also a critical comment that can be used as evidence for nonprofessional behavior or poor quality of care. Just chart, "Refuses all treatments and medications."

1. A nurse preceptor is working with a student nurse. Which behavior by the student nurse will require the nurse preceptor to intervene? a. The student nurse reads the patient's plan of care. b. The student nurse reviews the patient's medical record. c. The student nurse shares patient information with a friend. d. The student nurse documents medication administered to the patient.

ANS: C When you are a student in a clinical setting, confidentiality and compliance with the Health Insurance Portability and Accountability Act (HIPAA) are part of professional practice. When a student nurse shares patient information with a friend, confidentiality and HIPAA standards have been violated, causing the preceptor to intervene. You can review your patients' medical records only to seek information needed to provide safe and effective patient care. For example, when you are assigned to care for a patient, you need to review the patient's medical record and plan of care. You do not share this information with classmates and you do not access the medical records of other patients on the unit.

7. A staff nurse delegates a task to a nursing assistive personnel (NAP), knowing that the NAP has never performed the task before. As a result, the patient is injured, and the nurse defensively states that the NAP should have known how to perform such a simple task. Which element of the decision-making process is the nurse lacking? a. Authority b. Autonomy c. Responsibility d. Accountability

ANS: D Accountability refers to individuals being answerable for their actions. The nurse in this situation is not taking ownership of the inappropriate delegation of a task. Autonomy is freedom of choice and responsibility for the choices. Responsibility refers to the duties and activities that an individual is employed to perform. Authority refers to legitimate power to give commands and make final decisions specific to a given position.

16. A nurse is prioritizing care for four patients. Which patient should the nurse see first? a. A patient needing teaching about medications b. A patient with a healed abdominal incision c. A patient with a slight temperature d. A patient with difficulty breathing

ANS: D An immediate threat to a patient's survival or safety must be addressed first, like difficulty breathing. Teaching, healed incision, and slight temperature are not immediate needs.

4. A nurse manager discovers that the readmission rate of hospitalized patients is very high on the hospital unit. The nurse manager desires improved coordination of care and accountability for cost-effective quality care. Which nursing care delivery model is best suited for these needs? a. Team nursing b. Total patient care c. Primary nursing d. Case management

ANS: D Case management is a care approach that coordinates and links health care services to patients and families while streamlining costs. In team nursing, the RN assumes the role of group or team leader and leads a team made up of other RNs, practical nurses, and nursing assistive personnel. Total patient care involves an RN being responsible for all aspects of care for one or more patients. The primary nursing model of care delivery was developed to place RNs at the bedside and improve the accountability of nursing for patient outcomes and the professional relationships among staff members.

2. A nurse is overseeing the care of patients with severe diabetes and patients with heart failure to improve cost-effectiveness and quality of care. Which nursing care delivery model is the nurse using? a. Team nursing b. Total patient care c. Primary nursing d. Case management

ANS: D Case management is unique because clinicians, either as individuals or as part of a collaborative group, oversee the management of patients with specific, complex health problems or are held accountable for some standard of cost management and quality. Case management is a care approach that coordinates and links health care services to patients and families while streamlining costs. In the team nursing care model, the RN assumes the role of group or team leader and leads a team made up of other RNs, practical nurses, and nursing assistive personnel. Total patient care involves an RN being responsible for all aspects of care for one or more patients. The primary nursing model of care delivery was developed to place RNs at the bedside and improve the accountability of nursing for patient outcomes and the professional relationships among staff members.

1. A registered nurse (RN) is the group leader of practical nurses and nursing assistive personnel. Which nursing care model is the RN using? a. Case management b. Total patient care c. Primary nursing d. Team nursing

ANS: D In team nursing, the RN assumes the role of group or team leader and leads a team made up of other RNs, practical nurses, and nursing assistive personnel. Case management is a care approach that coordinates and links health care services to patients and families while streamlining costs. Total patient care involves an RN being responsible for all aspects of care for one or more patients. The primary nursing model of care delivery was developed to place RNs at the bedside and improve the accountability of nursing for patient outcomes and the professional relationships among staff members.

13. Which assessment of a patient who is 1 day postsurgery to repair a hip fracture requires immediate nursing intervention? a. Patient ate 40% of clear liquid breakfast. b. Patient's oral temperature is 98.9° F. c. Patient states, "I did not realize I would be so tired after this surgery." d. Patient reports severe pain 30 minutes after receiving pain medication.

ANS: D It is important to prioritize in all caregiving situations because it allows you to see relationships among patient problems and avoid delays in taking action that possibly leads to serious complications for a patient. The nurse needs to report severe pain that is unrelieved by pain medication to the health care provider. The nurse needs to recognize and differentiate normal from abnormal findings and set priorities. Eating 40% of breakfast, having a slightly elevated temperature, and being tired the day after surgery are expected findings following surgery and do not require immediate intervention.

14. A nurse has a transactional leader as a manager. Which finding will the nurse anticipate from working with this leader? a. Increased turnover rate b. Increased patient mortality rate c. Increased rate of medication errors d. Increased level of patient satisfaction

ANS: D Research has found that on nursing units where the nurse manager uses transactional leadership there is an increased level of patient satisfaction, a lower patient mortality rate, and a lower rate of medication errors. Turnover rate is decreased since staff retention is increased with transformational leadership.

10. A nurse manager conducts rounds on the unit and discovers that expired stock medicine is still in the cabinet despite the e-mail that was sent stating that it had to be discarded. The staff nurse dress code is not being adhered to as requested in the same e-mail. Several staff nurses deny having received the e-mail. Which action should the nurse manager take? a. Close the staff lounge. b. Enforce a stricter dress code. c. Include the findings on each staff member's annual evaluation. d. Place a hard copy of announcements and unit policies in each staff member's mailbox.

ANS: D The identified problem is lack of staff communication. Sending an e-mail was not effective; therefore, giving each staff member a hard copy along with e-mailing is another approach the manager can take. An effective manager uses a variety of approaches to communicate quickly and accurately to all staff. For example, many managers distribute biweekly or monthly newsletters of ongoing unit or facility activities. Including the findings on evaluations, closing the lounge, and enforcing stricter dress codes do not address the problem.

5. A nurse is standing beside the patient's bed. Nurse: How are you doing? Patient: I don't feel good. Which element will the nurse identify as feedback? a. Nurse b. Patient c. How are you doing? d. I don't feel good.

ANS: D "I don't feel good" is the feedback because the feedback is the message the receiver returns. The sender is the person who encodes and delivers the message, and the receiver is the person who receives and decodes the message. The nurse is the sender. The patient is the receiver. "How are you doing?" is the message. DIF: Apply (application) REF: 319-320 OBJ: Describe features of the circular transactional communication process. TOP: Communication and Documentation MSC: Psychosocial Integrity

19. When making rounds, the nurse finds a patient who is not able to sleep because of surgery in the morning. Which therapeutic response is most appropriate? a. "You will be okay. Your surgeon will talk to you in the morning." b. "Why can't you sleep? You have the best surgeon in the hospital." c. "Don't worry. The surgeon ordered a sleeping pill to help you sleep." d. "It must be difficult not to know what the surgeon will find. What can I do to help?"

ANS: D "It must be difficult not to know what the surgeon will find. What can I do to help?" is using therapeutic communication techniques of empathy and asking relevant questions. False reassurances ("You will be okay" and "Don't worry") tend to block communication. Patients frequently interpret "why" questions as accusations or think the nurse knows the reason and is simply testing them. DIF: Apply (application) REF: 328-329 OBJ: Demonstrate qualities, behaviors, and communication techniques of professional communication while interacting with patients. TOP: Communication and Documentation MSC: Psychosocial Integrity

4. After providing care, a nurse charts in the patient's record. Which entry will the nurse document? a. Appears restless when sitting in the chair b. Drank adequate amounts of water c. Apparently is asleep with eyes closed d. Skin pale and cool

ANS: D A factual record contains descriptive, objective information about what a nurse observes, hears, palpates, and smells. Objective data is obtained through direct observation and measurement (skin pale and cool). For example, "B/P 80/50, patient diaphoretic, heart rate 102 and regular." Avoid vague terms such as appears, seems, or apparently because these words suggest that you are stating an opinion, do not accurately communicate facts, and do not inform another caregiver of details regarding behaviors exhibited by the patient. Use of exact measurements establishes accuracy. For example, a description such as "Intake, 360 mL of water" is more accurate than "Patient drank an adequate amount of fluid."

A nurse identifies a clinical problem with pressure ulcers. Which step should the nurse take next in the research process? a. Analyze results. b. Conduct the study. c. Determine method. d. Develop a hypothesis.

ANS: D After identifying an area of interest or clinical problem, the steps of the research process are as follows: Develop research question(s)/hypotheses; determine how the study will be conducted; conduct the study; and analyze results of the study.

25. Which behavior indicates the nurse is using a process recording correctly to enhance communication with patients? a. Shows sympathy appropriately b. Uses automatic responses fluently c. Demonstrates passive remarks accurately d. Self-examines personal communication skills

ANS: D Analysis of a process recording enables a nurse to evaluate the following: examine whether nursing responses blocked or facilitated the patient's efforts to communicate. Sympathy is concern, sorrow, or pity felt for the patient and is nontherapeutic. Clichés and stereotyped remarks are automatic responses that communicate the nurse is not taking concerns seriously or responding thoughtfully. Passive responses serve to avoid conflict or to sidestep issues. DIF: Apply (application) REF: 331 OBJ: Identify opportunities to improve communication with patients while giving care. TOP: Evaluation MSC: Psychosocial Integrity

23. A nurse is implementing nursing care measures for patients' special communication needs. Which patient will need the most nursing care measures? a. The patient who is oriented, pain free, and blind b. The patient who is alert, hungry, and has strong self-esteem c. The patient who is cooperative, depressed, and hard of hearing d. The patient who is dyspneic, anxious, and has a tracheostomy

ANS: D Facial trauma, laryngeal cancer, or endotracheal intubation often prevents movement of air past vocal cords or mobility of the tongue, resulting in inability to articulate words. An extremely breathless person needs to use oxygen to breathe rather than speak. Persons with high anxiety are sometimes unable to perceive environmental stimuli or hear explanations. People who are alert, have strong self-esteem, and are cooperative and pain free do not cause communication concerns. Although hunger, blindness, and difficulty hearing can cause communication concerns, dyspnea, tracheostomy, and anxiety all contribute to communication concerns. DIF: Analyze (analysis) REF: 325 | 331 OBJ: Implement nursing care measures for patients with special communication needs. TOP: Evaluation MSC: Psychosocial Integrity

13. A nurse uses SBAR when providing a hands-off report to the oncoming shift. What is the rationale for the nurse's action? a. To promote autonomy b. To use common courtesy c. To establish trustworthiness d. To standardize communication

ANS: D SBAR is a popular communication tool that helps standardize communication among health care providers. Common courtesy is part of professional communication but is not the purpose of SBAR. Being trustworthy means helping others without hesitation. Autonomy is being self-directed and independent in accomplishing goals and advocating for others. DIF: Understand (comprehension) REF: 323 OBJ: Identify desired outcomes of nurse-health care team member relationships. TOP: Planning MSC: Management of Care

A nurse is reviewing research studies for evidence-based practice. Which article should the nurse use for qualitative nursing research? a. An article about the number of falls after use of no side rails b. An article about infection rates after use of a new wound dressing c. An article about the percentage of new admissions on a new floor d. An article about emotional needs of dying patients and their families

ANS: D Studying emotional needs is a qualitative study. Qualitative nursing research is the study of phenomena that are difficult to quantify or categorize, such as patients' perceptions of illness. The number of falls, infection rates, and percentages of new admissions are all examples of quantitative research.

The nurse is caring for a patient with chronic low back pain. The nurse wants to determine the best evidence-based practice regarding clinical guidelines for low back pain. What is the best database for the nurse to access? a. MEDLINE b. EMBASE c. PsycINFO d. AHRQ

ANS: D The Agency for Healthcare Research and Quality (AHRQ) includes clinical guidelines and evidence summaries. MEDLINE includes studies in medicine, nursing, dentistry, psychiatry, veterinary medicine, and allied health. EMBASE includes biomedical and pharmaceutical studies. PsycINFO deals with psychology and related health care disciplines.

1. A newly hired experienced nurse is preparing to change a patient's abdominal dressing and hasn't done it before at this hospital. Which action by the nurse is best? a. Have another nurse do it so the correct method can be viewed. b. Change the dressing using the method taught in nursing school. c. Ask the patient how the dressing change has been recently done. d. Check the policy and procedure manual for the facility's method.

ANS: D The Joint Commission requires accredited hospitals to have written nursing policies and procedures. These internal standards of care are specific and need to be accessible on all nursing units. For example, a policy/procedure outlining the steps to follow when changing a dressing or administering medication provides specific information about how nurses are to perform. The nurse being observed may not be doing the procedure according to the facility's policy or procedure. The procedure taught in nursing school may not be consistent with the policy or procedure for this facility. The patient is not responsible for maintaining the standards of practice. Patient input is important, but it's not what directs nursing practice.

After reviewing the literature, the evidence-based practice committee institutes a practice change that bedrails should be left in the down position and hourly nursing rounds should be conducted. The results indicate over a 40% reduction in falls. What is the committee's next step? a. Evaluate the changes in 1 month. b. Implement the changes as a pilot study. c. Wait a month before implementing the changes. d. Communicate to staff the results of this project.

ANS: D The last step of evidence-based practice (EBP) is to share the outcomes of EBP changes with others. Changes must be evaluated before the outcomes are shared. Once communicated, changes should be put in place as the committee deems reasonable (i.e., either hospital wide or as a pilot study). Waiting should not be an option unless the results are not to the committee's liking.

15. A female nursing student in the final term of nursing school is overheard by a nursing faculty member telling another student that she got to insert a nasogastric tube in the emergency department while working as a nursing assistant. Which advice is best for the nursing faculty member to give to the nursing student? a. "Just be careful when you are doing new procedures and make sure you are following directions by the nurse." b. "Review your procedures before you go to work, so you will be prepared to do them if you have a chance." c. "The nurse should not have allowed you to insert the nasogastric tube because something bad could have happened." d. "You are not allowed to perform any procedures other than those in your job description even with the nurse's permission."

ANS: D When nursing students work as nursing assistants or nurse's aides when not attending classes, they should not perform tasks that do not appear in a job description for a nurse's aide or assistant. The nursing student should always follow the directions of the nurse, unless doing so violates the institution's guidelines or job description under which the nursing student was hired, such as inserting a nasogastric tube or giving an intramuscular medication. The nursing student should be able to safely complete the procedures delegated as a nursing assistant, and reviewing those not done recently is a good idea, but it has nothing to do with the situation. The focus of the discussion between the nursing faculty member and the nursing student should be on following the job description under which the nursing student is working.

10. A nurse wants to find the daily weights of a patient. Which form will the nurse use? a. Database b. Progress notes c. Patient care summary d. Graphic record and flow sheet

ANS: D Within a computerized documentation system, flow sheets and graphic records allow you to quickly and easily enter assessment data about a patient, such as vital signs, admission and or daily weights, and percentage of meals eaten. In the problem-oriented medical record, the database section contains all available assessment information pertaining to the patient (e.g., history and physical examination, nursing admission history and ongoing assessment, physical therapy assessment, laboratory reports, and radiologic test results). Many computerized documentation systems have the ability to generate a patient care summary document that you review and sometimes print for each patient at the beginning and/or end of each shift; it includes information such as basic demographic data, health care provider's name, primary medical diagnosis, and current orders. Health care team members monitor and record the progress made toward resolving a patient's problems in progress notes.