Practice Questions for Exam 3

A hospital utilizes the SOAP method of charting. Within this model, which of the nurse's following statements would appear at the beginning of a charting entry? A) "Client complaining of abdominal pain rated at 8/10." B) "Client is guarding her abdomen and occasionally moaning." C) "Client has a history of recent abdominal pain." D) "2 mg Dilaudid PO administered with good effect"

A) "Client complaining of abdominal pain rated at 8/10." The SOAP method of charting (Subjective data, Objective data, Assessment, Plan) begins with the information provided by the client, such as a complaint of pain. The nurse's objective observations and assessments follow, with interventions, actions, and plans later in the charting entry.

Which of the following are examples of breaches of client confidentiality? Select all that apply. A) A nurse discusses a client with a coworker in the elevator. B) A nurse shares her computer password with a relative of a client. C) A nurse checks the medical record of a client to see who should be called in an emergency. D) A nurse updates the employer of a client regarding the client's return to work. E) A nurse uses a computer to document a client's response to pain medication.

A) A nurse discusses a client with a coworker in the elevator. B) A nurse shares her computer password with a relative of a client. D) A nurse updates the employer of a client regarding the client's return to work. Nurses may use computers to document client data as long as they are not in a public area, and as long as the computer is shut down following the entries. A nurse can also check the medical record for a relative to call in case of an emergency. All the other examples are violations of client confidentiality.

A client's diagnosis of pneumonia requires treatment with antibiotics. The corresponding order in the client's chart should be written as: A) Avelox (moxifloxacin) 400 mg daily B) Avelox (moxifloxacin) 400 mg Q.D. C) Avelox (moxifloxacin) 400 mg qd D) Avelox (moxifloxacin) 400 mg OD

A) Avelox (moxifloxacin) 400 mg daily Among the JCAHO's list of "do not use" abbreviations are Q.D., qd, and OD when denoting a once-per-day drug administration. Because of the potential for misinterpretation and consequent drug errors, the JCAHO recommends writing "daily" in the order.

A nurse uses informatics to plan nursing care for a client. Which three terms best describes this science as it is applied to nursing? A) Data, information, knowledge B) Process, documentation, analysis C) Research, controls, variables D) Hypothesis, nursing, practice

A) Data, information, knowledge According to the ANA Scope and Standards of Nursing Informatics Practice, nursing informatics is a specialty that integrates nursing science, computer science, and information science to manage and communicate data, information, and knowledge in nursing practice. Nursing informatics facilitates the integration of data, information, and knowledge to support clients, nurses, and other providers in their decision making in all roles and settings. This support is accomplished through the use of information structures, information processes, and information technology (ANA, 2001, p. vii).

The nurse is a manager on an orthopedic unit. The unit changed to a new computer documentation system three days ago. One of the night nurses has called in sick every shift since the new system started. The nursing manager is aware that this situation has to do with resistance to change. Which of the following are common reasons why people resist change? Choose all that apply. A) Feel threatened B) Fear increased responsibility C) Lack of understanding D) See no benefits to the change E) Dislike hospital chief officer

A) Feel threatened B) Fear increased responsibility C) Lack of understanding D) See no benefits to the change The most common reasons people resist change are threat to self, lack of understanding, fear of increased responsibility, envisioning a lack of benefits to the change, and being unable to tolerate working in a state of flux. Dislike of the hospital CEO is not a common reason to resist change.

Review the following: 38 years old; growth in height to 52; female gender; weight gain of 15 pounds. This list can be referred to as which of the following? A) Information B) Knowledge C) Data D) Patient record

A) Information The segments are grouped into a meaningful, structured form and are considered together as information. However, 38, 52, female, 15 standing alone would be examples of raw, unprocessed numbers, symbols, or words that have no meaning by themselves and therefore would be data.

What is the primary purpose of an incident report? A) Means of identifying risks B) Basis for staff evaluation C) Basis for disciplinary action D) Format for audiotaped report

A) Means of identifying risks An incident report, also termed a variance or occurrence report, is a tool used by health care agencies to document the occurrence of anything out of the ordinary that results in, or has the potential to result in, harm to a client, employee, or visitor. Incident reports should not be used for disciplinary action against staff members.

The nurse managers of a home health care office wish to maximize nurses' freedom to characterize and record client conditions and situations in the nurses' own terms. Which of the following documentation formats is most likely to promote this goal? A) Narrative notes B) SOAP notes C) Focus charting D) Charting by exception

A) Narrative notes One of the advantages of a narrative notes model of documentation is that it allows nurses to describe clinical encounters in their own terms, as they understand them. Other documentation formats, such as SOAP notes, focus charting, and charting by exception, are more rigidly delineated and allow nurses less latitude in their documentation.

Which one of the following methods of documentation is organized around client diagnoses rather than around patient information? A) Problem-oriented medical record (POMR) B) Source-oriented record C) PIE charting system D) focus charting

A) Problem-oriented medical record (POMR) The POMR is organized around a client's problems rather than around sources of information. With POMRs, all health care professionals record information on the same forms. The advantages of this type of record are that the entire health care team works together in identifying a master list of client problems and contributes collaboratively to the plan of care.

Which of the following are main functions of a computer? Choose all that apply. A) Process B) Storage C) Memory D) Output

A) Process B) Storage D) Output

Which of the following health information is protected in the electronic health record? Choose all that apply. A) Social Security number B) Insurance information C) Physicians name D) Laboratory results

A) Social Security number B) Insurance information D) Laboratory results A patients protected health information includes any individually identifiable health information; current, past, or potential physical or mental conditions; and any payment information, such as Social Security numbers or insurance.

The nurse is reviewing a client's chart. When reading the history, physical, and physician progress notes, the nurse anticipates finding which of the following? A) The physician's assessment and treatment B) Results of laboratory and diagnostic studies C) Nursing documentation and plan of care D) Information from other members of the health care team

A) The physician's assessment and treatment The medical history, physical examination, and progress notes record the findings of physicians as they assess and treat the client. They focus on identifying pathologic conditions and their causes, as well as determining the medical regimen for treatment.

Which of the following abbreviations is on the list of the Joint Commission do not use abbreviations? Select all that apply. A) U (unit) B) QD (daily) C) NPO (nothing per os) D) mL (milliliters) E) > (greater than)

A) U (unit) B) QD (daily) E) > (greater than) The words "unit", "daily", "greater than" and "less than" should be spelled out. NPO, mL, and mcg are acceptable abbreviations.

The nurses who provide care in a large, long-term care facility utilize charting by exception (CBE) as the preferred method of documentation. This documentation method may have which of the following drawbacks? A) Vulnerability to legal liability since nurse's safe, routine care is not recorded B) Increased workload for nurses in order to complete necessary documentation C) Failure to identify and record client problems and associated interventions D) Significant differences in the charting between nurses due to lack of standardization

A) Vulnerability to legal liability since nurse's safe, routine care is not recorded A significant drawback to charting by exception is its limited usefulness when trying to prove high-quality safe care in response to a negligence claim made against nursing. CBE is generally less time-consuming than alternate methods of documentation, and both standardization of charting and identification of client-specific problems are possible within this documentation framework.

A client complains to the nurse-in-charge about another nurse on night shift. The client says that he kept calling the nurse but she never responded. Further, when he questioned the nurse, she said that she had other patients to take care of. The nurse-in-charge is aware that the client can be very demanding. What is an appropriate response for the nurse? A) "I am sorry that you had to suffer this way. The nurse on night duty should be fired." B) "It's hard to be in bed and ask for help. You ring for a nurse who never seems to help." C) "You seem to be impatient. The nurses work very hard and they do whatever they can." D) "I can see that you are angry. What the nurse did is wrong, and it won't happen again."

B) "It's hard to be in bed and ask for help. You ring for a nurse who never seems to help." The nurse should empathize with the client to perceive how the client is feeling. The nurse shares his or her perception with the client, which makes him comfortable to share his anxieties, fear, and concerns. The first response conveys pity on the client, which is inappropriate. In the third response, the nurse is taking the side of the nursing staff and the client may not like it. The fourth response is nontherapeutic.

Alice Jones, a registered nurse, is documenting assessments at the beginning of her shift. How should she sign the entry? A) Alice J, RN B) A. Jones, RN C) Alice Jones D) AJRN

B) A. Jones, RN Each entry is signed with the first initial, last name, and title. In this case, A. Jones, RN, is correct.

Which of the following methods of documenting client data is least likely to hold up in court if a case of negligence is brought against a nurse? A) Problem-oriented medical record B) Charting by exception C) PIE charting system D) Focus charting

B) Charting by exception Charting by exception is a shorthand documentation method that makes use of well-defined standards of practice; only significant findings or "exceptions" to these standards are documented in narrative notes. A significant drawback to charting by exception is its limited usefulness when trying to prove high-quality safe care in response to a negligence claim made against nursing.

In informatics, raw, unprocessed numbers, symbols, or words that have no meaning by themselves are called which of the following? A) Information B) Data C) Knowledge D) Wisdom

B) Data Data are raw, unprocessed numbers, symbols, or words that have no meaning by themselves. Information consists of groupings of data processed into a meaningful, structured form. Knowledge is formed when data are grouped, creating meaningful information and relationships, which are then added to other structured information. Wisdom is the appropriate use of knowledge in managing or solving human problems.

A physician's order reads "up ad lib." What does this mean in terms of client activity? A) May walk twice a day B) May be up as desired C) May only go to the bathroom D) Must remain on bed rest

B) May be up as desired The abbreviation "up ad lib" means the client may be up as desired.

A nurse is documenting information about a client in a long-term care facility. What is used in a Medicare-certified facility as a comprehensive assessment and as the foundation for the Resident Assessment Instrument (RAI)? A) PIE system B) Minimum data set C) OASIS D) Charting by exception

B) Minimum data set Long-term care documentation is specified by the RAI with the minimum data set forming the foundation for the assessment. This is required in all facilities certified to participate in Medicare or Medicaid. OASIS is used in the home health care industry.

Which of the following aspects of a computer determine its power? Choose all that apply. A) User friendliness B) Speed of operations C) Accessibility for the user D) Data storage capacity

B) Speed of operations D) Data storage capacity The power of a computer is determined by its speed, accuracy, reliability, and data storage and processing capabilities. Although ease of use and accessibility are important features for users, these factors do not determine the power of a computer.

Which of the following data entries follows the recommended guidelines for documenting data? A) "Client is overwhelmed by the diagnosis of pancreatic cancer." B) "Client's kidneys are producing sufficient amount of measured urine." C) "Following oxygen administration, vital signs returned to baseline." D) "Client complained about the quality of the nursing care provided on previous shift."

C) "Following oxygen administration, vital signs returned to baseline." The nurse should record client findings (observations of behavior) rather than an interpretation of these findings, and avoid words such as "good," "average," "normal," or "sufficient," which may mean different things to different readers. The nurse should also avoid generalizations such as "seems comfortable today." The nurse should avoid the use of stereotypes or derogatory terms when charting, and should chart in a legally prudent manner.

What is the nurse's best defense if a client alleges nursing negligence? A) Testimony of other nurses B) Testimony of expert witnesses C) Client's record D) Client's family

C) Client's record The client record is the only permanent legal document that details the nurse's interactions with the client. It is the best defense if a client or client surrogate alleges nursing negligence.

A nurse has access to computerized standardized plans of care. After printing one for a client, what must be done next? A) Date it and put it in the client's record. B) Sign it and put it in the Kardex. C) Individualize it to the specific client. D) Use it as printed, based on common needs.

C) Individualize it to the specific client. Standardized care plans that identify common problems and needs with relation to select client cohorts may be used. Unless such care plans are individualized to a specific client, however, they may not address individual client needs.

Computers are important for evidence-based practice because: A) They are available in all healthcare institutions. B) Extra training is not required for information retrieval. C) Information can be accessed and managed more efficiently. D) All of the best evidence is located on a computer.

C) Information can be accessed and managed more efficiently. To incorporate the current, best evidence in your nursing practice, you must be able to locate the evidence, evaluate its quality and relevance to the problem, and apply the solution to clinical care. Computers are useful for data access, management, storage, and retrieval when conducting research or reviewing research findings. Specialized software aids in statistical analysis of research data. Computers are not available to all personnel in all healthcare institutions nor can the entirety of best evidence be found electronically. Training and experience are required to learn how to use a computer as well as how to conduct a literature search.

A nurse in a nursing home is writing a note that addresses the care a resident has received during the day and the resident's response to care. What type of note does this represent? A) PIE note B) Flow sheet C) Narrative note D) SOAP note

C) Narrative note A narrative note in a skilled nursing facility might include the type of morning care, nutritional intake, client activity pattern, and comfort measures provided, along with the client's response.

A nurse realizes that the dosage of the medication administered to the client has been entered incorrectly into the client records. Which of the following would be most appropriate for the nurse to do? A) Completely erase or delete the erroneous entry if possible. B) Use a highlighter to mark the incorrect entry and place initials next to it. C) Strike out the entry with a single line, place initials next to it, and write the correct entry. D) Black out the erroneous entry with a dark pen or marker.

C) Strike out the entry with a single line, place initials next to it, and write the correct entry. The nurse should strike out the erroneous entry with a single line and place initials over it. When an error occurs, erasure or use of correction fluid is not permissible. Use of highlighters is not allowed and can draw attention to the erroneous documentation.

A nurse is documenting the intensity of a client's pain. What would be the most accurate entry? A) "Client complaining of severe pain." B) "Client appears to be in a lot of pain and is crying." C) "Client states has pain; walking in hall with ease." D) "Client states pain is a 9 on a scale of 1 to 10."

D) "Client states pain is a 9 on a scale of 1 to 10." Information should be documented in a complete, accurate, relevant, and factual manner. Avoid interpretations of behavior, generalizations, and words such as "good."

A nurse at a health care facility has just reported for duty. Which of the following should the nurse do to ensure maximum efficiency of change-of-shift reports? A) Pay courtesy calls to staff members before attending the meeting. B) Wait for the physicians to arrive before exchanging notes. C) Avoid asking questions related to the medical record. D) Come prepared with material required to take notes.

D) Come prepared with material required to take notes. The nurse should come prepared with material required to take notes during the change-of-shift reports. The nurse should not delay the meeting for change-of-shift report by paying courtesy calls to staff members before attending the meeting. Change-of-shift reports are not conducted in the presence of physicians, thus the nurse does not need to wait for the physicians to arrive before exchanging notes. The nurse should ask questions related to the medical record if any information is unclear.

A nurse is manually documenting information related to a client's condition. When documenting this information, the nurse makes an error on the manual record sheet. Which is the best technique for recording the error made in documentation? A) Erase the incorrect statement and write the correct one. B) Cross out the wrong statement in a way that is not readable. C) Use correction fluid to obliterate what has been written. D) Cross out the incorrect statement with a single line.

D) Cross out the incorrect statement with a single line. When recording an error in documentation, the nurse should always cross out the incorrect statement with a single line so that it remains readable, add the date, initial, and then document the correct information. The nurse should not erase the incorrect statement and replace it with the correct one, nor cross out the wrong statement in a way that makes the statement unreadable, nor use correction fluid to obliterate what has been written. These methods render the medical record a poor legal defense.

What part of the client's record is commonly used to document specific client variables, such as vital signs? A) Progress notes B) Nursing notes C) Critical paths D) Graphic record

D) Graphic record The graphic record is a form used to document specific client variables such as vital signs, weight, intake and output, and bowel movements.

CINAHL is a(n): A) Popular periodical. B) Internet site. C) Scholarly journal. D) Literature database

D) Literature database CINAHL, The Cumulative Index of Nursing and Allied Health Literature, is a literature database covering nursing, allied health, biomedical, and consumer health journal articles. CINAHL may be accessed by the Internet or in hard copy in most libraries.

A group of nurses visits selected clients individually at the beginning of each shift. What are these procedures called? A) Nursing care conferences B) Staff visits C) Interdisciplinary referrals D) Nursing care rounds

D) Nursing care rounds Nursing care rounds are procedures in which a group of nurses visits select clients individually at each client's bedside. The primary purposes are to gather information to help plan and evaluate nursing care and to provide the client with an opportunity to discuss care.

What activity in charting will assist most in the avoidance of errors? A) Objectivity B) Organization C) Legibility D) Timeliness

D) Timeliness Documentation in a timely manner can help avoid errors.

_____ is the managing and processing of information necessary to make decisions.

Informatics

_____ such as NIC, NOC, NANDA-I, and PNDS can be used to describe the unique nursing contributions to patient care.

Standardized nursing languages

_____ is the use of telecommunication to send healthcare information between patients and professionals at different locations.

Telehealth

Facebook, MySpace, and LinkedIn are examples of _____ tools.

social networking

A nurse refers a client with a new colostomy to a support group. This nurse is practicing which of the following aims of nursing? A) Promoting health B) Preventing illness C) Restoring health D) Facilitating coping

D) Facilitating coping Not all clients fully recover from their illness or injury; many clients will need to learn to cope with permanent health alterations.

A nurse is described as a "quantum leader." Which action characterizes this type of leadership? A) A nurse conducts a blind survey to evaluate her leadership skills. B) A nurse relinquishes power to a group deciding hospital policy. C) A nurse makes policy decisions for coworkers without consulting them. D) A nurse sticks to the "tried and true" methods when implementing client care.

A) A nurse conducts a blind survey to evaluate her leadership skills. Quantum leaders must have excellent communication skills, encourage personal critiques, and challenge current ways of thinking and doing. A nurse who relinquishes power to a group to make decisions is using laissez-faire leadership. A nurse making decisions for coworkers without considering their feelings is an autocratic leader.

An older adult client who has had a colostomy for over 10 years states, "I won't need any teaching about colostomies. I understand how to change the bag and care for my colostomy, but I'm not sure how to best clean my stoma." What does this statement indicate? A) An incongruent relationship B) A confused relationship C) A non-therapeutic relationship D) An evaluative relationship

A) An incongruent relationship The client's two statements are incongruent with each other. This indicates the need for further education.

A nurse is writing learning outcomes for a client recovering from severe burns. Which of the following verbs would be good choices to use when preparing outcomes related to learning how to change dressings? Select all that apply. A) Assembles B) Demonstrates C) Gives examples D) Identifies E) Chooses

A) Assembles B) Demonstrates Changing dressings falls into the psychomotor domain. "Assembles" and "demonstrates" are appropriate verbs for outcomes. "Gives examples" and "identifies" are verbs best used for the cognitive domain. "Chooses" and "values" relate to the affective domain.

A nurse is educating an elderly client with diabetes and his family members about the importance of a nutritious diet. The nurse knows that client education promotes which of the following purposes? Select all that apply. A) Helps the nurse to restore optimal health in the client B) Helps the client to cope with alterations in health status C) Helps the nurse to be more aware of the client's health D) Helps the nurse to diagnose the client's illness early E) Helps the nurse to be well-informed about the client's care

A) Helps the nurse to restore optimal health in the client B) Helps the client to cope with alterations in health status Nurses are involved in client education to promote wellness (primary prevention), prevent or diagnose illness early (secondary prevention), restore optimal health and function if illness has occurred (tertiary prevention), and assist clients and families to cope with alterations in health status. Simply being knowledgeable about the client's health status and care is not enough. Nurses must know the education and learning process and know how best to include the client's family in the process.

A student nurse has just graduated with a baccalaureate degree in nursing. What type of nursing leadership will this nurse be expected to provide? A) Nursing care of the individual client B) Demonstration of selected critical skills C) Ability to be a follower rather than a leader D) Nursing care of groups of clients

A) Nursing care of the individual client New graduates have leadership responsibilities when they begin nursing. Nursing leadership begins with nursing care of the individual client.

Which of the following should the nurse first consider when attempting to become culturally competent? A) Personal cultural beliefs and prejudices B) Understanding the client's response C) Avoiding labeling clients D) Treating the client with dignity

A) Personal cultural beliefs and prejudices The first step toward cultural competence requires becoming aware of your own personal cultural beliefs and prejudices.

A head nurse assumes the leadership role when directing and supervising coworkers. Which of the following are attributes of a leader? Select all that apply. A) Philosophical B) Task-oriented C) Charismatic D) Dynamic E) Intimidating

A) Philosophical C) Charismatic D) Dynamic Leadership involves philosophy, perception, and judgment whereas management tasks are the core of the management role. Leaders need to be comfortable with themselves (i.e., have a positive self-image) and present themselves as role models for followers. Ideally, they also have a vision that energizes the group and brings forth the best efforts of members. Leaders may be charismatic, dynamic, enthusiastic, poised, confident, and self-directed.

A group of nursing students is working together on a presentation for their clinical instructor. One student in the group participates by arguing and attempting to block each step of the process of this presentation. The student's behavior is causing frustration for the others and slowing their progress. Which of the following best describes the role this individual student is playing in relationship to the group dynamics? A) Self-serving B) Task-oriented C) Maintenance D) Group-building

A) Self-serving The student's behavior is best described as self-serving. Self-serving roles advance the needs of individual members at the group's expense. Task-oriented roles focus on the work to be completed. Group-building or maintenance roles focus on the well-being of the people doing the work.

A nurse pays a house visit to a client who is on total parenteral nutrition. The client expresses that he misses enjoying food with his family. What is the most appropriate response by the nurse? A) Tell me more about how it feels to eat with your family. B) You can sit with your family at meal times, even though you don't eat. C) In a few weeks you may be allowed to eat a little; you may enjoy then. D) I know that you must be missing your favorite foods.

A) Tell me more about how it feels to eat with your family. The nurse should help the client to verbalize his feelings and cope with aspects of illness and treatment. Asking open-ended questions is most appropriate as the nurse encourages the client to express his feelings. The other options block communication and are not appropriate. Telling the client that he can sit with his family but avoid eating does not consider the client's feelings. Informing the client that he will be able to eat food in a few weeks changes the subject and stops communication. Stating that the client is missing his favorite dishes devalues the client's feelings.

A nurse is educating a home care client on how to administer a topical medication. The client is watching television while the nurse is talking. What might be the result of this interaction? A) The message will likely be misunderstood. B) The stimulus for communication is unclear. C) The receiver will accurately interpret the message. D) The communication will be reciprocal.

A) The message will likely be misunderstood. Noise, which is a factor that distorts the quality of a message, can interfere with communication at any point in the process. If the client is watching television, it is likely that the message from the nurse will be misunderstood.

The nurse has entered a client's room after receiving a morning report. The nurse rapidly assessed the client's airway, breathing, and circulation and greeted the client by saying "Good morning." The client has made no reciprocal response to the nurse. How should the nurse best respond to the client's silence? A) The nurse should ask appropriate questions to understand the reasons for the client's silence. B) The nurse should apologize for bothering the client, perform necessary assessments efficiently and leave the room. C) The nurse should document the client's withdrawal and diminished mood in the nurse's notes. D) The nurse should ask the client if he feels afraid or angry.

A) The nurse should ask appropriate questions to understand the reasons for the client's silence. Silence can have many meanings, and the nurse should attempt to identify the meaning of the client's silence in a tactful manner. Directly asking if the client is angry or fearful is likely presumptuous and may harm rapport. The nurse should not make assumptions around the client's mood nor should the nurse cease to engage with the client.

A diabetes nurse educator is teaching a client, newly diagnosed with diabetes, about his disease process, diet, exercise, and medications. What is the goal of this education? A) To help the client develop self-care abilities B) To ensure the client will return for follow-up care C) To facilitate complete recovery from the disease D) To implement ordered teaching and counseling

A) To help the client develop self-care abilities The basic purpose of educating and counseling is to help clients and families develop the self-care abilities (knowledge, attitude, skills) needed to maintain and improve health.

A nurse is attempting to change the method for documenting client care in a hospital setting. Which of the following should be considered before planning change? Select all that apply. A) What is amenable to change? B) How does the group function as a unit? C) Is the group ready for change? D) Are the changes major or minor? E) How can I keep from changing again?

A) What is amenable to change? B) How does the group function as a unit? C) Is the group ready for change? D) Are the changes major or minor? Before planning to make a change, a nurse manager should consider the following; What is amenable to change? Considering this question might reveal a behavior not amenable to change. How does the group function as a unit? Is the person or group ready for change and, if so, at what rate can that change be expected to be accepted? Are the changes major or minor? A series of small changes might be more easily accomplished than one large, dramatic change. Change is inevitable; a more appropriate question to ask is how often this change needs to be evaluated.

Which of the following is an example of a closed-ended question or statement? A) "How did that make you feel?" B) "Did you take those drugs?" C) "What medications do you take at home?" D) "Describe the type of pain you have."

B) "Did you take those drugs?" The closed-ended question or statement provides the receiver with limited choices of possible responses and might often be answered by one or two words, such as "yes" or "no." When not used appropriately, closed-ended questions are a barrier to effective communication.

When caring for a client, the nurse gives day-to-day examples to explain certain points of the health education. The nurse also notes the client's concentration level and educates when the client is active. Which category does the client fall into? A) Motivation B) Attention and concentration C) Learning readiness D) Learning needs

B) Attention and concentration The client's attention and concentration affect the duration, delivery, and education methods employed. It is helpful to observe the client and implement health education when he or she is most alert and comfortable. This also means involving the client in an active way by providing examples of day-to-day activities. Learning is optimal when a person has a purpose for acquiring new information. The client needs to be motivated to learn new things. Readiness refers to the client's physical and psychological well-being. The best education and learning take place when both are individualized. To be most efficient and personalized, the nurse must gather pertinent information from the client and determine the client's needs when learning.

A nurse educating a new mother on how to bathe her infant uses the acronym TEACH to maximize the effectiveness of the education plan. Which of the following are guidelines based on this acronym? Select all that apply. A) Tune out the individual client. B) Edit client information. C) Act on every teaching moment. D) Always refer a client to counseling. E) Clarify often.

B) Edit client information. C) Act on every teaching moment. E) Clarify often. To maximize the effectiveness of patient education, the nurse should use the acronym TEACH — T: tune into the client, E: edit client information, A: act on every teaching moment, C: clarify often, H: honor the client as a partner in the education process.

What action by the nurse will facilitate the helping relationship during the orientation phase? A) Providing assistance to meet activities of daily living B) Introducing oneself to the client by name C) Designing a specific teaching plan of care D) Preparing for termination of the relationship

B) Introducing oneself to the client by name In the orientation phase of the helping relationship, the nurse and patient meet and learn to identify each other by name. It is especially important that the nurse introduce herself or himself to the patient during this phase.

A nurse uses the SBAR method to hand off the communication to the health care team. Which of the following might be listed under the "B" of the acronym? A) Vital signs B) Mental status C) Client request D) Further testing

B) Mental status SBAR stands for Situation, Background, Assessment, and Recommendations, and provides a consistent method for hand-off communication that is clear, structured, and easy to use. Vital signs would fall under the category of situation; mental status: background; client request: assessment; further testing: recommendations.

A nurse tells a client, "Aren't you going to get out of bed or are you just going to sleep all day and night?" This is an example of which of the following barriers to communication? A) Using comments that give advice B) Using judgmental or belittling language C) Using leading questions D) Using probing questions

B) Using judgmental or belittling language Using judgmental comments tends to impose the nurse's standards on the client. In this case, the nurse judges the client as being lazy and the nurse's apparent hostility could end effective communication.

Which of the following statements accurately describes the use of power by change agents? A) They know that power comes from one source—management. B) When introducing change they do not enlist the support of key power players. C) They are often accomplished professional women. D) They do not recognize their own strengths and weaknesses.

C) They are often accomplished professional women. Power, the ability to influence others to achieve a desired effect, has many sources. When introducing change, it is helpful to recognize and enlist the support of key power players who can then encourage others to become involved. Women are accomplished professionals and occupy powerful leadership positions in corporations, health care organizations, and political arenas. Nursing leaders recognize the strengths and limitations of their own power and encourage others to develop and use power constructively.

A nurse tells a client that she will come back in 10 minutes to re-assess the client's pain. When the nurse returns in 10 minutes, which aspect of the therapeutic relationship is the nurse developing? A) Empathy B) Sympathy C) Trust D) Closure

C) Trust When a nurse repeatedly upholds commitments made to a client, it fosters foundational trust within the therapeutic relationship. The other options may be part of the therapeutic relationship, but in this case the nurse's behavior will instill trust.

A nurse manager makes all of the decisions for staff activities. What type of leadership is demonstrated by this action? A) Democratic B) Self-governance C) Laissez-faire D) Autocratic

D) Autocratic Autocratic leadership involves the leader assuming complete control over the decisions and activities of the group. An extremely autocratic leader might make all decisions for workers without considering their ideas or feelings.

A nurse notices that a toddler is constantly snatching toys from the hands of other preschool children at the health care facility, placing the toddler and other children at risk for injury. Which of the following would be a most effective method for teaching the toddler not to snatch toys? A) Ask the children to play another game. B) Tell the toddler that God punishes children who snatch. C) Give the toddler another toy with which to play. D) Enlist the aid of the toddler's parents in education.

D) Enlist the aid of the toddler's parents in education. The nurse should inform the toddler's parents as to his or her behavior. Since toddlers and preschoolers are accustomed to learning from and communicating with their parents, the parents are usually the most effective teachers. Children learn through play, so using dolls or toys as models can enhance learning. Giving another toy to the toddler or asking the children to play another game may not solve the problem, as the toddler would still want someone else's toys. Telling the toddler that God punishes children who snatch is not correct because the nurse is indirectly trying to scare and threaten the toddler.

What is the most critical element of documentation of education? A) A summary of the education plan B) The implementation of the education plan C) the client's need for learning D) Evidence that learning has occurred

D) Evidence that learning has occurred Documentation of the education-learning process includes a summary of the learning need, the plan, the implementation of the plan, and the evaluation results. The evaluative statement is crucial and must show concrete evidence that demonstrates that learning has occurred. If the desired learning has not occurred, the notes should indicate how the problem was resolved. It is insufficient to document only what was taught; the charting must show evidence that the client or significant other has actually learned the material taught.

A male client age 42 years recovering from a MI is having difficulty following the care plan to stop smoking and exercise. What is the nurse's best response to this client? A) Praise him for trying. B) Tell him that he will have another MI and it will be his own fault. C) Tell him that his cigarettes will be taken away if he smokes again. D) Ignore the behavior and recommend a behavior modification program.

D) Ignore the behavior and recommend a behavior modification program. Negative reinforcement (criticism or punishment) is generally ineffective; undesirable behavior is usually best ignored. Behavior modification programs that reward desired behaviors and ignore undesired behaviors might be best for this client.

A nurse leader is described as charismatic, motivational, and passionate. Communications are open and honest, and the nurse is willing to take risks. What type of leadership is the nurse practicing? A) Democratic B) Autocratic C) Quantum D) Transformational

D) Transformational Transformational leaders are often described as charismatic, challenging, and passionate about their vision. They communicate openly and honestly, show concern for others, and are willing to take risks.

The nurse has entered a client's room and observes that the client is hunched over and appears to be breathing rapidly. What type of question should the nurse first implement in this interaction? A) A yes/no question B) A directing question C) An open-ended question D) A reflective question

A) A yes/no question There are times when yes/no questions are appropriate. In this case, the nurse may want to ask, "Do you feel short of breath?" or something similar. Directing questions and reflective questions follow up on earlier communication. An open-ended question may elicit the necessary assessment data, but a yes/no question accomplishes this goal more directly.

The nurse has just graduated with a Bachelor of Science in Nursing and is eager to find a mentor at this early stage in her career. Which of the following individuals is most likely to be an appropriate mentor for the nurse? A) An experienced nurse who was a preceptor in a previous clinical placement B) The nurse educator on the hospital unit where the novice nurse has been hired C) A colleague who graduated with honors at the same time as the novice nurse. D) The unit manager who the novice nurse.

A) An experienced nurse who was a preceptor in a previous clinical placement A person who demonstrates positive qualities and who possesses more experience is often a good choice to be a nurse's mentor. A person in formal authority or oversight, such as the unit educator or manager, is a less ideal choice, and a peer is not normally an ideal choice of mentor.

Which of the following nursing care tasks is acceptable for a graduate nurse to delegate to unlicensed assistive personnel (UAP)? A) Assisting a client with ambulation B) Evaluation of nursing care delivered to a client C) Initial and ongoing assessments D) Development of a client teaching plan

A) Assisting a client with ambulation Tasks that should be performed by a registered nurse include initial and ongoing assessments, determining nursing diagnoses, plan of care, evaluation of client progress, evaluation of the nursing care delivered to the patient, supervision and education of nursing personnel, and client education. Tasks such as ambulation, assistance with meals and hygiene, and obtaining vital signs are acceptable tasks for a UAP to perform.

What type of leader shares decisions and activities with group participants? A) Democratic B) Autocratic C) Laissez-faire D) Situational

A) Democratic Democratic leadership, also called participative leadership, is characterized by equality among the leader and other participants. Decisions and activities are shared.

What type of leadership can a graduate nurse working in a magnet hospital expect? A) Democratic B) Autocratic C) Situational D) Quantum

A) Democratic Working in a magnet hospital can maximize the potential of new graduates who prefer democratic leadership.

The nurse is having an exceptionally busy shift on an obstetrical unit. Which of the following tasks is the nurse justified in delegating to an unlicensed care provider? A) Emptying a client's Foley catheter bag and reporting the volume to the nurse B) Helping a first-time mother achieve a good latch when breast-feeding her infant C) Assessing the size and quantity of clots that are in a client's bedpan and informing the nurse D) Giving an anti-inflammatory to a client who is eight hours postdelivery

A) Emptying a client's Foley catheter bag and reporting the volume to the nurse Emptying a Foley catheter bag and reporting the volume is within the scope of an unlicensed care provider. Assistance with breast-feeding, assessments, and medication administration are not tasks that should be delegating to anyone but an RN.

Which of the following strategies might a nurse use to increase compliance with education? A) Include the client and family as partners. B) Use short, simple sentences for all ages. C) Provide verbal instruction at all times. D) Maintain clear role as the authority.

A) Include the client and family as partners. Compliance is facilitated by including the client and family in the education-learning process. Other strategies include making sure instructions are understandable, using interactive education methods, and having a strong interpersonal relationship with clients and their families.

The ANA, which is committed to monitoring the regulation, education, and use of NAPs, recommends adherence to which one of the following principles? A) It is the nursing profession that determines the scope of nursing practice. B) It is the RN who defines and supervises the education, training, and use of any unlicensed assistant roles. C) It is the assigned NAP who is responsible and accountable for his or her nursing practice. D) It is the purpose of the RN to work in a supportive role to the assistive personnel.

A) It is the nursing profession that determines the scope of nursing practice. It is the nursing profession that determines the scope of nursing practice, and defines and supervises the education, training, and use of any unlicensed assistant roles involved in providing direct nursing care. It is the registered nurse who is responsible and accountable for nursing practice, and who supervises any assistant involved in providing direct client care. It is the purpose of assistive personnel to work in a supportive role to the registered nurse, carrying out tasks that enable the professional nurse to concentrate on caring for the client.

A client has been recently diagnosed with diabetes. He is seen in the emergency room every day with high blood sugar. The client apologizes to the nurse for bothering them every day, but he cannot give himself insulin injections. What should the nurse's response be? A) "I myself cannot take insulin injections." B) "Has someone taught you how to take them?" C) "You should learn to take injections yourself." D) "Ask the doctor to change the medications."

B) "Has someone taught you how to take them?" The nurse should assess whether the client has a knowledge deficit regarding self-injection. If there is a knowledge deficit, the nurse should educate the client in the correct method of taking insulin injections. Answer A is a negative reinforcement and is therefore inappropriate. Demanding that the client learn injection administration is also inappropriate. Answer D is inappropriate, because the nurse should not offer a change that cannot be carried out.

Planned change is a purposeful, systematic effort to alter or bring about change. What occurs next after alternative solutions to a problem are determined and analyzed? A) All of the alternative solutions are implemented. B) A course of action is chosen from among the alternatives. C) The effects of the change are evaluated. D) The change is stabilized and established.

B) A course of action is chosen from among the alternatives. After determining and analyzing alternative solutions to a problem, select a course of action from the possible alternatives. It is best to avoid initiating too many courses of action and thereby dissipating resources and energy.

When comparing team nursing with functional nursing, what characteristic is found? A) Team nursing is very similar to functional nursing. B) Team nursing focuses on individual client care. C) Functional nursing has a stronger focus on the client. D) Functional nursing is based on total client care.

B) Team nursing focuses on individual client care. In team nursing, a registered nurse and other caregivers provide care to a designated group of clients for a given shift. Team nursing modifies the depersonalized approach of functional nursing and focuses on individual client care.

Which type of skills is not needed for nursing leadership? A) Communication skills B) Technical skills C) Problem-solving skills D) Self-evaluation skills

B) Technical skills The four basic types of skills needed for nursing leadership are communication, problem solving, management, and self-evaluation. Technical skills are important to other nursing roles, but are not leadership skills.

A client comes to the clinic complaining of abdominal pain. Which first question would be most appropriate for the nurse to ask to facilitate the assessment? A) "Do you have sharp, stabbing pain?" B) "Is the pain associated with meals?" C) "What activities exaggerate the pain?" D) "Does the pain increase on palpation?"

C) "What activities exaggerate the pain?" "What activities exaggerate the pain?" is an open-ended question, because it gives the client an opportunity to express feelings and describe the pain. "Do you have sharp, stabbing pain?"; "Is the pain associated with meals?"; and "Does the pain increase on palpation?" are questions that can be answered with "Yes" or "No." These questions would be helpful later in the assessment to help focus on the client's statements.

Which of the following is an example of nonverbal communication? A) A nurse says, "I am going to help you walk now." B) A nurse presents information to a group of clients. C) A client's face is contorted with pain. D) A client asks the nurse for a pain shot.

C) A client's face is contorted with pain. Nonverbal communication is the transmission of information without the use of words. In this situation, the facial contortion is a nonverbal message of pain.

Which of the following is an essential component of the definition of learning? A) Increases self-esteem B) Decreases stress C) Can be measured D) Cannot be measured

C) Can be measured Learning is the process by which a person acquires or increases knowledge, or changes behavior in a measurable way, as a result of an experience.

A nurse manager has encountered resistance to a planned change. What is one way the nurse can overcome the resistance? A) Tell the staff that if they don't like it, they can quit. B) Implement change rapidly and all at once. C) Encourage open communication and feedback. D) Let the staff know that the change is mandated.

C) Encourage open communication and feedback. Providing opportunities for open communication and feedback is one way to overcome resistance to change.

A senior student has been elected president of the Student Nurses Association. Which of the following qualities is essential to being a nursing leader? A) Physical stamina B) Physical attractiveness C) Flexibility D) Independence

C) Flexibility Flexibility is a must for all nurse leaders. The needs of clients, families, and the nursing team can change from minute to minute. Leaders of nursing organizations must also demonstrate the characteristics of a nursing leader.

A nurse manager has directed a registered nurse who is out of school for one year to become a member of the institution's policy and procedure committee. A goal in the nurse manager's delegation is to assist the nurse to what? A) Be involved in the hospital B) Be confident in employment C) Grow in her profession D) Understand the hospital setting

C) Grow in her profession Delegation of activities to staff members will assist them to grow and become more committed to their organization.

Which of the following is a characteristic of mentorship? A) It is a paid position to orient new nurses to the workplace. B) It involves membership in a professional organization. C) It is a link to a protégé with common interests. D) It is not encouraged in health care settings

C) It is a link to a protégé with common interests. Mentorship is a relationship in which an experienced individual (the mentor) advises and assists a less experienced individual (protégé). This is an effective way of easing a new nurse into leadership responsibilities. Mentors link with protégés by common interest and provide support, information, and network links. The relationship does not include financial reward. An alternative model is preceptorship. The preceptor (experienced nurse) is selected (and generally paid) to introduce an employee to new responsibilities through education and guidance.

An older adult client is very stressed about who will care for his pets while he is hospitalized for a fall that caused a fractured hip. What type of counseling would the nurse conduct? A) None B) Long-term C) Short-term D) Motivational

C) Short-term Short-term counseling focuses on an immediate problem or concern of the client or family. Even if it is a relatively minor concern, it needs immediate attention.

A client tells the nurse that he is very worried about his surgery. Which of the following responses by the nurse is a cliché? A) "Tell me what you are worried about." B) "Have you spoken to your family about your concerns?" C) "Do you want to cancel your surgery?" D) "Don't worry, everything will be fine."

D) "Don't worry, everything will be fine." A cliché is a stereotypical, trite, or pat answer. Most health care clichés suggest there is no cause for concern, or they often offer false assurance. Their use tends to be interpreted as a lack of real interest in what has been said.

A nurse working on leadership skills should keep in mind which of the following accurate statements regarding leaders? A) People are born leaders. B) Leadership should be approached quickly. C) Leaders develop leadership skills in undefined situations. D) All nurse leaders began as inexperienced nurses.

D) All nurse leaders began as inexperienced nurses. Leadership should be approached like any other new role or skill: slowly and carefully. Nursing students and beginning nurses should be prepared with all of the necessary tools or skills before attempting the new role. Initially, nurses develop leadership skills in well-defined clinical situations. With each experience, growth occurs and leadership is strengthened. All nurse managers, nurse administrators, and nursing leaders also began as inexperienced nurses.

What word or phrase best describes an effective counselor? A) Technically skilled B) Knowledgeable C) Practical D) Caring

D) Caring An effective counselor needs to be a caring individual with the interpersonal skills of warmth, friendliness, openness, and empathy.

The nurse has engaged the services of an interpreter when interviewing a client who speaks a language that the nurse does not understand. The interpreter is functioning in which role during the communication process? A) Sender B) Encoder C) Receiver D) Communication channel

D) Communication channel The interpreter's role is that of a communication channel. A communication channel is the medium, the carrier of the message. The interpreter conveys the message sent by the client to the nurse. The client is the sender and the encoder of the message. The nurse is the receiver of the message.

A nursing student caring for an unconscious client knows that communication is important even if the client does not respond. Which nonverbal action by the nursing student would communicate caring? A) Making constant eye contact with the client B) Waving to the client when entering the room C) Sighing frequently while providing care D) Holding the client's hand while talking

D) Holding the client's hand while talking Tactile sense is a form of nonverbal communication and is viewed as one of the most effective nonverbal ways to express feelings of comfort.

A nurse who is discharging a client is terminating the helping relationship. Which of the following actions might the nurse perform in this phase? Select all that apply. A) Making formal introductions B) Making a contract regarding the relationship C) Providing assistance to achieve goals D) Helping client perform activities of daily living E) Examining goals of the relationship to determine their achievement

E) Examining goals of the relationship to determine their achievement In the termination phase, the nurse examines with the client the goals of the helping relationship for indications of their attainment, or for evidence of progress toward them. If goals were not attained, the nurse should help the client establish a relationship with the new nurse. Answers A and B occur in the orientation phase, and answers C and D occur in the working phase.

There is a perception in a long-term care facility that the older adult residents are experiencing falls more often than in the past. An audit of incident reports has confirmed this, and the nursing leadership has recognized the need to make changes to reduce the incidence of falls. How should the leaders proceed with this planned change? Place the following steps in the correct order. 1. Implement the change in nursing practice. 2. Choose a new protocol that is likely to reduce falls. 3. Take measures to ensure that nursing practice does not revert. 4. Determine and analyze different solutions to the problem. 5. Develop a plan for implementing the change.

4. Determine and analyze different solutions to the problem. 2. Choose a new protocol that is likely to reduce falls. 5. Develop a plan for implementing the change. 1. Implement the change in nursing practice. 3. Take measures to ensure that nursing practice does not revert. The eight-step program of planned change is similar to the nursing process of assessment, diagnosis, planning, implementation, and evaluation. After this process, measures are taken to ensure that the change is stabilized and made permanent.

A nursing faculty member is teaching a class of second-degree students who have an average age of 32. What is important to remember when teaching adult learners? A) A focus on the immediate application of new material B) A need for support to reduce anxiety about new learning C) Older students may feel inferior in terms of new learning D) All students, regardless of age, learn the same

A) A focus on the immediate application of new material Adults need to be taught differently. Andragogy, the study of teaching adults, is based on several principles. One of those is that most adults' orientation to learning is that new material should be immediately applicable.

Which of the following are examples of incidental disclosures of client health information that are permitted? Select all that apply. A) A nurse working in a physician's office puts out a sign-in sheet for incoming clients. B) Two nurses are overheard talking about a client through the door of an empty client room. C) A nurse places a client chart in a holder on the examining room door with the name facing out. D) A nurse leaves an x-ray on a light board in the hallway that leads to the examining rooms. E) A nurse calls out the name of a client who is seated in the waiting room.

A) A nurse working in a physician's office puts out a sign-in sheet for incoming clients. B) Two nurses are overheard talking about a client through the door of an empty client room. E) A nurse calls out the name of a client who is seated in the waiting room. Permitted incidental disclosures of PHI include using sign-in sheets without the reason for visit; the possibility of a conversation being overheard if measures are taken to be private; placing a client chart on the door with the face pages facing inward; placing an x-ray on a light board as long as it is not unattended; calling the name of a waiting patient; and leaving appointment reminders on answering machines (provided only a minimal amount of information is given).

A nurse has drafted an SBAR communication before contacting the primary care provider of a client whose condition has worsened suddenly. How should the nurse best conclude this communication? A) Ask the care provider to come and assess the client. B) Provide the client's most recent vital signs. C) Ask the care provider if he or she is familiar with this client. D) Provide the most likely diagnosis of the problem.

A) Ask the care provider to come and assess the client. The final phase of an SBAR communication involves making a recommendation. In the case of a client whose condition is worsening, this may entail recommending that the primary care provider come to assess the client. Asking the care provider if he or she is familiar with the client should be done early in the communication. Providing assessment data and possible diagnoses are addressed in the background and assessment sections of the tool.

A nurse strives to establish trusting interpersonal relationships with clients, peers, subordinates, and superiors to facilitate goal achievement and personal growth of all participants. Which type of skills is this nurse demonstrating? A) Communication skills B) Problem-solving skills C) Management skills D) Self-evaluation skills

A) Communication skills Communication skills involve the ability to establish trusting interpersonal relationships with clients, peers, subordinates, and superiors to maximize goal achievement and enhance the personal growth. Problem-solving skills refer to the ability to analyze all sides of a problem, to suspend judgment, to explore multiple options, and to work toward a creative solution. Management skills pertain to the ability to direct others toward goal achievement. Self-evaluation skills involve the ability to assess honestly one's effectiveness, to accept both praise and criticism, and to direct personal professional growth and development.

Which of the nursing roles is primarily performed during the working phase of the helping relationship? A) Educator and counselor B) Provider of care C) Leader and manager D) Researcher

A) Educator and counselor The nursing roles of educator and counselor are primarily performed during the working phase of the helping relationship. This is where the nurse's interpersonal skills are used to the fullest.

The nurse notes that the blood glucose level of a client has increased and is planning to notify the health care provider by telephone. Which of the following techniques would be most appropriate for the nurse to use when communicating with the health care provider? A) ISBAR B) EMAR C) SOAP D) CBE

A) ISBAR The nurse should use ISBAR to communicate verbally to the health care provider. Identify/Introduction, Situation, Background, Assessment, and Recommendation (ISBAR) is the communication tool to provide critical client information to the health care provider. EMAR is Electronic Medication Administration Record, which documents medication administration. SOAP is Subjective, Objective, Assessment, and Plan, which is a progress note that relates to only one health problem. CBE is Charting by Exception and permits the nurse to document only those findings that fall outside the standard of care and norms that have been developed by the institution.

The nursing student is working to improve his time management. Which of the following would assist the nursing student in accomplishing his goal? Choose all that apply. A) Identify priorities for the day. B) Evaluate time management at the end of the day. C) Establish a reasonable time line. D) Plan to arrive right at start of shift. E) Plan on his cohorts helping him

A) Identify priorities for the day. B) Evaluate time management at the end of the day. C) Establish a reasonable time line. Establish goals and priorities for each day. The nurse should identify what needs to be accomplished each day, differentiating need to do from nice to do tasks. Then nurse should establish a time line so that it is clearly evident when he or she is falling behind schedule, in time to correct it. The nurse should evaluate success or failure and use the results to plan the next day 's time management. The nurse should plan to arrive at least 15 minutes or more before the start of shift so that he or she can be prepared to receive change of shift report. Then nurse should plan time to assist his cohorts instead of them helping him. The cohorts may be too busy to assist or may need assistance themselves.

A nurse caring for a client who is being treated by three physicians uses the source-oriented format for documentation. What are the benefits of using this format of documentation? A) Information is documented in separate forms by each health care personnel. B) It is a unified, cooperative approach for resolving the client's problems. C) It is organized at one location according to the client's health problems. D) It is compiled to facilitate communication among health care professionals.

A) Information is documented in separate forms by each health care personnel. Source-oriented documentation is a record organized according to the source of documented information. This type of record contains separate forms on which health care personnel make written entries about their own specific activities in relation to the client's care. The problem-oriented method of recording demonstrates a unified, cooperative approach to resolving the client's problems. Source-oriented records are organized at numerous locations; there is not one location for information. The problem-oriented record is compiled to facilitate communication among health care professionals.

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

A) When communicating a client's change in condition to the client's physician ISBARR communication is an increasingly common tool for interdisciplinary communication. It is not typically used during change-of-shift report nor when communicating with family members. ISBARR is considered a framework for communication rather than a format for documentation.

Which informatics concept concerns the appropriate use of knowledge in managing or solving human problems? A) Wisdom B) Data C) Knowledge D) Information

A) Wisdom Wisdom is the appropriate use of knowledge in managing or solving human problems. Data are raw, unprocessed numbers, symbols, or words that have no meaning by themselves. Information consists of groupings of data processed into a meaningful, structured form. Knowledge is formed when data are grouped, creating meaningful information and relationships, which are then added to other structured information.

A student has reviewed a client's chart before beginning assigned care. Which of the following actions violates client confidentiality? A) Writing the client's name on the student care plan B) Providing the instructor with plans for care C) Discussing the medications with a unit nurse D) Providing information to the physician about laboratory data

A) Writing the client's name on the student care plan Students using client records are bound professionally and ethically to keep in strict confidence all the information they learn from those records. The student may discuss care with the instructor, medications with a staff nurse, and laboratory data with the physician. The student should not use actual client names or other identifiers in written assignments or oral reports.

The nurse is preparing to pass the 0900 medications prescribed for her patients. She removes the medications from the automated dispensing unit. When scanning the medication, an alert notifies the nurse that the patient is allergic to this medication. What action should the nurse take? Choose all that apply. A) Override the alert and administer the medication. B) Confirm the patients allergies and type of reaction. C) Notify the prescriber of the patient medication allergy. D) Be sure an antidote is available at the patients bedside.

B) Confirm the patients allergies and type of reaction. C) Notify the prescriber of the patient medication allergy. Alerts are configured to notify the nurse of potential adverse effects before the patient receives the medication. Sometimes patients state they are allergic to a medication when, in reality, they may only have experienced a side effect. The physician or pharmacist can be instrumental in discerning if the patients reaction was a true allergy. The physician should always be notified before administering medications when an allergy error has been received. Although an antidote to a medication could be useful in the event of a harmful effect, the medication in the situation should not be given, and therefore, the antidote would not be necessary.

When is the best time to evaluate one's own teaching effectiveness? A) During the education session B) Immediately after an education session C) 1 week after the education session D) 1 month after the education session

B) Immediately after an education session It is best to evaluate one's own teaching effectiveness immediately after an education session by quickly reviewing how one feels the plan was implemented; noting both strengths and weaknesses helps plan for subsequent sessions.

The family of a client in a burn unit asks the nurse for information. The nurse sits with the family and discusses their concerns. What type of communication is this? A) Intrapersonal B) Interpersonal C) Organizational D) Focused

B) Interpersonal Interpersonal communication occurs among two or more people with a goal to exchange messages. Nurses spend most of their day communicating with clients, family members, and health care team members.

A nurse is documenting client information using PIE charting. Which information would the nurse expect to document? A) Client assessment B) Intervention carried out C) Written plan of care D) Multidisciplinary interventions

B) Intervention carried out In the PIE notes, the nurse documents the problem, intervention and evaluation. Thus the nurse would document the intervention carried out. Client assessment is not a part of the PIE notes, because this information is recorded on flow sheets for each shift. Although the PIE system uses a nursing plan-of-care format, there is no written plan of care. The PIE system is not multidisciplinary; it provides a documentation system for nursing only.

A nurse is entering a pharmacy request for patient medication in the patients electronic health record (EHR) while seated at a computer in the nursing station. A physician approaches her and asks her to access another patients EHR so that he can look at the patients laboratory report. Which of the following is the best action for the nurse to take? A) Access the lab report for the physician. B) Log off the computer before proceeding. C) Quickly finish the pharmacy requisition before the physician logs on. D) Allow the physician to access the laboratory report without logging out.

B) Log off the computer before proceeding. The nurse should log off the computer and then allow the physician to log on under his own password. Accessing information that is not relevant to the care that the nurse is providing is a HIPAA violation. Rushing to complete a pharmacy request for patient medication is a situation of risk for medication error. The nurse should never hurriedly order or administer medication because that is when errors are more likely to occur. The nurse should never allow anyone to use her password to access information.

In what type of documentation method would a nurse document narrative notes in a nursing section? A) Problem-oriented medical record B) Source-oriented record C) PIE charting system D) Focus charting

B) Source-oriented record A source-oriented record is one in which each health care group keeps data on its own separate form (e.g., physicians, nurses, and laboratory). Progress notes written by nurses using this method are narrative notes.

The National Patient Safety Foundation recently collaborated with the Partnership for Clear Health Communication (2007) to create awareness of the need for improved health literacy and developed the Ask Me 3 tool. Which of the following is an Ask Me 3 question? Select all that apply. A) Who will be my health care provider? B) What is my main problem? C) What do I need to do? D) Where will I get help? E) Why is it important for me to do this?

B) What is my main problem? C) What do I need to do? E) Why is it important for me to do this? Ask Me 3 questions are: What is my main problem? What do I need to do? Why is it important for me to do this?

The nurse is caring for a client who had a sudden episode of vomiting, which produced 900 mL of frank blood. The nurse directed and delegated to colleagues in order to notify the physician. She started intravenous fluids, and provided physical and emotional support for the client. Different situations call for different leadership styles. Which of the following leadership styles did the nurse display in this situation? A) Democratic B) Laissez-faire C) Autocratic D) Transformational

C) Autocratic Autocratic leadership involves the leader assuming complete control. Democratic leadership displays a sense of equality among the leader and other participants. With laissez-faire leadership, the leader relinquishes power to the group. Transformational leaders create intellectually stimulating practice environments and challenge themselves and others to grow personally and professionally, and to learn.

In general, how do most people view change? A) By how it affects the cohesiveness of the group B) By how much it will cost in time and resources C) By how they are affected personally D) By how it will affect others on the staff

C) By how they are affected personally In general, people view change in terms of how they are affected personally. Examples include threats to self-esteem, amount of work required, and effect on social relationships.

What is the primary focus of communication during the nurse-client relationship? A) Time available to the nurse B) Nursing activity to be performed C) Client and client needs D) Environment of the client

C) Client and client needs Communication in the nurse-client relationship should focus on the client and patient needs, not on the nurse or an activity in which the nurse is engaged.

Which of the following statements is true of factors that influence communication? A) Nurses provide the same information to all clients, regardless of age. B) Men and women have similar communication styles. C) Culture and lifestyle influence the communication process. D) Distance from a client has little effect on a nurse's message.

C) Culture and lifestyle influence the communication process. Culture and lifestyle do influence the communication process; understanding a client's culture assists nurses in understanding nonverbal communication and enables the nurse to deliver accurate care.

When the newly diagnosed, insulin-dependent diabetic client tells the nurse that he has never received instruction on the administration of injections, an appropriately stated nursing diagnosis for the client is what? A) Self-care deficit related to lack of knowledge about injections B) Knowledge deficit related to lack of knowledge about injections C) Deficient knowledge of injection administration as verbalized by the client, related to the lack of instruction and experience D) Ineffective health care maintenance related to diabetic instructions

C) Deficient knowledge of injection administration as verbalized by the client, related to the lack of instruction and experience Many factors can contribute to deficient knowledge, such as a lack of exposure, lack of recall, information misinterpretation, cognitive limitations, lack of interest in learning, and unfamiliarity with information resources.

When providing client education it is essential for the nurse to incorporate what action so that learning can be optimized? A) Have the clients read material after client education B) Be sure that clients are formally engaged C) Include educational strategies that encourage clients to be active participants D) Administer tests to evaluate learning

C) Include educational strategies that encourage clients to be active participants The teaching-learning relationship is a dynamic, interactive process that involves active participation from the nurse and client.

A nurse is considering the delegation of administering medications to an unskilled assistant. What is the first question the nurse must ask herself before doing so? A) Has the assistant been trained to perform the task? B) Have I evaluated the client's response to this task? C) Is the delegated task permitted by law? D) Is appropriate supervision available?

C) Is the delegated task permitted by law? The first question the nurse should always consider before delegating a task is "Is the delegated task permitted by law?" In this case, it would not be, and the task (administering medications) would not be delegated.

What client characteristic is important to assess when using the health belief model as the framework for teaching? A) Developmental level B) Source of information C) Motivation to learn D) Family support

C) Motivation to learn When assessing a client's learning readiness, it is important to consider his or her motivation. Motivation is influenced by an individual's health beliefs and plays a key role in the health belief model. Motivation encourages the client to adopt health promotion and disease prevention actions.

You are a preceptor for a new nursing employee at the local hospital. She needs to access a patients electronic health record (EHR) to retrieve laboratory results; however, the newly hired nurse has not yet received a computer password. What action should you take? A) Give her your password to use until she obtains her own password. B) Log on and remain with her while she views the record. C) Notify your supervisor that the new employee needs a password. D) Inform her that she will not receive a password until her orientation is complete.

C) Notify your supervisor that the new employee needs a password. Never share your password with another person or log on to a computer to allow another access to information. Instead, notify your supervisor that the new employee needs a password. In most hospitals, nurses are given a password during their orientation.

A newly hired nurse is participating in the orientation program for the health care facility. Part of the orientation focuses on the use of the SOAP (subjective, objective, assessment, and plan) method for documentation, which the facility uses. The nurse demonstrates understanding of this method by identifying which of the following as the firststep? A) Plan of care B) Data, action, and response C) Problem selected D) Nursing activities during a shift

C) Problem selected The SOAP method begins by selecting a problem from a list. PIE (problems, interventions, and evaluation) notes incorporate the plan of care into the progress notes. Focus DAR notes organizes entries by data, action, and response. The narrative notes are used to record relevant client and nursing activities throughout a shift.

A client 36 years of age is able to understand the health education when she is given the opportunity to put the education into practice. The nurse helps the client to self-administer the medication dosage before the client is discharged from the health care facility. Which domain correctly identifies the client's learning style? A) Cognitive domain B) Affective domain C) Psychomotor domain D) Interpersonal domain

C) Psychomotor domain The client's learning style falls into the psychomotor domain, which is a style of processing that focuses on learning by performing what has been learned. The cognitive domain is a style of processing information by listening or reading facts and descriptions. The affective domain is a style of processing, which appeals to a person's feelings, beliefs, or values. The interpersonal domain is a style of processing that focuses on learning through social relationships.

A nurse touches a client's hand to indicate caring and support. What channel of communication is the nurse using? A) Auditory B) Visual C) Olfactory D) Kinesthetic

D) Kinesthetic The nurse is using a kinesthetic channel of communication. The channel of communication is the medium the sender has selected to send the message. The channel might target any of the receiver's senses. The channels are auditory (spoken words and cues), visual (sight, observations, and perceptions), and kinesthetic (touch).

The parents of an infant suffering from apnea need to be educated on the apnea monitor and cardiopulmonary resuscitation. What should the nurse assess first regarding the parents? A) Educational levels B) Home environment C) Infant bonding D) Baseline knowledge of these concepts

D) Baseline knowledge of these concepts Before educating parents on the apnea monitor and cardiopulmonary resuscitation, the nurse should determine the parents' baseline knowledge so that the nurse knows where to begin. Educational level would be the next assessment in order to plan the appropriate teaching delivery method.

To meet accreditation standards regarding client care, a health care facility must show evidence of what? A) Employee satisfaction surveys B) Financial accounts and statements C) Documentation of indigent care D) Client education documentation

D) Client education documentation The Joint Commission also has established standards for client education that health care agencies must meet to receive accreditation.

A nurse is designing a teaching program for individuals who have recently immigrated to the United States from Iraq. Which of the following considerations is necessary for culturally competent client teaching? A) Use materials developed previously for U.S. citizens. B) Use all visual materials when teaching content. C) Use a lecture format to teach content with few questions. D) Develop written materials in the client's native language.

D) Develop written materials in the client's native language. With changes in society, nurses are faced with the challenge of teaching clients from different cultural and ethnic backgrounds. One of the strategies is to develop written materials in the native language of the client.

Which of the following tasks could the nurse safely delegate to unlicensed assistive personnel? A) An initial assessment of a client B) Determination of a nursing diagnosis C) Evaluation of client progress D) Documentation of client's I+O on a flow sheet

D) Documentation of client's I+O on a flow sheet Nursing care or tasks that should never be delegated except to another RN include (Ayers & Montgomery, 2008) the following: the initial and ongoing nursing assessment of the client and his or her nursing care needs; the determination of the nursing diagnosis, nursing care plan, evaluation of the client's progress in relation to care plan, and evaluation of the nursing care delivered to the client; the supervision and education of nursing personnel; client education that requires an assessment of the client and his or her education needs; and any other nursing intervention that requires professional nursing knowledge, judgment, and/or skill.

A student is developing an education plan for her assigned client. The student wants to educate the client on what symptoms to report after chemotherapy. What would the student need to do first? A) Ask other students what should be included in content. B) Ask the client what he or she wants to know. C) Tell the instructor that this topic hasn't been covered yet. D) Review information available in writing and on the Internet.

D) Review information available in writing and on the Internet. New nurses (and students) usually need to research the subject to be taught to determine what information exists on the topic. Books, journals, manuals, and Web-based sources may be used to find information.

In which of the following conflict resolution strategies is the conflict rarely resolved? A) Collaborating B) Compromising C) Competing D) Smoothing

D) Smoothing Smoothing is an effort to complement the other party and focus on agreement rather than disagreement, thus reducing the emotion in the conflict. The original conflict is rarely resolved with this technique.

In Lewin's classic theory of change, what happens during unfreezing? A) Planning is conducted. B) Change is initiated. C) Change becomes operational. D) The need for change is recognized.

D) The need for change is recognized. In Lewin's change theory, during unfreezing the need for change is recognized. Unfreezing does not include planning, initiating, or operationalizing change.

A male client age 61 years has been admitted to a medical unit with a diagnosis of pancreatitis secondary to alcohol use. Which of the client's following statements suggests that nurses' education has resulted in affective learning? A) "I'm starting to see how my lifestyle has caused me to end up here." B) "I understand why they're not letting me eat anything for the time being." C) "My intravenous drip will keep me from getting dehydrated right now." D) "I can see how things could have been much worse if I hadn't gotten to the hospital when I did."

A) "I'm starting to see how my lifestyle has caused me to end up here." The client's understanding of his contribution to his problem demonstrates a shift in attitude and feelings that is characteristic of affective learning. Understanding the treatment, course, and prognosis of his illness are aspects of cognitive learning.

The daughter of an older adult female client has asked the nurse why a urine specimen was collected from her mother earlier that morning. How can the nurse best respond to the daughter's query? A) "We want to test your mother's urine to make sure she doesn't have a urinary tract infection." B) "Your mother's doctor ordered a urine C&S to rule out a UTI." C) "We want to do everything we can to get your mother healthy again." D) "Sometimes sick urine can make the whole person sick, and this might be causing her fever."

A) "We want to test your mother's urine to make sure she doesn't have a urinary tract infection." In order to communicate effectively, the nurse needs to avoid the use of jargon or abbreviations ("C&S") that are unfamiliar to those outside the health care system. At the same time, accuracy is important, and vague and "dumbed-down" answers ("we want to do everything we can," "sick urine") are inappropriate.

The nurse has been working with a client for several days during the client's recovery from a femoral head fracture. How should a nurse best evaluate whether client education regarding the prevention of falls in the home has been effective? A) "What changes will you make around your house to reduce the chance of future falls?" B) "Do you have any questions about the fall prevention measures that we've talked about?" C) "In light of what we've talked about, why is it important that you remove the throw rugs in your house?" D) "Do you think that the safety measures I taught you are clear and realistic?"

A) "What changes will you make around your house to reduce the chance of future falls?" An open-ended question that requires the client to apply the information that has been taught is often the most accurate way to evaluate the effectiveness of client education. Yes/no questions are much less effective ("Do you have any questions?"; "Do you think that the safety measures I taught you are clear and realistic?"). Asking the client about the importance of preventing falls does not directly assess what the client will actually do to prevent falls.

Which of the following statements accurately describes the relationship between therapeutic communication and the nursing process? Select all that apply. *Tricky A) Effective communication techniques, as well as observational skills, are used extensively during the assessment step. B) Only the written word in the form of a medical record is used during the diagnosing step of the nursing process. C) The implementing step requires communication among the client, nurse, and other team members to develop interventions and outcomes. D) Verbal and nonverbal communication are used to educate, counsel, and support clients and their families during the implementation phase. E) Nurses rely on the verbal and nonverbal cues they receive from their clients to evaluate whether client objectives have been achieved.

A) Effective communication techniques, as well as observational skills, are used extensively during the assessment step. D) Verbal and nonverbal communication are used to educate, counsel, and support clients and their families during the implementation phase. E) Nurses rely on the verbal and nonverbal cues they receive from their clients to evaluate whether client objectives have been achieved. Effective communication techniques, as well as observational skills, are used extensively during the assessment phase, since the major focus of assessment is to gather information in both verbal and nonverbal communication forms. Following the formulation of the nursing diagnoses, the nurse communicates findings to other nursing professionals through the use of the written and spoken word. The planning step requires communication among the client, nurse, and other team members, as mutually agreed-upon outcomes are developed and interventions are determined. Verbal and nonverbal communication are employed to enhance basic caregiving measures and to educate, counsel, and support clients and their families during the implementation phase. Nurses often rely on the verbal and nonverbal cues they receive from their clients to verify whether client objectives have been achieved. Because one nurse cannot provide 24- hour coverage for clients, significant information must be passed on to others through nursing progress notes and care plans (documentation).

Nurses with varying levels of experience possess leadership skills. A graduate nurse walks out of the nurse manager's office after a meeting. The graduate nurse reflects on the positive and negative feedback that she received from the manager regarding her three months working on the unit. What nursing leadership skill is best illustrated by the graduate nurse in this scenario? A) Self-evaluation skills B) Communication skills C) Problem-solving skills D) Management skills

A) Self-evaluation skills Self-evaluation skills incorporate the ability to assess honestly one's effectiveness, to accept both praise and criticism, and to direct personal professional growth. Communication skills demonstrate the ability to establish trusting interpersonal relationships with clients, peers, subordinates, and superiors to maximize goal achievement. Problem-solving skills include the ability to analyze all sides of a problem, to suspend judgment, to explore multiple options, and to work toward a creative solution. Management skills are the ability to direct others toward goal achievement.

A nurse instructs a client to tell her about the side effects of a medication. What learning domain is the nurse evaluating? A) Affective B) Cognitive C) Psychomotor D) Emotional

B) Cognitive Cognitive learning involves storing and recalling new knowledge in the brain. Cognitive learning may be evaluated through oral questioning.

When documenting client care, the nurse understands that the most important reason for correct and accurate documentation is which of the following? A) Legal representation to care B) Conveyance of information C) Assisting in organization of care D) Noting the client's response to interventions

B) Conveyance of information Documentation of care in the client's record is most important for communicating with other health care team members that are involved in the care of the patient.

A mother of a toddler wants to learn how to do CPR. What education strategy would be most effective in helping her learn? A) Lecture B) Discussion C) Demonstration D) Discovery

C) Demonstration When a client wants to learn a specific skill, such as CPR, demonstration is an effective strategy. The client's learning can be evaluated by return demonstration. Lecture, discussion, and discovery are not as effective in teaching a skill.

Which of the following statements accurately describes recommended guidelines for overcoming resistance to change? Select all that apply. A) Explain the proposed changes only to the managers of the people involved. B) Whenever possible, use technical language to describe the changes. C) List the advantages of the proposed change for members of the group. D) Avoid relating the change to the group's existing beliefs and values. E) If possible, introduce change gradually.

C) List the advantages of the proposed change for members of the group. E) If possible, introduce change gradually. To overcome resistance to change, the nurse should explain the proposed change to all affected people in simple, concise language; list the advantages of the proposed change, both for the individual and for members of the group; relate the proposed change to the person's (or group's) existing beliefs and values; if possible, introduce change gradually; provide incentives for commitment to change such as money, status, time off, or a better working environment.

A young mother asks the nurse in a pediatric office for information about safety, diet, and immunizations for her baby. Which nursing diagnosis would be appropriate for this client? A) Knowledge Deficit: Infant care B) Impaired Health Maintenance C) Readiness for Enhanced Parenting D) Readiness for Enhanced Coping

C) Readiness for Enhanced Parenting A client who requests information is demonstrating motivation and readiness to learn. The appropriate nursing diagnosis would be Readiness for Enhanced Parenting.

A nurse is working with an older adult client, educating the client on how to ambulate with the aid of a walker. The nurse notes that the client appears to lack the motivation to learn how to use device. The client states, "I'm just too old to learn." Which of the following would be most appropriate for the nurse to do to motivate this client? A) Tell the client how to move the walker as he ambulates. B) Explain how the walker supports the client's lower extremities C) Fully discuss the rationale for using the walker. D) Describe how the walker can improve the client's quality of life.

D) Describe how the walker can improve the client's quality of life. Motivating the older adult client can be done by showing the client how the new knowledge will improve his quality of life, regardless of how long that may be. It will also demonstrate how the new knowledge could improve the client's level of independence. Although demonstrating the use of the walker and explaining how the walker assists with ambulation (and the rationale for its use) can be used to educate the client, these actions would not promote motivation for the client to learn.

A nurse organizes client data using the SOAP format. Which of the following would be recorded under "S" of this acronym? A) Client complaints of pain B) Client history C) Client's chief complaint D) Client interventions

A) Client complaints of pain The SOAP format (subjective data, objective data, Assessment [the caregiver's judgment about the situation], plan) is used to organize data entries in the progress notes of the POMR. A client complaint of pain is subjective data (S).

According to Rosenstock, which of the following are health beliefs critical for client motivation? Select all that apply. A) Clients view themselves as susceptible to the disease in question. B) Clients view the disease as a serious threat. C) Clients believe there are actions they can take to reduce the probability of contracting the disease. D) Clients believe the threat of taking these actions is greater than the disease itself. E) Patients view themselves as victims of the disease in question.

A) Clients view themselves as susceptible to the disease in question. B) Clients view the disease as a serious threat. C) Clients believe there are actions they can take to reduce the probability of contracting the disease. A client's health beliefs can have great influence on motivation. The health belief model identifies several health beliefs as critical for client motivation (Rosenstock, 1974). Motivation is enhanced when clients view themselves as susceptible to the disease in question; when clients view the disease as a serious threat; when clients believe there are actions they can take to reduce the probability of contracting the disease; when clients believe the threat of taking these actions is not as great as the disease itself.

At completion of the health education for a client, the nurse documents the details of the health education in the client's medical record. What can be determined by this documentation? A) Proof of compliance with education standards B) Client's response to the health education C) Self-administration of medications D) Dietary instructions for the client

A) Proof of compliance with education standards The information about who was taught, what was taught, the education method, and the evidence of learning is the best proof of compliance with education standards. These are entered in the client's medical record. The client's response to the health education cannot be determined by this document. Self administration of medications and dietary instructions for the client are not implied from who was taught, what was taught, the education method, and the evidence of learning.

A nurse is using motivational interviewing to find out why a client refuses to participate in the recommended rehabilitation program. Which of the following is an example of using the skill of reflective listening to help motivate this client? A) So, you feel that you are not ready to start a program this week...? B) Why do you feel that you are not ready to start rehabilitation? C) I understand that you are afraid to start rehabilitation; where do you see yourself in a week? D) Remember we discussed what needs to be done to get you back on your feet...How do you feel about getting started?

A) So, you feel that you are not ready to start a program this week...? Four skills have proved effective in motivational interviewing. These include: (answer A) reflective listening (restates the client's response back to him or her), (answer B) asking open questions (encourages discussion of the reason for making desired changes), (answer C) affirming (supports the client's efforts and encourages further exploration), and (answer D) summarizing (links and reinforces material that has been discussed).

Why is communication important to the "assessing" step of the nursing process? A) The major focus of assessing is to gather information. B) Assessing is primarily focused on physical findings. C) Assessing involves only nonverbal cues. D) Written information is rarely used in assessment.

A) The major focus of assessing is to gather information. The major focus of assessment is to gather information using both verbal and nonverbal communication forms. Nurses use the written word, the spoken word, and one-to-one communication with clients. Effective communication techniques, as well as observational skills, are used extensively during assessment.

During a staff meeting, the nurse is discussing new quantum leadership. The nurse explains that in this type of leadership change is viewed as which of the following? A) Constant and predictable B) Dynamic and constantly unfolding C) Evolving very slowly D) An entity needing planning

B) Dynamic and constantly unfolding We are in a difficult transition period between the old and the new age. In the old age, change was viewed as an entity to be planned, carefully managed, and accepted. In the new quantum age, change is conceived as dynamic, ever-present, and continually unfolding.

A nurse in a neighborhood clinic is conducting educational sessions on weight loss. What aim of nursing is met by these educational programs? Select all that apply. A) Practicing advocacy B) Preventing illness C) Restoring health D) Facilitating coping E) Maintaining and promoting health

B) Preventing illness C) Restoring health E) Maintaining and promoting health If this education is directed toward those who are healthy, weight loss information can help maintain health and prevent illness. If this education is used in those already ill (hypertension, diabetes), weight loss can restore health. The nurse is not practicing advocacy or facilitating coping by providing weight loss education.

A nurse is sitting near a client while conducting a health history. The client keeps edging away from the nurse. What might this mean in terms of personal space? A) The nurse is outside the client's personal space. B) The nurse is in the client's personal space. C) The client does not like the nurse. D) The client has concerns about the questions.

B) The nurse is in the client's personal space. Each person has a sense of how much personal or private space is needed and what distance between individuals is optimum. It is best to take cues from the client; a client moving backward indicates discomfort with invasion of his or her personal space.

In which of the following cases should a progress note be written? Select all that apply. A) For any nurse-client interaction B) When admitting a client C) When receiving a client postoperatively D) When assisting a client with ADLs E) When a procedure is performed

B) When admitting a client C) When receiving a client postoperatively E) When a procedure is performed A progress note should be written in the following instances: upon admission, transfer to another unit, and discharge; when a procedure is performed; upon receiving a client postoperatively or postprocedure; upon communicating with physicians regarding critical client information (e.g., abnormal lab value result); or for any change in client status.

A nurse is caring for a client who is visually impaired. Which of the following is a recommended guideline for communication with this client? A) Ease into the room without acknowledging presence until the client can be touched. B) Speak in a louder tone of voice to make up for lack of visual cues. C) Explain reason for touching client before doing so. D) Keep communication simple and concrete.

C) Explain reason for touching client before doing so. For clients who are visually impaired, the nurse should acknowledge his or her presence in the client's room, identify self by name, speak in a normal tone of voice, explain the reason for touching the client before doing so, and indicate to the client when the conversation has ended and when leaving the room.

A nurse is caring for a client with myasthenia gravis. The client is having difficulty forming words and his tone is nasal. Which of the following is an effective communication strategy for this client? A) Engage the client in a lengthy discussion to strengthen his voice. B) Encourage the client to speak quickly while talking. C) Repeat what the client has said to verify the meaning. D) Nod continuously when the client is talking.

C) Repeat what the client has said to verify the meaning. The client is having a problem forming words and has a nasal tone due to a nerve involvement that controls speech. For effective communication, the nurse should repeat and verify whatever the client says. The nurse should ask those questions which can be answered in a yes or no form. Lengthy discussions may tire the client. Encouraging the client to speak quickly is inappropriate. Nodding continuously when the client is talking would not facilitate an effective communication strategy.

Which term describes a nurse who is sensitive to the client's feelings, but remains objective enough to help the client achieve positive outcomes? A) Competent B) Caring C) Honest D) Empathic

D) Empathic Empathy is identifying with the way another person feels. An empathic nurse is sensitive to the client's feelings and problems, but remains objective enough to help the client work to attain positive outcomes.

What is (are) the primary benefit(s) of computer physician order entry (CPOE)? A) Increased privacy B) Improved access to patient data C) Cost savings D) Reduced medication errors

D) Reduced medication errors Computer physician order entry (CPOE) is technology that allows healthcare providers to enter orders into a computerized prescribing system instead of handwriting them. Orders are integrated with patient information, including allergy history and laboratory and other prescription data. The new order is then automatically checked for potential errors or problems. This reduces prescription errors resulting from illegible penmanship. It can detect dosing errors by flagging medication dilution or dosages that fall outside normal dosing standards. The system warns about the possibility of a drug interaction, allergy, or incorrect dose. As some drug names sound like other drugs, CPOE can alert prescribers and potentially avoid a drug error that could be serious or fatal. Although the efficiencies of the CPOE reduce costs, it is not the primary benefit of the system. Likewise, orders entered into the computer are more conveniently accessed by nurses and pharmacists, but the most important benefit of CPOE is to reduce errors.

The nurse is caring for a client who speaks Chinese, and the nurse does not speak Chinese. An appropriate approach for communication with this client includes what? A) Using a caring voice and repeating messages frequently B) Speaking directly and loudly to the client C) Avoiding the use of gesture or play-acting D) Writing messages for the client and offering him a dictionary for translation.

A) Using a caring voice and repeating messages frequently Approaches to use when a client speaks a different language include speaking slowly and distinctly, and avoiding loud voices. Use a caring voice, keeping messages simple, and repeat messages frequently. The use of a language dictionary by the nurse is appropriate, but writing messages and asking the client to translate is not an appropriate approach. Gestures, pictures, and play-acting help the client understand.

Developing an education plan is comparable to what other nursing activity? A) Documenting in the nurses notes B) Formulating a nursing care plan C) Performing a complex technical skill D) Using a standardized form or format

B) Formulating a nursing care plan Planning for learning involves the development of an education plan. Both education plans and nursing care plans follow the steps of the nursing process.

What is the goal of the nurse in a helping relationship with a client? A) To provide hands-on physical care B) To ensure safety while caring for the client C) To assist the client to identify and achieve goals D) To facilitate the client's interactions with others

C) To assist the client to identify and achieve goals A helping relationship exists among people who provide and receive assistance in meeting human needs. When a nurse and a client are involved in a helping relationship, the nurse assists the client to identify and achieve goals that allow the client's human needs to be met.

A nurse believes in listening to clients and coworkers more than talking to them, allowing more personal control for all involved. This is a quality of which of the following managerial mindsets? A) Reflective B) Analytical C) Worldly D) Collaborative

D) Collaborative The collaborative mindset involves listening more than talking, and allowing people to take initiative and control their own work. The reflective mindset allows managers to mentally digest experiences and reflect on them in a different way. The analytical mindset encourages introspection so that one can recognize biases and see things in a unique way. This facilitates a change in course and movement toward resolution of problems. The worldly mindset recognizes cultures and contexts or "seeing differently out to reflect differently in."