Pearson Accountability

The nurse administrator is likely to perform which task? A. Write a budget for nursing services B. Recommend an area for research C. Examine evidence-based practices D. Educate critical care nurses

Answer: A A nurse administrator would write a budget, plan programs, and address staffing issues. Patient care, research, education, and quality assurance would be done by a clinical nurse specialist.

A patient with end-stage renal disease has stopped dialysis treatment and the spouse will not leave the patient's bedside. Which intervention should the nurse implement to support this family's needs? A. Providing a meal tray for the spouse B. Suggesting that the spouse resume normal activities C. Reinforcing visiting hours with the spouse D. Explaining that the patient needs rest and that the spouse should leave

Answer: A Care for the dying focuses on helping the patient live as long as possible in comfort until death occurs. The nurse also cares for the patient's family throughout this process. Providing a meal tray for the spouse supports care for the family during this time. Reinforcing visiting hours, explaining that the patient needs rest, and suggesting the spouse resume normal activities are not supporting the family during the dying process.

The staff nurse wants to help the code team revive a patient but is stopped by the team leader when attempting an intraosseous IV insertion. Which is the most likely reason the team leader intervened? A. The nurse has not been trained in this clinical competency. B. The team leader is controlling and wants to complete the insertion. C. The healthcare provider must be present during insertion. D. The nurse is in the way of the code team.

Answer: A Clinical competencies ensure safety. Whether or not the nurse is able to safely insert an intraosseous device, it is inappropriate for them to participate in the code without the requisite training. Because they are not trained in all the procedures, they lack the clinical competency to act as part of the code team. They may have performed the skill correctly, but they do not belong there, not because they are in the way, but because they lack training. The statement about the team leader being controlling is subjective and judgmental. A healthcare provider is not required to be present during the insertion of an intraosseous IV line.

The nurse is planning to discuss how economics has created more accountability in nursing practice. Which information should the nurse include? A. Medicare and Medicaid have incentivized efficient and effective care that meets outcomes without driving up costs. B. The nursing shortage has made it easier for nurses to keep their jobs. C. Costs incentivize the use of shortcuts, such as not using personal protective equipment unless you really need to. D. Unemployment has driven people to go back to school to become nurses.

Answer: A Economics incentivizes efficient and effective care that doesn't drive up costs. The main economic drivers are Medicare and Medicaid. Economic pressures can work against good nursing; the nursing shortage often provides job security to nurses who would otherwise be fired, and the cost of healthcare can lead to shortcuts on the floor (such as saving money on gloves). While lawsuits are a cost, they are not the main drivers.

The nurse is comparing health promotion to wellness. Which description is accurate? A. Health promotion empowers one to improve health; wellness is a healthy state of being. B. Health promotion is the teaching of ill patients; wellness is the teaching of healthy patients. C. Health promotion is a healthy state of being; wellness empowers one to improve their health. D. Health promotion and wellness are identical concepts.

Answer: A Health promotion is the process of empowering individuals to take control of their health and achieve a state of wellness. Wellness is a state of balance and optimal health. Wellness is a continuum; a chronically ill person can still achieve a state of wellness, even though they rely on insulin, medication, or therapies to control the illness state.

The patient asks the nurse about health information that they obtained from a website. Which response should the nurse give? A. "There are sites where the information is reliable." B. "Most information on the internet is false." C. "I use Wikipedia all the time when I need to do research." D. "Following your physician's advice is better than reading about what to do on the internet."

Answer: A Research has found that a large number of adults use the internet for medical information. Nurses need to help patients with information access by directing patients to high-quality websites for information. The nurse should teach the patient how to interpret the information and not state that the information is false. The nurse should summarize how to determine if information is applicable and not direct the patient to follow healthcare provider's instructions. The nurse should not model behaviors such as using Wikipedia, an unreliable common source site that is not peer reviewed.

Which action by the nurse best exemplifies the definition of nursing as set by the American Nurses Association? A. Approaching the provider about alternative treatment when the patient refuses a blood transfusion B. Allowing the family to stay past visiting hours to keep from upsetting the family C. Choosing the patient's lunch menu because the nurse does not want to wake the patient D. Telling the patient's neighbor that the patient is stable when the neighbor calls to inquire

Answer: A The American Nurses Association's latest definition of nursing includes the importance of advocacy for patients. Ordering the patient's lunch is not a priority nursing intervention; the nurse can wait until the patient wakes up and find out from the patient what they prefer, based on their diet order from the provider. Telling a patient's neighbor about the patient's condition violates the patient's privacy; the nurse should always verify to whom the patient wishes to disclose information. Allowing the family to stay past visiting hours keeps the patient and other patients on the unit from obtaining the necessary rest to heal.

The nurse wants to become competent in a new skill. Which action most effectively ensures clinical competence according to best practices? A. Attending a continuing education aimed at becoming wound certified B. Watching other nurses model care C. Asking other nurses how they bandage wounds D. Practicing by using trial and error

Answer: A The key to answering this question is to think of "best practices." Continuing education toward wound care certification will provide evidence-based training. Trial and error and learning from other nurses may teach some valuable skills, but there is a high probability that shortcuts, improper technique, and outmoded practices will be learned along with the good content.

Consumers of nursing services are increasingly searching for integrated health services. Which behavior is expected of a contemporary consumer of healthcare? A. Practicing yoga and taking vitamins B. Doing exactly as the doctor suggests C. Researching old medical books D. Eating too many sweets

Answer: A Today's consumer is interested in complementary modalities such as yoga. Since the contemporary consumer is well educated and believes in self-advocacy, they are more likely to research health conditions online with up-to-the-minute research than rely on family wisdom, research old books, or rely solely on the doctor. There are no data to support that consumers of healthcare eat too many sweets.

The nurse discusses the status of morning care completed by unlicensed assistive personnel​ (UAPs). Which behavior is the nurse​ demonstrating? A. Accountability B. ​Client-centered care C. Safety D. Responsibility

Answer: A ​Rationale: Accountability is being responsible for the outcome of a completed task or assignment. Nurses are accountable for their own actions and behaviors but are also accountable for the actions of​ others, such as UAPs. Responsibility is the obligation to perform duties within the nursing role.​ Client-centered care and safety are competencies that support accountability in nursing practice.

The nurse is discussing the differences between accountability and responsibility with a colleague. Which statement by the nurse is accurate? A. "Responsibility has to do with subordinates performing their duties well." B. "Accountability involves being answerable for my actions as well as a subordinate's." C. "Responsibility is answering for outcomes." D. "Accountability has to do only with outcomes for the work of subordinates."

Answer: B Accountability is a broader concept than responsibility. The nurse is responsible for performing their own tasks well. But they are accountable for the outcomes of all nursing duties that they perform as well as those they delegate to subordinates.

The patient with a question about hypertension has a choice between going to an unlicensed health educator or a registered nurse (RN). Which healthcare worker is the best choice for the patient? A. The unlicensed educator for complementary advice and the RN for medical advice. B. The RN because they have completed a rigorous education and licensing exam to practice. C. Either one since both are capable of answering the patient's question. D. Unlicensed health educators have lower fees; the patient should choose them.

Answer: B Nurses are accountable to patients because of their rigorous schooling, licensing exam, and professional ethics. Nurses are trained in evidence-based complementary modalities and are a more reliable source of healthcare advice in these matters. The patient is better served by consulting a licensed nurse, even if cost and convenience argue in favor of seeing the unlicensed consultant.

The nurse is talking to a patient who is recovering from an eating disorder. Which statement by the nurse demonstrates the role of counselor? A. "Therapy is important since your feelings about your eating disorder are out of your control." B. "Tell me more about your feelings related to the recovery process." C. "Tell me more about how your eating disorder started and why." D. "I'm sure you are worried that you are going to relapse, and that is a normal feeling."

Answer: B Nurses counsel healthy individuals with normal adjustment difficulties and focus on helping these individuals develop new attitudes, feelings, and behaviors by encouraging them to look at alternative behaviors, recognize the choices, and develop a sense of control. Nurses counsel ill patients in how to develop more healthy and self-protective behaviors and how to recognize and respond to triggers, signs, and symptoms in a timely manner. It is not therapeutic or appropriate for the nurse to focus on why the disorder started or that a relapse is a possibility. Telling the patient their feelings are out of their control goes against helping the patient develop a sense of control.

Which group should the nurse recognize as the official body holding legal authority, providing professional autonomy, and setting standards for nursing care? A. The American Red Cross B. State board of nursing C. American Nurses Association D. Health and Human Services

Answer: B Professional accountability is established by a legal authority that can set and enforce professional standards. In nursing, this authority belongs to state boards of nursing. The American Nurses Association is a national professional association, but it does not enforce standards and regulate licenses. The American Red Cross is a charitable nonprofit organization, rather than an enforcing body. Health and Human Services is a government agency, but it has no authority to enforce standards.

The nurse is responsible for providing care to a group of patients. Which should the nurse use to guide the provision of safe quality care? A. Patient Self-Determination Act guidelines B. Standards of care C. Standards of practice D. Quality and Safety Education for Nurses competencies

Answer: B Standards of care are guidelines that determine what a nurse can or cannot do. These standards provide guidance to perform an action or a prescribed treatment for a patient. Quality and Safety Education for Nurses competencies are six competencies that support accountability in practice. The Patient Self-Determination Act is legislation that impacts patients and the profession of nursing. Standards of practice describe responsibilities for which nurses are accountable. These standards have been defined by nursing regulatory bodies and are often used as measures for quality and safety.

The nurse reads, "Nursing is the protection, promotion, and optimization of health and abilities." The nurse recognizes that which organization included this statement in their definition of professional nursing? A. National League for Nursing (NLN) B. American Nurses Association (ANA) C. The Joint Commission D. Quality and Safety Education for Nurses (QSEN)

Answer: B The current definition by the ANA is as follows: "Nursing is the protection, promotion, and optimization of health and abilities, preventions of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations." QSEN is an initiative sponsored by the Robert Wood Johnson Foundation to include quality and safety in pre-licensure nursing programs. The Joint Commission, NLN, and ANA have established standards of care that describe the responsibility for which nurses are accountable.

The nurse is listening empathetically and provides therapeutic feedback to a teenage girl who confesses to cutting herself. Which nursing role is the school nurse fulfilling in this case? A. Advocacy B. Counseling C. Change agent D. Teaching

Answer: B The nurse is fulfilling the role of the counselor in this case. Empathetic listening and therapeutic communication are counseling techniques that nurses use. Teaching, advocacy, change agency, and leadership are not primarily involved in this situation, although these may take place based on her conversation with the student.

A long-term care home is unable to recruit more nurses to work in their facility. Which is the most likely outcome for the facility as a result of short staffing? A. There are too many nurses and not enough jobs; the facility will be able to hire more staff. B. If the facility is understaffed, more nurses will quit due to burnout and exhaustion. C. The facility will have to increase pay, and this will attract more nurses. D. When the facility implements a $10,000 sign-on bonus, their problem will be solved.

Answer: B Understaffing and long hours lead to a downward spiral and constitute a major reason for the nursing shortage. Job satisfaction is lower, and nurses will quit from exhaustion and burnout. A problem with understaffing cannot be solved by merely adding incentives since the new nurses will also experience a pressured environment and by this time the system will show signs of strain. Hiring temporary workers may disrupt the company culture, also adding to current nurses' job dissatisfaction. While recruiting is the answer to the shortage, it is more involved than adding incentives and integrating independent workers who can't be mentored by senior nurses on staff.

Which helps to ensure that clients get the right care at the right time while avoiding unnecessary duplication of services and preventing medical​ errors? A. Quality and Safety Education for Nurses B. Accountable care organization C. Affordable Care Act D. Centers for Medicare and Medicaid Services

Answer: B ​Rationale: An accountable care organization​ (ACO) is a group of healthcare​ providers, hospitals, and other institutions and providers who come together voluntarily to give​ coordinated, high-quality care to their Medicare clients. The goal of an ACO is to ensure that​ clients, especially the chronically​ ill, get the right care at the right time while avoiding unnecessary duplication of services and preventing medical errors. The linkage of healthcare institutions through ACOs ensures that healthcare providers in all phases of a​ client's care are accountable to the core​ goal: ensuring the​ client's health. The Affordable Care Act and the other organizations do not ensure that clients get the right care at the right time.

The nurse is planning to teach a class about prevention of injuries. Which action reflecting the​ nurse's accountability should be included in the​ teaching? A. Taking action to prevent further harm B. Keeping clients safe within the healthcare environment C. Assessing the​ client's current level of health and wellness D. Assessing the​ client's level of comfort

Answer: B ​Rationale: The nurse is accountable for keeping clients safe within the healthcare​ environment, as well as for teaching clients ways to reduce the risk of illness and injury in their daily lives by​ (1) identifying and address safety hazards in the immediate healthcare​ environment; (2) assessing​ clients' risk for various types of injury outside the healthcare​ environment; and​ (3) as​ appropriate, teaching clients about actions that can reduce their risk of injury.

The clinical instructor is concerned that a student nurse is having difficulty implementing the Code for Nursing Students. Which student behavior supports this​ concern? (Select all that​ apply.) A. Asking a staff nurse for permission to observe a procedure at the bedside B. Placing the side rails in the down position for a confused client C. Stating that a client has to wait for pain medication because there were more important tasks to do D. Requesting assistance to complete a complicated dressing change E. Returning money that dropped out of a staff​ nurse's pocket while reaching for scissors

Answer: B, C ​Rationale: Behaviors that do not adhere to the Code for Nursing Students include not ensuring the safety of clients by keeping the side rails down in a client with confusion and not acting professionally when telling a client to wait for pain medication. Requesting​ assistance, asking for​ permission, and returning found money adhere to the principles of the Code for Nursing Students.

The nurse works at a multispecialty hospital with the main mission of providing quality care and client satisfaction. Which nursing behavior is a characteristic of​ competence? (Select all that​ apply.) A. Working alone B. Preventing medication errors C. Encouraging teamwork D. Promoting effective communication E. Knowing the law

Answer: B, C, D ​Rationale: Nursing competence includes preventing medication​ errors, promoting effective​ communication, and encouraging teamwork. These promote client​ safety, quality​ care, and client satisfaction.

The nurse consults with the dietitian regarding meal plans for a patient who is newly diagnosed with heart disease. Which professional function is the nurse demonstrating? A. Competence B. Socialization C. Collaboration D. Autonomy

Answer: C Collaboration is part of the American Nurses Association's Scope and Standards of Practice. An example of collaboration would be for the nurse to contact a dietitian to discuss the patient's eating plan. Socialization is the process by which individuals learn to become members of groups and society as well as learn the social rules defining the relationships into which they will enter. Autonomy means independence or freedom; thus, a profession is autonomous if it is able to regulate itself and set standards of practice for its own members. Competence includes many qualities, one of which is collaboration. Competence is defined as possessing the knowledge and skills necessary to perform one's job appropriately and safely.

The nurse is planning to discuss how the chain of command supports nursing. Which information should the nurse include? A. The chain of command provides responsibility. B. The chain of command gives nurses a way to report subordinates. C. The chain of command is a structure to address concerns. D. The chain of command enforces rules.

Answer: C The chain of command provides the nurse with an immediate supervisor who can address the nurse's professional concerns and questions about patient care. The chain of command is not primarily for discipline, although this is an important aspect in a high-stress profession that relies on structure. It is not meant to keep nurses in their place, nor is it meant as a way to get subordinates in trouble.

Which statement by the nurse reflects the American Nurses Association (ANA) definition of nursing? A. "Nursing is the ability to help the patient gain as much independence as rapidly as possible." B. "Nursing is direct, goal oriented, and adaptable to the needs of the individual and family." C. "Nursing is the protection, promotion, advocacy, and optimization of the health of many." D. "Nursing is the diagnosis and treatment of human responses to actual or potential health problems."

Answer: C The definition of nursing has changed many times over the years. The current definition by the ANA is as follows: "Nursing is the protection, promotion, and optimization of health and abilities, preventions of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations." The others are past definitions that are no longer currently used in nursing.

The nurse manager is preparing the staff for the arrival of nursing students for a clinical rotation on the unit. Which statement by the manager reflects support for the Code for Nursing Students? A. "Show the students the shortcuts that you use to quickly complete care." B. "Remind the students that learning does not occur by reading a book." C. "Ask the patients for permission before permitting the students to provide care." D. "Challenge these students to perform tasks for which they might not be prepared."

Answer: C The nurse manager should support the Code for Nursing Students by ensuring patients provide authorization before accepting treatment from the students. The students should not perform any tasks for which they are not prepared. Lifelong learning should be supported, and it may include reading a book. Care should be provided in a professional manner that may be violated through the use of shortcuts. Copying and pasting charting is unprofessional and may falsify important medical information.

The nurse is teaching a client with diabetes how to perform insulin injections. The client​ says, "I already know how to do it. I gave an injection to a friend​ before." Which standard of care should the nurse​ perform? A. Letting the client go home without seeing the client do the injection B. Telling the supervisor C. Asking the client to demonstrate the procedure to make sure D. Documenting that the client refused to do the demonstration

Answer: C ​Rationale: Accountability in nursing cannot be achieved without clear definitions of what is an accepted standard of care. The nurse is responsible for upholding the standards of care and is accountable for making the decision regarding the discharge of the client and ensuring that proper instruction and understanding have been achieved.

The nurse is providing care to a client from a different culture and notices that the​ client's spouse is always present and answers questions asked to the client. Which action should the nurse​ include? A. Reporting to the supervisor B. Documenting all interaction C. Understanding cultural differences D. Ignoring the spouse

Answer: C ​Rationale: Nurses can learn how to provide culturally competent care to clients of various cultural backgrounds. This information can help the nursing staff communicate effectively with clients and their families and help nurses provide care that is appropriate to the culture and the individual.

During a hospital​ orientation, the nurse was given copies of hospital​ policies, procedures, and protocols and asked to perform chart reviews. Which goal is this task aiming to​ achieve? A. Developing resources for quick reference B. Learning precautions C. Knowing what needs to be communicated to the client D. Earning continuing education units

Answer: C ​Rationale: These documents provide an overview of a procedure or​ skill, the desired​ outcome, facts,​ step-by-step instructions, red​ flags, and information on what needs to be communicated to the client and the​ client's family. Resources help develop nursing​ competency, critical thinking​ skills, and communication skills.

The nurse screens blood pressure levels, offers immunizations to children, offers a bicycle safety course, and offers a course in nutrition for families. Which activity is an example of health promotion? A. The bicycle safety course B. Offering immunizations C. Blood pressure screenings D. The nutrition course

Answer: D A nutrition course is a health promotion activity that enables families to achieve a state of wellness. The bicycle safety course is meant to prevent injuries, which is a form of illness prevention. Immunization is a form of primary illness prevention. Blood pressure screenings are secondary illness prevention, which identifies conditions needing treatment.

The nurse planning care for an obese patient realizes that the assistance of another healthcare professional is needed. Which action should the nurse take to exemplify the standard of collaboration? A. Calling physical therapy to have a larger wheelchair delivered to the care area B. Discussing the time breakfast trays arrive with the dietary supervisor C. Directing an unlicensed assistive personnel (UAP) to make the bariatric bed D. Contacting a dietitian to discuss a carbohydrate eating plan with the patient

Answer: D Collaboration is part of the American Nurses Association's Scope and Standards of Practice. An example of collaboration would be for the nurse to contact a dietitian to discuss the patient's eating plan. Telephoning for a wheelchair, timing of breakfast tray delivery, and directing UAPs to make the bed are all normal nursing tasks.

The nurse is caring for a patient and is unsure of how to perform a nursing procedure. Which action by the nurse reflects safe practice? A. Asking the unlicensed assistive personnel (UAP) if they have done the procedure and if so, if they can help. B. Calling the healthcare provider to come and perform the procedure C. Looking up how to do the procedure and perform as indicated D. Asking a more experienced nurse if they can assist

Answer: D Nurses continue to build competence throughout their career, with expertise coming from experience, gaining new knowledge, and improving their performance of skills. Even the most competent nurses sometimes encounter situations that make them question how best to respond. Luckily, nurses can collaborate with each other and with others on the interprofessional team, sharing opinions, ideas, and information. Although collaboration is helpful and even critical, each nurse is nevertheless accountable for their own choices and must weigh all information and choose the best course of action. The nurse who recognizes that there will always be a need to collaborate with others maintains a safe practice. It would not be appropriate to ask the UAP for assistance or call the healthcare provider since this is a nursing procedure. Looking up the procedure and performing as noted could risk injury to the patient.

The nurse provides a newly admitted patient with a copy of an advance directive to fill out. Which piece of legislation should the nurse recognize as being responsible for this accountability measure? A. The Informed Consent Act B. The Nurse Practice Act C. The Emergency Treatment Statute D. The Patient Self-Determination Act

Answer: D The Patient Self-Determination Act is a federal law that ensures patients are offered advanced directives upon admission and give informed consent for treatment, especially before any procedure. The Nurse Practice Act governs the practice of nursing in each particular state. The Informed Consent Act and the Emergency Treatment Statute do not exist.

The nurse caring for a patient recovering from surgery is mentoring a nursing student. Which question should the nurse ask the patient? A. "A student is here today to take care of you, but please let me know if you need anything." B. "A student will give you medications today since I have other patients." C. "I have a student following me today, so I may be running behind with your medications." D. "Would you feel comfortable allowing a nursing student to help with your care today?"

Answer: D The nurse should support the Code for Nursing Students by ensuring patients provide authorization before accepting treatment from the students. The students should not perform any tasks for which they are not prepared. It is not appropriate to simply tell a patient that they will have a student caring for them; the patient should be asked permission. The nurse and student should provide care for the patient in a timely, compassionate, and professional manner.

A student decides to change their major from nursing to business. Which reason for leaving the nursing program illustrates a factor in the nursing shortage? A. "I want to make a decent salary." B. "I would like to open a fashion boutique." C. "I can make more money in business than I can in nursing." D. "My mom's a nurse and says they have too many patients and not enough staff."

Answer: D When the student recounts their mother's experience of burnout as a factor in changing their major, she is describing one of the known factors in the nursing shortage. Nurses do make a decent middle-class salary, although many nurses feel their hard work deserves more compensation. The other reasons expressed by the student involve a personal preference, rather than factors in the nursing shortage.

The nurse is reviewing actions that reflect accountability. Which action should the nurse​ question? A. Accepting responsibility for doing the procedure B. Performing the procedure under the policies and protocols of the organization C. Having the ability to perform the procedure or intervention D. Performing all procedures and tasks delegated even when unsure of how to perform them

Answer: D ​Rationale: All practitioners must ensure that they perform competently and that they​ don't work beyond their level of competence. They must inform a senior member of staff when they are unable to perform competently. To be​ accountable, practitioners/nurses must​ (1) have the ability to perform the procedure or​ intervention, (2) perform the procedure under the policies and protocols of the​ organization, and​ (3) accept responsibility for doing the procedure.

The nurse is reading about means to ensure compliance with the Patient​ Self-Determination Act. Which item should the nurse​ question? A. Living will B. Advance directive C. Durable power of attorney D. Explanation of benefits

Answer: D ​Rationale: The Patient​ Self-Determination Act​ (PSDA) is a federal​ law, and compliance is mandatory. It is the purpose of this act to ensure that a​ client's right to​ self-determination in healthcare decisions be communicated and protected. Through advance​ directives, the living​ will, and the durable power of​ attorney, the right to accept or reject medical or surgical treatment is available to adults while competent so​ that, in the event that such adults become incompetent to make​ decisions, they would more easily continue to control decisions affecting their healthcare.