censa exit

17. Which of the following is NOT an essential component of a restraint order? A. Informed consent for the restraint B. The reason for the restraint C. The type of restraint to be used D. Client behaviors that necessitated the restraints

A. Informed consent for the restraint Correct Response: A The minimal components of orders for restraint include the reason for and rationale for the use of the restraint, the type of restraint to be used, how long the restraint can be used, the client behaviors that necessitated the use of the restraints, and any special instructions beyond and above those required by the facility's policies and procedures. Informed consent is not necessary for the initiation or the use of restraints

34. Which is most closely aligned with ethics? A. Morals B. Laws C. Statutes D. Client rights

A. Morals Correct Response: A Morals are most closely aligned with ethics. Ethics is a set of beliefs and principles that guide us in terms of the right and wrong thing to do which is the most similar to ethics. Laws and statutes defined what things are legal and what things are illegal. Lastly, client rights can serve as a factor to consider when ethical decisions are made; but they are not most closely aligned with ethics, but only, one consideration of many that can be used in ethical decision making.

19. What is the primary goal of multidisciplinary case conferences? A. To fulfill the nurse's role in terms of collaboration B. To plan and provide for optimal client outcomes C. To solve complex multidisciplinary patient care problems D. To provide educational experiences for experienced nurses

C. To solve complex multidisciplinary patient care problems Correct Response: C The primary goal of multidisciplinary case conferences is to plan care that facilitates optimal client outcomes. Other benefits of multidisciplinary case conferences include the fulfillment of the nurse's role in terms of collaboration and collegiality, to solve complex multidisciplinary patient care problems so that optimal client outcomes can be achieved and also to provide educational experiences for nurses; these things are secondary rather than primary goals.

31. Number the priority of the following conditions using the numbers # 1 through # 6 with # 1 as the greatest priority and # 6 as the least priority. 1. Atrial fibrillation 2. First degree heart block 3. Shortness of breath upon exertion 4. An obstructed airway 5. Fluid needs 6. Respect and esteem by others A. 3,4,2,1,5,6 B. 3,4,5,1,2,6 C. 2,3,5,1,4,6 D. 3,2,4,1,5,6

4 An obstructed airway 2 First degree heart block 1 Atrial fibrillation 3 Shortness of breath upon exertion 5 Fluid needs 6 Respect and esteem by others Correct Response: Client needs are prioritized in a number of different ways including Maslow's Hierarchy of Human Needs and the ABCs. In terms of priorities from # 1 to # 6 the conditions above are prioritized as follows: 4 An obstructed airway 2 First degree heart block 1 Atrial fibrillation 3 Shortness of breath upon exertion 5 Fluid needs 6 Respect and esteem by others The ABCs identifies the airway, breathing and cardiovascular status of the patient as the highest of all priorities in that sequential order; and Maslow's Hierarchy of Needs identifies the physiological or biological needs, including the ABCs, the safety/psychological/emotional needs, the need for love and belonging, the needs for self-esteem and the esteem by others and the self-actualization needs in that order of priority

19. A comprehensive health assessment includes: A. A complete medical history, a general survey and a complete physical assessment. B. A complete medical history, a general survey and a focused physical assessment. C. A client interview, a significant other interview, a general survey and a complete physical assessment. D. A client interview, a significant other interview, a general survey and a focused physical assessment.

A. A complete medical history, a general survey and a complete physical assessment. Correct Response: A A comprehensive health assessment includes a complete medical history, a general survey and a complete physical assessment. Although a complete medical history is done using a client interview and a significant other interview for much data, it is the health history and not the interview that is part of the comprehensive health assessment. A focused assessment is done as based on some pathology, sign or symptom and it is not considered a part of a comprehensive health assessment.

14. You assess your family as having a deficit in terms of their instrumental activities of daily living (ADLs). Which healthcare professional would you most likely refer this family to in order to address this deficit? A. A social worker B. A physical therapist C. An occupational therapist D. A speech therapist

A. A social worker Correct Response: A The healthcare professional would you most likely refer this family to in order to address this deficit in terms of their instrumental activities of daily living (ADLs) is a social worker. The activities of daily living are differentiated in terms of the basic activities of daily living and the instrumental activities of daily living. Examples of basic activities of daily living include things like bathing, mobility, ambulation, toileting, personal care and hygiene, grooming, dressing, and eating. Deficits in terms of the basic activities of daily living are best addressed by a physical and/or occupational therapist. The instrumental activities of daily living are more advanced than the basic activities of daily living. The instrumental activities of daily living include things like grocery shopping, housework, meal preparation, the communication with others using something like a telephone, and having transportation. Deficits in terms of the instrumental activities of daily living are best addressed by a social worker. For example, the social worker may assist the client in terms of their transportation and they can also teach the client about how to grocery shop, for example.

4. Which of the following is considered an internal disaster? A. A tornado that has touched down on the healthcare facility B. A severe cyclone that has destroyed nearby homes C. A massive train accident that brings victims to your facility D. An act of bioterrorism in a nearby factory

A. A tornado that has touched down on the healthcare facility Correct Response: A A tornado that has touched down on the healthcare facility is an example of an internal disaster because this tornado has directly affected the healthcare facility. Tornados, cyclones, hurricanes and other severe weather emergencies can be both an internal disaster when they affect the healthcare facility and also an external disaster when they impact on the lives of those living in the community. Hurricane Katrina is a good example of a weather emergency that affected not only healthcare facilities but also members of the community.

9. Which of the following patient care tasks is coupled with the appropriate member of the nursing care team in terms of their legal scope of practice? A. An unlicensed staff member who has been "certified" by the employing agency to monitor telemetry: Monitoring cardiac telemetry B. An unlicensed assistive staff member like a nursing assistant who has been "certified" by the employing agency to insert a urinary catheter: Inserting a urinary catheter C. A licensed practical nurse: The circulating nurse in the perioperative area D. A licensed practical nurse: The first assistant in the perioperative area

A. An unlicensed staff member who has been "certified" by the employing agency to monitor telemetry: Monitoring cardiac telemetry Correct Response: A An unlicensed staff member who has been "certified" by the employing agency to monitor telemetry can monitor cardiac telemetry; they cannot, however, interpret these cardiac rhythms and initiate interventions when interventions are indicated. Only the nurse can perform these roles. Unlicensed assistive staff member like a nursing assistant cannot under any circumstances be certified" by the employing agency to insert a urinary catheter or insert a urinary catheter because this is a sterile procedure and, legally, no sterile procedures can be done by an unlicensed assistive staff member like a nursing assistant. Lastly, the role of the circulating nurse is within the exclusive scope of practice for the registered nurse and the role of the first assistant is assumed only by a registered nurse with the advanced training and education necessary to perform competently in this capacity. Neither of these roles can be delegated to a licensed practical nurse or an unlicensed assistive staff member like a nursing assistant or a surgical technician.

5. A nurse who organizes and establishes a political action committee (PAC) in their local community to address issues relating to the accessibility and affordability of healthcare resources in the community is serving in which capacity and role of the registered nurse? A. Client advocate B. Collaborator C. Politician D. Entrepreneur

A. Client advocate Correct Response: A A nurse who organizes and establishes a political action committee (PAC) in their local community to address issues relating to the accessibility and affordability of healthcare resources in the community is serving as the client advocate. As you should know, the definition of "client" includes not only individual clients, and families as a unit, but also populations such as the members of the local community. Although the nurse, as the organizer of this political action committee (PAC), will have to collaborate with members of the community to promote the accessibility and affordability of healthcare resources in the community, this is a secondary role rather than the primary role. Additionally, although the nurse is serving in a political advocacy effort, the nurse is not necessarily a politician and there is no evidence that this nurse is an entrepreneur.

49. The primary purpose of root cause analysis is to: A. Discover a process flaw B. Determine who erred C. Discover environmental hazards D. Determine basic client needs

A. Discover a process flaw Correct Response: A The primary purpose of root cause analysis is to discover process flaws. Root cause analysis and a blame free environment are essential to a successful performance improvement activity, therefore, root cause analysis does not aim to determine who erred and made a mistake. Root cause analysis explores and digs down to the roots of the problem, its root causes and the things, not people, which are the real reasons why medical errors and mistakes are made. It is nursing assessment that determines the basic client needs and environmental surveillance that discovers environmental safety hazards, and not root cause analysis.

12. Which of the following is an essential component for insuring that medical equipment is being used safely and properly by those who you supervise? A. Education and training on all pieces of equipment B. Pilot testing new equipment C. Reading all the manufacturer's instructions D. Researching the equipment before recommending its purchase

A. Education and training on all pieces of equipment Correct Response: A Education and training on all pieces of equipment is an essential component for insuring that medical equipment is being used safely and properly by those who you supervise. Other essential components include validated and documented competency to use any and all pieces of equipment by a person qualified to do so, preventive maintenance and the prompt removal of all unsafe equipment from service. Pilot testing new equipment, researching the equipment before recommending its purchase, and reading the entire manufacturer's instructions are things done prior to the purchase of the equipment and these things do not impact on the safety of the piece of medical equipment.

15. Select all of the cranial nerves that are accurately paired with its distinguishing characteristics and description. Again, select all that apply. A. Olfactory Cranial Nerve: The sensory nerve that transmits the sense of smell to the olfactory foramina of the nose B. Optic Cranial Nerve: This sensory nerve transmits the sense of vision from the retina to the brain. C. Oculomotor Cranial Nerve: This motor and sensory nerve controls eye movements and visual acuity. D. Trochlear Cranial Nerve: This motor nerve innervates eye ball movement and the superior oblique muscle of the eyes. E. Abducens Cranial Nerve: This motor nerve innervates and controls the abduction of the eye using the lateral rectus muscle. F. Facial Cranial Nerve: This motor nerve controls facial movements, some salivary glands and gustatory sensations from the anterior part of the tongue. G. Glossopharyngeal Cranial Nerve: This sensory nerve This nerve gives us the sense of taste from the posterior tongue, and it also innervates the parotid glands

A. Olfactory Cranial Nerve: The sensory nerve that transmits the sense of smell to the olfactory foramina of the nose B. Optic Cranial Nerve: This sensory nerve transmits the sense of vision from D. Trochlear Cranial Nerve: This motor nerve innervates eye ball movement and the superior oblique muscle of the eyes. E. Abducens Cranial Nerve: This motor nerve innervates and controls the abduction of the eye using the lateral rectus muscle. Correct Response: A,B,D,E The olfactory cranial nerve is a sensory nerve that transmits the sense of smell to the olfactory foramina of the nose; the optic cranial nerve is also a sensory nerve and it transmits the sense of vision from the retina to the brain. The trochlear cranial nerve is a motor nerve that innervates eye ball movement and the superior oblique muscle of the eyes; and the abducens cranial nerve is a motor nerve that innervates and controls the abduction of the eye using the lateral rectus muscle. The oculomotor cranial nerve is a motor nerve controls eye movements, the sphincter of the pupils and the ciliary body muscles; it has no sensory function. The facial cranial nerve is a motor and sensory nerve which controls facial movements, some salivary glands and gustatory sensations from the anterior part of the tongue. And, lastly, the glossopharyngeal cranial nerve is both a motor and sensory nerve that gives us the sense of taste from the posterior tongue, and it also innervates the parotid glands.

3. You are caring for a client who has been taking illicit amphetamines and states that they continue to use this illicit drug because they "suffer and feel lousy" when they try to stop taking it. Which nursing diagnosis is the most appropriate for this client? A. Psychological dependence secondary to amphetamine use B. Substance abuse secondary to amphetamine use C. Addiction secondary to amphetamine use D. Physical dependence secondary to amphetamine use

A. Psychological dependence secondary to amphetamine use Correct Response: A The appropriate nursing diagnosis for this client is "Psychological dependence secondary to amphetamine use". Psychological dependence is defined as the person's need to continue the use of the substance to avoid any unpleasant feelings and experiences that can occur when the substance is not taken. Amphetamines and hallucinogenic drugs like LSD are often associated with psychological dependence. Substance abuse, simply defined, is one's overindulgence of an addictive substance which can be alcohol, prescription drugs and/or illicit, illegal drugs. Substance abuse does not include prescribed medications, such as narcotic pain medications, that are being used for medical reasons; however, these same medications when used after there is no longer a medical need to use them is considered substance abuse. Addiction is defined as the unending and constant need for the person to have the chosen substance even when the use of the substance causes the client to have serious physical, psychological, social and/or economic consequences and harm including a loss of control over the substance abuse and use. Contrary to popular opinion, addiction can occur with and without physical dependence. Physical dependence occurs when the cessation of a drug causes adverse physical effects; these ill effects are typically greater and more intense when the cessation of the drug is rapid and abrupt. Some of the drugs that are most often associated with physical dependence include cocaine, opioid drugs, alcohol and benzodiazepines. As previously stated, physical dependence does not necessarily indicate addiction; addiction can be present with or without any physical dependency.

52. Which statement about referrals is accurate? A. Referrals complement the healthcare teams' abilities to provide optimal care to the client. B. Referrals simply allow the client to be discharged into the community with the additional care they need. C. Nurses facilitate referrals to only the resources within the facility.

A. Referrals complement the healthcare teams' abilities to provide optimal care to the client. Correct Response: A Referrals complement the healthcare teams' abilities to provide optimal care to the client. When clients have assessed needs that cannot be fulfilled and met by the registered nurse in collaboration with other members of the nursing care team, the registered nurse should then seek out resources, as well as utilize and employ different internal or external resources such as a physical therapist, a clergy member or a home health care agency in the community and external to the nurse's healthcare agency.

38. One of the roles of the registered nurse in terms of informed consent is to: A. Serve as the witness to the client's signature on an informed consent. B. Get and witness the client's signature on an informed consent. C. Get and witness the durable power of attorney for health care decisions' signature on an informed consent. D. None of the above

A. Serve as the witness to the client's signature on an informed consent. Correct Response: A One of the roles of the registered nurse in terms of informed consent is to serve as the witness to the client's signature on an informed consent. Other roles and responsibilities of the registered nurse in terms of informed consent include identifying the appropriate person to provide informed consent for client, such as the client, parent or legal guardian, to provide written materials in client's spoken language, when possible, to know and apply the components of informed consent, and to also verify that the client comprehends and consents to care and procedures. The registered nurse does not get the client's or durable power of attorney for health care decisions' signature on an informed consent, this is the role and responsibility of the physician or another licensed independent practitioner.

15. Select the basic sterile asepsis procedures that are accurate. Select all that apply: A. Sterile items ONLY are placed on the sterile field. B. The nurse must keep the sterile field below waist level. C. Coughing or sneezing over the sterile field contaminates the sterile field. D. The nurse must maintain a 1/2 inch border around the sterile field that is not sterile. E. Moisture and wetness contaminate the sterile field. F. Sterile masks are used by staff and the client when a sterile field is being set up and/or maintained

A. Sterile items ONLY are placed on the sterile field. C. Coughing or sneezing over the sterile field contaminates the sterile field. E. Moisture and wetness contaminate the sterile field. Correct Response: A, C, E Sterile items ONLY are placed on the sterile field; coughing or sneezing over the sterile field contaminates the sterile field; and all moisture and wetness contaminate the sterile field. Some of the other principles that are applied to setting up and maintaining a sterile field include keeping the sterile field above the waist level and preventing coughing or sneezing by professional staff and the client during the set up and during the maintenance of the sterile field. If there is a danger that anyone may cough or sneeze over the field, the professional staff and/or the client should don a mask to prevent contamination. Lastly, a one inch border, not a ½ border that is not sterile is maintained around the perimeter of the sterile field.

13. Which of these case management methods employs the intrinsic use of multidisciplinary plans of care that are based on the client's current condition, and reflect interventions and expected outcomes within a pre-established time line? A. The Case Manager Model B. The ProACT Model C. The Collaborative Practice Model D. The Triad Model of Case Management

A. The Case Manager Model Correct Response: A The Case Manager Model and the Collaborative Practice Model of case management are the only models of case management that employ the mandated and intrinsic use of critical pathways which are multidisciplinary plans of care that are based on the client's current condition, and that reflect interventions and expected outcomes within a pre-established time line. The ProACT Model, the Collaborative Practice Model and the Triad Model of Case Management do not necessarily employ critical pathways; these models can use any system of medical records and documentation.

41. Legal prohibitions against sharing passwords are legally based on: A. The Security Rule B. The American Nurses Association's Code of Ethics C. The American Hospital's Patients' Bill of Rights D. The Autonomy Rule

A. The Security Rule Correct Response: A Prohibitions against sharing passwords are legally based on the Security Rule of HIPAA mandates administrative, physical, and technical safeguards to insure the confidentiality, integrity, and availability of electronic protected health information. This rule relates to electronic information security as well as other forms of information. The American Nurses Association's Code of Ethics and the American Hospital's Patients' Bill of Rights both address client confidentiality and their rights to privacy, however, these statements are not legal, but instead ethical and regulatory statements; and lastly, there is no autonomy law or rule.

8. You are working as a National Board for Certification of Hospice and Palliative Nurses certified hospice and palliative care nurse who is caring for your clients in their home. Which of the following nursing diagnoses or client goal would be the most likely appropriate and expected for the vast majority of these clients? A. The client will accept impending death B. Guilt related to past transgressions C. Spiritual distress related to guilt D. Pain related to end of life symptoms

A. The client will accept impending death Correct Response: A "The client will accept impending death" is the client goal would be the most likely appropriate and expected for the vast majority of these clients. In fact, one of the primary goals of hospice and palliative care is to facilitate the client's and family member's acceptance. Other goals are the freedom for guilt, spiritual distress and pain at the end of life; therefore, these diagnoses are not expected.

10. Which statement about targeted assessments is accurate? A. The need for a targeted assessment is based on the application of the nurse's knowledge of pathophysiology and the presenting symptoms. B. The need for a targeted assessment is based on the application of the nurse's knowledge of developmental needs and developmental delays. C. Targeted assessment is done on an annual basis for existing clients rather than a complete assessment that is done for new clients. D. Targeted assessments consist of a brief medical history and a complete assessment consists of a complete health history and a complete physical assessment.

A. The need for a targeted assessment is based on the application of the nurse's knowledge of pathophysiology and the presenting symptoms. Correct Response: A The need for a targeted assessment is based on the application of the nurse's knowledge of pathophysiology and the presenting symptoms. Targeted assessments and screenings are done in addition to routine and recommended screenings when a particular disorder has a genetic pathophysiological component for risk and when a client is presenting with a particular sign or symptom. For example, a targeted assessments relating to nutritional status may be indicated when an infant or young child is listless and not gaining weight according the established criteria; an adolescent may be target screened for visual acuity when a high school teacher reports that the teen does not seem to be able to read things on the blackboard; and a toddler may be target screened when the parent reports that the child is not responding to their name.

17. Select the member of the multidisciplinary team that you would most likely collaborate with when the client is at risk for falls due to an impaired gait. A. The physical therapist B. The occupational therapist C. The podiatrist D. The nurse practitioner

A. The physical therapist Correct Response: A The member of the multidisciplinary team that you would most likely collaborate with when the client is at risk for falls due to an impaired gait is a physical therapist. Physical therapists are licensed healthcare professionals who assess, plan, implement and evaluate interventions including those related to the patient's functional abilities in terms of their gait, strength, mobility, balance, coordination, and joint range of motion. They also provide patients with assistive aids like walkers and canes and exercise regimens. Occupational therapists assess, plan, implement and evaluate interventions including those that facilitate the patient's ability to achieve their highest possible level of independence in terms of their activities of daily living such as bathing, grooming, eating and dressing. Podiatrists care for disorders and diseases of the foot; and nurse practitioners, depending on their area of specialty, may also collaborate with nurses when a client is affected with a disorder in terms of gait, strength, mobility, balance, coordination, and joint range of motion, however the member of the multidisciplinary team that you would most likely collaborate with when the client is at risk for falls due to an impaired gait is a physical therapist.

33. Which of these skills is most closely related to successfully meeting the established priority needs of a group of clients? A. Time management skills B. Communication skills C. Collaboration skills D. Supervision skills

A. Time management skills Correct Response: A Time management skills are most closely related to successfully meeting the established priority needs of a group of clients. In addition to prioritizing and reprioritizing, the nurse should also have a plan of action to effectively manage their time; they should avoid unnecessary interruptions, time wasters and helping others when this helping others could potentially jeopardize their own priorities of care. Although good communication skills, collaboration skills and supervision are necessary for the delivery of nursing care, it is time management skills that are most closely related to successfully meeting the established priority needs of a group of clients.

6. You are working in a community pediatric health clinic. Which developmental task should you apply into your practice? A. You should apply the principles of initiative when caring for preschool children. B. You should apply the principles of sensorimotor thought when caring for preschool children. C. You should apply the principles of intimacy when caring for the adolescent. D. You should apply the principles of concrete operations when caring for the adolescent.

A. You should apply the principles of initiative when caring for preschool children. Correct Response: A You should apply the principles of initiative when caring for preschool children. The developmental task for preschool children is initiative, according to Eric Erickson. The other developmental tasks, according to Eric Erickson are: Infant: Trust Toddler: Autonomy School Age Child: Industry Adolescent: Identity formation Young Adult: Intimacy Middle Aged Adult: Generativity Older Adults: Ego integrity In the correct sequential order, Jean Piaget's levels of cognitive development include: Sensorimotor thought: Infancy to About 2 Years of Age Preoperational and symbolic functioning: From 2 to 7 Years of Age Concrete operations: 7 to 11 Years of Age Formal operations: 12 Years of Age

1. You are caring for a client at the end of life. The client tells you that they are grateful for having considered and decided upon some end of life decisions and the appointments of those who they wish to make decisions for them when they are no longer able to do so. During this discussion with the client and the client's wife, the client states that "my wife and I are legally married so I am so glad that she can automatically make all healthcare decisions on my behalf without a legal durable power of attorney when I am no longer able to do so myself" and the wife responds to this statement with, "that is not completely true. I can only make decisions for you and on your behalf when these decisions are not already documented on your advance directive." How should you, as the nurse, respond to and address this conversation between the husband and wife and the end of life? A. You should respond to the couple by stating that only unanticipated treatments and procedures that are not included in the advance directive can be made by the legally appointed durable power of attorney for healthcare decisions. B. You should be aware of the fact that the wife of the client has a knowledge deficit relating to advance directives and durable powers of attorney for healthcare decisions and plan an educational activity to meet this learning need. C. You should be aware of the fact that the client has a knowledge deficit relating to advance directives and durable powers of attorney for healthcare decisions and plan an educational activity to meet this learning need. D. You should reinforce the wife's belief that legally married spouses automatically serve for the other spouse's durable power of attorney for health care decisions and that others than the spouse cannot be legally appointed while people are married

A. You should respond to the couple by stating that only unanticipated treatments and procedures that are not included in the advance directive can be made by the legally appointed durable power of attorney for healthcare decisions.Correct Response: A You should respond to the couple by stating that only unanticipated treatments and procedures that are not included in the advance directive can be made by the legally appointed durable power of attorney for healthcare decisions. Both the client and the client's spouse have knowledge deficits relating to advance directives. Legally married spouses do not automatically serve for the other spouse's durable power of attorney for health care decisions; others than the spouse can be legally appointed while people are married.

14. Which type of legal consent is indirectly given by the client by the very nature of their voluntary acute care hospitalization? A. An opt out consent B. An implicit consent C. An explicit consent D. No consent at all is given

B. An implicit consent Correct Response: B The type of legal consent that is indirectly given by the client by the very nature of their voluntary acute care hospitalization is an implicit consent indirectly given by the client by the very nature of their voluntary acute care hospitalization is an implicit consent. An explicit consent, on the other hand, is the direct and formal consent of the client; and an opt out consent is given when a patient does NOT refuse a treatment; this lack of objections by the patient indicates that the person has consented to the treatment or procedure with an opt out consent.

21. Conflicts, according to Lewin, include which types of conflict? Select all that are accurate. A. Conceptualization conflicts B. Avoidance - Avoidance conflicts C. Approach - Approach conflicts D. Resolvable conflicts E. Unresolvable conflicts F. Double Approach - Avoidance conflicts G. Approach-Avoidance conflicts

B. Avoidance - Avoidance conflicts C. Approach - Approach conflicts F. Double Approach - Avoidance conflicts G. Approach-Avoidance conflicts Correct Response: B, C, F, G According to Lewin, the types of conflict are Avoidance-Avoidance conflicts, Approach- Approach conflicts, Double Approach - Avoidance conflicts and Approach-Avoidance conflicts.

13. Which of the following security concerns is also a sentinel event that must be reported? A. A possible vulnerability of the facility's information technology to hacking B. The assisted suicide of a client in your facility by the spouse of the client C. Vulnerability to computer hacking D. Potential information theft

B. The assisted suicide of a client in your facility by the spouse of the client Correct Response: B The assisted suicide of a client in your facility by the spouse of the client is a security concern that is also a sentinel event that must be reported. A possible vulnerability of the facility's information technology to hacking, vulnerability to computer hacking and potential information theft is security concerns but they are not sentinel events that must be reported.

47. The current focus of performance improvement activities is to facilitate and address: A. Sound structures like policies and procedures B. Processes and how they are being done C. Optimal client outcomes D. Optimal staff performance

C. Optimal client outcomes Correct Response: C The current focus of performance improvement activities is to facilitate and address optimal client outcomes. Throughout the last several decades performance improvement activities have evolved from a focus on structures to a focus on process and now, to a focus on outcomes. Staff performance is not the focus of performance improvement activities but instead the focus of competency assessment and validation.

3. Your client is in the special care area of your hospital with multiple trauma and severe bodily burns. This 45 year old male client has an advance directive that states that the client wants all life saving measures including cardiopulmonary resuscitation and advance cardiac life support, including mechanical ventilation. As you are caring for the client, the client has a complete cardiac and respiratory arrest. This client has little of no chance for survival and they are facing imminent death according to your professional judgement, knowledge of pathophysiology and your critical thinking. You believe that all life saving measures for this client would be futile. What is the first thing that you, as the nurse, should do? A. Call the doctor and advise them that the client's physical status has significantly changed and that they have just had a cardiopulmonary arrest. B. Begin cardiopulmonary resuscitation other emergency life saving measures. C. Notify the family of the client's condition and ask them what they should be done for the client. D. Insure that the client is without any distressing signs and symptoms at the end of life.

B. Begin cardiopulmonary resuscitation other emergency life saving measures. Correct Response: B You must immediately begin cardiopulmonary resuscitation and all life saving measures as requested.by the client in their advance directive despite the nurse's own beliefs and professional opinions. Nurses must uphold the client's right to accept, choose and reject any and all of treatments, as stated in the client's advance directive. You would not call the doctor first; your priority is the sustaining of the client's life; you would also not immediately notify the family for the same reason and, when you do communicate with the family at a later time, you would not ask them what should or should not be done for the client when they wishes are already contained in the client's advance directive. Finally, you would also insure that the client is without pain and all other distressing signs and symptoms at the end of life, but the priority and the first thing that you would do is immediately begin cardiopulmonary resuscitation and all life saving measures as requested by the client in their advance directive, according to the ABCs and Maslow's Hierarchy of Needs.

46. Which of these choices contains the six elements necessary for malpractice? A. Causation, foreseeability, damages to the patient, a duty that was owed to the client and this duty was breached, and direct rather than indirect harm to the client. B. Causation, foreseeability, damages to the patient, a duty that was owed to the client and this duty was breached, and direct and/or indirect harm to the client. C. Causation, correlation, damages to the patient, a duty that was owed to the client and this duty was breached, and direct and/or indirect harm to the client. D. Causation, foreseeability, damages to the patient, a duty that was owed to the client and this duty was breached, and a medical license.

B. Causation, foreseeability, damages to the patient, a duty that was owed to the client and this duty was breached, and direct and/or indirect harm to the client. Correct Response: B The six essential components of malpractice include causation, foreseeability, damages to the patient, a duty that was owed to the client and this duty was breached, and, lastly, this breach of duty led to direct and/or indirect harm to the client. A medical license is not necessary; nurses and other healthcare professionals can be found guilty of malpractice. Lastly, correlation is the relationship of simultaneously changing variables. For example, a ppositive correlation exists when the two variables both increase or decrease; and a negative occurs when one variable increases and the other decreases

23. You are the chair person for the healthcare facility's newly formed multidisciplinary Safety Committee. During the Forming stage of this group's development major conflicts have arisen. Which technique of conflict resolution should you use to resolve these conflicts? A. Passivity B. Compromise C. Competition D. Accommodating Others

B. Compromise Correct Response: B Conflicts can be effectively resolved using a number of different strategies and techniques such as compromise, negotiation, and mediation. Avoidance of the conflict, withdrawing in addition to other passivity, competition, and accommodating others are not effective and healthy conflict resolution techniques.

28. Which of the following terms is used to describe the sound, timely, smooth, unfragmented and seamless transition of the client from one level of acuity to another? A. Case management B. Continuity of care C. Medical necessity D. Critical pathway

B. Continuity of care Correct Response: B The continuity of care is defined as the sound, timely, smooth, unfragmented and seamless transition of a client from one area within the same healthcare facility, from one level of care to a higher and more intense level of care or to a less intense level of care based on the client's status and level of acuity, from one healthcare facility to another healthcare facility and also any discharges to the home in the client's community. Case management and critical pathways may be used to facilitate the continuity of care, but they are not the sound, timely, smooth, unfragmented and seamless transition of the client from one level of acuity to another. Lastly, medical necessity is necessary for reimbursement and it is one of the considerations for moving the client from one level of acuity to another but medical necessity is not the continuity of care.

20. Select the sound that is heard with percussion with its description. A. Tympany: A hollow sound B. Dullness: A thud like sound C. Dullness: A hollow sound D. Resonance: A booming sound

B. Dullness: A thud like sound Correct Response: B Dullness is a thud like sound and not a hollow sound. Tympany is a drum like sound; and resonance is a hollow sound.

24. The stages of conflict and conflict resolution in the correct sequential order are: A. Conceptualization B. Frustration C. Resolution D. Taking action

B. Frustration A. ConceptualizationCorrect D. Taking action C. Resolution Response: B, A, D, C The stages of conflict and conflict resolution in the correct sequential order are frustration, conceptualization, and taking action.

11. You are fully aware of the fact that some risk factors are correctable or modifiable and other risk factors are innate and not modifiable. Which of the following risk factors is the most likely able to be correctable? A. Genetic predisposition B. Lifestyle choices C. High risk behaviors D. An external locus of control

B. Lifestyle choices Correct Response: B Life style choices are the risk factors that are most likely able to be corrected. Poor life style choices place a person at risk and they are often considered also risky behaviors. As discussed before, some risks are preventable and correctable and others are not. For example, genetics, age and gender are NOT modifiable risks, but the risks associated with life style choices are modifiable, correctable and able to be eliminated when the person changes their behavior in reference to these risky behaviors. Some risky life style choices include: Excessive sun exposure The lack of regular exercise A poor diet Cigarette smoking and the use of other tobacco products Alcohol use Illicit drug use Unprotected sex Avocational and hobby choices such as rock climbing Inadequate sleep and rest Genetic predisposition is an innate and not correctable risk factor and an external locus of control can lead to poor life style choices, however, this is not the most likely correctable risk factor.

2. The Patient Self Determination Act of the United States protects clients in terms of their rights to what? Select all that apply. A. Privacy and to have their medical information confidential unless the client formally approves the sharing of this information with others such as family members. B. Make healthcare decisions and to have these decisions protected and communicated to others when they are no longer competent to do so. C. Be fully informed about all treatments in term of their benefits, risks and alternatives to them so the client can make a knowledgeable and informed decision about whether or not to agree to having it D. Make decisions about who their health care provider is without any coercion or undue influence of others including healthcare providers.

B. Make healthcare decisions and to have these decisions protected and communicated to others when they are no longer competent to do so. D. Make decisions about who their health care provider is without any coercion or undue influence of others including healthcare providers. Correct Response: B, D The Patient Self Determination Act, which was passed by the US Congress in 1990, gives Americans the right to make healthcare decisions and to have these decisions protected and communicated to others when they are no longer competent to do so. These decisions can also include rejections for future care and treatment and these decisions are reflect in advance directives. This Act also supports the rights of the client to be free of any coercion or any undue influence of others including healthcare providers. The Health Insurance Portability and Accountability Act (HIPAA) supports and upholds the clients' rights to confidentially and the privacy of their medical related information regardless of its form. It covers hard copy and electronic medical records unless the client has formally approved the sharing of this information with others such as family members. The elements of informed consent which includes information about possible treatments and procedures in terms of their benefits, risks and alternatives to them so the client can make a knowledgeable and informed decision about whether or not to agree to having it may be part of these advanced directives, but the law that protects these advance directives is the Patient Self Determination Act.

10. You are providing care to a permanently disabled Iraqi war veteran who is 28 years of age. When he returned home from the war at the age of 24 years of age 2 years ago he was deemed permanently disabled by both the Veterans Administration (VA) and the Social Security Administration. He receives a substantial monthly service connected disability check from the Veterans Administration and he has no spouse or legal dependents. Which type of governmental health insurance is he now entitled to? A. Only the VA health care services because he is not 65 years of age B. Medicare because he has been deemed permanently disabled for 2 years C. Medicaid because he is permanently disabled and not able to work D. Choices B and C

B. Medicare because he has been deemed permanently disabled for 2 years Correct Response: B This client is legally eligible for Medicare because he has been deemed permanently disabled for more than 2 years in addition to the VA health care services. People over the age of 65 and those who are permanently disabled for at least two years, according to the Social Security Administration, are eligible for Medicare. Based on the information in this scenario, the client is not eligible for Medicaid because has a "substantial" VA disability check on a monthly basis and is not indigent and with a low income.

7. You are working in a community pediatric health clinic. Which expected life transition should you apply into your practice for these pediatric clients as you are caring for pediatric clients of all ages? A. Pregnancy B. Puberty C. Childhood immunizations D. Separation anxiety

B. Puberty Correct Response: B The expected life transition should you apply into your practice for these pediatric clients as you are caring for pediatric clients of all ages is puberty. Throughout the life span, there are several significant expected life transitions that require the person to cope and adjust. Some of these expected life transitions include puberty, maternal and paternal attachments and bonding to the neonate, pregnancy, care of the newborn, parenting, and retirement. Although young children will experience separation anxiety and they will also be maintained on an immunization schedule, these are not expected life changes.

9. The lack of necessary supplies and equipment to adequately and safely care for patients is an example of a (n): A. Sentinel event. B. System variance. C. Adverse effect. D. Provider variance.

B. System variance. Correct Response: B The lack of necessary supplies and equipment to adequately and safely care for patients is an example of a system variance. A variance is defined as a deviation that leads to a quality defect or problem. Variances can be classified as a practitioner variance, a system/institutional variance, a patient variance, a random variance and a specific variance. A sentinel event is defined as is an event or occurrence, incident or accident that has led to or may possibly lead to client harm. Adverse effects are serious and unanticipated responses to interventions and treatments, including things like medications.

2. You are the nursing supervisor in a long term care facility. One of the major considerations that you apply into your practice is strict infection control prevention measures because you are knowledgeable about the fact that the normal aging process is associated with the deterioration of the body's normal defenses. Which theory of aging supports your belief that strict infection control prevention measures are necessary? A. The Programmed Longevity Theory B. The Immunological Theory of Aging C. The Endocrine Theory D. The Rate of Living Theory

B. The Immunological Theory of Aging Correct Response: B The theory of aging that supports your belief that strict infection control prevention measures are necessary is the Immunological Theory of Aging. The Immunological Theory of Aging states that aging leads to the decline of the person's defensive immune system and the decreased ability of the antibodies to protect us against infection. The Programmed Longevity Theory of aging states that genetic instability and changes occur such as some genes turning on and off lead to the aging process; the Endocrine Theory of aging states that aging results from hormonal changes and the biological clock's ticking; and Rate of Living Theory states that one's longevity is the result of one's rate of oxygen basal metabolism. Other theories of aging are: Wear and Tear Theory: This theory describes aging as a function of the simple wearing out of the tissues and cells as one ages. Cross Linking Theory: This theory of aging explains that aging results for cell damage and disease from cross linked proteins in the body. Free Radicals Theory: This theory is based on the belief that free radicals in the body lead to cellular damage and the eventual cessation of organ functioning. Somatic DNA Damage Theory: Somatic DNA Damage theory is based on the belief that aging and death eventually occur because DNA damage, as continuously occurs in the human cells, continues to the point where they can no longer be repaired and replaced and, as a result, they accumulate in the body.

16. The sense of hearing is assessed using which standardized test? A. The Taylor test B. The Rinne test C. The Babinski test D. The APGAR test

B. The Rinne test Correct Response: B The sense of hearing is assessed using the Rinne test and the Weber test and a tuning fork. A Taylor hammer, not a Taylor test, is used to check reflexes like the biceps and triceps reflexes; the Babinski sign occurs when the foot goes into dorsiflexion and the great toe curls up; this sign is an abnormal response to this stimulation and it can indicate the presence of deep vein thrombosis. And lastly, the APGAR test is used to assess the neonate immediately after birth in terms of the infant's appearance, grimace and reflexes, appearance in terms of skin color, and respiratory rate and effort.

9. You are caring for a hospice client who is at the end of life. Based on this client's signs and symptoms, the client is comatose, dehydrated, free of pain, constipated, without distress and expected to die in a day or two. Which of the following is an appropriate client outcome or an appropriate intervention for this client? A. The client will be free of constipation B. The client will remain free of pain and distress C. The administration of an antiemetic to prevent vomiting and further dehydration D. The administration of an enema to correct the constipation

B. The client will remain free of pain and distress Correct Response: B Based on this client's signs and symptoms and the fact that the client is expected to die in a day or two, the appropriate client outcome for this client is that the client will remain free of pain and distress. "The client will be free of constipation" requires interventions such as an enema which are not indicated when death is imminent unless, of course, the client is adversely affected with pain and discomfort as the result of it which is not the case with this client. Additionally, the administration of an antiemetic to prevent vomiting is not indicated because there is no evidence in this question that the client is actually vomiting.

18. Select the member of the multidisciplinary team that you would most likely collaborate with when the client can benefit from the use of adaptive devices for cutting food? A. The physical therapist B. The occupational therapist C. The dietician D. The podiatrist

B. The occupational therapist Correct Response: B The member of the multidisciplinary team that you would most likely collaborate with when the client can benefit from the use of adaptive devices for eating is the occupational therapist. Occupational therapists assess, plan, implement and evaluate interventions including those that facilitate the patient's ability to achieve their highest possible level of independence in terms of their activities of daily living such as bathing, grooming, eating and dressing. Many of these interventions include adaptive devices such as special eating utensils and grooming aids. Physical therapists are licensed healthcare professionals who assess, plan, implement and evaluate interventions including those related to the patient's functional abilities in terms of their gait, strength, mobility, balance, coordination, and joint range of motion. They also provide patients with assistive aids like walkers and canes and exercise regimens. Dieticians assess, plan, implement and evaluate interventions including those relating to dietary needs of those patients who need regular or therapeutic diets. They also provide dietary education and work with other members of the healthcare need when a client has dietary needs secondary to physical disorders such as dysphagia; and podiatrists care for disorders and diseases of the foot.

6. Which of the following are the five Rights of Supervision? A. The right task, the right circumstances, the right person, the right competency, and the right supervision or feedback B. The right task, the right circumstances, the right person, the right direction or communication, and the right supervision or feedback C. The right competency, the right education and training, the right scope of practice, the right environment and the right client condition D. The right competency, the right person, the right scope of practice, the right environment and the right client condition

B. The right task, the right circumstances, the right person, the right direction or communication, and the right supervision or feedback Correct Response: B The Five Rights of Delegation include the right task, the right circumstances, the right person, the right direction or communication, and the right supervision or feedback. The right competency is not one of these basic Five Rights, but instead, competency is considered and validated as part of the combination of matching the right task and the right person; the right education and training are functions of the right task and the right person who is able to competently perform the task; the right scope of practice, the right environment and the right client condition are functions of the legal match of the person and the task; and the setting of care which is not a Right of Delegation and the matching of the right person, task and circumstances.

1. Your client has an allergy to both penicillin and latex. Which of these pathophysiological facts should you apply when you are providing to this client? A. The sensitizing dose of penicillin can lead to anaphylaxis. B. The second dose of penicillin can lead to distributive shock. C. You should be aware of the fact that about 10% of the population has an allergy to both penicillin and latex. D. You should be aware of the fact that about 20% of the population has an allergy to both penicillin and latex.

B. The second dose of penicillin can lead to distributive shock. Correct Response: B The second dose of penicillin can lead to anaphylactic shock which is a form of distributive shock. The first exposure to penicillin, referred to as the "sensitizing dose", sensitizes and prepares the body to respond to a second exposure or dose. It is then the second exposure or dose that leads to anaphylaxis, or anaphylactic shock. It is estimated that approximately 10% of people have had a reaction to penicillin. Some of these reactions are an allergic response and others are simply a troublesome side effect. There is no scientific data that indicates that 10% or 20% of the population has an allergy to both penicillin and latex.

42. Which of these statements related to information technology is accurate? A. Social networks and cell phone cameras pose low risk in terms of information technology security and confidentiality. B. The security of technological data and information in healthcare environments is most often violated by those who work there. C. The security of technological data and information in healthcare environments is most often violated by computer hackers. D. Computer data deletion destroys all evidence of the data.

B. The security of technological data and information in healthcare environments is most often violated by those who work there. Correct Response: B The security of technological data and information in healthcare environments is most often violated by those who work there. The vast majority of these violations occur as the result of inadvertent breaches with carelessness and the lack of thought on the part of employees. Technology is a double edged sword. Technological advances such as cell phone cameras, social networks like Facebook, telephone answering machines and fax machines pose great risk in terms of the confidentiality and the security of medical information. Computer data deletion does not always destroy all evidence of the data; data remains.

5. After your assessment of your client and the need to transfer your client from the bed to the chair, what is the best and safest way to transfer this paralyzed client when you suspect that you will need the help of another for the client's first transfer out of bed? A. Use a slide board. B. Use a mechanical lift. C. Use a gait belt. D. Notify the client's doctor that the client cannot be safely transferred by you.

B. Use a mechanical lift. Correct Response: B The best and safest way to transfer this paralyzed client when you suspect that you will need the help of another for the client's first transfer out of bed is to use a mechanical lift. It is not necessary or appropriate to notify the doctor. Mechanical lifts are used mostly for patients who are obese and cannot be safely moved or transferred by two people, and also for patients who are, for one reason or another, not able to provide any help or assistance with their lifts and transfers, such as a person who is paralyzed. A gait or transfer belt and slide boards are assistive devices that can be used to assist with transfers and lifting however, they are not appropriate for this client as based on your assessment.

35. Select the ethical term that is accurately paired with it brief description. A. Deontology: The school of ethical of thought that requires that only the means to the goal must be ethical. B. Utilitarianism: The school of ethical of thought that requires that only the end goal must be ethical. C. Deontology: The school of ethical of thought that requires that only the end goal must be ethical. D. Utilitarianism: The school of ethical of thought that requires that only the means to the goal must be ethical.

B. Utilitarianism: The school of ethical of thought that requires that only the end goal must be ethical. Correct Response: B The two major classifications of ethical principles and ethical thought are utilitarianism and deontology. Deontology is the ethical school of thought that requires that both the means and the end goal must be moral and ethical; and the utilitarian school of ethical thought states that the end goal justifies the means even when the means are not moral.

50. Which question is asked more than any other root cause analysis activity? A. What? B. Why? C. Who? D. When?

B. Why? Correct Response: B Root cause analysis activities ask "Why", rather than "Who", which would place blame on a person or group of people: and What? and When? Questions are rarely asked.

27. You are the Nurse Manager for the trauma unit. Which of these staff comments or statements indicate the need for you to provide an educational activity relating to confidentiality and information security? A. "A computer in the hallway was left unattended and a client's medical record was visible to me." B. "I just saw a nursing student looking at the medical record for a client that they are NOT caring for during this clinical experience." C. "As I was walking past the nursing station, I saw a dietician reading the progress notes written by members of the laboratory department in addition to other dieticians' progress notes." D. "I refused the nursing supervisor's request to share my electronic password for the new nurse on the unit."

C. "As I was walking past the nursing station, I saw a dietician reading the progress notes written by members of the laboratory department in addition to other dieticians' progress notes." Correct Response: C A staff members comment, "As I was walking past the nursing station, I saw a dietician reading the progress notes written by members of the laboratory department in addition to other dieticians' progress notes" "indicates the need for the Nurse Manager to provide an educational activity relating to confidentiality and information security because dieticians often have the "need to know" about laboratory data so that they can, for example, assess the client's nutritional status in terms of their creatinine levels. The report that the nursing student was "looking at the medical record for a client that they are NOT caring for during this clinical experience" indicates that the reporting staff member is correctly applying the principles for maintaining confidentiality and privacy of information; the report that a "computer in the hallway was left unattended and a client's medical record was visible to me" indicates that the reporting staff member is correctly applying the principles for maintaining confidentiality and privacy of information; and lastly, "I refused the nursing supervisor's request to share my electronic password for the new nurse on the unit" also indicates that the staff member is knowledgeable about privacy and confidentiality.

10. Based on the fact that you family unit client is experiencing a situational crisis that has led to dysfunctional communication within the family unit, you have recommended that the entire nuclear family and members of the extended family who live in the family's home begin family therapy. The grandparents tell you that it is their grandson, rather than their son, who is addicted to prescription pain killers, is the cause of the problem; therefore, they do not have to participate in this group therapy. How should you respond to these grandparents? A. "You should try to come to a few sessions at least because they may be very informative to you". B. "You are probably correct. This really is not your problem". C. "Despite the fact that it is your grandson's drug addiction, situations such as this affect all members of the family including grandparents who live in the home." D. You should attend because the doctor has ordered family therapy for you as extended family members".

C. "Despite the fact that it is your grandson's drug addiction, situations such as this affect all members of the family including grandparents who live in the home." Correct Response: C You should respond to the grandparents' statement with "Despite the fact that it is your grandson's drug addiction, situations such as this affect all members of the family including grandparents who live in the home". After this statement, you should also educate the grandparents about the fact that group and family therapy is often indicated when the family unit is affected with stressors and dysfunction because family members may not fully understand the need for the entire family unit to participate when only one member of the family is adversely affected with a stressor and poor coping and that all family members are affected when only one member of the family unit is adversely affected. You would NOT state "You should try to come to a few sessions at least because they may be very informative to you" because these sessions are therapeutic and not educational; you would not state "You are probably correct. This really is not your problem" because this statement is not true; and you should also not state "You should attend because the doctor has ordered family therapy for you as extended family members" because this is not the real reason why attending these sessions is needed.

2. Which of these clients is at greatest risk for falls? A. A 77 year old female client in a client room that has low glare floors. B. An 87 year old female client in a client room that has low glare floors. C. A 27 year old sedated male client. D. A 37 year old male client with impaired renal perfusion.

C. A 27 year old sedated male client. Correct Response: C The 27 year old sedated male client is at greatest risk for falls. Some of the risk factors associated with falls are sedating medications, high glare, not low glare, floors and other environmental factors such as clutter and scatter rugs, not low glare floors, a history of prior falls, a fear of falling, incontinence, confusion, sensory deficits, a decreased level of consciousness, impaired reaction time, advancing age, poor muscular strength, balance, coordination, gait and range of motion and some physical disorders, particularly those that affect the musculoskeletal or neurological systems; falls are not associated with poor and impaired renal perfusion.

1. Which couple is at greatest risk for domestic violence? A. A couple which consists of a husband and wife both of whom are affected with Alzheimer's disease B. A poverty stricken couple without any healthcare resources in the community C. A pregnant woman and a husband who was physically abused as a young child D. A wealthy couple with feelings that they are immune from punishment and above the law

C. A pregnant woman and a husband who was physically abused as a young child Correct Response: C A pregnant woman and a husband who was physically abused as a young child is the couple is at most risk for domestic violence because pregnancy and a personal prior history of abuse are two commonly occurring risk factors among abused woman and male abusers, respectively. Current research indicates that abuse and neglect affect all people of all ages and of all socioeconomic classes including the wealthy as well as the poverty stricken. Other patient populations at risk of abuse and neglect include female gender, infants, children, the cognitively impaired, the developmentally challenged, the elderly and those with physical or mental disabilities; some of the other traits and characteristics associated with abusers include substance related use and abuse, a psychiatric mental health disorder, poor parenting skills, poor anger management skills, poor self-esteem, poor coping skills, poor impulse control, immaturity, and the presence of a current crisis.

10. The first thing that you should do immediately after a client accident is to: A. Notify the doctor. B. Render care. C. Assess the cleint. D. Notify the nurse manager.

C. Assess the cleint. Correct Response: C The first thing that you should do immediately after a client accident is to assess the client and the second thing you should do is render care after this assessment and not before it. Lastly, notifications to the doctor and the nurse manager are only done after the client is assessed and emergency care, if any, is rendered.

3. You are caring for a group of elderly clients, many of whom are affected with multiple chronic disorders and are also, at times, affected with some acute disorders that require medical and nursing attention. As you are caring for these clients some will need a new medication regimen for an acute disorder. You should consider that fact that the elderly population is at risk for more side effects, adverse drug reactions, and toxicity and over dosages of medications because the elderly have a (n): A. Increased creatinine clearance. B. Impaired immune system. C. Decreased hepatic metabolism. D. Increased bodily fat.

C. Decreased hepatic metabolism. Correct Response: C The elderly population is at risk for more side effects, adverse drug reactions, and toxicity and over dosages of medications because the elderly have a decrease in terms of their hepatic metabolism secondary to the hepatic functioning changes of the elderly secondary to a decreased hepatic blood flow and functioning. The elderly have decreased rather than increased creatinine clearance; the immune system is also decreased in terms of its functioning, however, this change impacts on the elderly's ability to resist infection rather than impacting a medication's side effects, adverse drug reactions, toxicity and over dosages; and, lastly, a decrease in terms of bodily fat, rather than an increase in terms of bodily fat impacts on medications. The distribution of drugs is impaired by decreases in the amount of body water, body fat and serum albumin; drug absorption is decreased with the aged patient's increases in gastric acid pH and decreases in the surface area of the small intestine which absorbs medications and food nutrients.

51. The primary distinguishing characteristic of risk management when compared and contrasted to performance improvement is that risk management activities focus on: A. Historical data and performance improvement activities focus on current data. B. Current data and performance improvement activities focus on historical data. C. Decreasing financial liability and performance improvement activities focus on process improvements. D. Decreasing falls and performance improvement activities focus on process improvements.

C. Decreasing financial liability and performance improvement activities focus on process improvements. Correct Response: C The primary distinguishing characteristic of risk management when compared and contrasted to performance improvement is that risk management activities focus on decreasing financial liability and performance improvement activities focus on process improvements. Risk management focuses on decreasing and eliminating things that are risky and place the healthcare organization in a position of legal liability. Some examples of risk management activities include preventing hazards and adverse events such as patient falls and infant abduction and the legal liabilities associated with these events.

17. Which of the following steps is the final step that is used during the physical assessment of the abdomen? A. Inspection B. Light palpation C. Deep palpation D. Percussion

C. Deep palpation Correct Response: C Deep palpation is cautiously done after light palpation when necessary because the client's responses to deep palpation may include their tightening of the abdominal muscles, for example, which will make the light palpation less effective for this assessment, particularly if an area of pain or tenderness has been palpated. Inspection is typically the first step and percussion of the abdomen should be done prior to any palpation, particularly deep palpation.

6. Your client in crisis is detaching from self. Which psychological ego defense mechanism is this client most likely using? A. Displacement B. Sublimation C. Dissociation D. Reaction formation

C. Dissociation Correct Response: C Dissociation is the psychological ego defense mechanism occurs when the client detaches and dissociates with person or time to avoid the stress until they are ready to cope with it. Displacement transforms the target of one's anger and hostility from one person to another person or object. Displacement allows the person to ventilate and act out on their anger in a less harmful and a more socially acceptable manner. A client uses the ego defense mechanism of sublimation when they transform and replace unacceptable urges and feelings into a socially acceptable urge or feeling. A client is using reaction formation when the client acts and behaves in a manner that is completely the polar opposite of their true feelings.

29. The Joint Commission on the Accreditation of Healthcare Organizations mandates standardized "hand of" change of shift reporting. Which of the following is a standardized "hand off" change of shift reporting system that you may want to consider for implementation on your nursing care unit? A. The Four P`s B. UBAR C. ISBAR D. MAUMAR

C. ISBAR Correct Response: C The standardized "hand off" change of shift reporting system that you may want to consider for implementation on your nursing care unit is ISBAR. Other standardized change of shift "hand off" reports, as recommended by the Joint Commission on the Accreditation of Healthcare Organization, include: SBAR, not IBAR BATON The Five Ps not the Four Ps and IPASS Lastly, MAUUAR is a method of priority setting and not a standardized "hand off" change of shift reporting system.

15. You are asked by your supervisor to take photographs of the residents and their family members who are attending a holiday dinner and celebration at your long term care facility. What should you do? A. Take the photographs because these photographs are part of the holiday tradition at this facility B. Take the photographs because all of the residents are properly attired and in a dignified condition C. Refuse to take the photographs unless you have the consent of all to do so D. Refuse to take the photographs because this is not part of the nurse's role

C. Refuse to take the photographs unless you have the consent of all to do so Correct Response: C You should refuse to take the photographs unless you have the consent of all to do so because to do otherwise is a violation of the residents' rights to privacy and confidentiality as provided in the Health Insurance Portability and Accountability Act (HIPAA). This, rather than the false belief that this is not part of the nurse's role, is the reason that you would not automatically take these photographs. Regardless of whether or not these photographs are part of the holiday tradition at this facility and whether or not the residents are properly attired and in a dignified condition, no photographs can be legally taken without the residents' permission and consent.

13. Your 87 year old client has a history of heart disease and fibromyalgia. This client has an internal pacemaker and is also a diabetic client. During your annual visit with this client, the client tells you that they would like to begin some alternative and homeopathic health care practices. What should you include in your teaching plan for this client? A. Information about the lack of scientific evidence regarding the effectiveness of all herbs. B. Data to support the fact that magnets can be effective in terms of fibromyalgia pain, and as such, may be a good choice for this client. C. Research that suggests that prayer is an effective alternative method to relieve pain and stress that can be helpful to this client. D. Information that contraindicates the use of biofeedback because this alternative, complementary health practice can interfere with the client's pacemaker functioning.

C. Research that suggests that prayer is an effective alternative method to relieve pain and stress that can be helpful to this client. Correct Response: C Scientific data now indicates that prayer is effective for the relief of stress, anxiety and pain, and as such, may be helpful to this client. Some herbs, minerals and supplements are scientifically deemed as safe and effective and others are not scientifically effective and they can also lead to harm; at the current time, the National Institutes of Health (NIH) states that magnets are not scientifically effective and they are also not considered safe for clients with a pacemaker or insulin pump because these internally implanted devices can be adversely affected by the magnetic force of the magnet; and, lastly, biofeedback does not interfere with the client's pacemaker functioning.

39. Which of the following is most closely aligned with the principles and concepts of informed consent? A. Justice B. Fidelity C. Self determination D. Nonmalficence

C. Self determination Correct Response: C Self-determination is most closely aligned with the principles and concepts of informed consent. Self-determination supports the client's right to choose and reject treatments and procedures after they have been informed and fully knowledgeable about the treatment or procedure. Justice is fairness. Nurses must be fair when they distribute care and resources equitably, which is not always equally among a group of patients; fidelity is the ethical principle that requires nurses to be honest, faithful and true to their professional promises and responsibilities by providing high quality, safe care in a competent manner; and, lastly, nonmaleficence is doing no harm, as stated in the historical Hippocratic Oath.

43. Select the legal term that is accurately paired with its description. A. Assault: Touching a person without their consent B. Battery: Threatening to touch a person without their consent C. Slander: False oral defamatory statements. D. Slander: False written defamatory statements.

C. Slander: False oral defamatory statements. Correct Response: C Slander is false oral defamatory statements; and libel is written defamation of character using false statements. Assault, an intentional tort, is threatening to touch a person without their consent; and battery, another intentional tort, is touching a person without their consent.

7. The registered nurse, prior to the delegation of tasks to other members of the nursing care team, evaluates the ability of staff members to perform assigned tasks for the position as based on which legal consideration? A. The American Nurses Association's Scopes of Practice B. The American Nurses Association's Standards of Care C. State statutes D. Federal law

C. State statutes Correct Response: C The registered nurse, prior to the delegation of tasks to other members of the nursing care team, evaluates the ability of staff members to perform assigned tasks for the position as based on state statutes that differentiate among the different types of nurses and unlicensed assistive personnel that are legally able to perform different tasks. Although the American Nurses Association's Standards of Care guide nursing practice, these standards are professional rather than legal standards and the American Nurses Association does not have American Nurses Association's Scopes of Practice, only the states' laws or statutes do. Lastly, scopes of practice are within the legal domain of the states and not the federal government.

22. Select the types and stages of conflict that are accurately paired with their description. Select all that apply. A. Frustration: The phase of conflict that is characterized with personal agendas and obstruction B. Conceptualization: The phase of conflict that occurs when contending parties have developed a clear and objective understanding of the nature of the conflict and factors that have led to it C. Taking action: The phase of conflict that is characterized with individual responses to and feelings about the conflict D. Resolution: The type of conflict that can be resolved E. Avoidance-Avoidance: A stage of conflict that occurs when there are NO alternatives that are acceptable to the contending parties F. Approach- Approach Conflicts: The type of conflict that occurs when the people involved in the conflict want more than one alternatives or actions that could resolve the conflict. G. Approach-Avoidance Conflicts: The type of conflict that occurs when the people involved in the conflict believe that all of the alternatives are NEITHER completely satisfactory nor completely dissatisfactory.

C. Taking action: The phase of conflict that is characterized with individual responses to and feelings about the conflict F. Approach- Approach Conflicts: The type of conflict that occurs when the people involved in the conflict want more than one alternatives or actions that could resolve the conflict. G. Approach-Avoidance Conflicts: The type of conflict that occurs when the people involved in the conflict believe that all of the alternatives are NEITHER completely satisfactory nor completely dissatisfactory. Correct Response: C, F, G Taking action is the phase of conflict that is characterized with individual responses to and feelings about the conflict; Approach- Approach conflicts are a type of conflict that occurs when the people involved in the conflict want more than one alternatives or actions that could resolve the conflict; and Approach-Avoidance conflicts are a type of conflict that occurs when the people involved in the conflict believe that all of the alternatives are NEITHER completely satisfactory or completely dissatisfactory. Frustration is the phase of conflict that occurs when those involved in the conflict believe that their goals and needs are being blocked and not met, and not necessarily characterized with personal agendas and obstruction; conceptualization is the phase of conflict that occurs when those involved in the conflict begin to understand what the conflict is all about and why it has occurred. This understanding often varies from person to person and this personal understanding may or may not be accurate, clear or objective, and not a clear and objective understanding of the nature of the conflict and factors that have led to it; resolution is a phase of conflict resolution, not a type of conflict, that is characterized when the contending parties are able to come to some agreement using mediation, negotiation or another method; an Avoidance-Avoidance conflict is a type of conflict and not a phase of conflict, that occurs when there are NO alternatives that are acceptable to any the contending parties; Approach- Approach conflicts occur when the people involved in the conflict want more than one alternative or action that could resolve the conflict; and lastly, Double Approach - Avoidance is a type of conflict and not a stage of conflict that occurs when the people involved in the conflict are forced to choose among alternatives and actions, all of which have BOTH positive and negative aspects to them.

30. Select the standardized "hand off" change of shift reporting system that is accurately paired with its elements. A. SBAR: Symptoms, background, assessment and recommendations B. ISBAR: Interventions, symptoms, background, assessment and recommendations C. The Five Ps: The patient, plan, purpose, problems and precautions D. BATON: Background, assessment, timing, ownership and next plans

C. The Five Ps: The patient, plan, purpose, problems and precautions Correct Response: C The Five Ps are the patient, plan, purpose, problems and precautions. The elements of the other standardized reporting systems are listed below: SBAR stands for: S: Situation: The patient's diagnosis, complaint, plan of care and the patient's prioritized needs B: Background: The patient's code or DNR status, vital Signs, medications and lab results A: Assessment: The current assessment of the situation and the patient's status and R: Recommendations: All unresolved issues including things like pending diagnostic testing results and what has to be done over the next few hours ISBAR stands for: I: Introduction: The introduction of the nurse, the nurse's role in care and the area or department that you are from S: Situation: The patient's diagnosis, complaint, plan of care and the patient's prioritized needs B: Background: The patient's code or DNR status, vital Signs, medications and lab results A: Assessment: The current assessment of the situation and the patient's status and R: Recommendations: All unresolved issues including things like pending diagnostic testing results and what has to be done over the next few hours BATON stands for: B: Background: Past and current medical history, including medications A: Actions: What actions were taken and/or those actions that are currently required T: Timing: Priorities and level of urgency O: Ownership: Who is responsible for what? and N: Next: The future plan of care IPASS stands for: Introduction: The introduction of the nurse, the nurse's role in care and the area or department that you are from P: Patient: The patient's name, age, gender, location and other demographic data A: Assessment: The current assessment of the situation and the patient's status S: Situation: The patient's diagnosis, complaint, plan of care and the patient's prioritized needs and S: Safety concerns: Physical, mental and social risks and concerns

25. Which federal law is most closely associated with the highly restrictive "need to know"? A. The Patient Self Determination Act B. The Mental Health Parity Act C. The Health Insurance Portability and Accountability Act D. The Americans with Disabilities Act of 1990

C. The Health Insurance Portability and Accountability Act Correct Response: C The federal law is most closely associated with the highly restrictive "need to know" is the Health Insurance Portability and Accountability Act. This law restricts access to medical information to only those persons who have the need to know this information in order to provide direct and/or indirect care to the client. The Patient Self Determination Act, which was passed by the US Congress in 1990, gives Americans the right to make healthcare decisions and to have these decisions protected and communicated to others when they are no longer competent to do so. These decisions can also include rejections for future care and treatment and these decisions are reflect in advance directives. This Act also supports the rights of the client to be free of any coercion or any undue influence of others including healthcare providers. The Mental Health Parity Act passed in 2008, mandates insurance coverage for mental health and psychiatric health services in a manner similar to medical and surgical insurance coverage. And, lastly the Americans with Disabilities Act of 1990 and the Rehabilitation Act of 1973 forbid and prohibit any discrimination against people with disabilities.

8. Registered nurses care for clients in many settings and environments. These clients can be individual clients, couples, families, populations and communities. You have decided to use the Dimensions Model of Health model to assess, monitor and evaluate the health status of the community. Which of these dimensions is NOT an element of this Dimensions Model of Health model? A. The Biophysical Dimension B. The Psychological and Emotional Dimension C. The Spiritual Dimension D. The Health Systems Dimension

C. The Spiritual Dimension Correct Response: C The Dimensions Model of Health includes six dimensions that impact on the client, including the community. The Spiritual Dimension is not one of these six dimensions. These dimensions are the: Biophysical Dimension Psychological and Emotional Dimension Health Systems Dimension Behavioral Dimension Socio-Cultural Dimension Physical Environment Dimension

11. You are a registered nurse who is performing the role of a case manager in your hospital. You have been asked to present a class to newly employed nurses about your role, your responsibilities and how they can collaborate with you as the case manager. Which of the following is a primary case management responsibility associated with reimbursement that you should you include in this class? A. The case manager's role in terms of organization wide performance improvement activities B. The case manager's role in terms complete, timely and accurate documentation C. The case manager's role in terms of the clients' being at the appropriate level of care D. The case manager's role in terms of contesting denied reimbursements

C. The case manager's role in terms of the clients' being at the appropriate level of care Correct Response: C Registered nurse case managers have a primary case management responsibility associated with reimbursement because they are responsible for insuring that the client is being cared for at the appropriate level of care along the continuum of care that is consistent with medical necessity and the client's current needs. A failure to insure the appropriate level of care jeopardizes reimbursement. For example, care in an acute care facility will not be reimbursed when the client's current needs can be met in a subacute or long term care setting. Nurse case managers do not have organization wide performance improvement activities, the supervision of complete, timely and accurate documentation or challenging denied reimbursements in their role. These roles and responsibilities are typically assumed by quality assurance/performance improvement, supervisory staff and medical billers, respectively.

14. Which of the following is an effective security plan that you may most likely want to consider for implementation within your facility? A. Training all nurses to serve as a part of a security response team B. Training all clerical staff to be a part of a security response team C. The restriction of visitors in a special care area D. Bar coded client identification bands to insure proper identification

C. The restriction of visitors in a special care area Correct Response: C The restriction of visitors in a special care area is an effective security plan that you may want to consider for implementation within your facility. Some of the other security measures that you may want to consider include security alert systems to alert staff to a security breach such as security breach of the newborn nursery, the use of visitor identification badges or stickers that identify people who are authorized to be in a facility, closed circuit monitoring and alarm systems in high risk areas such as the emergency care area, automatically locking security doors, and electronic wristbands for the newborn and the mother to prevent infant abductions. Special assignments and training for a group of people so that this specially trained group can act when a security breach occurs is also a good idea but it is not necessary to train all nurses or clerical staff; it is sufficient to train a limited group of people, provided an ample number of these team members are assigned and available on all tours of duty around the clock, including on holidays.

36. What ethical principle below is accurately paired with a way that ethical principle is applied into nursing practice? A. Justice: Equally dividing time and other resources among a group of clients B. Beneficence: Doing no harm during the course of nursing care C. Veracity: Fully answering the client's questions without any withholding of information D. Fidelity: Upholding the American Nurses Association's Code of Ethics

C. Veracity: Fully answering the client's questions without any withholding of information Correct Response: C Fully answering the client's questions without any withholding of information is an example of the application of veracity into nursing practice. Veracity is being completely truthful with patients; nurses must not withhold the whole truth from clients even when it may lead to patient distress. Justice is fairness. Nurses must be fair when they distribute care and resources equitably, which is not always equally among a group of patients. Beneficence is doing good and the right thing for the patient; it is nonmaleficence that is doing no harm.

8. Which characteristic of carbon monoxide makes it a particularly dangerous gas? A. It is clear? B. It is damaging to the lungs. C. It is damaging to the spleen and the liver. D. It leads to the over production of hemoglobin.

Correct Response: Carbon monoxide is particularly dangerous because it is clear, invisible and odorless. Carbon monoxide poisoning can occur when a person is exposed to an excessive amount of this odorless and colorless gas; it severely impairs the body to absorb life sustaining oxygen which is the result of this deadly gas and not damage to the lungs. This oxygen absorption deficit can lead to serious tissue damage and death. For these reasons, home carbon monoxide alarms are recommended. These dangers are associated with deoxygenation and not splenic or hepatic damage or the over production of hemoglobin.

45. Which statement about Respondeat Superior is accurate? A. Respondeat Superior does not mean that a nurse cannot be held liable. B. Respondeat Superior does not mean that a nurse cannot be held libel. C. Respondeat Superior is an ethical principle. D. Respondeat Superior is a law.

Correct Response: A Respondeat Superior does not mean that a nurse cannot be held liable and not libel which is a written defamation of character using false statements. Liability is legal vulnerability. Respondeat Superior is the legal doctrine or principle and not a law or ethical principle.

4. What is the expected date of delivery for your pregnant client when her last menstrual period was on 10/20/2016? A. 7/7/2017 B. 8/7/2017 C. 6/7/2017 D. 8/1/2017

Correct Response: A The expected date of delivery is calculated using Nagle's rule which is: The first day of last menstrual period - 3 months + 7 days = the estimated date of delivery For example, when the first day of the last menstrual period is 10/20/2016 you would: Subtract three months from 10/20/2016 and then you get 7/20/2016 and then Add seven days to 7/20/2016 and then get 7/27/2016, after which you would Add one year to 7/27/2016 to get the estimated date of delivery for7/27 of the following year which is 7/27/2017.

1. You are caring for an infant who is just about 12 months old. Which assessment data is normal for the infant at this age? A. The infant had doubled their birth weight at twelve months. B. The infant had tripled their birth weight at twelve months. C. The mother reports that the infant is drinking 60 mLs per kilogram of its body weight. D. The infant had grown ¼ inch since last month.

Correct Response: A The normal assessment data for the infant at 12 months of age is that the infant has doubled their birth weight at 12 months of age. The mother's reports that the infant is drinking 60 mLs per kilogram of its body weight and the fact that the infant had grown ¼ inch since last month are not normal assessment data. Infants are fed breast milk or formula every two to four hours with a total daily intake of 80 to 100 mLs per kilogram of body weight. As the neonate grows, they gain five to seven ounces during the first six months and then they double their birth weight during the first year; the head circumference increases a half inch each month for six months and then two tenths of an inch until the infant is one year of age. Similarly, the height or length of the newborn increases an inch a month for the first 6 months and then 1/2 inch a month until the infant is 1 year of age.

18. Place the phases or stages of the inflammatory response in the correct sequential order, do NOT include any phases that is NOT part of the inflammatory process. 1. The vascular phase 2. The prodromal phase 3. The incubation phase 4. The initial injury 5. The exudate phase 6. The convalescence phase A. 4,2,1 B. 4,1,5 C. 4,5,1 D. 4,2,5

Correct Response: B The stages of the inflammatory process in correct sequential order are: The initial tissue injury which can result from an infection or a traumatic cause The vascular response. The release of histamine, prostaglandins and kinins. These substances lead to vasodilation which increases the necessary blood supply to the injured tissue and the area surrounding The exudate response. The release of leukocytes, including macrophages and neutrophils, to the injured area to combat the infection. The signs of infection such as the incubation, prodromal and convalescence stages, in the correct sequential order are: The incubation period The prodromal phase The illness stage The convalescence stage

6. You are serving as the preceptor for a newly graduated nurse. As you observe the new nurse for their application of body mechanics principles into client care, you observe that the nurse spreads her legs apart during a transfer with a client. What should you do? A. Advise the nurse that the legs must be close together for stability during lifting and transfers. B. Advise the nurse that the legs should be one in front of the other and not spread apart during a transfer. C. Validate the nurse's competency in terms of the application of body mechanics principles during a transfer. D. Validate the nurse's competency in terms of the application of ergonomics principles during a transfer.

Correct Response: C You should validate the nurse's competency in terms of the application of body mechanics principles during a transfer because the nurse had spread her legs apart during the transfer to provide a wide base of support, which is a basic principle of body mechanics and not ergonomics. Simply defined ergonomics addresses correct bodily alignment such as the lumbar curve accommodation in an ergonomically designed chair; and body mechanics is the safe use of the body using the correct posture, bodily alignment, balance and bodily movements to safely bend, carry, lift and move objects and people.

4. You are caring for a high risk pregnant client who is in a life threatening situation. The fetus is also at high risk for death. Clinical decisions are being made that concern you because some of these treatments and life saving measures promote the pregnant woman's life at the same time that they significantly jeopardize the fetus' life and viability and other decisions can preserve the fetus's life at the expense of the pregnant woman's life. Which role of the nurse is the priority at this time? A. Case manager B. Collaborator C. Coordinator of care D. Advocacy

Correct Response: D The priority role of the nurse is advocacy. The nurse must serve as the advocate for both the fetus and the mother at risk as the result of this ethical dilemma where neither option is desirable. As an advocate, the nurse would seek out resources and people, such as the facility's ethicist or the ethics committee, to resolve this ethical dilemma.

5. Place the following phases of crisis in the correct sequential order. Order each response with a number from first to last, with #1 as the first phase of crisis to #4 which is the fourth phase of crisis. 1. The signs and symptoms of the General Adaptation Syndrome 2. Detachment and disorientation 3. Trying alternative methods of coping 4. The use of psychological ego defense mechanisms A. 3,2,1,4 B. 1,2,3,4 C. 4,3,2,1 D. 4,3,1,2

D. 4,3,1,2 Correct Response: D The characteristics of the stages or phases of crisis, in the correct sequential order, are: Level 1 Crisis Signs and Symptoms: Patients experiencing a level one crisis typically experience anxiety and they also typically begin to use one or more psychological ego defense mechanisms. Level 2 Crisis Signs and Symptoms: Patients experiencing a level two crisis most likely exhibit some loss of their ability to function. They may also try to experiment with alternative methods of coping in order to deal with the crisis that is not being effectively coped with using one's currently used coping mechanisms. Level 3 Crisis Signs and Symptoms: Patients experiencing a level three crisis show the signs and symptoms of the General Adaptation Syndrome which is characterized with fight, flight and panic as discussed above under the section entitled "Coping Mechanisms: Introduction". Level 4 Crisis Signs and Symptoms: Clients experiencing a level four crisis exhibit severe signs and symptoms such as being totally detached and removed from others, feeling overwhelmed, becoming disoriented, and even with thoughts of violence toward self and others.

16. Select the term which is most completely and accurately paired with its definition. A. A physical restraint: A physical restraint is a manufactured device that is used, when necessary, to prevent falls. B. A physical restraint: A physical restraint is any mechanical device, material, or equipment attached to or adjacent to the resident's body that the individual cannot remove easily which restricts freedom of movement or normal access to one's body. C. A chemical restraint: A chemical restraint is a drug used for sedation to prevent falls. D. A chemical restraint: A chemical restraint is a drug used for discipline or convenience and not required to treat medical symptoms.

D. A chemical restraint: A chemical restraint is a drug used for discipline or convenience and not required to treat medical symptoms. Correct Response: D A chemical restraint: A chemical restraint is a drug used for discipline or convenience and not required to treat medical symptoms, according to the Centers for Medicare and Medicaid Services. The most complete and accurate definition of a physical restraint is any manual method or physical or mechanical device, material, or equipment attached to or adjacent to the resident's body that the individual cannot remove easily which restricts freedom of movement or normal access to one's body and is NOT a safety devices that is routinely used for certain procedures, according to the Centers for Medicare and Medicaid Services.

26. Which of the following personnel do not have the "right to know" medical information? A. The facility's Performance Improvement Director who is not a healthcare person and who has no direct contact with clients B. A nursing student who is caring for a client under the supervision of the nursing instructor C. The facility's Safety Officer who is not a healthcare person and who has no direct contact with clients D. A department supervisor with no direct or indirect care duties

D. A department supervisor with no direct or indirect care duties Correct Response: D A department supervisor with no direct or indirect care duties does not have the "right to know" medical information; all of the others have the "right to know" medical information because they provide direct or indirect care to clients. For example, both the facility's Performance Improvement Director who is not a healthcare person and who has no direct contact with clients and the facility's Safety Officer who is not a healthcare person and who has no direct contact with clients provide indirect care to clients. For example, they collect and analyze client data in order to fulfill their role and responsibilities in terms of process improvements and the prevention of incidents and accidents, respectively. Nursing and other healthcare students also have the "need to know" medical information so that they can provide direct client care to their assigned client(s).

20. Which member of the multidisciplinary team would you most likely collaborate with when your pediatric client has had a traumatic amputation one or more months ago? A. A Pedorthist B. A pediatric nurse practitioner C. A trauma certified clinical nurse specialist D. A prosthetist

D. A prosthetist Correct Response: D The member of the multidisciplinary team would you most likely collaborate with when your pediatric client has had a traumatic amputation secondary to a terrorism blast explosion a month ago or more ago is a prosthetist. Prosthetists, in collaboration with other members of the healthcare team, assess patients and then design, fit and supply the patient with an artificial body part such as a leg or arm prosthesis. They also follow-up with patients who have gotten a prosthesis to check and adjust it in terms of proper fit, patient comfort and functioning. Pedorthists modify and provide corrective footwear and employ supportive devices to address conditions which affect the feet and lower limbs. Lastly, you may collaborate with a trauma certified clinical nurse specialist and a pediatric nurse practitioner but this consultation and collaboration should begin immediately upon arrival to the emergency department, and not a month after the injury.

48. What is the term that is used to describe a healthcare related incident or accident that may have possibly led to client harm? A. An adverse event B. A root cause C. A healthcare acquired event D. A sentinel event

D. A sentinel event Correct Response: D A sentinel event is an event or occurrence, incident or accident that has led to or may have possibly led to client harm. Even near misses, that have the potential for harm, are considered sentinel events because they have the potential to cause harm in the future. An adverse event, like an adverse effect of a medication, has actually led to an adverse response; it is not a near miss. A root cause is a factor that has led to a sentinel event; and there is no such thing as a healthcare acquired event.

8. The best way to objectively evaluate the effectiveness of an individual staff member's time management skills in a longitudinal manner is to: A. Observe the staff member during an entire shift of duty to determine whether or not the nurse has accurately and appropriately established priorities. B. Observe the staff member during an entire shift of duty to determine whether or not the nurse has accurately and appropriately completed priority tasks. C. Ask the staff member how they feel like they have been able to employ their time management skills for the last six months. D. Collect outcome data over time and then aggregate and analyze this data to determine whether or not the staff member has completed reasonable assignments in the allotted time before the end of their shift of duty.

D. Collect outcome data over time and then aggregate and analyze this data to determine whether or not the staff member has completed reasonable assignments in the allotted time before the end of their shift of duty. Correct Response: D The best way to objectively evaluate the effectiveness of an individual staff member's time management skills in a longitudinal manner is to collect outcome data over time, and then aggregate and analyze this data to determine whether or not the staff member has completed reasonable assignments in the allotted time before the end of their shift of duty. Another way to perform this longitudinal evaluation is to look at the staff member's use of over time, like the last six months, when the unit was adequately staffed. Observing the staff member during an entire shift of duty to determine whether or not the nurse has accurately and appropriately established priorities is a way to evaluate the short term abilities for establishing priorities and not assignment completion and observing the staff member during an entire shift of duty to determine whether or not the nurse has accurately and appropriately completed priority tasks is a way to evaluate the short term abilities for completing established priorities and not a complete assignment which also includes tasks that are not of the highest priority. Lastly, asking the staff member how they feel like they have been able to employ their time management skills for the last six months is the use of subjective rather than objective evaluation.

44. You have loosely applied a bed sheet around your client's waist to prevent a fall from the chair. What have you done? A. Ensured the client's safety which is a high patient care priority B. Violated Respondeat Superior C. Violated the client's right to dignity D. Committed a crime

D. Committed a crime Correct Response: D When you loosely apply a bed sheet around your client's waist to prevent a fall from the chair, you have falsely imprisoned the client with this make shift restraint. False imprisonment is restraining, detaining and/or restricting a person's freedom of movement. Using a restraint without an order is considered false imprisonment even when it is done to protect the client's safety. Respondeat Superior is the legal doctrine or principle that states that employers are legally responsible for the acts and behaviors of its employees. Respondeat Superior does not, however, relieve the nurse of legal responsibility and accountability for their actions. They remain liable. There is no evidence in this question that you have violated the client's right to dignity.

18. Which sound should you expect to hear when you percuss the liver during a complete physical assessment? A. Resonance B. Flatness C. Tympany D. Dullness

D. Dullness Correct Response: The five types of sounds that are elicited during percussion are flatness, resonance, hyperresonance, tympany and dullness. Dullness is heard when percussion is done over a solid organ like the liver and spleen. Flatness is normally assessed over muscles and bones; resonance is a hollow sound that is heard, for example, over the air filled lungs; and hyperresonance, which is a booming sound that is heard over abnormal lung tissue, as occurs among clients with chronic obstructive pulmonary disease (COPD); and, lastly, tympany is heard over the stomach with air as a drum like sound.

2. You are caring for a client who has been assessed as having a past history of violent and dangerous behaviors towards others. You, as the nurse, are concerned about this client's past history and the dangers that may adversely affect others including staff, visitors and other clients on the unit. What is the first thing that you should do to prevent violence towards others? A. Restrain the client B. Place the client in seclusion C. Get an order for a sedating medication D. Establish trust with the client.

D. Establish trust with the client. Correct Response: D The first thing that you should do to prevent violence towards others is to establish trust with the client. The first step in the nurse-client relationship is to establish trust in this therapeutic relationship. Without trust future collaboration, interventions and client outcomes cannot be accomplished to facilitate appropriate and safe behaviors. Restraints and seclusion are not indicated until others are in imminent danger because of this client's current violent behaviors and not a history of it. Lastly, sedating medications to prevent violence are also not the first things that are done.

7. You are the Assistant Director of Nursing in a multiethnical and culturally diverse inner city acute care facility. You will be chairing a committee to develop a philosophy of nursing that addresses these facility characteristics and the characteristics of the clients. Which theoretical framework would you recommend that this committee should consider when addressing mutiethnicity and the culturally diverse nature of this facility for this philosophy? A. Jean Watson's B. Martha Rogers' C. Nagi`s theory D. Madeleine Leininger's theory

D. Madeleine Leininger's theory Correct Response: D The theoretical framework that you would recommend that this committee should consider when addressing mutiethnicity and the culturally diverse nature of this facility for this philosophy is Madeleine Leininger's theory. Madeleine Leininger's theory of Transcultural Nursing and her book "Culture Care Diversity and Universality: A Theory of Nursing" "searches for comprehensive and holistic care data relying on social structure, worldview, and multiple factors in a culture in order to get a holistic knowledge base about care" (Leininger, 2006, p. 219) Jean Watson's Jean Watson developed the Human Caring Theory which states that caring is the essence of nursing. Watson's theory has the four major concepts of health, nursing, society/environment and human being. Caring consists of the following 10 nursing interventions that demonstrate genuine caring. Martha Rogers' theory is the Science of Unitary Human Beings which is based on general systems theory without any focus on multiethnicity and cultural diversity; and lastly, Nagi's Model of disability model describes disabilities and its limitations are the result of a discrepancy between the client's abilities and the limitations of the physical and social environment within which the client lives.

12. Your family, as the client, now has four children and the parents do not want any other children at this time. The mother has a history of deep vein thrombosis and cigarette smoking; and both parents have a history of the lack of adherence to medical regimens. Which form of contraception would you recommend for this couple? A. A transdermal contraceptive patch B. A diaphragm C. A vaginal contraceptive ring D. None of the above

D. None of the above Correct Response: D You would not recommend any of the above methods of contraception for this family. You would not recommend the use of a transdermal contraceptive patch or a vaginal contraceptive ring for the couple because both of these contraceptive methods are contraindicated when the woman has a history of deep vein thrombosis and cigarette smoking; and you would also not recommend a diaphragm because the compliance of this couple cannot trusted because the couple has a history of the lack of adherence to medical regimens.

11. You have collected, aggregated and analyzed data which reflects the frequency of your staff returning medical equipment to the appropriate department because the staff members thought it was too unsafe to use. After the experts in the medical equipment inspect and test the equipment they report back to you, as the nurse manager, whether or not the equipment was indeed unsafe. This data indicates that 83% of the returns that were made by your staff were deemed safe and operable. What should you do? A. Counsel the staff about their need to stop wasting the resources of this department. B. Check the equipment yourself to determine the accuracy of this equipment department. C. Ignore it because everyone can make an innocent mistake. D. Plan an educational activity about determining what equipment to send for repairs.

D. Plan an educational activity about determining what equipment to send for repairs. Correct Response: D You should plan an educational activity about determining what equipment should and should not be sent for repairs. This data suggests that the staff members need education and training about the proper functioning of equipment used on the nursing care unit. Counseling the staff about their need to stop wasting the resources of this department is placing blame and this blame may prevent future valid returns of equipment. You should not check the equipment yourself to determine the accuracy of this equipment department because they are the experts, not you, with these matters. You should also not ignore it because everyone can make an innocent mistake. The issue has to be addressed and corrected.

32. The 2 nd priority needs according to the MAAUAR method of priority setting include which of the following? A. Assessment B. Movement C. Understanding level D. Risks

D. Risks Correct Response: D One of the 2nd priority needs according to the MAAUAR method of priority setting is risks. The ABCs / MAAUAR method of priority setting places the ABCs, again, as the highest and greatest priorities which are then followed with the 2nd and 3rd priority level needs of the MAAUAR method of priority setting. The 2nd priority needs according to the MAAUAR method of priority setting after the ABCs include M-A-A-U-A-R which stands for: Mental status changes and alterations Acute pain Acute urinary elimination concerns Unaddressed and untreated problems that require immediate priority attention Abnormal laboratory and other diagnostic data that are outside of normal limits and Risks including those relating to a healthcare problem like safety, skin breakdown, infection and other medical conditions The 3rd level priorities include all concerns and problems that are NOT covered under the 2nd level priority needs and the ABCs. For example, increased levels of self care abilities and skills and enhanced knowledge of a medical condition are considered 2nd level priority needs.

9. You are the registered nurse in a multi ethnic community health department clinic. In this role you are asked to identify clients who have genetic risk factors related to ethnicity in order to screen them for some commonly occurring diseases and disorders. You would identify a client who is of: A. Mediterranean ethnicity for cystic fibrosis. B. African American ethnicity for Tay Sachs disease. C. British Isles ethnicity for psychiatric mental health disorders. D. Saudi Arabian ethnicity for sickle cell anemia.

D. Saudi Arabian ethnicity for sickle cell anemia. Correct Response: D You would identify a client who is of Saudi Arabian ethnicity for sickle cell anemia. Other ethnicities at greatest risk for sickle cell anemia include those who are African, Latin Americans, Southern Europeans and some clients from some Mediterranean nations. Other disorders and diseases and the ethnicities associated with them are listed below Thalassemia: Clients with a Mediterranean ethnicity Tay Sachs Disease: Ashkenazi Jewish people Cystic Fibrosis: Clients with a European ethnicity Psychiatric Mental Health Disorders: African Americans and Native Americans Hypertension: African Americans, Pacific Islanders , Native Americans, Alaskan natives, Hispanic and Caribbean clients Diabetes: African Americans, Caribbeans, Native Americans and clients from India, Pakistan and Bangladesh Cancer: Caucasians and clients from Scotland and Ireland

37. You have been asked to teach an inservice class for nurses in your facility about ethics. Which of the following should you consider during the planning of this educational activity? A. Planning a way to evaluate the effectiveness of the class by seeing a decrease in the amount of referrals to the facility's Ethics Committee B. Establishing educational objectives for the class that reflect the methods and methodology that you will use to present the class content C. The need to exclude case studies from the class because this would violate client privacy and confidentiality D. Some of the most commonly occurring bioethical concerns including genetic engineering into the course content

D. Some of the most commonly occurring bioethical concerns including genetic engineering into the course content Correct Response: D You would consider including some of the most commonly occurring bioethical concerns including genetic engineering into the course content. You would also plan how you could evaluate the effectiveness of the class by seeing an increase, not a decrease in the amount of referrals to the facility's Ethics Committee, because one of the elements of this class should address ethical dilemmas and the role of the Ethics Committee in terms of resolving these. You would additionally establish educational objectives for the class that reflect specific, measurable learner outcomes and not the methods and methodology that you will use to present the class content; and lastly, there is no need to exclude case studies from the class because "sanitized" medical records can, and should be, used to avoid any violations of client privacy and confidentiality.

16. Select the law that is accurately paired with its description in terms of client rights. A. The Patient Self Determination Act: The client's right to choose the level of care B. The Patient Self Determination Act: The clients' right to healthcare insurance coverage for mental health disorders C. The Mental Health Parity Act: The privacy and security of technological psychiatric information D. The Health Insurance Portability and Accountability Act (HIPAA): The privacy and security of technological medical information

D. The Health Insurance Portability and Accountability Act (HIPAA): The privacy and security of technological medical information Correct Response: D The Health Insurance Portability and Accountability Act (HIPAA) protects the client's legal rights to the privacy, security and confidentiality of all medical information including data and information that is technologically stored and secured. The Patient Self Determination Act uphold the client's right to choose and reject care and not the level of care that is driven and decided upon as based on medical necessity and health insurance reimbursement; this Act also does not give client's the right to any health insurance including healthcare insurance coverage for mental health disorders. Lastly, the Mental Health Parity and Addiction Equality Act, passed in 2008, mandates insurance coverage for mental health and psychiatric health services in a manner similar to medical and surgical insurance coverage; it does not protect the privacy and security of technological psychiatric information, HIPAA does.

12. Select the nurse case management model used for patient care delivery that is accurately paired with one of its descriptors: A. The ProACT Model: Registered nurses perform the role of the primary nurse in addition to the related coding and billing functions B. The Collaborative Practice Model: The registered nurse performs the role of the primary nurse in addition to the role of the clinical case manager with administrative, supervisory and fiscal responsibilities C. The Case Manager Model: The management and coordination of care for clients throughout a facility who share the same DRG or medical diagnosis D. The Triad Model of Case Management: The joint collaboration of the social worker, the nursing case manager, and the utilization review team

D. The Triad Model of Case Management: The joint collaboration of the social worker, the nursing case manager, and the utilization review team Correct Response: D The Triad Model of case management entails the joint collaboration of the social worker, the nursing case manager, and the utilization review team. The Professionally Advanced Care Team, referred to as the ProACT Model, which was developed at the Robert Wood Johnson University Hospital, entails registered nurses serving in the role of both the primary nurse the clinical case manager with no billing and coding responsibilities; these highly specialized and technical billing and coding responsibilities are done by the business office, medical billers and medical coders. The Case Manager Model entails the registered nurses' role in terms of case management for a particular nursing care unit for a group of clients with the same medical diagnosis or DRG. In contrast to this Case Manager Model of Beth Israel Hospital, the Collaborative Practice Model of case management entails the role of some registered nurses in a particular healthcare facility to manage, coordinate, guide and direct the complex care of a population of clients throughout the entire healthcare facility who share a particular diagnosis or Diagnostic Related Group.

7. You are serving as the supervisory nurse for a home healthcare agency in the community. You are doing an admission assessment for a 76 year old male client who resides with his elderly wife. Which of the following assessments would indicate that the couple needs some education relating to home safety? A. The client has refrigerated foods labelled with an expiration date. B. You assess that the home is free of scatter rugs that many use to protect the feet against hard floors. C. The client uses the FIFO method for insuring food safety. D. The client assures you that the smoke alarm batteries are replaced annually to insure that they work.

D. The client assures you that the smoke alarm batteries are replaced annually to insure that they work. Correct Response: D When the client assures the nurse that they replace their smoke alarm batteries annually to insure that they work, the assessing nurse should immediately know that the client is in need of education relating to the fact that smoke alarm batteries should be changed at least twice a year. The client has demonstrated that they are knowledgeable about food safety and environmental safety because they have expiration dates on refrigerated foods, they use the FIFO method for food safety and they do not use scatter rugs which can lead to falls. The FIFO rule is First In is First Out. In other words, the first foods in the pantry or refrigerator are the first foods that should be consumed or discarded.

3. Which statement about environmental safety is accurate? A. The nurse should advise clients in a smoke filled room to open the windows. B. The first thing that the nurse should do when using a fire extinguisher to put out a small fire is to aim the fire extinguisher at the base of the fire. C. Rapidly lift and move a client away from the source of the fire when their slippers are on fire. D. The home health care nurse should advise the client that the best fire extinguisher to have in the home is an ABC fire extinguisher.

D. The home health care nurse should advise the client that the best fire extinguisher to have in the home is an ABC fire extinguisher. Correct Response: D The home health care nurse should advise the client that the best fire extinguisher to have in the home is an ABC fire extinguisher because this one fire extinguisher is a combination of a type A fire extinguisher, a type B and a type C, which put out all types of fires including common household solids like wood, household oils like kitchen grease and electrical fires. The nurse should advise the client GET LOW AND GO if a room fills with smoke. They should not take any time to open window. The first thing to do when using a fire extinguisher is to pull the pin and then aim it at the base of the fire. Later, you would squeeze the trigger and sweep the spray over and over again over the base of the fire. The acronym PASS is used to remember these sequential steps. When a person has clothing that has caught on fire, the person should STOP, DROP AND ROLL. Tell the person, to STOP, DROP, and to not run, and as you also cover the person with a blanket to smother the fire.

40. Which of the following is NOT an essential minimal component of the teaching that occurs prior to getting an informed consent? A. The purpose of the proposed treatment or procedure B. The expected outcomes of the proposed treatment or procedure C. Who will perform the treatment or procedure D. When the procedure or treatment will be done

D. When the procedure or treatment will be done Correct Response: D The minimal essential components of the education that occurs prior to getting an informed consent include the purpose of the proposed treatment or procedure, the expected outcomes of the proposed treatment or procedure, and who will perform the treatment or procedure. It is not necessary to include when the treatment or procedure will be done at this time. Other essential elements include: The benefits of the proposed treatment or procedure The possible risks associated with the proposed treatment or procedure The alternatives to the particular treatment or procedure The benefits and risks associated with alternatives to the proposed treatment or procedure The client's right to refuse a proposed treatment or procedure

5. As you are assessing the fetus during labor you are determining and the fetal lie, presentation, attitude, station and position. Your client asks you what all these assessments are. Among other things, how should you respond to the mother? A. You should explain that fetal lie is where the fetus' presenting part is within the birth canal during labor, among other information about the other assessments. B. You should explain that fetal presentation is the relationship of the fetus's spine to the mother's spine, among other information about the other assessments. C. You should explain that fetal attitude is the relationship of the fetus' presenting part to the anterior, posterior, right or left side of the mother's pelvis, among other information about the other assessments. D. You should explain that fetal station is the level of the fetus' presenting part in relationship to the mother's ischial spines, among other information about the other assessments.

D. You should explain that fetal station is the level of the fetus' presenting part in relationship to the mother's ischial spines, among other information about the other assessments. Correct Response: D You should explain that fetal station is the level of the fetus' presenting part in relationship to the mother's ischial spines. Fetal station is measured in terms of the number of centimeters above or below the mother's ischial spines. Fetal station is -1 to -5 when the fetus is from 1 to 5 centimeters above the ischial spines and it is from +1 to +5 when the fetus is from 1 to 5 centimeters below the level of the maternal ischial spines. Fetal lie is defined as the relationship of the fetus's spine to the mother's spine. Fetal lie can a longitudinal, transverse or oblique life. Longitudinal lie, the most common and normal lie, occurs when the fetus' spine is aligned with the mother's spine in an up and down manner; a transverse lie occurs when the fetus' spine is at a right ninety degree angle with the maternal spine; and, lastly, an oblique lie occurs when the fetus' spine is diagonal to the mother's spine. Fetal presentation is defined by where the fetus' presenting part is within the birth canal during labor. The possible fetal presentations are the cephalic presentation, the cephalic vertex presentation, the cephalic sinciput presentation, the cephalic face presentation, the cephalic brow presentation, the breech presentation, the complete breech presentation, the frank breech presentation, the shoulder breech presentation, and the footling presentation. Fetal attitude is the positioning of the fetus's body parts in relationship to each other. The normal attitude is general flexion in the "fetal position". All attitudes, other than the normal attitude, can lead to a more intense and prolonged labor. Fetal position is the relationship of the fetus' presenting part to the anterior, posterior, right or left side of the mother's pelvis.

4. You are the supervising nurse in a physical rehabilitation center that has the philosophy that clients have the need to cope with their disabilities and its limitations are the result of a discrepancy between the client's abilities and the limitations of the physical and social environment within which the client lives. Which model of disability is this philosophy based on? A. Orem's Self Care Model B. Nagis Model C. A cognitive model of disability D. A biomedical model of disability

Nagis Model Correct Response: B Nagi's Model of disability model describes disabilities and its limitations are the result of a discrepancy between the client's abilities and the limitations of the physical and social environment within which the client lives. Although clients with disabilities should be assessed and have interventions related to their self care abilities, Dorothea Orem's Self Care Model is not a model of disability. This model describes self care needs and abilities as wholly compensatory, partly compensatory and supportive educative. Cognitive models of disability focus on the importance of affected client's ability to remain as independent as possible and ways that the empowered client can exercise their own self-determination, confidence, self efficacy, and control. Lastly, biomedical models address pathology, impairments and the manifestations of impairments that can be cured or lead to death.