340 Final
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
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
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
Ans: B Feedback: Each entry is signed with the first initial, last name, and title. In this case, A. Jones, RN, is correct.
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
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
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
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, B, D
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.
Ans: A
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
Ans: A
The nursing student asks the nurse for an example of a "never event." Which example provided by the nurse best answers the nursing student's question? A) The client scheduled for a cholecystectomy has a total abdominal hysterectomy. B) The client receives preoperative medication before signing the informed consent. C) The client receives a medication and develops a rash on the trunk of the body, itching, and dyspnea. D) The client fails to receive a regularly scheduled medication.
Ans: A Feedback: A "never event" is an extremely rare medical error that should never occur. The performance of the wrong surgery on a client is an example of a never event. The other examples are examples of incidents or variances, events that occur out of the ordinary that result in, or have the potential to result in, harm to a client, employee, or visitor.
A nurse provides client care within a philosophy of ethical decision making and professional expectations. What is the nurse using as a framework for practice? A) Code of Ethics B) Standards of Care C) Definition of Nursing D) Values
Ans: A Feedback: A professional code of ethics provides a framework for making ethical decisions and sets forth professional expectations. Codes of ethics inform both nurses and society of the primary goals and values of the profession.
A nurse has had, on several occasions, the opportunity to share personal prescriptions with family members when they we're in need of pain medication or antibiotics. Which set of rules should govern this moral decision? A) Ethics B) Administrative law C) Common law D) Civil law
Ans: A Feedback: Although all of the options may affect your decision, moral decisions are guided by ethics, which are internal set of principles and values that guide the behavior of a person. Sharing medications prescribed to you with other people, including family members, would be considered unethical. It is important to distinguish ethics from law, religion, custom, and institutional practices. For example, the fact that an action is legal or customary does not in itself make the action ethically or morally right.
A nurse states to the client that she will keep her free of pain. However, her family wishes to try a treatment to prolong her life that may necessitate withholding pain medication. This factor will cause an ethical dilemma for the nurse in relation to which ethical principle? A) Fidelity B) Veracity C) Justice D) Autonomy
Ans: A Feedback: Fidelity means being painful to one's commitment and promises.
A lawsuit has been brought against a nurse for malpractice. The client fell and suffered a skull fracture, resulting in a longer hospital stay and need for rehabilitation. What does the description of the client and his injuries represent as proof of malpractice? A) Damages B) Causation C) Duty D) Breach of duty
Ans: A Feedback: Liability involves four elements: duty (obligation to use care and follow standards), breach of duty (failure to follow standards of care), causation (the failure to follow standards of care resulted in the injury), and damages (the actual harm or injury resulting to the patient).
A home health nurse who performs a careful safety assessment of the home of a frail elderly patient to prevent harm to the patient is acting in accord with which of the following, a principle of bioethics? A) Nonmaleficence B) Advocacy C) Morals D) Values
Ans: A Feedback: Nonmaleficence is a principle of bioethics and is defined as the obligation to prevent harm. Advocacy, morals, and values are not principles of bioethics.
A nurse is caring for a client who is a practicing Jehovah's Witness. The physician orders two units of packed cells based on his low hemoglobin and hematocrit levels. The nurse states to the surgeon that it is unethical to go against the patient's beliefs even though his blood counts are very low. What is the best description of the nurse's intentions? A) Acting in the patient's best interest B) Siding with the patient over the surgeon C) Observing institutional policies D) Being legally responsible
Ans: A Feedback: Nurses' ethical obligations include acting in the best interest of their clients, not only as individual practitioners, but also as members of the nursing profession, the health care team, and the community at large.
A male client age 56 years is experiencing withdrawal from alcohol and is placing himself at risk for falls by repeatedly attempting to scale his bedrails. Benzodiazepines have failed to alleviate his agitation and the nurse is considering obtaining an order for physical restraints to ensure his safety. The nurse should recognize that this measure may constitute what? A) Paternalism B) Deception C) Harm D) Advocacy
Ans: A Feedback: Paternalism involves the violation of a client's autonomy in order to maximize good or minimize harm, a situation that requires careful consideration in light of ethical principles. Deception is unlikely to occur and the risk for harm is likely decreased by the use of restraints. Advocacy is the protection and support of another's rights.
A nursing instructor is teaching a class about ethical principles to a group of nursing students. The instructor determines that the teaching was successful when the students give which of the following as an example of nonmaleficence? A) Protecting clients from a chemically impaired practitioner B) Performing dressing changes to promote wound healing C) Providing emotional support to clients who are anxious D) Administering pain medications to a client in pain
Ans: A Feedback: Protecting clients from a chemically impaired practitioner is an appropriate example of nonmaleficence. Nonmaleficence means to avoid doing harm, to remove from harm, and to prevent harm. Performing dressing changes to promote wound healing, providing emotional support to clients who are anxious, and administering pain medications to a client in pain are examples of beneficence, which means doing or promoting good.
A home care nurse is caring for a quadriplegic client who needs regular position changes and back massages. A gentleman identifying himself as a family friend inquires if he can be of any help to the family. What should be the nurse's response be? A) The nurse should ask the gentleman to talk to the family directly. B) The nurse should invite the gentleman to learn the caring techniques. C) The nurse should state that the family does not need any help. D) The nurse should refer the gentleman to the local social worker.
Ans: A Feedback: The nurse should ask the gentleman to talk to the family directly. Revealing information about the client's care is a violation of the client's privacy. The nurse should not invite the gentleman for a learning session because it would be a breach of the client's right to privacy. Referring him to a social worker is not an appropriate choice.
A group of nurse researchers has proposed a study to examine the efficacy of a new wound care product. Which of the following aspects of the methodology demonstrates that the nurses are attempting to maintain the ethical principle of nonmaleficence? A) The nurses are taking every reasonable measure to ensure that no participants experience impaired wound healing as a result of the study intervention. B) The nurses have organized the study in such a way that the foreseeable risks and benefits are distributed as fairly as possible. C) iThe nurses have given multiple opportunities for potential participants to ask questions, and have been following the informed consent process systematically. D) The nurses have completed a literature review that suggests the new treatment may result in decreased wound healing time.
Ans: A Feedback: The principle of nonmaleficence dictates that nurses avoid causing harm. In this study, this may appear in the form of taking measures to ensure that the intervention will not cause more harm than good. The principle of justice addresses the distribution of risks and benefits, and the informed consent process demonstrates that autonomy is beingprotected. Preliminary indications of the therapeutic value of the intervention show a respect for the principle of beneficence.
A nurse using the principle-based approach to client care seeks to avoid causing harm to clients in all situations. What is this principle known as? A) Nonmaleficence B) Justice C) Fidelity D) Autonomy
Ans: A Feedback: The principle-based approach to ethics combines elements of both utilitarian and deontologic theories and offers specific action guides for practice. The Beauchamp and Childress principle-based approach to bioethics (2001) identifies four key principles: autonomy (promote self-determination), nonmaleficence (avoid causing harm), beneficence (benefit the patient), and justice (act fairly)
A client with a diagnosis of colorectal cancer has been presented with her treatment options, but wishes to defer any decisions to her uncle, who acts in the role of a family patriarch within the client's culture. By which of the following is the client's right to self-determination best protected? A) Respecting the client's desire to have the uncle make choices on her behalf B) Revisiting the decision when the uncle is not present at the bedside C) Teaching the client about her right to autonomy D) Holding a family meeting and encouraging the client to speak on her own behalf
Ans: A Feedback: The right to self-determination (autonomy) means that it should never be forced on anyone. The client has the autonomous right to defer her decision-making to another individual if she freely chooses to do so.
A student nurse is working in the library on her plan of care for a clinical assignment. The client's name is written at the top of her plan. What ethical responsibility is the student violating? A) Confidentiality B) Accountability C) Trust D) Informed consent
Ans: A Feedback: The student is violating confidentiality. Confidentiality is violated when patients are identified by name on written documents available to those who are not directly responsible for their care.
A mother always thanks clerks at the grocery store. Her daughter age 6 years echoes her thank you. The child is demonstrating what mode of value transmission? A) Modeling B) Moralizing C) Reward and punishment D) Responsible choice
Ans: A Feedback: Through modeling, children learn of high or low value by observing parents, peers, and significant others. Modeling can thus lead to socially acceptable or unacceptable behaviors. Children whose caregivers use the moralizing mode of value transmission are taught a complete value system by parents or an institution (e.g., church or school) that allows little opportunity for them to weigh different values. Through rewarding and punishing, children are rewarded for demonstrating values held by parents and punished for demonstrating unacceptable values. Caregivers who follow the responsible-choice mode of value transmission encourage children to explore competing values and to weigh their consequences.
The nurse reports a nursing colleague on the unit who is lethargic and verbally responding in a slow manner. What is an example of? A) Whistle-blowing B) Collective bargaining C) Delegating nursing care D) Ensuring adequate staffing
Ans: A Feedback: Whistle-blowing is when the nurse reports unsafe practice environments. Impaired nurses threaten the safety of clients in the clinical setting, as does inadequate staffing. Nurses may delegate or assign tasks involved in the delivery of nursing care to individuals as long as the individual has sufficient knowledge and skill to perform the assigned task. Collective bargaining is a legal process in which representatives of organized employees negotiate with employers about work conditions.
A nurse in a physician's office has noted on several occasions that one of the physicians frequently obtains controlled- drug prescription forms for prescription writing. The physician reports that his wife has chronic back pain andrequires pain medication. One day the nurse enters the physician's office and sees him take a pill out of a bottle. Thedoctor mentions that he suffers from migraines and that his wife's pain medication alleviates the pain. What type of nurse-physician ethical situation is illustrated in this scenario? A) Unprofessional, incompetent, unethical, or illegal physician practice B) Disagreements about the proposed medical regimen C) Conflicts regarding the scope of the nurse's role D) Claims of loyalty
Ans: A The physician is demonstrating unprofessional, incompetent, unethical, or illegal physician practice. The client was diagnosed with diabetes three years ago, but has failed to integrate regular blood glucose monitoring or dietary modifications into his lifestyle. He has been admitted to the hospital for tx of acute renal failure secondary to diabetic nephropathy, an event that has prompted the client to reassess his values.
A client is suing a nurse for malpractice. What is the term for the person bringing suit? A) Plaintiff B) Defendant C) Litigator D) Witness
Ans: A Feedback: A lawsuit is a legal action in a court. Litigation is the process of bringing and trying a lawsuit. The person or government bringing suit against another is called the plaintiff. The one being accused of a crime or tort (defined later) is called the defendant. The defendant is presumed innocent until proved guilty of a crime or tort.
The nurses who provide care in a large, long-term care facility utilize charting by exception (CBE) as the preferred 2. 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
Ans: A Feedback: 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'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
Ans: A Feedback: 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 client refuses to have a pain medication administered by injection. A nurse says, "If you don't let me give you the shot, I will get help to hold you down and give it." With what crime might the nurse be charged? A) Assault B) Battery C) Negligence D) Defamation
Ans: A Feedback: Assault and battery are intentional torts. Assault is a threat or attempt to make bodily contact with another person without that person's consent. Threatening to forcibly administer an injection after the patient has refused it is assault. Battery is an assault that is carried out and includes willful, angry, and violent or negligent touching of another person's body, clothes, or anything attached to or held by that other person. Negligence is defined as performing an act that a reasonably prudent person under similar circumstances would not do or, conversely, failing to perform an act that a reasonably prudent person under similar circumstances would do. Defamation is an intentional tort in which one party makes derogatory remarks about another that diminish the other party's reputation.
When the nurse inserts an ordered urinary catheter into the client's urethra after the client has refused the procedure, and then the client suffers an injury, the client may sue the nurse for which type of tort? A) Battery B) Assault C) Invasion of privacy D) Dereliction of duty
Ans: A Feedback: Battery is the actual carrying out of such threat (unlawful touching of a person's body). A nurse may be sued for battery if he or she fails to obtain consent for a procedure.
During a clinical placement on a subacute, geriatric medicine unit, a student nurse fed a stroke client some beef broth, despite the fact that the client's diet was restricted to thickened fluids. As a result, the client aspirated and developed pneumonia. Which of the following statements underlies the student's potential liability in this situation? A) The same standards of care that apply to a registered nurse apply to the student. B) The student and the nursing instructor share liability for this lapse in care. C) The patient's primary nurse is liable for failing to ensure that delegated care was appropriate. D) The student's potential liability is likely negated by the insurance carried by the school of nursing.
Ans: A Feedback: Despite the fact that their knowledge and skills are still under development, nursing students are held to the same standards of care as registered nurses. Consequently, primary liability does not lie with the student's instructor or the patient's primary nurse. Insurance may be carried by the school of nursing, but this does not negate the student's legal responsibility to provide care at a high standard.
A group of nurses working in a long-term care facility fails to keep the narcotic medications in a secure location. The nurses also fail to count the medications before and after each shift, as indicated by the institution's policies and procedures. These failures may result in what type of disciplinary action? A) Action against the nurses' licenses B) Action against the facility's state license C) Action against the state regulating body D) Action against the pharmacist's license
Ans: A Feedback: In institutions, most controlled substances must be kept secure and monitored closely in accordance with institutional and state regulations. Failure to do so may lead to disciplinary action against the nurse's license.
A nurse is providing client care in a hospital setting. Who has full legal responsibility and accountability for the nurse's actions? A) The nurse B) The head nurse C) The physician D) The hospital
Ans: A Feedback: In modern practice, nurses assess and diagnose clients and plan, implement, and evaluate nursing care. Full legal responsibility and accountability for these nursing actions rest with the nurse.
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
Ans: A Feedback: 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.
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
Ans: A Feedback: 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.
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
Ans: A Feedback: 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.
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"
Ans: A Feedback: 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 aspects of nursing would be most likely defined by legislation at a state level? A) The differences in the scope of practice between registered nurses (RNs) and licensed practical nurses (LPNs). B) The criteria that a nurse must consider when delegating tasks to unlicensed care providers. C) The criteria that clients must meet in order to qualify for Medicare or Medicaid. D) The process that nurses must follow when handling and administering medications.
Ans: A Feedback: The scope of practice defines the parameters within which nurses provide care, and is established by state legislation, most commonly in the form of a Nurse Practice Act. The criteria and due process for delegation in the clinical setting is addressed by a state board of nursing. Qualification criteria for programs such as Medicare and Medicaid are established by federal legislation, while the process for safe and appropriate medication administration is defined and monitored by a state board of nursing.
The children of a female client 78 years of age with a recent diagnosis of early-stage Alzheimer's disease are attempting to convince their mother to move into an assisted living facility, a move to which the client is vehemently opposed. Both the client and her children have expressed to the nurse how they are entrenched in their position. Which of the following statements expresses a utilitarian approach to this dilemma? A) The decision should be made in light of consequences. B) The client's autonomy and independence are the priority considerations. C) Benefits and burdens should be evenly distributed between the children and the client. D) The client has a right to self-determination.
Ans: A Feedback: Utilitarianism is the theory of ethics that weighs rightness and wrongness according to consequences and outcomes for all those who are affected. Utilitarianism prioritizes these consequences and outcomes over principles such as autonomy and justice; principles that underlie the other statements addressing the patient's right to self-determination; and fair distribution of benefits and burdens.
Which of the following best describes voluntary standards? A) Voluntary standards are guidelines for peer review, guided by the public's expectation of nursing. B) Voluntary standards set requirements for licensure and nursing education. C) Voluntary standards meet criteria for recognition, specified area of practice. D) Voluntary standards determine violations for discipline and who may practice.
Ans: A Feedback: Voluntary standards are developed and implemented by the nursing profession itself. They are not mandatory but are used as guidelines for peer review. The organizations that set standards are guided by society's need for nursing and by the public's expectations of nursing.
Which of the following 2. actions most clearly demonstrates that this client is engaging in the step of prizing within his valuing process? A) The client expresses pride that he now has the knowledge and skills to take control of his diabetes management. B) The client states that he will now begin to check his blood glucose before each meal and at bedtime. C) The client is now able to explain how his choices have contributed to his renal failure. D) The client expresses remorse at how his failure to take make lifestyle changes has adversely affected his health.
Ans: A Feedback: Within the valuing process, expressions of pride and happiness are considered to be indications of prizing. Resolving to make changes is an aspect of choosing, while expressing insight about his role in his current diagnosis demonstrates that the client has the desire to re-examine his values.
Which of the following are examples of a nurse demonstrating the professional value of altruism? Select all that apply. A) The nurse arranges for an interpreter for a client whose primary language is Spanish. B) The nurse calls the physician of a client whose pain medication is not strong enough. C) The nurse provides information for a client so he is capable of participating in planning his care. D) The nurse reviews a client chart to determine who may be informed of the patient's condition. E) The nurse documents client care accurately and honestly and reviews the entry to ensure there are no errors.
Ans: A, B Feedback: The altruistic nurse demonstrates understanding of cultures, beliefs, and perspectives of others; advocates for clients; and takes risks on behalf of clients and colleagues. The professional practice reflects autonomy when the nurse respects clients' rights to make decisions about their health care. Human dignity is reflected when the nurse values and respects all clients and colleagues by preserving their confidentiality. Integrity is reflected in professional practice when the nurse is honest and provides care based on an ethical framework that is accepted within the profession. Social justice is upholding moral, legal, and humanistic principles. One way to do this is by encouraging legislation and policy consistent with the advancement of nursing care and health care.
According to HIPPA regulations, which of the following is a client right regarding the client's medical record? Select all that apply. A) To see the health record B) To copy the health record C) To make additions to the health record D) To cross out sections of the health record E) To restrict certain disclosures of the health record
Ans: A, B, E Feedback: According to HIPAA, clients have a right to see and copy their health record; to update their health record; to get a list of the disclosures a health care institution has made independent of disclosures made for the purposes of treatment, payment, and health care operations; to request a restriction on certain uses or disclosures; and to choose how to receive health information. The client may not make additions, cross out sections, or destroy the health record.
Which of the following statements accurately describes an aspect of the credentialing process used in nursing practice? Select all that apply. A) Credentialing refers to the way in which professional competence is ensured and maintained. B) Accreditation is the process by which the state determines that a person meets minimum requirements to practice nursing. C) Certification grants recognition in a specified practice area to people who meet certain criteria. D) Legal accreditation of a school preparing nursing personnel by the state Board of Nursing is voluntary. E) Once earned, a license to practice is a property right and may not be revoked without due process.
Ans: A, C, E
A nurse explains the informed consent form to a client who is scheduled for heart bypass surgery. Which of the following are elements of this consent form? Select all that apply. A) Disclosure B) Organ donation C) DNR orders D) Comprehension E) Competence
Ans: A, D, E Feedback: Every person is granted freedom from bodily contact by another person, unless consent is granted. In all health care agencies, informed and voluntary consent is needed for admission (for routine treatment), for each specialized diagnostic procedure or medical or surgical treatment, and for any experimental treatments or procedures. Elements of informed consent include disclosure, comprehension, competence, and voluntariness.
Which of the following nursing actions would be considered a violation of HIPPA regulations? Select all that apply. A) A nurse ambulates a client through a hospital hallway in a hospital gown that is open in the back. B) A nurse shoves a confused, bedridden client into bed after he made several attempts to get up. C) A nurse inadvertently administers the wrong dose of morphine to a client in the ICU. D) A nurse uses a client's chart as a sample teaching case without changing the client's name. E) A nurse reports the condition of a client to the client's employer.
Ans: A, D, E Feedback: HIPPA regulations exist to protect patient privacy. Answers A, D, and E are examples of violations of HIPPA. Shoving a patient is battery and inadvertently administering the wrong dose of a medicine is negligence. A person fraudulently misrepresenting himself or herself to obtain a license to practice nursing is considered fraud.
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
Ans: B
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
Ans: B
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
Ans: B
A client is admitted with symptoms of psychosis. The nurse hurries to the client's room when she hears the client calling for help. She finds the client lying on the ground. The nurse assists the client back to the bed and performs a thorough assessment. The nurse informs the physician and completes the incident report. Which of the following statements should the nurse document in the incident report? A) The client was trying to lower the side rails. B) The client was found lying on the floor. C) The client was trying to get out of the bed. D) The client was not aware that he had fallen.
Ans: B Feedback: An incident report is a written account of an unusual, potentially injurious event involving a client, employee, or visitor. All of the details given in the incident report should be accurate and not assumed. Accurate and detailed documentation helps to prove that the nurse acted reasonably or appropriately in the circumstance. The nurse should document that the client was found lying on the floor. The other statements are assumptions and should not be included in the incident report.
When a nurse refuses to compromise a client's right to privacy, even when the nurse is threatened, the nurse is expressing an ethical framework termed what? A) Utilitarian B) Deontologic C) Justice D) Nonmaleficence
Ans: B Feedback: Deontologic frameworks emphasize roles or responsibilities that one is morally obligated to fulfill.
A client who has undergone resection of the intestine is on a liquid diet with a nasogastric tube in place. He refuses the food tray with regular food that comes to his room and insists that a physician be called. The nurse insists that it is the right food and makes the client take it. The client develops complications and has to be re-operated upon. How is negligence determined in this situation? A) The nurse did not call the physician when the client asked. B) The nurse did not realize the importance of the tube. C) The dietary department sent the wrong diet for the client. D) The nurse insisted the patient have the solid food
Ans: B Feedback: Negligence is defined as harm that occurs because the person did not act reasonably. In this case, the nurse did not realize that the client was on a nasogastric tube, and should consequently have been on liquid feeds after intestinal surgery; as a result, the patient developed complications. The acts of not calling the physician and insisting the patient have food do not amount to negligence. The dietary department sending the wrong food is unrelated to the nurse.
While at lunch, a nurse heard other nurses at a nearby table talking about a client they did not like. When they asked him 10. what he thought, he politely refused to join in the conversation. What value was the nurse demonstrating? A) The importance of food in meeting a basic human need B) Basic respect for human dignity C) Men do not gossip with women D) A low value on collegiality and friendship
Ans: B Feedback: Nurses who feel uncomfortable gossiping with other nurses about patients realize that this behavior contradicts a basic respect for human dignity. This respect is a value that allows one to choose freely to believe in the worth and uniqueness of each individual.
What is the function of the American Nurses Association's Code of Ethics for Nurses? A) Serves to establish personal ethics for nurses B) Delineates nurses' conduct and responsibilities C) Serves as a guideline for all health care practice D) Plays an important role in legal proceedings
Ans: B Feedback: The ANA recently revised the Code of Ethics for Nurses that delineates the conduct and responsibilities expected of all nurses in their nursing practices.
A client who is scheduled to have surgery for a hernia the next day is anxious about the whole procedure. The nurse assures the client that surgery for hernias is very common and that the prognosis is very good. What skills of the nurse are reflected here? A) Imaginal skills B) Interpersonal skills C) Instrumental skills D) Systemsskill
Ans: B Feedback: The scenario reflects the nurse's interpersonal skills. It shows how a person relates with others. The nurse shows imaginal skills when he or she envisions a plan for adapting and personalizing client care. Instrumental skills are associated with basic physical and intellectual competencies. Systems skills are those that help the nurse see the whole picture and how various parts relate.
A dying client tells the nurse that he doesn't want to see his family because he doesn't want to cause them more sadness. Which action by the nurse is most appropriate? A) Arrange a meeting between the family and the client. B) Help the patient clarify his values. C) Educate the patient on death and dying concepts. D) Allow the patient time for quiet reflection.
Ans: B Feedback: Values clarification is a method of self-discovery by which people identify their personal values and value rankings. The client's value of family may be obscured because of his overwhelming need to protect his family.
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
Ans: B Feedback: 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.
Two nurses are discussing a client's condition in an elevator full of visitors. With what crime might the nurses be charged? A) Defamation of character B) Invasion of privacy C) Unintentional negligence D) Intentional negligence
Ans: B Feedback: Certain acts by nurses could constitute invasion of privacy, including talking about patients in public areas, such as elevators. This violates federal law. In this case, the nurses would not be charged with defamation or negligence.
A nurse moves from Ohio to Missouri. Where can a copy of the Nurse Practice Act in Missouri be obtained? A) Ohio State Board of Nursing B) Missouri State Board of Nursing C) Federal government nursing guidelines D) National League for Nursing
Ans: B Feedback: Each state has a Nurse Practice Act that protects the public by broadly defining the legal scope of nursing practice. A copy of the Nurse Practice Act for the state in which a nurse practices can be obtained from that state's board of nursing. Neither the federal government nor the National League for Nursing has copies of nurse practice acts.
A nurse has taken a telephone order from a physician for an emergency medication. The dose of the medication is abnormally high. What should the nurse do next? A) Administer the medication based on the order B) Question the order for the medication C) Refuse to administer the medication D) Document concerns about the order
Ans: B Feedback: The nurse should question any physician order that is ambiguous, contraindicated by normal practice (such as an abnormally high medication dose), or contraindicated by the client's present condition. The nurse should not administer the medication, refuse to administer the medication without contacting the physician, or document concerns about the order without doing anything further.
An ethical conflict exists around a female client's expressed desire to have a neighbor make her treatment decisions. This neighbor is an individual who the client's children characterize as a predator. Place in the correct order the steps that the nurse should follow in resolving this ethical conflict. 1. Clearly identify the ethical problem 2. Apply ethical principles to the situation 3. Identify the different options 4. Gather relevant data about the situation 5. Make and evaluate a decision A) 1, 2, 3, 4, 5 B) 4, 1, 3, 2, 5 C) 2, 3, 4, 1, 5 D) 1, 4, 3, 2, 5
Ans: B Feedback: The nursing process of assessment, diagnosis, planning, implementation, and evaluation can be applied to appropriately respond to many ethical dilemmas.
Which of the following is the most frequent reason for revocation or suspension of a nurse's license? A) Fraud B) Mental impairment C) Alcohol or drug abuse D) Criminal acts
Ans: C Feedback: A nurse's license may be suspended or revoked for fraud, deceptive practices, criminal acts, previous disciplinary action by other state boards, negligence, physical or mental impairments, or alcohol or drug abuse. The most frequent reason is alcohol or drug abuse.
A woman age 83 years who has suffered a cerebrovascular accident and is unable to swallow refuses the insertion of a feeding tube. This is an example of what ethical principle? A) Nonmaleficence B) Veracity C) Autonomy D) Justice
Ans: C Feedback: Autonomy essentially means independence and the ability to be self-directed.
A nurse working in a long-term care facility has an elderly male client who is very confused. What ethical dilemma is posed when using restraints in a long-term care setting? A) It limits personal safety. B) It increases confusion. C) It threatens autonomy. D) It prevents self-directed care
Ans: C Feedback: Because there are safety risks involved when using restraints on elderly confused clients, this is a common ethical problem in long-term care settings, as well as other health care settings. Restraints limit the individual's autonomy because they are perceived as imprisonment. Restraints should not limit personal safety. Often, restraints increase confusion, and they prevent self-directed care.
A nurse is caring for a woman 28 years of age who has delivered a baby by Cesarean section. She describes her pain as a 9. The nurse medicates her for pain. This is an example of which of the following ethical frameworks? A) Justice B) Fidelity C) Beneficence D) Nonmaleficence
Ans: C Feedback: Beneficence means doing or promoting good. The treatment of the client's pain is the nurse's act of doing good.
What type of law regulates the practice of nursing? A) Common law B) Public law C) Civil law D) Criminal law
Ans: C Feedback: Civil laws regulate the practice of nursing. A law is a standard or rule of conduct established and enforced by the government, chiefly to protect the rights of the public. Private law, also called civil law, regulates relationships among people and includes laws related to the practice of nursing.
Which of the following is the nurse's best legal safeguard? A) Collective bargaining B) Written or implied contracts C) Competent practice D) Patient education
Ans: C Feedback: Competent practice is the nurse's most important and best legal safeguard. Each nurse is responsible for making sure his or her educational background and clinical experience are adequate to fulfill the nursing responsibilities described in the job description. Collective bargaining, written or implied contracts, and/or patient education do not provide the best legal safeguard.
A client nearing the end of life requests that he be given no food or fluids. The physician orders the insertion of a nasogastric tube to feed the client. What situation does this create for the nurse providing care? A) Nurse must follow the physician's orders B) An inability to provide care for the patient C) An ethical dilemma about inconsistent courses of action D) A barrier to establishing an effective nurse-patient relationship
Ans: C Feedback: In an ethical dilemma, two or more clear moral principles apply but support mutually inconsistent courses of action. In this case, the nurse must decide what to do based on ethical decision making and take action that can be justified ethically based on that process.
A nurse fails to administer a medication that prevents seizures, and the client has a seizure. The nurse is in violation of the Nurse Practice Act. What type of law is the nurse in violation of? A) Criminal B) Federal C) Civil D) Supreme
Ans: C Feedback: Malpractice cases are generally the kind of civil cases that involve nurses.
A client, unsure of the need for surgery, asks the nurse, "What should I do?" What answer by the nurse is based on advocacy? A) "If I were you, I sure would not have this surgical procedure." B) "Gosh, I don't know what I would do if I were you." C) "Tell me more about what makes you think you don't want surgery." D) "Let me talk to your doctor and I will get back to you as soon as I can."
Ans: C Feedback: Nurses as advocates must realize that they do not make ethical decisions for their clients. Rather, they facilitate clients' decision-making by interpreting findings, informing cliients of various aspects to be considered, helping clients verbalize and organize their feelings, calling in others involved in the decision making, and helping clients assess all their options in relation to their beliefs.
A nurse has a duty of nonmaleficence. Which of the following would be considered a contradiction to that duty? A) Provide comfort measures for a terminally ill patient. B) Assist the patient with ADLs. C) Refuse to administer pain medication as ordered. D) Provide all information related to procedures.
Ans: C Feedback: The duty not to inflict harm, as well as prevent and remove harm, is termed nonmaleficence. Providing comfort measures for a terminally ill patient, assisting a patient with ADLs and providing information related to procedures would not be considered a contradiction to the nurse's duty of nonmaleficence.
A nurse is caring for a client who is a celebrity in the area. A person claiming he is a family member inquires about the medical details of the client. The nurse reveals the information but later comes to find out that the person was not a family member. The nurse has violated which of the following? A) Veracity B) Fidelity C) Confidentiality D) Autonomy
Ans: C Feedback: The nurse has violated the principle of confidentiality by revealing the client's personal medical information to a third person. Confidentiality is a professional duty and a legal obligation. What is documented in the client's record is accessible only to those providing care to that client. The nurse's action does not violate rules of veracity, fidelity, or autonomy. Fidelity means being faithful to one's commitments and promises. Veracity means telling the truth, which is essential to the integrity of the client-provider relationship. Autonomy involves a client making his or her own decisions.
A nurse in a women's health clinic values abstinence as the best method of birth control. However, she offers 9. compassionate care to unmarried pregnant adolescents. What is the nurse demonstrating? A) modeling of value transmission B) conflict in values acceptance C) nonjudgmental "value neutral" care D) values conflict that may lead to stress
Ans: C Feedback: The nurse is demonstrating nonjudgmental "value neutral" care. This means she is respecting and accepting the individuality of patients, does not assume that her personal values are right, and does not judge the patients' values as right or wrong depending on their congruence with hers.
A home care nurse visits a client who is confined to bed and is cared for by her daughter. The daughter is known to suffer from chemical dependence. The home is cluttered and unclean. During the assessment the nurse notes that the client is wet with urine and has dried feces on her buttocks, and demonstrates signs of dehydration. After caring for the client, the nurse contacts the physician and reports the incident to Adult Protective Services. This is an example of which ethical framework? A) Justice B) Autonomy C) Nonmaleficence D) Fidelity
Ans: C Feedback: The principle of nonmaleficence means to avoid doing harm, to remove harm, and to prevent harm. Autonomy means to respect the rights of clients or their surrogates to make healthcare decisions. Justice means to give each his or her due. Fidelity means to keep promises.
Which of the following modes of value transmission is most likely to lead to confusion and conflict? A) Modeling B) Moralizing C) Laissez-faire D) Responsible choice
Ans: C Feedback: Those who use the laissez-faire approach for value transmission leave children to explore values on their own (no one set of values is presented as best for all) and to develop a personal value system. This approach often involves little orno guidance and can lead to confusion and conflict.
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.
Ans: C Feedback: 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.
Which of the following accreditations is a legal requirement for a school of nursing to exist? A) National League for Nursing Accrediting Commission B) American Association of Colleges of Nursing accreditation C) State Board of Nursing accreditation D) Educational institution accreditation
Ans: C Feedback: State laws are enacted to ensure that schools preparing nursing practitioners maintain minimum standards of education. This is legal accreditation. Accreditation by voluntary agencies is not required for a school to exist.
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
Ans: C Feedback: 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 lawyer quotes a precedent for punishment of a crime committed by the defendant in a trial. What is court-made law known as? A) Public law B) Statutory law C) Common law D) Administrative law
Ans: C Feedback: The government provides for a judiciary system, which is responsible for reconciling controversies. It interprets legislation at the local, state, and national levels as it has been applied in specific instances and makes decisions concerning law enforcement. A body of law known as common law has evolved from these accumulated judiciary decisions. Common law is thus court-made law, and most law involving malpractice is common law.
A middle-aged man is having increasing difficulty breathing. He never exercises, eats fast food regularly, and smokes two packs of cigarettes a day. He tells the nurse practitioner that he wants to change the way he lives. What is one means of helping him change behaviors? A) Ethical change strategy B) Values neutrality choices C) Values transmission D) Values clarification
Ans: D Feedback: Values clarification is a process by which people come to understand their own values and value system. When nurses understand the values that motivate patients' decisions and behaviors, they can tap these values when teaching and counseling patients.
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."
Ans: C Feedback: 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 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
Ans: D
A baccalaureate-prepared nurse is applying for a nurse practitioner position. The nurse is: A) Well educated and can perform these duties B) Able to practice as a nurse practitioner C) Educated to practice only with pediatric patients D) Practicing beyond his scope according to licensure
Ans: D Feedback: A nurse without an advanced practice license is not able to practice beyond his or her scope in accordance with the Nurse Practice Act.
A nurse does not assist with ambulation for a postoperative client on the first day after surgery. The client falls and fractures a hip. What charge might be brought against the nurse? A) Assault B) Battery C) Fraud D) Negligence
Ans: D Feedback: A tort is a civil wrong committed by a person against another person or his or her property. Negligence, an unintentional tort, occurs when a person fails to exercise reasonable care in the performance of his or her duties. In this situation, the nurse did not initiate proper precautions to prevent patient harm and is subject to the charge of negligence.
An on-duty nurse discovers that her colleague is pilfering medicines. According to the Nurse Practice Acts, what should the nurse do? A) Keep silent and overlook the incident B) Inform the local police station C) Discuss this incident with the colleague D) Report the incident to the supervisor
Ans: D Feedback: According to the Nurse Practice Acts, the nurse should report the incident to the supervisor. Laws are enacted to regulate the practice of nursing and may be used to decide upon an appropriate action. Discussing the incident with a colleague may alarm the nurse who is pilfering medicines and she may become cautious. The nurse should not overlook the incident because pilfering of medicines is an offense. Calling local police may lead to undue interference.
A client gets out of bed following hip surgery, falls, and re-injures her hip. The nurse caring for her knows that it is her duty to make sure an incident report is filed. Which of the following statements accurately describes the correct procedure for filing an incident report? A) The physician in charge should fill out the report. B) The names of the staff involved should not be included. C) The reports are used for disciplinary action against the staff. D) The report should contain all the variables related to the incident.
Ans: D Feedback: An incident report, also called a variance or occurrence report, is 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 patient, employee, or visitor. The nurse responsible for a potentially (or actually) harmful incident or who witnesses an injury is the one who fills out the incident form. This form should contain the complete name of the person or people involved and the names of all witnesses; a complete factual account of the incident; the date, time, and place of the incident; pertinent characteristics of the person or people involved (e.g., alert, ambulatory, asleep) and of any equipment or resources being used; and any other variables believed to be important to the incident. These reports are used for quality improvement and should not be used for disciplinary action against staff members.
A nurse is arrested for possession of illegal drugs. What kind of law is involved with this type of activity? A) Civil B) Private C) Public D) Criminal
Ans: D Feedback: Criminal law concerns state and federal criminal statutes, which define criminal actions such as murder, manslaughter, criminal negligence, theft, and illegal possession of drugs. Civil law, also called private law, includes laws relating to contracts, ownership of property, and the practice of nursing, medicine, pharmacy, and dentistry. Public law is law in which the government is involved directly.
A nurse is concerned about the practice of routinely ordering a battery of laboratory tests for clients who are admitted to the hospital from a long-term care facility. An appropriate source in handling this ethical dilemma would be which of the following? A) The client's family B) The admitting physician C) The nurse in charge of the unit D) The institutional ethics committee
Ans: D Feedback: Many health care institutions have developed ethics committees whose functions include education, policymaking, case review, and consultation. These committees are multidisciplinary and provide a forum where divergent views can be discussed without fear of repercussion.
What is the legal source of rules of conduct for nurses? A) Agency policies and protocols B) Constitution of the United States C) American Nurses Association D) Nurse Practice Acts
Ans: D Feedback: Nurse Practice Acts are examples of statutory law, enacted by a legislative body in keeping with both the federal constitution and the applicable state constitution. They are the primary source of rules of conduct for nurses. Standards of practice, which differ from rules of conduct, are made by agency policies and protocols and by the American Nurses Association.
A nurse has been named as a defendant in a lawsuit. With whom should the nurse discuss the case? A) Colleagues B) Reporters C) Plaintiff D) Attorney
Ans: D Feedback: The nurse should only discuss the case with the attorney representing him or her and/or the institution. Recommendations for the nurse as defendant include not discussing the case with anyone at the employing agency (except the risk manager), the plaintiff, the plaintiff's lawyer, anyone testifying for the plaintiff, or reporters.
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
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."
Ans: D Feedback: Information should be documented in a complete, accurate, relevant, and factual manner. Avoid interpretations of behavior, generalizations, and words such as "good."
Two children need a kidney transplant. One is the child of a famous sports figure, whereas the other child comes from a low-income family. What ethically relevant consideration is important to the nurse as an advocate for these clients? A) Balance between benefits and harms in patient care B) Norms of family life C) Considerations of power D) Cost-effectiveness and allocation
Ans: D Feedback: The increasing awareness of how difficult it is to make valued and scarce health resources available to all in need has resulted in a new appreciation for the moral relevance of cost-effectiveness. Balance between benefits and harms in patient care relates to reasoning about the benefits or burdens of treatment and the related harms; in this scenario, both children's risk and benefits may be the same. Norms of family life relate to the ways a client's illness impacts family members and significant others; not enough information is provided to know how this ethical principle applies in this scenario. Considerations of power relates to abuse of power by clinicians; this scenario does not present information suggesting this is occurring.
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
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,C,E
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 first step? A) Plan of care B) Data, action, and response C) Problem selected D) Nursing activities
C
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
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
What activity in charting will assist most in the avoidance of errors? A) Objectivity B) Organization C) Legibility D) Timeliness
D
