Fundamentals; Chapter 6, 7, 8,9,31, 10,28, 29,

23. A nurse needs to administer a prescribed dose of a narcotic medication to a client with acute neck pain. Which of the following precautions should the nurse take when storing narcotic medications? A) In a double-locked drawer B) In a single container C) In a self-contained packet D) In disguised containers

A) In a double-locked drawer

1. The nurse is preparing to send a client to the operating room for an exploratory laparoscopy. The nurse recognizes that there is no informed consent for the procedure on the client's chart. The nurse informs the physician who is performing the procedure. The physician asks the nurse to obtain the informed consent signature from the client. What is the nurse's best action to the physician's request? A) Inform the physician that it is his or her responsibility to obtain the signature. B) Obtain the signature and ask another nurse to cosign the signature. C) Inform the physician that the nurse manager will need to obtain the signature. D) Call the house officer to obtain the signature.

A) Inform the physician that it is his or her responsibility to obtain the signature.

20. Of the many topics that may be taught to clients or caregivers about home wound care, which one is the most significant in preventing wound infections? A) Taking medications as prescribed B) Proper intake of food and fluids C) Thorough hand hygiene D) Adequate sleep and rest

Ans: C Feedback: The single most important information on which to educate clients and caregivers about home wound care is the importance of thorough hand hygiene to prevent wound infections.

15. Why would a home health care agency choose to be certified by Medicare? A) To remain open and offer services B) To ensure that all available services can be provided C) To receive reimbursement for Medicare-covered services D) To be able to admit clients without a physician's order

Ans: C Feedback: There are two types of home health care agencies: those certified by Medicare and those that are not. An agency must be certified by Medicare in order to receive reimbursement for Medicare-covered services.

33. A home health nurse who performs a careful safety assessment of the home of a frail elderly patient to prevent harm to the patient is acting in accord with which of the following, a principle of bioethics? A) Nonmaleficence B) Advocacy C) Morals D) Values

Ans: A Feedback: Nonmaleficence is a principle of bioethics and is defined as the obligation to prevent harm. Advocacy, morals, and values are not principles of bioethics.

9. Which health care provider is responsible for ensuring the room is prepared for admission and that the client is welcomed? A) Nursing assistant B) Admitting room clerk C) Social worker D) Nurse

Ans: D Feedback: Although the nurse may delegate most of the activities necessary to prepare a room for an admission, it is the nurse's responsibility to ensure other personnel complete the activities and to welcome the client to the unit.

1. Which of the following clients is the most appropriate candidate for receiving outpatient care? A) A client whose complaints of irregular bowel movements have necessitated a colonoscopy B) A woman who has previously borne two children and is entering the second stage of labor C) A man who is receiving treatment for sepsis after his blood cultures came back positive D) A client with a history of depression who is currently expressing suicidal ideation

Ans: A Feedback: Outpatient services are appropriate for clients who are medically stable but who require diagnostic testing, such as a colonoscopy. Clients in active labor and clients who are actively septic or suicidal require close monitoring and frequent interventions, which can only be safely provided on an inpatient basis.

34. A student has been assigned to provide morning care to a client. The plan of care includes the information that the client requires partial care. What will the student do? A) Provide total physical hygiene, including perineal care. B) Provide total physical hygiene, excluding hair care. C) Provide supplies and orient to the bathroom. D) Provide supplies and assist with hard-to-reach areas.

Ans: D Feedback: Morning care is often identified as either self-care, partial care, or complete care. Clients requiring partial morning care most often receive care at the bedside or seated near the sink in the bathroom. They usually require assistance with body areas that are difficult to reach.

12. A nurse working in long-term care is assessing residents at risk for the development of a decubitus ulcer. Which one would be most at risk? A) A client 83 years of age who is mobile B) A client 92 years of age who uses a walker C) A client 75 years of age who uses a cane D) A client 86 years of age who is bedfast

Ans: D Feedback: Most pressure ulcers occur in older adults as a result of a combination of factors, including aging skin, chronic illness, immobility, malnutrition, fecal and urinary incontinence, and altered level of consciousness. The bedfast resident would be most at risk in this situation.

11. At what point during hospital-based care does planning for discharge begin? A) Upon admission to the hospital B) After the patient is settled in a room C) Immediately before discharge D) After leaving the hospital

Ans: A Feedback: Planning for discharge begins on admission to the hospital, when admission information about the client is collected and documented.

33. The models of nursing care delivery have been many and varied throughout the history of nursing. Which of the following best describes the idea of the continuity of care? A) Money focused B) Client focused C) Primary nursing D) Functional nursing

Ans: B Feedback: Community-based nursing practice, admission and discharge from a health care setting, transfer from one setting to another, and readiness for home health care all have to do with the continuity of care and are client-focused. In other words, they focus on a client's needs and the nurse's role in providing that continuity. The other answers are incorrect.

25. When a nurse refuses to compromise a client's right to privacy, even when the nurse is threatened, the nurse is expressing an ethical framework termed what? A) Utilitarian B) Deontologic C) Justice D) Nonmaleficence

Ans: B Feedback: Deontologic frameworks emphasize roles or responsibilities that one is morally obligated to fulfill.

32. In providing nursing care, it is most important to perform which of the following actions? A) Administration of prescribed medications B) Implementation of physician's orders C) Evaluation of client's responses D) Coordination of care with the health care team

Ans: D Feedback: Nurses have moved from simply observing and giving prescribed medications to coordinating clinical information for the entire health care team.

16. A nurse is administering an intramuscular injection of a viscous medication using the appropriate-gauge needle. What does the nurse need to know about needle gauges? A) All needles for parenteral injection are the same gauge. B) The gauge will depend on the length of the needle. C) Ask the client what size needle is preferred. D) Gauges range from 18 to 30, with 18 being the largest.

D) Gauges range from 18 to 30, with 18 being the largest.

34. Which statement accurately represents a recommended guideline when providing postoperative care for the following clients? A) Force fluids for an adult client who has a urine output of less that 30 mL per hour. B) If client is febrile within 12 hours of surgery, notify the physician immediately. C) If the dressing was clean but now has a large amount of fresh blood, remove the dressing and reapply it. D) If vital signs are progressively increasing or decreasing from baseline, notify the physician of possible internal bleeding.

D) If vital signs are progressively increasing or decreasing from baseline, notify the physician of possible internal bleeding.

18. A clinic nurse is preparing for a tuberculosis screening. Knowing the injections will be administered intradermally, what size needles and syringes will the nurse prepare? A) 10-mL syringe, 3-inch 18-gauge needle B) 5-mL syringe, 2-inch 20-gauge needle C) Insulin syringe, 1-inch 16-gauge needle D) Tuberculin syringe, 1/2-inch 26-gauge needle

D) Tuberculin syringe, 1/2-inch 26-gauge needle

7. A nurse is conducting an interview for a health history. In addition to asking the client about medications being taken, what else should be asked to assess the risk for drug interactions? A) The effects of prescribed medications B) Type and amount of foods eaten C) Daily amount of intake and output D) Use of herbal supplements

D) Use of herbal supplements

10. What name is given to standardized plans of care? A) Critical pathways B) Computer databases C) Nursing problems D) Care plan templates

A) Critical pathways

17. What is a systematic way to form and shape one's thinking? A) Critical thinking B) Intuitive thinking C) Trial-and-error D) Interpersonal values

A) Critical thinking

31. Which medication system allows for client independence? A) Unit dose system B) Self-administered medication system C) Automated medication-dispensing system D) Bar Code Medication Administration

B) Self-administered medication system

13. A nurse is teaching an older adult at home about taking newly prescribed medications. Which information would be included? A) "You can identify your medications by their color." B) "I have written the names of your drugs with times to take them." C) "You won't forget a medication if you count them every day." D) "Don't worry if the label comes off; just look at the shapes."

B) "I have written the names of your drugs with times to take them."

15. What would a nurse instruct a client to do after administration of a sublingual medication? A) "Take a big drink of water and swallow the pill." B) "Try not to swallow while the pill dissolves." C) "Swallow frequently to get the best benefit." D) "Chew the pill so it will dissolve faster."

B) "Try not to swallow while the pill dissolves."

35. A diabetic client is undergoing surgery to amputate a gangrenous foot. This procedure would be considered which of the following categories of surgery based on purpose? A) Diagnostic B) Ablative C) Palliative D) Reconstructive

B) Ablative

6. A client who is taking an oral narcotic for pain relief tells the nurse he is constipated. What is this common response to narcotics called? A) Therapeutic effect B) Adverse effect C) Toxic effect D) Idiosyncratic effect

B) Adverse effect

19. A nurse asks a multidisciplinary team to collaborate in developing the most appropriate plan of care to meet the needs of an adolescent with a severe head injury. Which of the blended skills essential to nursing practice is the nurse using? A) Cognitive skills B) Interpersonal skills C) Technical skills D) Ethical/legal skills

B) Interpersonal skills

29. A physician has ordered a nurse to administer conscious sedation to a client. Which of the following is possible after administering conscious sedation to a client? A) Client can respond verbally despite physical immobility. B) Client can tolerate long therapeutic surgical procedures. C) Client is relaxed, emotionally comfortable, and conscious. D) Client's consciousness level can be monitored by equipment.

C) Client is relaxed, emotionally comfortable, and conscious.

27. When the nurse is administering Lasix 20 mg to a client in congestive heart failure, what phase of the nursing process does this represent? A) Assessment B) Planning C) Implementation D) Evaluation

C) Implementation

14. A preoperative assessment finds a client to be 75 pounds overweight. The client is to have abdominal surgery. What nursing diagnosis would be appropriate based on the client's weight? A) Risk for Aspiration B) Risk for Imbalanced Body Temperature C) Risk for Infection D) Risk for Falls

C) Risk for Infection

28. A nurse should read the instructions stated on a vial container before reconstituting it and administering it to a client. Which of the following instructions are stated on the label of a vial container? A) Type of needle to be used for withdrawal B) Directions for administering the drug C) Best site for administering the drug D) Amount of diluent to be added

D) Amount of diluent to be added

33. Which of the following nursing interventions occurs in the postoperative phase of the surgical experience? A) Airway/oxygen therapy/pulse oximetry B) Teaching deep breathing exercises C) Reviewing the meaning of p.r.n. orders for pain medications D) Putting in IV lines and administering fluids

A) Airway/oxygen therapy/pulse oximetry

30. A client diagnosed with anemia is receiving a blood transfusion. The client develops urticaria accompanied by wheezing and dyspnea not long after the transfusion starts. The nurse interprets this as indicative of which of the following? A) Allergic reaction B) Side effect C) Toxicity D) Antagonism

A) Allergic reaction

8. Which of the following modes of value transmission is most likely to lead to confusion and conflict? A) Modeling B) Moralizing C) Laissez-faire D) Responsible choice

Ans: C Feedback: Those who use the laissez-faire approach for value transmission leave children to explore values on their own (no one set of values is presented as best for all) and to develop a personal value system. This approach often involves little or no guidance and can lead to confusion and conflict.

11. What nursing diagnosis would be a priority for a client who has a large wound from colon surgery, is obese, and is taking corticosteroid medications? A) Self-care Deficit B) Risk for Imbalanced Nutrition C) Anxiety D) Risk for Infection

Ans: D Feedback: Clients who are taking corticosteroid medications are at high risk for delayed healing and wound complications such as infections, because corticosteroids decrease the inflammatory process that may in turn delay healing.

3. A nurse is arrested for possession of illegal drugs. What kind of law is involved with this type of activity? A) Civil B) Private C) Public D) Criminal

Ans: D Feedback: Criminal law concerns state and federal criminal statutes, which define criminal actions such as murder, manslaughter, criminal negligence, theft, and illegal possession of drugs. Civil law, also called private law, includes laws relating to contracts, ownership of property, and the practice of nursing, medicine, pharmacy, and dentistry. Public law is law in which the government is involved directly.

5. Which of the following nursing diagnoses would be appropriate for almost all clients entering a health care setting? A) Impaired Elimination B) Dysfunctional Grieving C) Fatigue D) Anxiety

Ans: D Feedback: Entering and leaving a health care setting, as well as receiving care at home, are experiences that produce anxiety for both clients and family members. Most clients entering a health care setting do not have impaired elimination, dysfunctional grieving, or fatigue.

18. Which of the following health care professionals prescribes home care and certifies the plan of care for the client? A) Social worker B) Discharge nurse C) Home healthcare nurse D) Physician

Ans: D Feedback: The physician certifies the client has a health problem so that the client may receive home health care services. The physician also prescribes and certifies a plan of care for the client. The plan is not certified by a social worker, discharge nurse, or home health care nurse.

11. A middle-aged man is having increasing difficulty breathing. He never exercises, eats fast food regularly, and smokes two packs of cigarettes a day. He tells the nurse practitioner that he wants to change the way he lives. What is one means of helping him change behaviors? A) Ethical change strategy B) Values neutrality choices C) Values transmission D) Values clarification

Ans: D Feedback: Values clarification is a process by which people come to understand their own values and value system. When nurses understand the values that motivate patients' decisions and behaviors, they can tap these values when teaching and counseling patients.

16. A nurse is reviewing results of preoperative screening tests and notes the client's potassium level is dangerously low. What should the nurse do next? A) Nothing; potassium levels have no influence on surgical outcome. B) Include the information in the postoperative end of shift report. C) Document the data and notify the physician who will do the surgery. D) Ask the client and family members why the potassium is low.

C) Document the data and notify the physician who will do the surgery.

12. Legally speaking, how would the nurse ensure that care was not negligent? A) Verbally reporting assessments to the client's physician B) Keeping private notes about the care given to each assigned client C) Documenting the nursing actions in the client's record D) Tape recording complete information for each oncoming shift

C) Documenting the nursing actions in the client's record

12. An operating room nurse is preparing for a surgical procedure on an infant. The nurse's perioperative care is based on what physiologic factor that puts infants at greater risk from surgery than adults? A) Increased vascular rigidity B) Diminished chest expansion C) Lower total blood volume D) Decreased peripheral circulation

C) Lower total blood volume

33. What is the name of the process by which a drug moves through the body and is eventually eliminated? A) Pharmacology B) Pharmacotherapeutics C) Pharmacokinetics D) Pharmacodynamics

C) Pharmacokinetics

5. The nurse would recognize which of these devices as an open drainage system? A) Penrose drain B) Jackson-Pratt drain C) Hemovac D) Negative pressure dressing

Ans: A Feedback: A Penrose drain is an open system that lacks a collection device. Jackson-Pratt drains, Hemovacs, and negative pressure dressings all utilize a suction device or collection reservoir and are considered to be closed systems.

14. A nurse is assessing a client with a stage IV pressure ulcer. What assessment of the ulcer would be expected? A) Full-thickness skin loss B) Skin pallor C) Blister formation D) Eschar formation

Ans: A Feedback: A stage IV pressure ulcer is characterized by the extensive destruction associated with full-thickness skin loss.

32. Nursing continues to recognize and participate in providing appropriate, uninterrupted care and facilitate clients' transitions between different settings and levels of care. What would be an example of this continuity of care? A) The nurse collaborating with other members of the health care team B) The nurse accompanying the physician on rounds C) The nurse taking detailed notes on how each client wants to continue care D) The nurse attending an appointment with the client in some place other than where the nurse works

Ans: A Feedback: Continuity of care is a process by which health care providers give appropriate, uninterrupted care and facilitate a client's transition between different settings and levels of care. To do this, the nurse must, along with other responsibilities, collaborate with other members of the health care team in meeting all the needs of each client. The other answers are incorrect because they are not examples of the idea of the continuity of care.

4. When measuring the size, depth, and wound tunneling of a client's stage IV pressure ulcer, what action should the nurse perform first? A) Perform hand hygiene. B) Insert a swab into the wound at 90 degrees. C) Measure the width of the wound with a disposable ruler. D) Assess the condition of the visible wound bed.

Ans: A Feedback: Hand hygiene should precede any wound assessment or wound treatment.

14. A home health care agency providing care in a local community is supported by the United Way and local donations. What type of agency is this? A) Voluntary B) Public C) Proprietary D) Institution-based

Ans: A Feedback: Home care agencies differ in the way they are organized and administered. They may be official or public (operated by state or local governments and primarily financed by tax funds), voluntary or not-for-profit (supported by donations, endowments, charities, and insurance reimbursements), proprietary (for-profit organizations governed by individual owners or national corporations), or institution-based (operate under a parent organization, such as a hospital).

2. Upon responding to the client's call bell, the nurse discovers the client's wound has dehisced. Initial nursing management includes calling the physician and doing which of the following? A) Covering the wound area with sterile towels moistened with sterile 0.9% saline B) Closing the wound area with Steri-Strips C) Pouring sterile hydrogen peroxide into the abdominal cavity and packing with gauze D) Holding the wound together until the physician arrives

Ans: A Feedback: If dehiscence occurs, cover the wound area with sterile towels moistened with sterile 0.9% saline. The client should also be placed in the low Fowler's position, and the exposed abdominal contents should be covered as previously discussed. Notify the physician immediately because this is a medical emergency. Do not leave the client alone.

15. Which of the following interventions is of major importance during preoperative education? A) Performing skills necessary for gastrointestinal preparation B) Encouraging the client to identify and verbalize fears C) Discussing the site and extent of the surgical incision D) Telling the client not to worry or be afraid of surgery

B) Encouraging the client to identify and verbalize fears

28. While performing a bed bath, the nurse notes an area of tissue injury on the client's sacral area. The wound presents as a shallow open ulcer with a red-pink wound bed and partial thickness loss of dermis. Which of the following is the correct name of this wound? A) Stage II pressure ulcer B) Stage I pressure ulcer C) Stage III pressure ulcer D) Stage IV pressure ulcer

Ans: A Feedback: Stage I is defined as intact skin with a localized area of nonblanchable redness, usually over a bony prominence. Stage II is defined as partial thickness loss of dermis presenting as a shallow open ulcer with a red-pink wound bed. Stage III is defined as full-thickness loss without exposed bone, tendon, or muscle. Stage IV is defined as full-thickness tissue loss with exposed bone, tendon, and muscle.

17. What is the goal of nurses who provide home health care? A) Helping clients achieve maximum independence and health B) Collaborating with other health care providers and services C) Minimizing the manifestations of disease processes D) Encouraging clients' dependence on family members

Ans: A Feedback: The essential components of home health care include the client, the family, and health care professionals from various disciplines. The goal of nursing care in the home is to help clients reach maximum independence and health. Although nurses collaborate with other health care providers, they do so to meet this goal. Home health care is not provided to minimize disease manifestations or to encourage clients' dependence on family members.

9. A physician has ordered that a medication be given "stat" for a client who is having an anaphylactic drug reaction. At what time would the nurse administer the medication? A) At the next scheduled medication time B) Immediately after the order is noted C) Not until verifying it with the client D) Whenever the client asks for it

B) Immediately after the order is noted

25. A client is diagnosed with mild dementia while in the hospital. In preparing for discharge, what should the nurse should discuss with the family? A) Possible need for home care B) Legal responsibility for the future C) Need for transfer to a long-term care facility D) Lack of free resources of care

Ans: A Feedback: The needs of the client should be considered when making discharge plans. Common risk factors associated with the need for home care include limited social, mental, or physical functioning. Legal issues, long-term care, and free resources are not indicated in this situation.

2. What role will the nurse play in transferring a client to a long-term care facility? A) Provide a verbal report to the nurse at the long-term care facility on the client, the hospital care, and the client's current condition. B) Assure that the client's original chart accompanies the client. C) Arrange for the client's belongings to remain at the hospital until discharge from the long-term care facility. D) Inform the client that transferring should be a stress-free situation.

Ans: A Feedback: The nurse at the hospital will provide a verbal report to the nurse at the long-term facility. The client's belongings will accompany the client to the long-term facility, and the nurse should assure that this occurs. The original chart will not accompany the client, but copies of the chart or sections of the chart may be sent based upon agency protocols. The nurse should also recognize and inform the client that while a transfer may be a welcome event, it also can be stressful.

1. Upon assessment of a client's wound, the nurse notes the formation of granulation tissue. The tissue easily bleeds when the nurse performs wound care. What is the phase of wound healing characterized by the nurse's assessment? A) Proliferation phase B) Hemostasis C) Inflammatory phase D) Maturation phase

Ans: A Feedback: The proliferation phase is characterized by the formation of granulation tissue (highly vascular, red tissue that bleeds easily). During the proliferation phase, new tissue is built to fill the wound space. Hemostasis involves the constriction of blood vessels and the beginning of blood clotting immediately after the initial injury. The inflammatory phase lasts about four to six days, and white blood cells and macrophages move to the wound. The maturation phase is the final phase of wound healing and involves remodeling of collagen that was haphazardly deposited in the wound; in addition, a scar forms.

34. The wristband is an important safety component during the client's stay because it is one of two identifiers required by which group's national safety standards (2008) to accurately identify a client during such activities as giving medication, fluids, and blood? A) The Joint Commission B) NANDA C) HIPAA D) The Kardex

Ans: A Feedback: The wristband is an important safety component during the client's stay because it is one of two identifiers required by The Joint Commission's national safety standards (2008) to accurately identify a patient during such activities as giving medication, fluids, and blood.

10. A client has suddenly become very ill, and a nurse is transferring him to the intensive care unit (ICU). How does the nurse provide information to ensure continuity of care? A) By giving a verbal report to nurses in the ICU B) By ensuring that the chart and all belongings are moved C) By delegating a nursing assistant to provide information D) By asking the family to provide the information

Ans: A Feedback: When a client is transferred to another unit, the nurse in the original unit gives a verbal report about the client to the nurse in the new area. Continuity of care is not ensured by moving the chart and belongings, delegating responsibility to a nursing assistant, or asking the family to provide information.

26. Which of the following are examples of nursing actions performed in the entry phase of the home visit? Select all that apply. A) Developing rapport B) Making assessments C) Evaluating safety issues D) Gathering supplies E) Collecting client information

Ans: A, B Feedback: In the entry phase, the nurse develops rapport with the patient and family, makes assessments, determines nursing diagnoses, establishes desired outcomes (along with the client and family), plans and implements prescribed care, and provides education. In the pre-entry phase, the nurse evaluates safety issues, gathers supplies, and collects client information.

27. Which of the following are functions of the skin? Select all that apply. A) Protection B) Temperature regulation C) Sensation D) Vitamin C production E) Immunological

Ans: A, B, C, E Feedback: The skin provides multiple functions: protection, temperature regulation, psychosocial, sensation, vitamin D production, immunological, absorption, and elimination.

28. Which of the following roles of the nurse is most important in providing continuity of care to clients? Select all that apply. A) Educator B) Collaborator C) Mentor D) Advocate E) Role model

Ans: A, B, D Feedback: To provide continuity of care, nurses must consider education and referrals in the care of any person admitted to any type of health care setting, and must also involve the client and family in a mutual planning process. The nurse must also collaborate with other members of the health care team in meeting the physical, psychological, sociocultural, and spiritual needs of the client and family, in all settings and at all levels of health or illness. Although it is important to be a mentor, role model, and researcher, these roles are not directly related to providing continuity of care.

26. A nurse is applying cold therapy to a client with a contusion of the arm. Which of the following is an effect of cold therapy? Select all that apply. A) Constricts peripheral blood vessels B) Reduces muscle spasms C) Increases blood flow to tissues D) Increases the local release of pain-producing substances E) Reduces the formation of edema and inflammation

Ans: A, B, E Feedback: The local application of cold constricts peripheral blood vessels, reduces muscle spasms, and promotes comfort. Cold reduces blood flow to tissues and decreases the local release of pain-producing substances such as histamine, serotonin, and bradykinin. This action in turn reduces the formation of edema and inflammation. Decreased metabolic needs and capillary permeability, combined with increased coagulation of blood at the wound site, facilitate the control of bleeding and reduce edema formation. Cold also reduces muscle spasms, alters tissue sensitivity (producing numbness), and promotes comfort by slowing the transmission of pain stimuli.

27. Which of the following interventions would be performed by the occupational therapist as a member of the home health care team? Select all that apply. A) Evaluate the client's functional level. B) Provide muscle-strengthening exercises. C) Educate client and family about promoting self-care in ADLs. D) Provide assistance with securing needed equipment. E) Implement the plan of care designed by the nurse.

Ans: A, C Feedback: The occupational therapist evaluates the client's functional level, educates the client and family on promoting self-care in activities of daily living, assesses the home for safety, and provides adaptive equipment (as necessary). Muscle-strengthening exercises are provided by the physical therapist. Assistance with securing needed equipment is provided by the social worker. The home health aide implements the plan of care designed by the nurse, and the nurse researches the cost-effectiveness of the plan.

25. Which of the following clients would be considered at risk for skin alterations? Select all that apply. A) A teenager with multiple body piercings B) A homosexual in a monogamous relationship C) A client receiving radiation therapy D) A client undergoing cardiac monitoring E) A client with diabetes

Ans: A, C, E Feedback: Body piercings, radiation therapy, and diabetes place clients at risk for skin alterations. Having a homosexual relationship with multiple partners would also place a client at risk for HIV and skin alterations. Cardiac monitoring and respiratory disorders are not risk factors.

7. A nurse is examining a child two years of age. Based on her findings, she initiates a care plan for a potential problem with normal growth and development. Which step of the nursing process identifies actual and potential problems? A) Assessing B) Diagnosing C) Planning D) Implementing

B) Diagnosing

6. Which is an example of a closed wound? A) Abrasion B) Ecchymosis C) Incision D) Puncture wound

Ans: B Feedback: A closed wound results from a blow, force, or strain caused by trauma (such as a fall, an assault, or a motor vehicle crash). The skin surface is not broken, but soft tissue is damaged, and internal injury and hemorrhage may occur. Examples include ecchymosis and hematomas. An open wound occurs from intentional or unintentional trauma. The skin surface is broken, providing a portal of entry for microorganisms. Bleeding, tissue damage, and increased risk for infection and delayed healing may accompany open wounds. Examples include incisions and abrasions.

22. A nurse caring for a female client notes a number of laceration wounds around the cervix of the uterus due to childbirth. How could the nurse describe the laceration wound in the client's medical record? A) A clean separation of skin and tissue with a smooth, even edge B) A separation of skin and tissue in which the edges are torn and irregular C) A wound in which the surface layers of skin are scraped away D) A shallow crater in which skin or mucous membrane is missing

Ans: B Feedback: A laceration wound can be described as a separation of skin and tissue in which the edges are torn and irregular. An incision wound is described as a clean separation of skin and tissue with a smooth, even edge. An abrasion is a wound in which the surface layers of skin are scraped away. Ulceration is a shallow crater in which skin or mucous membrane is missing.

35. A nurse and a client are discussing managed care. The nurse explains that the managed care model was designed for which of the following reasons? A) Increasing client satisfaction B) Controlling costs while maintaining quality of care C) Providing a distinct area of care D) Providing an all-RN staff

Ans: B Feedback: Case management is used in such situations to ensure optimum, high-quality care in the most efficient and economic manner. It is done by controlling costs while maintaining quality of care.

24. What technique should the nurse use to implement infection control in the home? A) Avoid touching any object in the home, including door knobs. B) Practice hand hygiene when beginning and ending the home visit. C) Wear gloves at all times when in the home or traveling in the car. D) Take prescribed antibiotics on a regular basis on working days.

Ans: B Feedback: Of all the methods used to prevent infection, hand hygiene is the most important and is necessary before and after treating the client (i.e., when beginning and ending the home visit).

22. Which of the following is recommended to ensure safety for the home health care nurse? A) Traveling with another nurse B) Carrying a cell phone C) Talking to family members D) Refusing assignments

Ans: B Feedback: The nurse must evaluate the safety of the neighborhood before making the first home visit. Guidelines for safety of the nurse include carrying a cell phone programmed with emergency numbers. In most instances, it is not economically feasible to travel with another nurse. Talking to family members and refusing assignments do not ensure safety.

8. A nurse is caring for a client who is two days postoperative after abdominal surgery. What nursing intervention would be important to promote wound healing at this time? A) Administer pain medications on a p.r.n. and regular basis. B) Assist in moving to prevent strain on the suture line. C) Tell the client that a mild fever is a normal response. D) If a scar forms over a joint, it may limit movement.

Ans: B Feedback: The proliferative phase of wound healing begins within two to three days of the injury. Collagen synthesis and accumulation continue, peaking in five to seven days. During this time, adequate nutrition, oxygenation, and prevention of strain on the suture line are important client care considerations.

13. What intervention should be included on a plan of care to prevent pressure ulcer development in health care settings? A) Change position at least once each shift. B) Implement a turning schedule every two hours. C) Use ring cushions for heels and elbows. D) Do not turn; use pressure-relieving support surface.

Ans: B Feedback: To protect clients at risk from the adverse effects of pressure, implement turning using an every-2-hour schedule in the health care setting. More frequent position changes may be necessary. Never use ring cushions or "donuts."

30. The nurse is identifying needs of the client and family during the initial home visit. Which question would be inappropriate for the nurse to ask? A) Tell me what responsibilities each member of the family has. B) "Can we get rid of some of this clutter in your home? C) What do you believe is causing your illness? D) What foods are important in your family life?

Ans: B Feedback: When identifying needs of the client and family the nurse needs to consider the culture of the family unit. Information regarding the responsibilities of each family member, cultural foods important to the family, and the family members' perceptions of what is causing the illness can assist the nurse in providing culturally sensitive care. The nurse also needs to assess the physical environment of the home. However, referring to the home as cluttered is a judgmental statement that will cause the family to become defensive and will prevent the development of a trusting relationship.

12. A nurse, preparing for a client's discharge after surgery, is teaching the client's wife to change the dressing. How can the nurse be certain the wife knows the procedure? A) Tell the wife exactly how to do it. B) Give the wife information about supplies. C) Have the wife demonstrate the procedure. D) Ask another nurse to reinforce teaching.

Ans: C Feedback: All steps of a procedure should be demonstrated, practiced, and provided in writing. The client or caregiver should then perform the procedure in the presence of the nurse to demonstrate understanding. Simply stating the information, providing information about supplies, or asking another nurse to reinforce teaching does not mean the caregiver knows the information.

4. Which of the following phrases best describes continuity of care? A) Focusing on acute care in the hospital B) Serving the needs of children C) Facilitating transition between settings D) Providing single-episode care services

Ans: C Feedback: Continuity of care is a process by which health care providers give appropriate uninterrupted care and facilitate the client's transition between different settings and levels of care. The other choices do not describe continuity of care.

3. The wound care clinical nurse specialist has been consulted to evaluate a wound on the leg of a client with diabetes. The wound care nurse determines that damage has occurred to the subcutaneous tissues; how would she document this wound? A) Stage I pressure ulcer B) Stage II pressure ulcer C) Stage III pressure ulcer D) Stage IV pressure ulcer

Ans: C Feedback: Damage to the subcutaneous tissue indicates a stage III ulcer. Extensive destruction associated with full-thickness skin loss is categorized as a stage IV pressure ulcer. A stage I ulcer is a defined area of persistent redness in lightly pigmented skin and a persistent red, blue, or purple hue in darker pigmented skin. A stage II pressure ulcer is superficial and may present as a blister or abrasion.

29. A nurse is treating the pressure ulcer of an African American client. How would the nurse assess for deep tissue injury in this client? A) Upon inspection the nurse would notice a purple or maroon localized area of discolored, intact skin. B) Upon inspection, the nurse would see a blood-filled blister due to damage of underlying soft tissue from pressure and/or shear. C) Upon palpation, the nurse determines that the area preceded by deep tissue injury is painful, firm, boggy, warmer or cooler as compared with adjacent tissue. D) Upon inspection the nurse notes partial thickness loss of dermis presenting as a shallow open ulcer with a red-pink wound bed, without slough.

Ans: C Feedback: Deep tissue injury may be difficult to detect in individuals with dark skin tones. The area may be preceded by tissue that is painful, firm, boggy, warmer or cooler as compared with adjacent tissue. Evolution may include a thin blister over a dark wound bed. The wound may further evolve and become covered by a thin eschar. Evolution may be rapid, exposing additional layers of tissue even with optimal treatment.

30. A nurse inspecting a client's pressure ulcer documents the following: full-thickness tissue loss; visible subcutaneous fat; bone, tendon, and muscle are not exposed. This pressure ulcer is categorized to be at which of the following stages? A) Stage I B) Stage II C) Stage III D) Stage IV

Ans: C Feedback: In stage III there is full-thickness tissue loss; subcutaneous fat may be visible, but bone, tendon, or muscle are not exposed. In stage I there is intact skin with nonblanchable redness of a localized area, usually over a bony prominence. In stage II there is partial thickness loss of dermis presenting as a shallow open ulcer with a red-pink wound bed, without slough. In stage IV, there is full-thickness tissue loss with exposed bone, tendon, or muscle.

24. An older adult client has edema of the right lower extremity with redness and clear drainage. This is most likely related to what? A) Beta-hemolytic streptococcus B) Age C) Venous insufficiency D) Hemangioma

Ans: C Feedback: Leg and foot ulcers occur from various causes, but the most common are ulcers secondary to venous insufficiency, arterial insufficiency, and neuropathy.

31. The Joint Commission is one agency that accredits health care institutions. The nurse understands that the Joint Commission has mandated the use of which national safety practice to protect clients admitted to a health care facility? A) Nurses use the Rights checklist prior to administering medications. B) Upon admission all clients sign advanced directives. C) The use of a wristband for identification of the patient. D) The use of standard precautions in the operating room.

Ans: C Feedback: The Joint Commission accredits health care organizations and has required that to maintain client safety the wristband with the identification number/bar-code, client's name, physician's name, and other important identifying information be worn by the client. It does not require clients to sign advanced directives, and does not regulate nursing practice regarding medications and standard precautions.

17. A nurse has administered an intramuscular injection. What will the nurse do with the syringe and needle? A) Recap the needle; place it in a puncture-resistant container. B) Do not recap the needle; place it in a puncture-resistant container. C) Break off the needle, place it in the barrel, and throw it in the trash. D) Take off the needle and throw the syringe in the client's trash can.

B) Do not recap the needle; place it in a puncture-resistant container.

21. Which one of the following roles of the home health care nurse illustrates the role of coordinator of services? A) Providing certification for home care B) Providing direct physical care to the client C) Providing information about community resources D) Educating the client and caregiver about wound care

Ans: C Feedback: The home health care nurse is generally the coordinator of all other health care providers visiting the client. He or she is also responsible for coordinating community resources needed by the client. The nurse does not provide certification. Providing direct care is a part of the caregiver role, whereas educating about wound care is part of the educator role.

6. A nurse is admitting an older woman (Grace Staples) to a long-term care facility. How should the nurse address the woman? A) "We will just call you Grace while you live here. Okay?" B) "I know you have lots of grandchildren, Grandma." C) "What name do you want us to use for you?" D) "I think you will enjoy living here, Sweetie."

Ans: C Feedback: The nurse should communicate with the client as an individual so he or she can maintain his or her own identity. Ask clients how you should address them. Do not call older adults Grandma or Grandpa.

23. A nurse caring for a post-operative client observes the drainage in the client's closed wound drainage system. The drainage is thin with a pale pink-yellow color. The nurse documents the drainage as which of the following? A) Serous B) Sanguineous C) Serosanguineous D) Purulent

Ans: C Feedback: The nurse should document the drainage as serosanguineous, which is pale pink-yellow, thin, and contains plasma and red cells. Serous drainage is pale yellow and watery, like the fluid from a blister. Sanguineous drainage is bloody, as from an acute laceration. Purulent drainage contains white cells and microorganisms and occurs when infection is present. It is thick and opaque and can vary from pale yellow to green or tan, depending on the offending organism.

18. A young man who has had a traumatic mid-thigh amputation of his right leg refuses to look at the wound during dressing changes. Which response by the nurse is appropriate? A) "Oh, for gosh sakes...it doesn't look that bad!" B) "I understand, but you are going to have to look someday." C) "I respect your wish not to look at it right now." D) "You won't be able to go home until you look at it."

Ans: C Feedback: The sight of the wound may disturb a client. If the wound involves a change in normal body functions or appearance, the pclient may not want to look at the wound. With patience and emotional support, clients learn to cope with and adapt to their wounds in time.

16. In addition to a physician's order, what is one of the eligibility requirements for Medicare-covered home health care? A) The client must have transportation to the physician's office. B) The family must be willing to meet health care needs. C) The client must be essentially homebound. D) The client must be able to leave the home unassisted.

Ans: C Feedback: To be eligible for Medicare-covered home health care services, the client must meet certain criteria. One is that the client must be homebound or normally unable to leave the home unassisted. The client may leave home for medical treatment or short, infrequent trips, but leaving the home must require considerable effort.

10. A nurse is educating a postoperative client on essential nutrition for healing. What statement by the client would indicate a need for more information? A) "I will drink a lot of orange juice and drink milk, too." B) "I will take the zinc supplement the doctor recommended." C) "I will restrict my diet to fats and carbohydrates." D) "I will drink 8 to 10 glasses of water every day."

Ans: C Feedback: Wound healing requires adequate proteins, carbohydrates, fats, vitamins, and minerals. Calories and proteins are necessary to rebuild cells and tissues. Vitamins C and D, zinc, and adequate fluids are also necessary for wound healing.

13. What is required of a client who leaves the hospital against medical advice (AMA)? A) Nothing. The hospital has no legal concerns. B) Full reimbursement of any medical expenses C) Providing contact phone numbers if needed D) Signing a form releasing legal responsibility

Ans: D Feedback: A client is legally free to leave the hospital, but must sign a form that releases the physician and health care institution from any legal responsibility for his or her health status. The client's signature must be witnessed, and the form becomes part of the client's medical record.

17. The plan of care for a postoperative client specifies that sterile 0.9% sodium chloride solution be used to clean the wound. What should the nurse do after reading this information? A) Question the physician about the accuracy of this agent. B) Refuse to use 0.9% normal saline on a wound. C) Document the rationale for not changing the dressing. D) Continue with the dressing change as planned.

Ans: D Feedback: Although various antiseptic cleaning agents could be used to clean a wound, sterile 0.9% normal saline is usually the agent of choice. Other agents may be caustic to skin and tissues.

9. A home health nurse has a caseload of several postoperative clients. Which one would be most likely to require a longer period of care? A) An infant B) A young adult C) A middle adult D) An older adult

Ans: D Feedback: An older adult heals more slowly than do children and adults as a result of physiologic changes of aging, resulting in diminished fibroblastic activity and circulation. Older adults are also more likely to have one or more chronic illnesses, with pathologic changes that impede the healing process.

21. Which of the following is a recommended guideline nurses follow when using an electric heating pad on a client? A) Secure the heating pad to the client's clothing with safety pins. B) Place a heavy towel or blanket over the heating pad to maximize heat effects. C) Use a heating pad with a selector switch that can be turned up by the client if needed. D) Place a heating pad anteriorly or laterally to, not under, the body part.

Ans: D Feedback: Guidelines include: Place a heating pad anteriorly or laterally to, not under, the body part. If the heating pad is between the client and the mattress, heat dissipation may be inadequate, leading to burning of the client or the bed linens. Avoid using pins to secure a heating pad because there is a danger of electric shock if a pin touches a wire. Do not cover the heating pad with anything that might be heavy; heat may accumulate and burn the client when it cannot dissipate normally from the pad. Use a heating pad with a selector switch that cannot be turned up beyond a safe temperature.

19. A nurse is teaching a client on home care about how to apply hot packs to an infected leg ulcer. What statement by the client indicates the need for further education? A) "I understand the rebound effect of heat." B) "I will put the heat packs only on the sore on my leg." C) "I will only leave the heat packs on for 20 minutes." D) "I will leave the heat packs on for an hour."

Ans: D Feedback: Initially, temperature receptors in the skin are strongly stimulated. This response decreases rapidly for the first few seconds after being stimulated and more slowly for the next 30 minutes as the receptors adapt to the temperature. Be sure to tell clients that increasing the temperature or lengthening the time of application can seriously damage tissues.

33. Which of the following is an indication for the use of negative pressure wound therapy? A) Bone infections B) Malignant wounds C) Wounds with fistulas to body cavities D) Pressure ulcers

Ans: D Feedback: Negative pressure wound therapy (NPWT) is used to treat a variety of acute or chronic wounds, wounds with heavy drainage, wounds failing to heal, or wounds healing slowly. Examples of such wounds include pressure ulcers; arterial, venous, and diabetic ulcers; dehisced surgical wounds; infected wounds; skin graft sites; and burns. NPWT is not considered for use in the presence of active bleeding; wounds with exposed blood vessels, organs, or nerves; malignancy in wound tissue; presence of dry/necrotic tissue; or with fistulas of unknown origin (Hess, 2008; Preston, 2008; Thompson, 2008).

20. A client is having problems with insurance reimbursement. The home health care nurse discusses the client's need for home health services with the insurance company. What role is the nurse demonstrating? A) Direct care provider B) Coordinator of services C) Educator D) Advocate

Ans: D Feedback: Patients often need help understanding the complex health care system, including handling insurance problems. Advocacy (the protection and support of another's rights) is an important role of the home health care nurse. By convincing the insurance company of the client's continued need for home care services, the nurse is acting as an advocate.

15. During a dressing change, the nurse assesses protrusion of intestines through an opened wound. What would the nurse do after covering the wound with towels moistened with sterile 0.9% sodium chloride solution? A) Document the assessments and intervention. B) Reinforce the dressing with additional layers. C) Administer pain medications intramuscularly. D) Notify the physician and prepare for surgery.

Ans: D Feedback: Protrusion of the intestines through an opened wound indicates evisceration. After covering the wound with towels soaked in sterile normal saline, the nurse should immediately notify the physician. Immediate surgical repair is required.

16. A nurse assessing a client's wound documents the finding of purulent drainage. What is the composition of this type of drainage? A) Clear, watery blood B) Large numbers of red blood cells C) Mixture of serum and red blood cells D) White blood cells, debris, bacteria

Ans: D Feedback: Purulent drainage is made up of white blood cells, liquefied dead tissue debris, and both dead and live bacteria. Purulent drainage is thick, often has a musty or foul odor, and varies in color (such as dark yellow or green), depending on the causative organism. Serous drainage is composed primarily of the clear, serous portion of the blood and from serous membranes. Serous drainage is clear and watery. Sanguineous drainage consists of large numbers of red blood cells and looks like blood. Bright-red sanguineous drainage is indicative of fresh bleeding, whereas darker drainage indicates older bleeding. Serosanguineous drainage is a mixture of serum and red blood cells. It is light pink to blood tinged.

8. According to established standards, which health care provider should conduct a holistic assessment for all clients admitted to the hospital? A) Physician B) Admission clerk C) Licensed practical nurse D) Registered nurse

Ans: D Feedback: The Joint Commission has established standards for hospital admission. These standards include assessment of each client's need for nursing care by a registered nurse and biophysical, psychosocial, environmental, self-care, educational, and discharge planning factors. The admission health assessment is not the responsibility of the physician, licensed practical nurse, or admission clerk.

12. A nurse is administering a liquid medication to an infant. Where will the nurse place the medication to prevent aspiration? A) Between the gum and the cheek B) In front of the teeth and gums C) On the front of the tongue D) Under the tongue

A) Between the gum and the cheek

3. The telemetry unit nurse is reviewing laboratory results for a client who is scheduled for an operative procedure later in the day. The nurse notes on the laboratory report that the client has a serum potassium level of 6.5 mEq/L, indicative of hyperkalemia. The nurse informs the physician of this laboratory result because the nurse recognizes hyperkalemia increases the client's operative risk for which of the following? A) Cardiac problems B) Infection C) Bleeding and anemia D) Fluid imbalances

A) Cardiac problems

18. A nurse is educating a preoperative client on how to cough effectively. What can the nurse tell the client to do to facilitate coughing? A) "Hold a pillow or folded bath blanket over the incision." B) "Get up and walk before you try to cough." C) "It would be best if you do not cough until you feel better." D) "When you cough, cover your nose and mouth with a tissue."

A) "Hold a pillow or folded bath blanket over the incision."

6. In order to prevent the possibility of venous stasis, a nurse is teaching a surgical client how to perform leg exercises. Which of the client's following statements indicates a sound understanding of leg exercises? A) "I'll practice these now and try to start them as soon as I can after my surgery." B) "I'll try to do these lying on my stomach so that I can bend my knees more fully." C) "I'll make sure to do these, as long as my doctor doesn't tell me to stay on bed rest after my operation." D) "I'm pretty sure my stomach muscles are strong enough to lift both of my legs off the bed at the same time."

A) "I'll practice these now and try to start them as soon as I can after my surgery."

3. Which of the following clients receives a drug that requires parenteral route? A) A woman who has been ordered intravenous antibiotics B) A woman who takes a diuretic pill each morning C) A man with emphysema who uses nebulized bronchodilators D) A man who has an antifungal ointment applied to his skin rash daily

A) A woman who has been ordered intravenous antibiotics

22. A postoperative home care client has developed thrombophlebitis in her right leg. What category of medications will probably be prescribed for this cardiovascular complication? A) Anticoagulants B) Antibiotics C) Antihistamines D) Antigens

A) Anticoagulants

6. A client comes to the emergency department complaining of severe chest pain. The nurse asks the client questions and takes vital signs. Which step of the nursing process is the nurse demonstrating? A) Assessing B) Diagnosing C) Planning D) Implementing

A) Assessing

5. A client returning to the floor after orthopedic surgery is complaining of nausea. The nurse is aware that an appropriate intervention is to do which of the following? A) Avoid strong smelling foods. B) Provide clear liquids with a straw. C) Avoid oral hygiene until the nausea subsides. D) Hold all medications.

A) Avoid strong smelling foods.

4. The nurse is providing education to a client regarding pain control after surgery. What time does the nurse inform the client is the best time to request pain medication? A) Before the pain becomes severe B) When the client experiences a pain rating of "10" on a 1-to-10 pain scale C) When there is no pain, but it is time for the medication to be administered D) After the pain becomes severe and relaxation techniques have failed

A) Before the pain becomes severe

1. The nursing student uses evidence-based practice findings in the development of a care plan. This is an example of which type of nursing skill? A) Cognitive skill B) Technical skill C) Interpersonal skill D) Ethical/legal skill

A) Cognitive skill

10. What does the nurse do to verify an order for a medication listed on a medication administration record (MAR)? A) Compare it with the original physician's order. B) Ask another nurse what the drug is. C) Look up the drug in a textbook. D) Call the pharmacist for verification.

A) Compare it with the original physician's order.

11. A client, scheduled for open-heart surgery, tells the nurse he does not want to be "saved" if he dies during surgery. What should the nurse do next? A) Discuss with and document the wishes of the client and family B) Administer the ordered oral and intravenous preoperative medications C) Notify the physician after completion of the surgical procedure D) Verbally report the client's wishes to the operating room supervisor

A) Discuss with and document the wishes of the client and family

20. A nurse at the health care facility is preparing the medication dosage for a client. Why should the nurse read and compare the label on the medication with the MAR at least three times (before, during, and after) while preparing the medication for administration? A) Ensures that the right medication is given at the right time by the right route B) Complies with the medical order and ensures that the right dose is given C) Ensures that the medication has been administered to the right client D) Demonstrates timely administration and compliance with the medical order

A) Ensures that the right medication is given at the right time by the right route

2. A nurse has come on day shift and is assessing the client's intravenous setup. The nurse notes that there is a mini-bag of the client's antibiotic hanging as a piggyback, but that the bag is still full. The nurse examines the patient's medication administration record (MAR) and concludes that the night nurse likely hung the antibiotic but failed to start the infusion. As a result, the antibiotic is three hours late and the nurse has consequently filled out an incident report. In doing so, the nurse has exhibited which of the following? A) Ethical/legal skills B) Technical skills C) Interpersonal skills D) Cognitive skills

A) Ethical/legal skills

2. Upon assessment, a client reports that he drinks five to six bottles of beer every evening after work. Based upon this information, the nurse is aware that the client may require which of the following? A) Larger doses of anesthetic agents and larger doses of postoperative analgesics B) Larger doses of anesthetic agents and lower doses of postoperative analgesics C) Lower doses of anesthetic agents and lower doses of postoperative analgesics D) Lower doses of anesthetic agents and larger doses of postoperative analgesics

A) Larger doses of anesthetic agents and larger doses of postoperative analgesics

26. A nurse at a health care facility has to instill ear drops in a client. The nurse knows that which of the following techniques varies for an adult and child client? A) Manipulation of the client's ear to straighten the auditory canal B) Dilution of the medication drops before instilling in the client's ear C) Position in which the client remains until medication reaches the eardrum D) Amount of time before instilling medication in the client's opposite ear

A) Manipulation of the client's ear to straighten the auditory canal ??

11. Which of the following groups developed standard language to increase the visibility of nursing's contribution to client care by continuing to develop, refine, and classify phenomena of concern to nurses? A) NANDA B) NIC C) NOC D) HHCC (now CCC)

A) NANDA

20. A student is asked to perform a skill for which he is not prepared. When using the method of critical thinking, what would be the first step to resolve the situation? A) Purpose of thinking B) Adequacy of knowledge C) Potential problems D) Helpful resources

A) Purpose of thinking

8. A client scheduled for major surgery will receive general anesthesia. Why is inhalation anesthesia often used to provide the desired actions? A) Rapid excretion and reversal of effects B) Safe administration in the client's own room C) Involves only the respiratory system and skin D) Slow onset of action and maintains reflexes

A) Rapid excretion and reversal of effects

26. After completing an assessment of a client, the nurse uses critical thinking and clinical reasoning to prioritize the client's problems. Which of the following would the nurse determine is the highest priority? A) Severe bleeding from a wound B) History of asthma C) Diabetes D) Lack of family support

A) Severe bleeding from a wound

28. When the nurse assesses the client's blood sugar, what is the term for the type of skill the nurse is using? A) Technical B) Therapeutic C) Interactional D) Adaptive

A) Technical

24. A client age 50 years reports to a primary care unit with an open wound due to a fall in the bathroom. Which of the following nursing actions represents caring skills? A) The nurse cleans the wound and applies a dressing to it. B) The nurse inspects and examines the wound for swelling. C) The nurse tells the client to use caution while on slippery surfaces. D) The nurse informs the client that the wound is small and will heal easily.

A) The nurse cleans the wound and applies a dressing to it.

4. In which of the following situations would the nurse be most justified in implementing trial-and-error problem solving? A) The nurse is attempting to landmark an obese client's apical pulse. B) The nurse is attempting to determine the range of motion of a client's hip joint following hip surgery. C) The nurse is attempting to determine which PRN (as needed) analgesic to offer a client who is in pain. D) The nurse is attempting to determine whether a poststroke client has a swallowing deficit.

A) The nurse is attempting to landmark an obese client's apical pulse.

3. The nurse recognizes that the goals established for a client's discharge are more likely to be accomplished when ... A) the client assists in developing the goals. B) the physician develops the goals. C) the nurse develops the goals. D) the multidisciplinary team develops the goals.

Ans: A Feedback: If the client is involved in establishing the goals, it is more likely that the expected outcomes of the discharge plan will be met. The client may fail to follow the plan if the goals are not mutually agreed on, or are not based on a complete assessment of the client's needs.

2. The medical chart of a newly admitted client notes a penicillin allergy, yet the physician has just written an order for an antibiotic in the same drug family after reviewing the client's wound culture and sensitivity. How should the nurse respond to this situation? A) Withhold the medication until the potential drug allergy has been addressed by the care team. B) Administer the medication and increase the frequency of assessments in the hours that follow. C) Substitute an antibiotic with similar action, but which is from a different drug family. D) Discuss the severity, signs and symptoms of the drug allergy with the client in order to ascertain the risks of administration.

A) Withhold the medication until the potential drug allergy has been addressed by the care team.

34. The nurse is providing care for a pediatric client on night shift. At 0400, the nurse notes that the child has a high fever but does not have an order for an antipyretic. What nursing action represents a good example of teamwork and collaboration as defined by the Quality and Safety Education for Nurses (QSEN) competencies? The nurse: A) calls the health care practitioner, reports her findings, and requests an order for an antipyretic. B) gives the child a common over-the-counter antipyretic based on dosing recommendations and reports this to the oncoming nurse. C) reports to the oncoming nurse at 0700 that the child has a fever so that when the healthcare provider comes in, she can obtain an order for an antipyretic. D) requests that the child 's mother give the child something for the fever that she brought from home.

A) calls the health care practitioner, reports her findings, and requests an order for an antipyretic.

3. A client who has been admitted to the hospital for the treatment of a gastrointestinal bleed requires a transfusion of packed red blood cells. Which of the following aspects of the nurse's execution of this order demonstrates technical skill? A) Starting a new, large-gauge intravenous site on the client, and priming the infusion tubing B) Understanding the Rh system that underlies the client's blood type C) Ensuring that informed consent has been obtained and properly filed in the client's chart D) Explaining the process that will be involved in preparing and administering the transfusion

A)Starting a new, large-gauge intravenous site on the client, and priming the infusion tubing

24. A young woman has been in an automobile crash that resulted in an amputation of her left lower leg. She verbalizes grief and loss. What knowledge by the nurse is used to provide interventions to help the client cope? A) The client should be grateful to be alive. B) This is a normal, appropriate response. C) This is an abnormal, inappropriate response. D) Tissue healing will help the client adapt.

B) This is a normal, appropriate response.

35. The home health nurse receives a referral from the hospital for a client who needs a home visit. After reading the referral, what would be the first action the nurse should take? A) Identify community services initially for the client B) Obtain client information from the discharge planner C) Call the client to obtain permission to visit D) Schedule a home health aide to visit the client

Ans: B Feedback: After receiving a referral, the first step is to call the physician or discharge planner to collect as much information as possible about the client. After the nurse reviews the information, he or she can call the client to obtain permission and schedule the visit. The nurse may identify community services or the need for a home health aide after she assesses the client and the home environment during the first visit with the client.

7. Which of the following is the major goal of ambulatory care facilities? A) To save money by not paying hospital rates B) To provide care to clients capable of self-care at home C) To perform major surgery in a community setting D) To perform tests prior to being admitted to the hospital

Ans: B Feedback: An individual may receive care in many different kinds of ambulatory facilities, including physician offices, clinics, hospital outpatient services, emergency rooms, and same-day surgery centers. The goal of these facilities is to provide health care services to patients who are able to provide self-care at home. Although this saves money on hospital bills, that is not the major goal of ambulatory facilities. Major surgery and pretesting for surgery are not usually done at these centers.

1. A client asks a nurse, "How does ergotamine (Ergostat) relieve migraine headaches?" The nurse should respond that it: A) dilates cerebral blood vessels. B) constricts cerebral blood vessels. C) decreases peripheral vascular resistance. D) decreases the stimulation of baroreceptors.

Ans: B Feedback: Ergotamine relieves migraine headaches by constricting, not dilating, cerebral arterial vessels. The drug's ability to prevent norepinephrine reuptake may add to this effect. The net result is decreased pulsatile blood flow through the cerebral vessels and symptom relief. Ergotamine doesn't decrease peripheral vascular resistance or stimulation of baroreceptors.

19. Although all of the following components are important, which two components of nursing care are identified by home health care nurses as most important when caring for clients in the home? A) Computer knowledge, cultural diversity B) Physical assessment, infection control C) Communications, technical skills D) Documentation, problem solving

Ans: B Feedback: Home health care nurses have identified the following areas of knowledge as most important: legal regulations, physical assessment, body mechanics, nursing diagnoses, and infection control.

29. The nurse is planning the discharge of a client who had surgery for a left hip replacement. The client is being discharged from the hospital to the home and requires a walker and high-rise toilet seat. Which type of home health care service does the client require? A) Custodial services B) Home medical services C) High-technology pharmacology services D) Hospice services

Ans: B Feedback: Home medical services provide durable medical equipment, such as walkers, canes, crutches, wheelchairs, high-rise toilet seats, commodes, beds, and oxygen. Custodial services include homemaking and housekeeping services, as well as companionship and live-in services. Hospice services provide pain management, physician services, spiritual support, respite care, and bereavement counseling. High-technology pharmacology services provide intravenous therapy, home uterine monitoring, ventilator management, and chemotherapy.

32. A physician orders a dressing to cover a wound that is shallow with minimal drainage. What would be the best type of dressing for this wound? A) Saline-moistened dressing B) Dressing secured with Montgomery straps C) Hydrocolloid dressing D) Foam dressing

Ans: C Feedback: Hydrocolloid dressings are used for wounds that are shallow to moderate depth with minimal drainage. Saline-moistened dressing is often used with chronic wounds and pressure wounds. Montgomery straps are recommended to secure dressings on wounds that require frequent dressing changes, such as wounds with increased drainage. Foam dressings are recommended for chronic wounds.

19. Nurses who assist clients to deal holistically with their health care needs at the end of their lives work primarily in which health care delivery system? A) Acute care B) Primary care C) Hospice D) Rehabilitation

Ans: C Feedback: The opportunity to help people maintain their ability to remain at home and deal holistically with their health and family needs at the end of their lives is home health hospice care.

31. Which of the following is an accurate step when applying a saline-moistened dressing on a client's wound? A) Do not use irrigation to clean the wound before changing the dressing. B) Hold the fine-mesh gauze over the basin and pour the ordered solution over the mesh to saturate it. C) Exert light pressure to pack the wound tightly with moistened dressing. D) Apply several dry, sterile gauze pads over the wet gauze and place the ABD pad over the gauze.

Ans: D Feedback: Answer D is the correct step in the procedure. The wound should be cleaned, if needed, using sterile forceps. Irrigation may be used as ordered or required. The wound should be cleaned from the top to the bottom, and from the center to the outside. The fine-mesh gauze should be placed into the basin and the ordered solution poured over the mesh to saturate it. The dressing should be gently and loosely packed inside the wound.

34. A nurse is caring for clients at an ambulatory care facility. Which care intervention is least likely to be provided by the nurse in this setting? A) Patient education B) Treatment of minor trauma C) Medication administration D) Crisis management

Ans: D Feedback: Nurses in ambulatory care centers and clinics provide technical services (e.g., administering medications), determine the priority of care needs, and provide teaching about all aspects of care. The urgent care center is a special type of ambulatory care center that provides walk-in care for illnesses and minor trauma. Crisis management or intervention is typical of mental health centers and not of ambulatory care settings.

33. The U.S. system of health care is based on an ability to pay for care, which leaves millions of people uninsured or underinsured, with inadequate access to health care. Nurses are often presented with ethical dilemmas when caring for patients and families. Which of the following is an example of an ethical dilemma? Select all that apply. A) All clients are entitled to care, whether they can pay or not, because health care is a right. B) You may have to pay higher insurance premiums to cover the cost of care because you smoke. C) There are free clinics and health programs to serve the poor; they should receive health care there. D) Should the uninsured person, who cannot pay for health care, receive the same care and services as someone who works and pays for insurance?

Ans: D Feedback: Only answer D suggests an ethical dilemma for which there is no easy answer. Answer A is an assumption that many have about health care. Answer B is a fact, as some health insurance programs charge more for those who smoke. Answer C is an opinion, as although there are some clinics for the poor, health care access is limited.

7. What are the two major processes involved in the inflammatory phase of wound healing? A) Bleeding is stimulated, epithelial cells are deposited B) Granulation tissue is formed, collagen is deposited C) Collagen is remodeled, avascular scar forms D) Blood clotting is initiated, WBCs move into the wound

Ans: D Feedback: The inflammatory phase of wound healing begins at the time of injury and prepares the wound for healing. The two major physiologic activities are blood clotting (hemostasis) and the vascular and cellular phase of inflammation.

23. What must a nurse do before altering the arrangement of furniture in the home to facilitate care? A) Nothing; the nurse may move the furniture if needed. B) Document the need to move the furniture. C) Tell the client that the furniture has to be moved. D) Ask the client's permission to move the furniture.

Ans: D Feedback: The nurse may believe the furniture in the client's home needs to be rearranged to allow the use of equipment and to remove safety hazards, but the client should give permission before any changes are made. It is not necessary to document the need to move furniture.

17. A nurse has been named as a defendant in a lawsuit. With whom should the nurse discuss the case? A) Colleagues B) Reporters C) Plaintiff D) Attorney

Ans: D Feedback: The nurse should only discuss the case with the attorney representing him or her and/or the institution. Recommendations for the nurse as defendant include not discussing the case with anyone at the employing agency (except the risk manager), the plaintiff, the plaintiff's lawyer, anyone testifying for the plaintiff, or reporters.

1. The nurse is preparing to administer a medication via a nasogastric tube. What guideline is appropriate for the nurse to follow when administering a drug via this route? A) Flush the tube with water between each drug administered. B) Position the client supine prior to administering the drug. C) Administer the medication at a cold temperature. D) If connected to suction, do not reconnect to suction for five minutes after drug administration.

Ans:A Feedback:Guidelines to consider when administering a drug via nasogastric tube include positioning the client with the head of the bed elevated, administering the medication at room temperature for the client's comfort, flushing the tube with water between each drugadministered, and avoiding the use of suction for 20 to 30 minutes after the drug is administered.

29. Nurses apply critical thinking to clinical reasoning and judgment in their nursing practice every day. Which of the following are characteristics of this practice? Select all that apply. A) It is guided by standards, policies and procedures, ethics codes, and laws. B) It is based on principles of nursing process, problem solving, and the scientific method. C) It carefully identifies the key problems, issues, and risks involved. D) It is driven by the nurse's need to document competent, efficient care. E) It calls for strategies that make the most of human potential.

Ans:A, B, C, EFeedback:Critical thinking is guided by standards, policies and procedures, ethics codes, and laws; is based on principles of nursing process, problem solving, and the scientific method; andcarefully identifies the key problems, issues, and risks involved. It is driven by client, family, and community needs, as well as nurses' needs to give competent, efficient care (e.g., streamlining paperwork to free nurses for client care). It calls for strategies that make the most of human potential and compensate for problems created by human nature. It is constantly re-evaluating, self-correcting, and striving to improve.

31. Which of the following is an essential feature of professional nursing? Select all that apply. A) Providing a caring relationship to facilitate health and healing B) Attention to a range of human experiences and responses to health and illness C) Use of objective data to negate the client's subjective experience D) Use of judgment and critical thinking to form a medical diagnosis E) Advancement of professional nursing knowledge through scholarly inquiry

Ans:A, B, E

30. Nurses make decisions in their practice every day. Which of the following are potential errors in this decision-making process? Select all that apply. A) Placing emphasis on the last data received B) Avoiding information contrary to one's opinion C) Selecting alternatives to maintain status quo D) Being predisposed to multiple solutions E) Prioritizing problems in order of importance

Ans:B, C Feedback:Potential errors in decision making include bias: placing emphasis on the first data received, avoiding information contrary to one's opinion, selecting alternatives to maintain status quo, and being predisposed to a single solution. Failure to prioritize problems in order of importance is failure to consider the total situation. Failure to use appropriate resources is impatience. All these actions can lead to errors in decision making (Lipe & Beasley, 2004

34. Medications administered that are renal toxic should have frequent assessments of which blood values? A) AST and ALT B) BUN and creatinine C) WBC and platelets D) RBC and differential

B) BUN and creatinine

5. What nursing organization first legitimized the use of the nursing process? A) National League for Nursing B) American Nurses Association C) International Council of Nursing D) State Board of Nursing

B) American Nurses Association

21. A nurse is providing ongoing postoperative care to a client who has had knee surgery. The nurse assesses the dressing and finds it saturated with blood. The client is restless and has a rapid pulse. What should the nurse do next? A) Document the data and apply a new dressing. B) Apply a pressure dressing and report findings. C) Reassure the family that this is a common problem. D) Make assessments every 15 minutes for four hours.

B) Apply a pressure dressing and report findings.

26. Which of the following interventions are recommended guidelines for meeting client postoperative elimination needs? A) Assess abdominal distention, especially if bowel sounds are audible or are low pitched. B) Assess for the return of peristalsis by auscultating bowel sounds every four hours when the client is awake. C) Encourage food and fluid intake when ordered, especially dairy products and low-fiber foods. D) Assess for bladder distention by Palpating below the symphysis pubis if the client has not voided within eight hours after surgery.

B) Assess for the return of peristalsis by auscultating bowel sounds every four hours when the client is awake.

25. The nurse, after gathering data, analyzes the information to derive meaning. The nurse is involved in which phase of the nursing process? A) Planning B) Diagnosis C) Implementation D) Outcome identification

B) Diagnosis

13. A nurse interviews a pregnant teenager and documents her answers on the client record. At the same time, the nurse responds to the client's concerns and makes a referral for counseling and maternity care. This scenario is an example of which of the descriptors of the nursing process? A) Systematic B) Dynamic C) Outcome oriented D) Universally applicable

B) Dynamic

7. A female client is scheduled for liposuction surgery to reduce her weight. Based on urgency, how is this surgery classified? A) Urgent B) Elective C) Emergency D) Emergent

B) Elective

14. An experienced ICU nurse is mentoring a student. The nurse tells the student, "I think something is going wrong with your client." What type of clinical decision making is the experienced nurse demonstrating? A) Trial-and-error problem solving B) Intuitive thinking C) Scientific problem solving D) Methodical reasoning

B) Intuitive thinking

32. A nurse is assisting a physician during a cesarean section for a client. The client is administered epidural anesthesia. Which of the following is an advantage of epidural anesthesia? A) It counteracts the effects of conscious sedation. B) It decreases the risk of gastrointestinal complications. C) It prevents clients from remembering the initial recovery period. D) It acts on the central nervous system to produce loss of sensation.

B) It decreases the risk of gastrointestinal complications.

30. A nurse is taking care of a client during the immediate post-operative period. Which of the following duties performed during the immediate post-operative period is most important? A) Ensure the safe recovery of surgical clients. B) Monitor the client for complications. C) Prepare a room for the client's return. D) Assess the client's health constantly.

B) Monitor the client for complications.

18. What step in the nursing process is most closely associated with cognitively skilled nurses? A) Assessing B) Planning C) Implementing D) Evaluating

B) Planning

8. A home health nurse reviews the nursing care with the client and family and then mutually discusses the expected outcomes of the nursing care to be provided. Which step of the nursing process is the nurse illustrating? A) Diagnosing B) Planning C) Implementing D) Evaluating

B) Planning

32. Self-evaluation is a method that nurses use to promote their own development, and to grow in confidence in their nursing roles. This process is referred to as what? A) Promoting the nurse's self-esteem. B) Reflective practice. C) Assessment of oneself. D) Learning from mistakes.

B) Reflective practice.

27. A nurse is showing an older adult client the correct method of self-administering an insulin injection at home. Which of the following points should the nurse tell the client in order to avoid lipoatrophy and lipohypertrophy? A) Change the needle daily with each injection. B) Rotate the site with each injection. C) Apply local anesthetic to the injection site. D) Massage the injection site for 10 minutes.

B) Rotate the site with each injection.

15. A nurse is caring for a client in the ER who was injured in a snowmobile accident. The nurse documents the following client data: uncontrollable shivering, weakness, pale and cold skin. Th nurse suspects the client is experiencing hypothermia. Upon further assessment, the nurse notes a heart rate of 53 BPM and core internal temperature of 90°F, which confirms the initial diagnosis. The nurse then devises a plan of care and continues to monitor the client to evaluate the outcomes. This nurse is using which of the following types of problem solving in her care of this client? A) Trial-and-error B) Scientific C) Intuitive D) Critical thinking

B) Scientific

10. A nurse has been asked to ensure informed consent for a surgical procedure. What might be a role of the nurse? A) Securing informed consent from the client B) Signing the consent form as a witness C) Ensuring the client does not refuse treatment D) Refusing to participate based on legal guidelines

B) Signing the consent form as a witness

35. Which of the following group of terms best describes the nursing process? A) nursing goals, medical terminology, linear B) nurse-centered, single focus, blended skills C) patient-centered, systematic, outcomes-oriented D) family-centered, single point in time, intuitive

C Feedback: The nursing process is a patient-centered, systematic, outcomes-oriented method of caring that provides a framework for nursing practice. It is nursing practice in action.

4. A physician has ordered peak and trough levels of a medication. When would the nurse schedule the trough level specimen? A) Before administering the first dose B) Immediately after the first dose C) 30 minutes before the next dose D) 24 hours after the last dose

C) 30 minutes before the next dose

24. A nurse at a health care facility administers a prescribed drug to a client and does not record doing so in the medical administration record. The nurse who comes during the next shift, assuming that the medication has not been administered, administers the same drug to the client again. The nurse on the previous shift calls to inform the health care facility that the administration of the drug to this client in the earlier shift was not recorded. What should the nurse on duty do immediately upon detection of the medication error? A) Report the incident to the physician. B) Report the incident to the supervising nurse. C) Check the client's condition. D) Fill in the accident report sheet.

C) Check the client's condition.

31. A nurse is caring for a client who is scheduled to undergo a breast biopsy. Which of the following major tasks does the nurse perform immediately during the pre-operative period? A) Obtain a signature on the consent form. B) Review the surgical checklist. C) Conduct a nursing assessment. D) Reduce the dosage of toxic drugs.

C) Conduct a nursing assessment.

16. Which of the following is one example of a client benefit of using the nursing process? A) Greater personal satisfaction B) Decreased reliance on the nursing staff C) Continuity of care D) Decreased incidence of medical errors

C) Continuity of care

14. A student nurse is administering medications through a nasogastric tube connected to continuous suction. How will the student do this accurately? A) Briefly disconnect tubing from the suction to administer medications, then reconnect. B) Realize this can't be done, and document information. C) Disconnect tubing from the suction before giving drugs, and clamp tubing for 20 to 30 minutes. D) Leave the suction alone and give medications orally or rectally.

C) Disconnect tubing from the suction before giving drugs, and clamp tubing for 20 to 30 minutes.

9. Based on an established plan of care, a nurse turns a client every two hours. What part of the nursing process is the nurse using? A) Assessing B) Planning C) Implementing D) Evaluating

C) Implementing

21. A client with allergy has been advised to have an allergy test. The nurse needs to administer an injection to the client for allergy testing. Which of the following injection routes is most suitable for allergy testing? A) Subcutaneous B) Intramuscular C) Intradermal D) Intravenous

C) Intradermal

22. As a beginning student in nursing, what is essential to the mastery of technical skills, such as giving an injection? A) Read the steps of the procedure before clinical assignments. B) Even if you do not know how to give an injection, act as if you do. C) Practice giving injections in the learning laboratory until you feel comfortable. D) Tell your instructor that you don't think you can ever give an injection.

C) Practice giving injections in the learning laboratory until you feel comfortable.

25. A client with dry skin has been prescribed inunction. Which of the following should the nurse do to promote absorption of the ointment? A) Shaking the contents of the ointment B) Applying inunction with a cotton ball C) Rubbing the ointment into the skin D) Warming the inunction before application

C) Rubbing the ointment into the skin

17. A nurse is educating a surgical client on postoperative p.r.n. pain control. Which of the following should be included? A) "We will bring you pain medications; you don't need to ask." B) "Even if you have pain, you may get addicted to the drugs." C) "You won't have much pain so just tough it out." D) "You need to ask for the medication before the pain becomes severe."

D) "You need to ask for the medication before the pain becomes severe."

9. A nurse is educating a client about regional anesthesia. Which of the following statements is accurate about this type of anesthesia? A) "You will be asleep and won't be aware of the procedure." B) "You will be asleep but may feel some pain during the procedure." C) "You will be awake but will not be aware of the procedure." D) "You will be awake and will not have sensation of the procedure."

D) "You will be awake and will not have sensation of the procedure."

22. A nurse needs to administer an intradermal tuberculin skin test injection to a client. Which of the following is the most suitable angle when administering an intradermal injection? A) 180-degree angle B) 90-degree angle C) 45-degree angle D) 10-degree angle

D) 10-degree angle

28. A client with abdominal incisions experiences excruciating pain when he tries to cough. What should the nurse do to reduce the client's discomfort when coughing? A) Administer prescribed pain medication just before coughing. B) Ask the client to drink plenty of water before coughing. C) Ask the client to lie in a lateral position when coughing. D) Administer prescribed pain medication 30 minutes before deliberately attempting to cough.

D) Administer prescribed pain medication 30 minutes before deliberately attempting to cough.

27. A nurse is assisting a postoperative client with deep-breathing exercises. Which of the following is an accurate step for this procedure? A) Place the client in prone position, with the neck and shoulders supported. B) Ask the client to place the hands over the stomach, so he or she can feel the chest rise as the lungs expand. C) Ask the client to exhale rapidly and completely, and inhale through the nose rapidly and completely. D) Ask the client to hold his or her breath for three to five seconds and mentally count "one, one thousand, two, one thousand" and so forth.

D) Ask the client to hold his or her breath for three to five seconds and mentally count "one, one thousand, two, one thousand" and so forth.

19. A nurse is caring for a client in the nursing unit when the physician, during the rounds, prescribes a medication for the client. What appropriate action should the nurse take to ensure the accuracy of the verbal medication order? A) Ask the physician to repeat the dosage. B) Ask the physician to spell out the medication name. C) Ask a second nurse to listen for accuracy. D) Ask the physician to write out the order.

D) Ask the physician to write out the order.

23. A student is assessing a postoperative client who has developed pneumonia. The plan of care includes positioning the client in the Fowler's or semi-Fowler's position. What is the rationale for this position? A) It increases blood flow to the heart. B) The client will be more comfortable and have less pain. C) It facilitates nursing assessments of skin color and temperature. D) It promotes full aeration of the lungs.

D) It promotes full aeration of the lungs.

13. After conducting a preoperative health assessment, the nurse documents that the client has physical assessments supporting the medical diagnosis of emphysema. Based on this finding, what postoperative interventions would be included on the plan of care? A) Perform sterile dressing changes each morning. B) Administer pain medications as needed. C) Conduct a head-to-toe assessment each shift. D) Monitor respirations and breath sounds.

D) Monitor respirations and breath sounds.

19. A cleansing enema is ordered for a client who is scheduled to have colon surgery. What is the rationale for this procedure? A) Surgical clients routinely are given a cleansing enema. B) Cleansing enemas are given before surgery at the client's request. C) There will be less flatus and discomfort postoperatively. D) Peristalsis does not return for 24 to 48 hours after surgery.

D) Peristalsis does not return for 24 to 48 hours after surgery.

23. Which of the following interpersonal skills is essential to the practice of nursing? A) Performing technical skills knowledgeably and safely B) Maintaining emotional distance from clients and families C) Keeping personal information among shared clients confidential D) Promoting the dignity and respect of patients as people

D) Promoting the dignity and respect of patients as people

5. A client taking insulin has his levels adjusted to ensure that the concentration of drug in the blood serum produces the desired effect without causing toxicity. What is the term for this desired effect? A) Peak level B) Trough level C) Half-life D) Therapeutic range

D) Therapeutic range

21. Members of the staff on a hospital unit are critical of a client's family, who has different cultural beliefs about health and illness. A student assigned to the patient does not agree,based on her care of the client and family. What critical thinking attitude is the student demonstrating? A) Being curious and persevering B) Being creative C) Demonstrating confidence D) Thinking independently

D) Thinking independently

29. A nurse is bunching the tissue of a client when administering a subcutaneous injection to that client. The nurse knows that which of the following is the reason for bunching when injecting subcutaneously? A) To prevent needle-stick injuries B) To ensure the accuracy of landmarking C) To facilitate blood circulation at injection site D) To avoid instilling medication within the muscle

D) To avoid instilling medication within the muscle

20. A nurse working in a PACU is responsible for conducting assessments on immediate postoperative clients. What is the purpose of these assessments? A) To determine the length of time to recover from anesthesia B) To use intraoperative data as a basis for comparison C) To focus on cardiovascular data and findings D) To prevent complications from anesthesia and surgery

D) To prevent complications from anesthesia and surgery

11. A nurse is administering a medication that is formulated as enteric-coated tablets. What is the rationale for not crushing or chewing enteric-coated tablets? A) To prevent absorption in the mouth B) To prevent absorption in the esophagus C) To facilitate absorption in the stomach D) To prevent gastric irritation

D) To prevent gastric irritation

33. Nursing is a profession in a rapidly changing health care environment. What is the most important reason for the nurse to develop critical thinking and clinical reasoning? A) To be able to employ the nursing process in client care. B) The licensing examination requires nurses to be adept at critical thinking. C) Because clients deserve experts who know how to care for them. D) To provide quality care with nursing ability and knowledge.

D) To provide quality care with nursing ability and knowledge.

25. A nurse in an outpatient surgical center is teaching a client about what will be necessary for discharge to home. What information should the nurse include about transportation? A) The client is not allowed to drive a car home. B) If the client is not dizzy, driving a car is allowed. C) Only adults over the age of 25 may drive home. D) None; this is not necessary information.

The client is not allowed to drive a car home.

A nurse in a physician's office has noted on several occasions that one of the physicians frequently obtains controlled-drug prescription forms for prescription writing. The physician reports that his wife has chronic back pain and requires pain medication. One day the nurse enters the physician's office and sees him take a pill out of a bottle. The doctor mentions that he suffers from migraines and that his wife's pain medication alleviates the pain. What type of nurse-physician ethical situation is illustrated in this scenario? A) Unprofessional, incompetent, unethical, or illegal physician practice B) Disagreements about the proposed medical regimen C) Conflicts regarding the scope of the nurse's role D) Claims of loyalty

Ans: A Feedback: The physician is demonstrating unprofessional, incompetent, unethical, or illegal physician practice.

2. The client was diagnosed with diabetes three years ago, but has failed to integrate regular blood glucose monitoring or dietary modifications into his lifestyle. He has been admitted to the hospital for treatment of acute renal failure secondary to diabetic nephropathy, an event that has prompted the client to reassess his values. Which of the following actions most clearly demonstrates that this client is engaging in the step of prizing within his valuing process? A) The client expresses pride that he now has the knowledge and skills to take control of his diabetes management. B) The client states that he will now begin to check his blood glucose before each meal and at bedtime. C) The client is now able to explain how his choices have contributed to his renal failure. D) The client expresses remorse at how his failure to take make lifestyle changes has adversely affected his health.

Ans: A Feedback: Within the valuing process, expressions of pride and happiness are considered to be indications of prizing. Resolving to make changes is an aspect of choosing, while expressing insight about his role in his current diagnosis demonstrates that the client has the desire to re-examine his values.

29. A nurse states to the client that she will keep her free of pain. However, her family wishes to try a treatment to prolong her life that may necessitate withholding pain medication. This factor will cause an ethical dilemma for the nurse in relation to which ethical principle? A) Fidelity B) Veracity C) Justice D) Autonomy

Ans: A Feedback: Fidelity means being faithful to one's commitments and promises.

33. The nursing student asks the nurse for an example of a "never event." Which example provided by the nurse best answers the nursing student's question? A) The client scheduled for a cholecystectomy has a total abdominal hysterectomy. B) The client receives preoperative medication before signing the informed consent. C) The client receives a medication and develops a rash on the trunk of the body, itching, and dyspnea. D) The client fails to receive a regularly scheduled medication.

Ans: A Feedback: A "never event" is an extremely rare medical error that should never occur. The performance of the wrong surgery on a client is an example of a never event. The other examples are examples of incidents or variances, events that occur out of the ordinary that result in, or have the potential to result in, harm to a client, employee, or visitor.

5. A client is suing a nurse for malpractice. What is the term for the person bringing suit? A) Plaintiff B) Defendant C) Litigator D) Witness

Ans: A Feedback: A lawsuit is a legal action in a court. Litigation is the process of bringing and trying a lawsuit. The person or government bringing suit against another is called the plaintiff. The one being accused of a crime or tort (defined later) is called the defendant. The defendant is presumed innocent until proved guilty of a crime or tort.

13. A nurse provides client care within a philosophy of ethical decision making and professional expectations. What is the nurse using as a framework for practice? A) Code of Ethics B) Standards of Care C) Definition of Nursing D) Values Clarification

Ans: A Feedback: A professional code of ethics provides a framework for making ethical decisions and sets forth professional expectations. Codes of ethics inform both nurses and society of the primary goals and values of the profession.

34. A nurse has had, on several occasions, the opportunity to share personal prescriptions with family members when they were in need of pain medication or antibiotics. Which set of rules should govern this moral decision? A) Ethics B) Administrative law C) Common law D) Civil law

Ans: A Feedback: Although all of the options may affect your decision, moral decisions are guided by ethics, which are internal set of principles and values that guide the behavior of a person. Sharing medications prescribed to you with other people, including family members, would be considered unethical. It is important to distinguish ethics from law, religion, custom, and institutional practices. For example, the fact that an action is legal or customary does not in itself make the action ethically or morally right.

14. A client refuses to have a pain medication administered by injection. A nurse says, "If you don't let me give you the shot, I will get help to hold you down and give it." With what crime might the nurse be charged? A) Assault B) Battery C) Negligence D) Defamation

Ans: A Feedback: Assault and battery are intentional torts. Assault is a threat or attempt to make bodily contact with another person without that person's consent. Threatening to forcibly administer an injection after the patient has refused it is assault. Battery is an assault that is carried out and includes willful, angry, and violent or negligent touching of another person's body, clothes, or anything attached to or held by that other person. Negligence is defined as performing an act that a reasonably prudent person under similar circumstances would not do or, conversely, failing to perform an act that a reasonably prudent person under similar circumstances would do. Defamation is an intentional tort in which one party makes derogatory remarks about another that diminish the other party's reputation.

27. When the nurse inserts an ordered urinary catheter into the client's urethra after the client has refused the procedure, and then the client suffers an injury, the client may sue the nurse for which type of tort? A) Battery B) Assault C) Invasion of privacy D) Dereliction of duty

Ans: A Feedback: Battery is the actual carrying out of such threat (unlawful touching of a person's body). A nurse may be sued for battery if he or she fails to obtain consent for a procedure.

2. During a clinical placement on a subacute, geriatric medicine unit, a student nurse fed a stroke client some beef broth, despite the fact that the client's diet was restricted to thickened fluids. As a result, the client aspirated and developed pneumonia. Which of the following statements underlies the student's potential liability in this situation? A) The same standards of care that apply to a registered nurse apply to the student. B) The student and the nursing instructor share liability for this lapse in care. C) The patient's primary nurse is liable for failing to ensure that delegated care was appropriate. D) The student's potential liability is likely negated by the insurance carried by the school of nursing.

Ans: A Feedback: Despite the fact that their knowledge and skills are still under development, nursing students are held to the same standards of care as registered nurses. Consequently, primary liability does not lie with the student's instructor or the patient's primary nurse. Insurance may be carried by the school of nursing, but this does not negate the student's legal responsibility to provide care at a high standard.

28. A group of nurses working in a long-term care facility fails to keep the narcotic medications in a secure location. The nurses also fail to count the medications before and after each shift, as indicated by the institution's policies and procedures. These failures may result in what type of disciplinary action? A) Action against the nurses' licenses B) Action against the facility's state license C) Action against the state regulating body D) Action against the pharmacist's license

Ans: A Feedback: In institutions, most controlled substances must be kept secure and monitored closely in accordance with institutional and state regulations. Failure to do so may lead to disciplinary action against the nurse's license.

6. A nurse is providing client care in a hospital setting. Who has full legal responsibility and accountability for the nurse's actions? A) The nurse B) The head nurse C) The physician D) The hospital

Ans: A Feedback: In modern practice, nurses assess and diagnose clients and plan, implement, and evaluate nursing care. Full legal responsibility and accountability for these nursing actions rest with the nurse.

14. A client has a private insurance policy that pays for most health care costs and services. Why is this plan called a third-party payer? A) The insurance company pays all or most of the costs. B) The family of the client is required to pay costs. C) The client gets the bill and pays out-of-pocket costs. D) Medicare and Medicaid will pay most of the costs.

Ans: A Feedback: Insurance for health care may be financed through private insurance, in which members pay a monthly premium. These plans are called third-party payers, because the insurance company pays all or most of the cost of care.

16. A lawsuit has been brought against a nurse for malpractice. The client fell and suffered a skull fracture, resulting in a longer hospital stay and need for rehabilitation. What does the description of the client and his injuries represent as proof of malpractice? A) Damages B) Causation C) Duty D) Breach of duty

Ans: A Feedback: Liability involves four elements: duty (obligation to use care and follow standards), breach of duty (failure to follow standards of care), causation (the failure to follow standards of care resulted in the injury), and damages (the actual harm or injury resulting to the patient).

2. After many years of advanced practice nursing, a nurse has recently enrolled in a nurse practitioner program. This nurse has been attracted to the program by the potential to provide primary care for clients after graduation, an opportunity that is most likely to exist in which of the following settings? A) A rural health center B) A long-term care facility C) A university hospital D) A community hospital

Ans: A Feedback: Many rural health centers employ few health care providers, and primary care is often provided by a nurse practitioner (NP). A nurse practitioner may provide care in a long-term care facility or hospital, but in these settings, the NP is less likely to be the provider of primary care to clients.

23. A nurse is caring for a client who is a practicing Jehovah's Witness. The physician orders two units of packed cells based on his low hemoglobin and hematocrit levels. The nurse states to the surgeon that it is unethical to go against the patient's beliefs even though his blood counts are very low. What is the best description of the nurse's intentions? A) Acting in the patient's best interest B) Siding with the patient over the surgeon C) Observing institutional policies D) Being legally responsible

Ans: A Feedback: Nurses' ethical obligations include acting in the best interest of their clients, not only as individual practitioners, but also as members of the nursing profession, the health care team, and the community at large.

6. A male client age 56 years is experiencing withdrawal from alcohol and is placing himself at risk for falls by repeatedly attempting to scale his bedrails. Benzodiazepines have failed to alleviate his agitation and the nurse is considering obtaining an order for physical restraints to ensure his safety. The nurse should recognize that this measure may constitute what? A) Paternalism B) Deception C) Harm D) Advocacy

Ans: A Feedback: Paternalism involves the violation of a client's autonomy in order to maximize good or minimize harm, a situation that requires careful consideration in light of ethical principles. Deception is unlikely to occur and the risk for harm is likely decreased by the use of restraints. Advocacy is the protection and support of another's rights.

11. Who provides physicians with the authority to admit and provide care to clients requiring hospitalization? A) The health care institution itself B) Board of Healing Arts C) American Medical Association D) State Board of Nursing

Ans: A Feedback: Physicians are granted the authority to admit clients to a health care agency or institution, and to provide care in that setting by the health care agency or institution itself. They are licensed to practice medicine by a state medical board, not a state board of nursing or a board of healing arts.

21. A nursing instructor is teaching a class about ethical principles to a group of nursing students. The instructor determines that the teaching was successful when the students give which of the following as an example of nonmaleficence? A) Protecting clients from a chemically impaired practitioner B) Performing dressing changes to promote wound healing C) Providing emotional support to clients who are anxious D) Administering pain medications to a client in pain

Ans: A Feedback: Protecting clients from a chemically impaired practitioner is an appropriate example of nonmaleficence. Nonmaleficence means to avoid doing harm, to remove from harm, and to prevent harm. Performing dressing changes to promote wound healing, providing emotional support to clients who are anxious, and administering pain medications to a client in pain are examples of beneficence, which means doing or promoting good.

25. One of the newest concepts in providing long-term care is called aging in place. What is the best description of this type of care? A) Clients move to an independent living apartment or home, then have access to increasing health care services as needed, provided within the health care community where they live. B) Clients move into the nursing home, and access more and more services as required in the same facility. C) A long-term-care facility, associated with a hospital, that provides acute care services as needed so the client can return to long term care. D) Clients are maintained in their own homes with home health care.

Ans: A Feedback: The best description of "aging in place" is the type of care where the client moves into an independent living space, and then has access to more services, such as assisted living and/or skilled care, that are part of the health care community in which they live.

30. Nurses work with various members of the health team. The nurse understands that the role of the hospitalist is best described as: A) the doctor who admits the patient, assumes the management of the patient's care, and maintains communication with the primary physician while the patient is hospitalized. B) the physician who manages the patient's care in emergency and intensive care units only. C) the doctor who notifies the primary physician that their patient has been admitted to the hospital, and transfers care to a the referral specialist. D) the specialist who admits the patient to hospital, and returns care to the primary physician for all other referrals and services.

Ans: A Feedback: The hospitalist is a physician who provides care to the patient in the emergency room and after admission to the hospital. The hospitalist communicates with the patient's primary doctor, but manages the hospital care.

23. A home care nurse is caring for a quadriplegic client who needs regular position changes and back massages. A gentleman identifying himself as a family friend inquires if he can be of any help to the family. What should be the nurse's response be? A) The nurse should ask the gentleman to talk to the family directly. B) The nurse should invite the gentleman to learn the caring techniques. C) The nurse should state that the family does not need any help. D) The nurse should refer the gentleman to the local social worker.

Ans: A Feedback: The nurse should ask the gentleman to talk to the family directly. Revealing information about the client's care is a violation of the client's privacy. The nurse should not invite the gentleman for a learning session because it would be a breach of the client's right to privacy. Referring him to a social worker is not an appropriate choice.

A) The nurses are taking every reasonable measure to ensure that no participants experience impaired wound healing as a result of the study intervention. B) The nurses have organized the study in such a way that the foreseeable risks and benefits are distributed as fairly as possible. C) The nurses have given multiple opportunities for potential participants to ask questions, and have been following the informed consent process systematically. D) The nurses have completed a literature review that suggests the new treatment may result in decreased wound healing time.

Ans: A Feedback: The principle of non-maleficence dictates that nurses avoid causing harm. In this study, this may appear in the form of taking measures to ensure that the intervention will not cause more harm than good. The principle of justice addresses the distribution of risks and benefits, and the informed consent process demonstrates that autonomy is being protected. Preliminary indications of the therapeutic value of the intervention show a respect for the principle of beneficence.

12. A nurse using the principle-based approach to client care seeks to avoid causing harm to clients in all situations. What is this principle known as? A) Nonmaleficence B) Justice C) Fidelity D) Autonomy

Ans: A Feedback: The principle-based approach to ethics combines elements of both utilitarian and deontologic theories and offers specific action guides for practice. The Beauchamp and Childress principle-based approach to bioethics (2001) identifies four key principles: autonomy (promote self-determination), nonmaleficence (avoid causing harm), beneficence (benefit the patient), and justice (act fairly).

5. A client with a diagnosis of colorectal cancer has been presented with her treatment options, but wishes to defer any decisions to her uncle, who acts in the role of a family patriarch within the client's culture. By which of the following is the client's right to self-determination best protected? A) Respecting the client's desire to have the uncle make choices on her behalf B) Revisiting the decision when the uncle is not present at the bedside C) Teaching the client about her right to autonomy D) Holding a family meeting and encouraging the client to speak on her own behalf

Ans: A Feedback: The right to self-determination (autonomy) means that it should never be forced on anyone. The client has the autonomous right to defer her decision-making to another individual if she freely chooses to do so.

1. Which of the following aspects of nursing would be most likely defined by legislation at a state level? A) The differences in the scope of practice between registered nurses (RNs) and licensed practical nurses (LPNs). B) The criteria that a nurse must consider when delegating tasks to unlicensed care providers. C) The criteria that clients must meet in order to qualify for Medicare or Medicaid. D) The process that nurses must follow when handling and administering medications.

Ans: A Feedback: The scope of practice defines the parameters within which nurses provide care, and is established by state legislation, most commonly in the form of a Nurse Practice Act. The criteria and due process for delegation in the clinical setting is addressed by a state board of nursing. Qualification criteria for programs such as Medicare and Medicaid are established by federal legislation, while the process for safe and appropriate medication administration is defined and monitored by a state board of nursing.

16. A student nurse is working in the library on her plan of care for a clinical assignment. The client's name is written at the top of her plan. What ethical responsibility is the student violating? A) Confidentiality B) Accountability C) Trust D) Informed consent

Ans: A Feedback: The student is violating confidentiality. Confidentiality is violated when patients are identified by name on written documents available to those who are not directly responsible for their care.

7. A mother always thanks clerks at the grocery store. Her daughter age 6 years echoes her thank you. The child is demonstrating what mode of value transmission? A) Modeling B) Moralizing C) Reward and punishment D) Responsible choice

Ans: A Feedback: Through modeling, children learn of high or low value by observing parents, peers, and significant others. Modeling can thus lead to socially acceptable or unacceptable behaviors. Children whose caregivers use the moralizing mode of value transmission are taught a complete value system by parents or an institution (e.g., church or school) that allows little opportunity for them to weigh different values. Through rewarding and punishing, children are rewarded for demonstrating values held by parents and punished for demonstrating unacceptable values. Caregivers who follow the responsible-choice mode of value transmission encourage children to explore competing values and to weigh their consequences.

7. What type of law regulates the practice of nursing? A) Common law B) Public law C) Civil law D) Criminal law

Ans: C Feedback: Civil laws regulate the practice of nursing. A law is a standard or rule of conduct established and enforced by the government, chiefly to protect the rights of the public. Private law, also called civil law, regulates relationships among people and includes laws related to the practice of nursing.

3. The children of a female client 78 years of age with a recent diagnosis of early-stage Alzheimer's disease are attempting to convince their mother to move into an assisted living facility, a move to which the client is vehemently opposed. Both the client and her children have expressed to the nurse how they are entrenched in their position. Which of the following statements expresses a utilitarian approach to this dilemma? A) The decision should be made in light of consequences. B) The client's autonomy and independence are the priority considerations. C) Benefits and burdens should be evenly distributed between the children and the client. D) The client has a right to self-determination.

Ans: A Feedback: Utilitarianism is the theory of ethics that weighs rightness and wrongness according to consequences and outcomes for all those who are affected. Utilitarianism prioritizes these consequences and outcomes over principles such as autonomy and justice; principles that underlie the other statements addressing the patient's right to self-determination; and fair distribution of benefits and burdens.

10. Which of the following best describes voluntary standards? A) Voluntary standards are guidelines for peer review, guided by the public's expectation of nursing. B) Voluntary standards set requirements for licensure and nursing education. C) Voluntary standards meet criteria for recognition, specified area of practice. D) Voluntary standards determine violations for discipline and who may practice.

Ans: A Feedback: Voluntary standards are developed and implemented by the nursing profession itself. They are not mandatory but are used as guidelines for peer review. The organizations that set standards are guided by society's need for nursing and by the public's expectations of nursing.

34. The nurse reports a nursing colleague on the unit who is lethargic and verbally responding in a slow manner. What is this an example of? A) Whistle-blowing B) Collective bargaining C) Delegating nursing care D) Ensuring adequate staffing

Ans: A Feedback: Whistle-blowing is when the nurse reports unsafe practice environments. Impaired nurses threaten the safety of clients in the clinical setting, as does inadequate staffing. Nurses may delegate or assign tasks involved in the delivery of nursing care to individuals as long as the individual has sufficient knowledge and skill to perform the assigned task. Collective bargaining is a legal process in which representatives of organized employees negotiate with employers about work conditions.

30. Which of the following are examples of a nurse demonstrating the professional value of altruism? Select all that apply. A) The nurse arranges for an interpreter for a client whose primary language is Spanish. B) The nurse calls the physician of a client whose pain medication is not strong enough. C) The nurse provides information for a client so he is capable of participating in planning his care. D) The nurse reviews a client chart to determine who may be informed of the patient's condition. E) The nurse documents client care accurately and honestly and reviews the entry to ensure there are no errors.

Ans: A, B Feedback: The altruistic nurse demonstrates understanding of cultures, beliefs, and perspectives of others; advocates for clients; and takes risks on behalf of clients and colleagues. The professional practice reflects autonomy when the nurse respects clients' rights to make decisions about their health care. Human dignity is reflected when the nurse values and respects all clients and colleagues by preserving their confidentiality. Integrity is reflected in professional practice when the nurse is honest and provides care based on an ethical framework that is accepted within the profession. Social justice is upholding moral, legal, and humanistic principles. One way to do this is by encouraging legislation and policy consistent with the advancement of nursing care and health care.

22. The nurse working in the hospital understands the changes that have resulted in shorter hospital stays, with a focus on acute care needs of the client. Which of the following factors influence shorter hospital stays? Select all that apply. A) Federal regulations for health care reimbursement policies. B) Increased emphasis on preventive care. C) Improvement in treatment of illness. D) Patients realize that longer stays result in infections and other problems.

Ans: A, B, C Feedback: Shorter hospital stays direct the focus on the acute care needs of the client and have resulted from improved treatment of disease, increases in preventive care, and federal regulations and other health care reimbursement policies. Longer hospital stays are often the result of infection, as this factor is not related to shorter hospital stays.

29. A nurse is making a visit to a client in the home. As a home health care nurse you may be expected to accomplish which of the following? A) Complete an assessment on each visit. B) Provide support to the client and family. C) Administer treatments and medications. D) Document actions regarding patient, activities, and progress. E) Communicate and collaborate with other members of the health team.

Ans: A, B, C, D, E Feedback: All of the above. Home health care nurses may provide all of these activities in the home setting.

27. The Public Health Service (PHS) is a federal agency of the U.S. Department of Health and Human Services. The professional nurse is aware that the services provided by the PHS include which of the following? Select all that apply. A) Care to migrant workers B) Care in federal prisons C) Veterans Administration (VA) hospitals D) Indian Health Services

Ans: A, B, D Feedback: The Public Health Services provides all of these services and others, except the Veterans Administration Hospitals. VA hospitals are supported by government-operated health care, not the PHS.

26. Health care is constantly changing and becoming more complex. Select the answers that describe clients as health care consumers today. Select all that apply. A) They often have health information obtained from the Internet. B) They prefer to control the decisions made about their own health care. C) Most are less concerned about health care costs as long as they receive good care. D) They express concern regarding access to care and the quality of service. E) They have helped develop clients' rights and cost-containment measures.

Ans: A, B, D, E Feedback: Health care consumers are increasingly more knowledgeable about health, and prefer to control the decisions about their care. They express concern about access to services, and the cost and quality of care. They question duplication of services, and are actively engaged. They have helped to develop client rights and cost-containment measures as protections for clients in health care settings. Today clients are surveyed regarding their experiences with doctors and nurses in hospitals.

30. According to HIPPA regulations, which of the following is a client right regarding the client's medical record? Select all that apply. A) To see the health record B) To copy the health record C) To make additions to the health record D) To cross out sections of the health record E) To restrict certain disclosures of the health record

Ans: A, B, E Feedback: According to HIPAA, clients have a right to see and copy their health record; to update their health record; to get a list of the disclosures a health care institution has made independent of disclosures made for the purposes of treatment, payment, and health care operations; to request a restriction on certain uses or disclosures; and to choose how to receive health information. The client may not make additions, cross out sections, or destroy the health record.

23. Medicare reimburses in-hospital costs based on a set payment for a diagnostic related group (DRG). This means the hospital is reimbursed for a fixed amount based on the diagnosis and projected cost for care. As a result of this system the hospital can make a profit or a loss. Select the responses that describe when a profit for care of the client can be achieved. A) All of the hospitalization charges are less than projected. B) The client receives incompatible blood so the hospital does not get charged for it. C) The client is discharged before the approved discharge date. D) The nursing care results in the client reaching outcomes for recovery, without complication, after the projected timetable.

Ans: A, C Feedback: The hospital will make a profit when cost of hospitalization is less than the reimbursement assigned for the severity of illness and projected care costs. If the client is discharged earlier than projected the hospital keeps the total reimbursed. Incompatible blood is a preventable error, for which the hospital is not reimbursed. Reaching outcomes after the approved time results in additional cost to the hospital.

21. Long-term care is often needed for the elderly client. Select all the services that may be provided to the resident in a long-term care facility. A) Assistance with activities of daily living B) Immediate post-op care C) Mental disability services D) Nonmedical care for chronic illness E) Day care meals and services

Ans: A, C, D Feedback: Acute/immediate post-op care is a specific need/care immediately following surgery/procedures and is completed at the facility. Day care meals and services are separate services and are not provided to residents in a long-term-care facility. All the others are part of what a long-term care facility provides.

29. Which of the following statements accurately describes an aspect of the credentialing process used in nursing practice? Select all that apply. A) Credentialing refers to the way in which professional competence is ensured and maintained. B) Accreditation is the process by which the state determines that a person meets minimum requirements to practice nursing. C) Certification grants recognition in a specified practice area to people who meet certain criteria. D) Legal accreditation of a school preparing nursing personnel by the state Board of Nursing is voluntary. E) Once earned, a license to practice is a property right and may not be revoked without due process.

Ans: A, C, E Feedback: Credentialing refers to the way in which professional competence is ensured and maintained. Licensure is the process by which a state determines that a candidate meets certain minimum requirements to practice in the profession and grants a license to do so. Certification is the process by which a person who has met certain criteria established by a nongovernmental association is granted recognition in a specified practice area. State accreditation is a legal requirement; legal accreditation of a school preparing nursing personnel by the state Board of Nursing should not be confused with voluntary accreditation. Once earned, a license to practice is a property right and may not be revoked without due process. This includes notice of an investigation, a fair and impartial hearing, and a proper decision based on substantial evidence. According to the National Council of State Boards of Nursing, a mutual recognition model of nurse licensure exists that allows a nurse to have one license in his or her state of residency, and to practice in other states (both physically and electronically) as well, subject to each state's practice law and regulation, unless otherwise restricted.

31. A nurse explains the informed consent form to a client who is scheduled for heart bypass surgery. Which of the following are elements of this consent form? Select all that apply. A) Disclosure B) Organ donation C) DNR orders D) Comprehension E) Competence

Ans: A, D, E Feedback: Every person is granted freedom from bodily contact by another person, unless consent is granted. In all health care agencies, informed and voluntary consent is needed for admission (for routine treatment), for each specialized diagnostic procedure or medical or surgical treatment, and for any experimental treatments or procedures. Elements of informed consent include disclosure, comprehension, competence, and voluntariness.

32. Which of the following nursing actions would be considered a violation of HIPPA regulations? Select all that apply. A) A nurse ambulates a client through a hospital hallway in a hospital gown that is open in the back. B) A nurse shoves a confused, bedridden client into bed after he made several attempts to get up. C) A nurse inadvertently administers the wrong dose of morphine to a client in the ICU. D) A nurse uses a client's chart as a sample teaching case without changing the client's name. E) A nurse reports the condition of a client to the client's employer.

Ans: A, D, E Feedback: HIPPA regulations exist to protect patient privacy. Answers A, D, and E are examples of violations of HIPPA. Shoving a patient is battery and inadvertently administering the wrong dose of a medicine is negligence. A person fraudulently misrepresenting himself or herself to obtain a license to practice nursing is considered fraud.

22. A dying client tells the nurse that he doesn't want to see his family because he doesn't want to cause them more sadness. Which action by the nurse is most appropriate? A) Arrange a meeting between the family and the client. B) Help the patient clarify his values. C) Educate the patient on death and dying concepts. D) Allow the patient time for quiet reflection.

Ans: B Feedback: Values clarification is a method of self-discovery by which people identify their personal values and value rankings. The client's value of family may be obscured because of his overwhelming need to protect his family.

24. A client is admitted with symptoms of psychosis. The nurse hurries to the client's room when she hears the client calling for help. She finds the client lying on the ground. The nurse assists the client back to the bed and performs a thorough assessment. The nurse informs the physician and completes the incident report. Which of the following statements should the nurse document in the incident report? A) The client was trying to lower the side rails. B) The client was found lying on the floor. C) The client was trying to get out of the bed. D) The client was not aware that he had fallen.

Ans: B Feedback: An incident report is a written account of an unusual, potentially injurious event involving a client, employee, or visitor. All of the details given in the incident report should be accurate and not assumed. Accurate and detailed documentation helps to prove that the nurse acted reasonably or appropriately in the circumstance. The nurse should document that the client was found lying on the floor. The other statements are assumptions and should not be included in the incident report.

15. Two nurses are discussing a client's condition in an elevator full of visitors. With what crime might the nurses be charged? A) Defamation of character B) Invasion of privacy C) Unintentional negligence D) Intentional negligence

Ans: B Feedback: Certain acts by nurses could constitute invasion of privacy, including talking about patients in public areas, such as elevators. This violates federal law. In this case, the nurses would not be charged with defamation or negligence.

9. A nurse moves from Ohio to Missouri. Where can a copy of the Nurse Practice Act in Missouri be obtained? A) Ohio State Board of Nursing B) Missouri State Board of Nursing C) Federal government nursing guidelines D) National League for Nursing

Ans: B Feedback: Each state has a Nurse Practice Act that protects the public by broadly defining the legal scope of nursing practice. A copy of the Nurse Practice Act for the state in which a nurse practices can be obtained from that state's board of nursing. Neither the federal government nor the National League for Nursing has copies of nurse practice acts.

3. Which of the following phrases best describes hospitals today? A) Focus on chronic illnesses B) Focus on acute care needs C) Primary care centers D) Voluntary agencies

Ans: B Feedback: Hospitals have become acute care providers for people who are too ill to care for themselves at home, who are severely injured, who require surgery or complicated treatment, or who are having babies. Hospitals rarely focus on chronic illnesses, and they are not primary care centers. Hospitals are not classified as voluntary agencies.

12. After a stroke, a client is having difficulty swallowing. The nurse may make a referral to what member of the health care team? A) Physical therapist B) Speech therapist C) Social worker D) Respiratory therapist

Ans: B Feedback: In addition to providing services to improve oral communication, a speech therapist may also diagnose and treat swallowing problems in clients who have had a head injury or stroke. A physical therapist assists with musculoskeletal and neurological impairments, a social worker is educated to help clients with economic and social issues, and a respiratory therapist provides treatments to improve breathing.

31. A nurse has been hired to work as an occupational health nurse. In this position as a registered nurse, what will this nurse provide? A) Occupational therapy to schoolchildren. B) Education and safety programs in industrial settings. C) Assessment and motivation services to the unemployed. D) Activities to assist patients with ADLs in homeless shelters.

Ans: B Feedback: Industrial settings is the best answer to define/describe occupational health nursing, which focuses on employee safety and health-promotion programs. The other options do not address health needs in an employment setting.

18. Which of the following health care insurance programs is most suitable for a client 68 years of age? A) Medicaid B) Medicare C) Capitation D) AmeriCare

Ans: B Feedback: Medicare is a federal program that finances health care costs of persons 65 years and older, permanently disabled workers of any age and their dependents, and those with end-stage renal disease. The system is funded primarily through withholdings from an employed person's income. Capitation is a reimbursement strategy in managed care organizations. AmeriCare is a type of private insurance. Capitation and AmeriCare are not the preferred providers for the client, considering the client's old age. Medicaid is a federal program that is operated by the states, and each state decides who is eligible and the scope of health services offered. In Medicaid, eligibility may be decided by the state, which is not the case in Medicare.

22. A client who has undergone resection of the intestine is on a liquid diet with a nasogastric tube in place. He refuses the food tray with regular food that comes to his room and insists that a physician be called. The nurse insists that it is the right food and makes the client take it. The client develops complications and has to be re-operated upon. How is negligence determined in this situation? A) The nurse did not call the physician when the client asked. B) The nurse did not realize the importance of the tube. C) The dietary department sent the wrong diet for the client. D) The nurse insisted the patient have the solid food.

Ans: B Feedback: Negligence is defined as harm that occurs because the person did not act reasonably. In this case, the nurse did not realize that the client was on a nasogastric tube, and should consequently have been on liquid feeds after intestinal surgery; as a result, the patient developed complications. The acts of not calling the physician and insisting the patient have food do not amount to negligence. The dietary department sending the wrong food is unrelated to the nurse.

10. While at lunch, a nurse heard other nurses at a nearby table talking about a client they did not like. When they asked him what he thought, he politely refused to join in the conversation. What value was the nurse demonstrating? A) The importance of food in meeting a basic human need B) Basic respect for human dignity C) Men do not gossip with women D) A low value on collegiality and friendship

Ans: B Feedback: Nurses who feel uncomfortable gossiping with other nurses about patients realize that this behavior contradicts a basic respect for human dignity. This respect is a value that allows one to choose freely to believe in the worth and uniqueness of each individual.

15. A person receiving health care insurance from his employer knows that he should check the approved list of contracted health care providers before seeking services, in order to receive them at a lower cost. What type of insurance is most likely involved? A) Medicaid B) Preferred provider organization C) Health maintenance organization D) Long-term care insurance

Ans: B Feedback: Preferred provider organizations (PPOs) allow a third-party payer (agencies that pay health care providers for services provided to individuals, such as a health insurance company) to contract with a group of health care providers to provide services at a lower fee in return for prompt payment and a guaranteed volume of clients and services. Although clients are encouraged to use specific providers, they may also seek care outside the panel without referral by paying additional out-of-pocket expenses.

24. What is the function of the American Nurses Association's Code of Ethics for Nurses? A) Serves to establish personal ethics for nurses B) Delineates nurses' conduct and responsibilities C) Serves as a guideline for all health care practice D) Plays an important role in legal proceedings

Ans: B Feedback: The ANA recently revised the Code of Ethics for Nurses that delineates the conduct and responsibilities expected of all nurses in their nursing practices.

19. A nurse has taken a telephone order from a physician for an emergency medication. The dose of the medication is abnormally high. What should the nurse do next? A) Administer the medication based on the order B) Question the order for the medication C) Refuse to administer the medication D) Document concerns about the order

Ans: B Feedback: The nurse should question any physician order that is ambiguous, contraindicated by normal practice (such as an abnormally high medication dose), or contraindicated by the client's present condition. The nurse should not administer the medication, refuse to administer the medication without contacting the physician, or document concerns about the order without doing anything further.

35. An ethical conflict exists around a female client's expressed desire to have a neighbor make her treatment decisions. This neighbor is an individual who the client's children characterize as a predator. Place in the correct order the steps that the nurse should follow in resolving this ethical conflict. 1. Clearly identify the ethical problem 2. Apply ethical principles to the situation 3. Identify the different options 4. Gather relevant data about the situation 5. Make and evaluate a decision A) 1, 2, 3, 4, 5 B) 4, 1, 3, 2, 5 C) 2, 3, 4, 1, 5 D) 1, 4, 3, 2, 5

Ans: B Feedback: The nursing process of assessment, diagnosis, planning, implementation, and evaluation can be applied to appropriately respond to many ethical dilemmas.

19. A client who is scheduled to have surgery for a hernia the next day is anxious about the whole procedure. The nurse assures the client that surgery for hernias is very common and that the prognosis is very good. What skills of the nurse are reflected here? A) Imaginal skills B) Interpersonal skills C) Instrumental skills D) Systems skill

Ans: B Feedback: The scenario reflects the nurse's interpersonal skills. It shows how a person relates with others. The nurse shows imaginal skills when he or she envisions a plan for adapting and personalizing client care. Instrumental skills are associated with basic physical and intellectual competencies. Systems skills are those that help the nurse see the whole picture and how various parts relate.

20. What is one of the most significant trends in health care today? A) Increased length of hospital stays B) Shift from hospitals to community-based care C) Emphasis on disease management D) Narrowing of the areas for nursing practice

Ans: B Feedback: The shift to community-based care is related to the public's desire to participate more actively in health care decisions, issues, and choices.

28. Health care costs are increasing as technology and related services increase. Patients interact with many health care providers, such as RNs, LPNs, physicians, physical therapists, medical technologists, radiation technologists, specialists, and others employed in health care. As a result of the complexity of care and multiple providers, health care is becoming fragmented. What are the major results of fragmented care? A) Less confusion for clients regarding treatment. B) Increased medication errors. C) Clients receive more specialized care. D) Lack of continuity of care.

Ans: B, C, D Feedback: Fragmented care increases health care costs and the number of providers/specialists seeing the client. A lack of continuity of care often results, increasing the client's confusion, and medication errors may increase. Although clients often receive specialized care and services, there may be conflicting care plans.

12. Which of the following is the most frequent reason for revocation or suspension of a nurse's license? A) Fraud B) Mental impairment C) Alcohol or drug abuse D) Criminal acts

Ans: C Feedback: A nurse's license may be suspended or revoked for fraud, deceptive practices, criminal acts, previous disciplinary action by other state boards, negligence, physical or mental impairments, or alcohol or drug abuse. The most frequent reason is alcohol or drug abuse.

24. Hospice nurses provide care in a variety of settings, including clients' homes, long-term-care facilities, and hospice residences. After the client dies, what happens next? A) The hospice services are provided to the families of the former residence clients only. B) The hospice services continue for family and friends during the bereavement period, up to one month after the death. C) The hospice nurse continues to care for the client's family for up to one year. D) Nurses assist the family to work through their grief during the period of mourning.

Ans: C Feedback: After the death of the patient, the hospice nurse continues to care for the client's family during the bereavement period for up to one year. Nurses help the family to work through their loss.

28. A woman age 83 years who has suffered a cerebrovascular accident and is unable to swallow refuses the insertion of a feeding tube. This is an example of what ethical principle? A) Nonmaleficence B) Veracity C) Autonomy D) Justice

Ans: C Feedback: Autonomy essentially means independence and the ability to be self-directed.

32. A nurse working in a long-term care facility has an elderly male client who is very confused. What ethical dilemma is posed when using restraints in a long-term care setting? A) It limits personal safety. B) It increases confusion. C) It threatens autonomy. D) It prevents self-directed care.

Ans: C Feedback: Because there are safety risks involved when using restraints on elderly confused clients, this is a common ethical problem in long-term care settings, as well as other health care settings. Restraints limit the individual's autonomy because they are perceived as imprisonment. Restraints should not limit personal safety. Often, restraints increase confusion, and they prevent self-directed care.

26. A nurse is caring for a woman 28 years of age who has delivered a baby by Cesarean section. She describes her pain as a 9. The nurse medicates her for pain. This is an example of which of the following ethical frameworks? A) Justice B) Fidelity C) Beneficence D) Nonmaleficence

Ans: C Feedback: Beneficence means doing or promoting good. The treatment of the client's pain is the nurse's act of doing good.

18. Which of the following is the nurse's best legal safeguard? A) Collective bargaining B) Written or implied contracts C) Competent practice D) Patient education

Ans: C Feedback: Competent practice is the nurse's most important and best legal safeguard. Each nurse is responsible for making sure his or her educational background and clinical experience are adequate to fulfill the nursing responsibilities described in the job description. Collective bargaining, written or implied contracts, and/or patient education do not provide the best legal safeguard.

10. What population do hospice nurses provide with care? A) Those requiring care to improve health B) Children with chronic illnesses C) Dying persons and their loved ones D) Older adults requiring long-term care

Ans: C Feedback: Hospice is a program of palliative and supportive services providing physical, psychological, social, and spiritual care for dying persons, their families, and other loved ones. Hospice nurses do not implement care to improve health, focus on children with chronic illnesses, or care for older adults in long-term care.

14. A client nearing the end of life requests that he be given no food or fluids. The physician orders the insertion of a nasogastric tube to feed the client. What situation does this create for the nurse providing care? A) Nurse must follow the physician's orders B) An inability to provide care for the patient C) An ethical dilemma about inconsistent courses of action D) A barrier to establishing an effective nurse-patient relationship

Ans: C Feedback: In an ethical dilemma, two or more clear moral principles apply but support mutually inconsistent courses of action. In this case, the nurse must decide what to do based on ethical decision making and take action that can be justified ethically based on that process.

16. What is the primary focus of health care today? A) Care of acute illnesses B) Care of chronic illnesses C) Health promotion D) Health restoration

Ans: C Feedback: In the past, health care focused on the treatment of illnesses rather than prevention through health promotion, because preventive strategies were not covered by health insurance. Health awareness and the desire to be involved in one's own health care have strongly influenced the delivery of health care services in our society.

7. Which of the following is true of long-term care facilities? A) They provide care only to older adults. B) They provide care for homeless adults. C) They provide care to people of any age. D) They provide care only for people with dementia.

Ans: C Feedback: Long-term care facilities provide health care, and help with the activities of daily living, for people of any age who are physically or mentally unable to care for themselves independently. They do not provide care only to older adults or those with dementia, although they do care for those populations as well as others. They do not provide care to homeless persons.

25. A nurse fails to administer a medication that prevents seizures, and the client has a seizure. The nurse is in violation of the Nurse Practice Act. What type of law is the nurse in violation of? A) Criminal B) Federal C) Civil D) Supreme

Ans: C Feedback: Malpractice cases are generally the kind of civil cases that involve nurses.

13. Medicare uses a prospective payment plan based on diagnosis-related groups (DRGs). What are DRGs? A) Locally supported health care financing, usually by donations B) A public assistance program for low-income individuals C) Predetermined payment for services based on medical diagnoses D) A private insurance plan for subscribers who pay a copayment

Ans: C Feedback: Medicare, based on DRGs, pays a hospital a fixed amount that is predetermined by the medical diagnosis or specific treatment rather than by the actual cost of hospitalization and care. This plan was put into effect in an effort to control rising health care costs. It is not supported by donations; it is not a public assistance program or a private insurance plan.

18. A client, unsure of the need for surgery, asks the nurse, "What should I do?" What answer by the nurse is based on advocacy? A) "If I were you, I sure would not have this surgical procedure." B) "Gosh, I don't know what I would do if I were you." C) "Tell me more about what makes you think you don't want surgery." D) "Let me talk to your doctor and I will get back to you as soon as I can."

Ans: C Feedback: Nurses as advocates must realize that they do not make ethical decisions for their clients. Rather, they facilitate clients' decision-making by interpreting findings, informing cliients of various aspects to be considered, helping clients verbalize and organize their feelings, calling in others involved in the decision making, and helping clients assess all their options in relation to their beliefs.

5. A nurse in a walk-in health care setting provides technical services (e.g., administering medications), determines the priority of care needs, and provides client teaching on all aspects of care. Which of the following terms best describes this type of health care setting? A) Hospital B) Physician's office C) Ambulatory center D) Long-term care

Ans: C Feedback: Nurses in ambulatory care centers (walk-in clinics) provide technical services (e.g., administering medications), determine the priority of care needs, and provide teaching about all aspects of care. Nurses employed in hospitals have many roles, including manager of other members of the health care team providing client care, administrator, nurse practitioner, clinical nurse specialist, patient educator, in-service educator, and researcher. In physician's offices, advanced practice registered nurses (APRNs), nurse practitioners, midwives, or clinical nurse specialists work independently or collaboratively with physicians to make assessments and care for clients who require health maintenance or health promotion activities. Long-term care provides medical and nonmedical care for people with chronic illnesses or disabilities.

11. Which of the following accreditations is a legal requirement for a school of nursing to exist? A) National League for Nursing Accrediting Commission B) American Association of Colleges of Nursing accreditation C) State Board of Nursing accreditation D) Educational institution accreditation

Ans: C Feedback: State laws are enacted to ensure that schools preparing nursing practitioners maintain minimum standards of education. This is legal accreditation. Accreditation by voluntary agencies is not required for a school to exist.

26. A baccalaureate-prepared nurse is applying for a nurse practitioner position. The nurse is: A) Well educated and can perform these duties B) Able to practice as a nurse practitioner C) Educated to practice only with pediatric patients D) Practicing beyond his scope according to licensure

Ans: D Feedback: A nurse without an advanced practice license is not able to practice beyond his or her scope in accordance with the Nurse Practice Act.

31. A nurse has a duty of nonmaleficence. Which of the following would be considered a contradiction to that duty? A) Provide comfort measures for a terminally ill patient. B) Assist the patient with ADLs. C) Refuse to administer pain medication as ordered. D) Provide all information related to procedures.

Ans: C Feedback: The duty not to inflict harm, as well as prevent and remove harm, is termed nonmaleficence. Providing comfort measures for a terminally ill patient, assisting a patient with ADLs and providing information related to procedures would not be considered a contradiction to the nurse's duty of nonmaleficence.

4. A lawyer quotes a precedent for punishment of a crime committed by the defendant in a trial. What is court-made law known as? A) Public law B) Statutory law C) Common law D) Administrative law

Ans: C Feedback: The government provides for a judiciary system, which is responsible for reconciling controversies. It interprets legislation at the local, state, and national levels as it has been applied in specific instances and makes decisions concerning law enforcement. A body of law known as common law has evolved from these accumulated judiciary decisions. Common law is thus court-made law, and most law involving malpractice is common law.

20. A nurse is caring for a client who is a celebrity in the area. A person claiming he is a family member inquires about the medical details of the client. The nurse reveals the information but later comes to find out that the person was not a family member. The nurse has violated which of the following? A) Veracity B) Fidelity C) Confidentiality D) Autonomy

Ans: C Feedback: The nurse has violated the principle of confidentiality by revealing the client's personal medical information to a third person. Confidentiality is a professional duty and a legal obligation. What is documented in the client's record is accessible only to those providing care to that client. The nurse's action does not violate rules of veracity, fidelity, or autonomy. Fidelity means being faithful to one's commitments and promises. Veracity means telling the truth, which is essential to the integrity of the client-provider relationship. Autonomy involves a client making his or her own decisions.

9. A nurse in a women's health clinic values abstinence as the best method of birth control. However, she offers compassionate care to unmarried pregnant adolescents. What is the nurse demonstrating? A) modeling of value transmission B) conflict in values acceptance C) nonjudgmental "value neutral" care D) values conflict that may lead to stress

Ans: C Feedback: The nurse is demonstrating nonjudgmental "value neutral" care. This means she is respecting and accepting the individuality of patients, does not assume that her personal values are right, and does not judge the patients' values as right or wrong depending on their congruence with hers.

27. A home care nurse visits a client who is confined to bed and is cared for by her daughter. The daughter is known to suffer from chemical dependence. The home is cluttered and unclean. During the assessment the nurse notes that the client is wet with urine and has dried feces on her buttocks, and demonstrates signs of dehydration. After caring for the client, the nurse contacts the physician and reports the incident to Adult Protective Services. This is an example of which ethical framework? A) Justice B) Autonomy C) Nonmaleficence D) Fidelity

Ans: C Feedback: The principle of nonmaleficence means to avoid doing harm, to remove harm, and to prevent harm. Autonomy means to respect the rights of clients or their surrogates to make healthcare decisions. Justice means to give each his or her due. Fidelity means to keep promises.

17. What is one way in which nurses can help shape health care reform? A) Do their job and do it well B) Refuse to participate in organizations C) Support legislation to improve care D) Become a member of a support group

Ans: C Feedback: There are many ways in which nurses can help shape health care reform, including supporting legislation to improve care. Nurses are expected to do their job well. Refusing to participate in organizations and/or becoming a member of a support group will not help shape health care reform.

13. A nurse does not assist with ambulation for a postoperative client on the first day after surgery. The client falls and fractures a hip. What charge might be brought against the nurse? A) Assault B) Battery C) Fraud D) Negligence

Ans: D Feedback: A tort is a civil wrong committed by a person against another person or his or her property. Negligence, an unintentional tort, occurs when a person fails to exercise reasonable care in the performance of his or her duties. In this situation, the nurse did not initiate proper precautions to prevent patient harm and is subject to the charge of negligence.

21. An on-duty nurse discovers that her colleague is pilfering medicines. According to the Nurse Practice Acts, what should the nurse do? A) Keep silent and overlook the incident B) Inform the local police station C) Discuss this incident with the colleague D) Report the incident to the supervisor

Ans: D Feedback: According to the Nurse Practice Acts, the nurse should report the incident to the supervisor. Laws are enacted to regulate the practice of nursing and may be used to decide upon an appropriate action. Discussing the incident with a colleague may alarm the nurse who is pilfering medicines and she may become cautious. The nurse should not overlook the incident because pilfering of medicines is an offense. Calling local police may lead to undue interference.

20. A client gets out of bed following hip surgery, falls, and re-injures her hip. The nurse caring for her knows that it is her duty to make sure an incident report is filed. Which of the following statements accurately describes the correct procedure for filing an incident report? A) The physician in charge should fill out the report. B) The names of the staff involved should not be included. C) The reports are used for disciplinary action against the staff. D) The report should contain all the variables related to the incident.

Ans: D Feedback: An incident report, also called a variance or occurrence report, is used by health care agencies to document the occurrence of anything out of the ordinary that results in, or has the potential to result in, harm to a patient, employee, or visitor. The nurse responsible for a potentially (or actually) harmful incident or who witnesses an injury is the one who fills out the incident form. This form should contain the complete name of the person or people involved and the names of all witnesses; a complete factual account of the incident; the date, time, and place of the incident; pertinent characteristics of the person or people involved (e.g., alert, ambulatory, asleep) and of any equipment or resources being used; and any other variables believed to be important to the incident. These reports are used for quality improvement and should not be used for disciplinary action against staff members.

4. A man is scheduled for hospital outpatient surgery. He tells the nurse, "I don't know what that word,outpatient, means." How would the nurse respond? A) "It means you will have surgery in the hospital and stay for 2 days." B) "It means the surgeon will come to your home to do the surgery." C) "Why would you ask such a question? Don't worry about it." D) "You will have surgery and go home that same day."

Ans: D Feedback: In addition to providing acute care, hospitals have many services for outpatients (those who require health care but do not need to stay in the facility). Clients who have outpatient surgery have the procedure, return to their hospital room for recovery, and then are discharged home on the same day.

17. A nurse is concerned about the practice of routinely ordering a battery of laboratory tests for clients who are admitted to the hospital from a long-term care facility. An appropriate source in handling this ethical dilemma would be which of the following? A) The client's family B) The admitting physician C) The nurse in charge of the unit D) The institutional ethics committee

Ans: D Feedback: Many health care institutions have developed ethics committees whose functions include education, policymaking, case review, and consultation. These committees are multidisciplinary and provide a forum where divergent views can be discussed without fear of repercussion.

8. What is the legal source of rules of conduct for nurses? A) Agency policies and protocols B) Constitution of the United States C) American Nurses Association D) Nurse Practice Acts

Ans: D Feedback: Nurse Practice Acts are examples of statutory law, enacted by a legislative body in keeping with both the federal constitution and the applicable state constitution. They are the primary source of rules of conduct for nurses. Standards of practice, which differ from rules of conduct, are made by agency policies and protocols and by the American Nurses Association.

6. Nurses who are employed in home care have a variety of responsibilities. Which of the following is one of those responsibilities? A) Provide all care and services B) Maintain a clean home environment C) Advise clients on financial matters D) Collaborate with other care providers

Ans: D Feedback: Nurses who provide care in the home make assessments, provide physical care, administer medications, teach, and support family members. They also collaborate with other health care providers in providing care and services. Home care nurses do not provide all care and services, maintain a clean home environment, or advise clients on financial matters.

8. A grade school is preparing a series of classes on the dangers of smoking. Who would be most likely to teach the classes? A) A community health nurse B) An outside consultant C) A teacher D) The school nurse

Ans: D Feedback: School nurses provide many different services, including maintaining immunization records, providing emergency care, administering prescribed medications, conducting routine screenings, conducting health assessments, and teaching for health promotion (e.g., the dangers of smoking). Although any of the other choices may provide teaching, it is the nurse who primarily provides health-related teaching.

9. An elderly woman has total care of her husband, who suffers from debilitative rheumatoid arthritis. The couple voices concern over the pain and stress associated with the condition. What type of care might the nurse suggest to help the couple? A) Primary care B) Respite care C) Bereavement care D) Palliative care

Ans: D Feedback: The goal of palliative care is relief from the symptoms, pain, and stress of a serious illness, and to improve the quality of life for both the client and the family. The main purpose of respite care is to give the primary caregiver some time away from the responsibilities of day-to-day care. Primary care is found in acute care settings and physicians' offices. Bereavement care is provided to families following the death of a family member.

15. Two children need a kidney transplant. One is the child of a famous sports figure, whereas the other child comes from a low-income family. What ethically relevant consideration is important to the nurse as an advocate for these clients? A) Balance between benefits and harms in patient care B) Norms of family life C) Considerations of power D) Cost-effectiveness and allocation

Ans: D Feedback: The increasing awareness of how difficult it is to make valued and scarce health resources available to all in need has resulted in a new appreciation for the moral relevance of cost-effectiveness. Balance between benefits and harms in patient care relates to reasoning about the benefits or burdens of treatment and the related harms; in this scenario, both children's risk and benefits may be the same. Norms of family life relate to the ways a client's illness impacts family members and significant others; not enough information is provided to know how this ethical principle applies in this scenario. Considerations of power relates to abuse of power by clinicians; this scenario does not present information suggesting this is occurring.