NURS 101 EXAM

Once clients consent, they cannot change their minds. a) True b) False

B

A substitute decision-maker has the right to access the information necessary to make an informed decision. a) True b) False

A

Consent can be written, oral or implied. a) True b) False

A

Is there a minimum age for consent under the Health Care Consent Act? a) Yes b) No

B

A 84 yo female suffers a stroke and is unconscious. She has a husband, one daughter and a son. The son is a medical doctor. The husband wants his wife to be a full code and all tx given. • The son calls in the night and speaks to the ICU physician and states that given his mother's age and complex medical situation he expects that she would be provided symptom management and comfort care but that no aggressive measures should be undertaken to interfere with the natural decline and progression of his mother's diseases. • Who is the SDM?

The husband

It is solely the employer's reponsibility to identify systems problems that may have an impact on a quality practice setting a) true b) false

b

A nurse teaches a client how to self-administer insulin. what should the nurse document in the client's health record? a) The information provided to the client b) the client's comprehension of the information c) the client's ability to administer the insulin d) all of the above

d

An RPN orders an RPN colleague to insert a urethral catheter into a newly admitted client. What should the RPN colleague do? A. Confirm the order with a physician before proceeding with the intervention B. Accept the order and proceed with the intervention C. Consult with an RN before proceeding with the intervention D. Decline to accept the order

d

A 58 year old female suffers a stroke. Her progress to improvement is slow but she is slowly improving. The daughters who are joint SDM, request that all tx be stopped. The HCT explains to the daughter's that this is premature. Their mom is improving slowly. After many discussions, the HCT and daughters still disagree. • What should the HCT do?

you can escalate to the CCB

If a client disagrees with the appointment or decision made by the substitute decision-maker, the client has a right to apply to the: a) Consent and Capacity Board b) Substitute Decision Board of Appeals c) Consent and Substitute Board

A

Substitute decision-makers are identified in the Health Care Consent Act as those who can make treatment decisions for clients incapable of making own their decisions. a) True b) False

A

As a nurse manager, I am faced with a staff shortage. It is a huge challenge to recruit and retain staff and frequently we work shortstaffed. What is the nurse manager's accountability in this situation? Choose the most appropriate answer. A) As a nurse manger, you are accountable for having mechanisms in place to address the staff shortage. B) As a nurse manager, you are accountable for ensuring client care needs are met. If the staff refuses to work overtime, it is considered abandonment.

A As a nurse manager, you are accountable for having mechanisms in place to address the staff shortage. Some administrators believe that staff nurses are abandoning clients and committing professional misconduct if they refuse to work overtime or extra shifts. This is not correct.

Edith, 89, lives in a long-term care home. She is able to make decisions about her nutrition and other activities of living but unable to make decisions about her health care treatments. Can Edith appoint someone to make decisions only about her health care treatments? a) Yes b) No

A Edith can appoint a substitute decision-maker only for health care. Under the Substitute Decisions Act, a person can be deemed capable of making decisions about one aspect of their care and incapable of making decisions about another aspect.

Susan, a client, was bruised after being pushed by another client. Louis, the nurse, completes an incident report but doesn't contact Susan's daughter (the substitute decisionmaker) to tell her of the injury. Should Louis have contacted Susan's daughter? A) Yes B) No

A Part of the nurse-client relationship is maintaining trust and respect with the family through communication. While Susan's injury wasn't serious, Louis has to be receptive to the fact that her daughter, the designated substitute decision-maker, has concerns about Susan's well-being and wants to be kept aware and involved in her care

In my workplace we are staffed with RNs, RPNs and unregulated care providers. Our employer wants us to wear name tags identifying us by name but not by professional designation. Do nurses have an obligation to fully identify themselves, including their designation to their clients? A) Yes B) No

A Three nurses noted that a client consistently refused to take his medication. Instead of addressing the issue of why the client was refusing his medication, the nurses threw it away and recorded that it had been administered. This action is professional misconduct.

Joseph and his family tell Diana, the nurse, that some health care staff have prevented the family from visiting Joseph due to his infection, and that they are not receiving regular updates on his condition. After listening to the concerns, Diana researches appropriate infection control measures, addresses the issues with the health care team and develops solutions involving all parties. Diana suggests that Holly, a novice nurse, assist her with the communication between the health care team and the family. From the list below chose the leadership indicators Diana demonstrated. A) Collaborate with clients and the health care team using communication skills B) Provide leadership through role-modelling and mentoring C) Advocate for the client D) Develop solutions to practice issues and take action to resolve conflict

ALL OF THEM All the answers are correct as Diana met all indicators listed. She listened and respected the concerns of the family and spoke up on behalf of the client. Diana researched options and developed solutions involving all parties and she recognized an opportunity to mentor and encourage another nurse's development skills.

What information must be provided to a client to obtain informed consent? a) Nature of the treatment b) Expected benefits c) Possible side effects d) Alternative courses of action e) Likely consequences of not having the treatment SELECT ALL THAT APPLIES

ALL OF THEM ARE RIGHT

You must be 16 years of age to give consent. b) False a) True

B

Jackie, a nurse, discovers that one of her colleagues has started a rumour about her. Jackie doesn't want to approach her colleague alone and tells Wendy, her manager, of the rumour. To facilitate a resolution, Wendy calls a meeting with Jackie and her colleague. After the meeting, Wendy schedules a team meeting to review the principles of conflict resolution with all of the staff. Did Wendy carry our her professional responsibilities as a nurse manager? A) No, as a manager, Wendy did not resolve the situation appropriately. B) Yes, Wendy carried out her professional responsibilities to resolve the situation

B By immediately assisting the nurses in resolving the conflict by acting as a mediator and a role model, Wendy demonstrated that she has a conflict-resolution system in place. Wendy also demonstrated her ability to support nursing in addressing unethical and unprofessional behaviour among colleagues

After a car accident, Claire, 40, is rushed by ambulance to the emergency room. She is unconscious and bleeding, and needs an immediate blood transfusion. Claire's husband, Franco, arrives in the ER. The nurse approaches Franco and explains the need for immediate treatment. He refuses, saying that Claire is a Jehovah's Witness and would not want a blood transfusion. The nurse explains the consequences of refusing treatment, and Franco says that his wife would not want this type of treatment even if it would save her life. Should the nurse find another substitute decision-maker for Claire? a) Yes b) No

B Claire is not able to make a decision, and the Substitute Decisions Act defines her substitute decision-maker as her spouse. The nurse must respect Franco's decision, and the blood transfusion must not be administered. Franco is capable, informed and following Claire's most recent wishes. A client's wishes may be in written form, such as in a living will or advanced directive, or may have been spoken to the substitute decisionmaker.

One of Nina's clients is from a First Nations community, and he asked to have a sweetgrass ceremony performed in his room. He explains the ceremony involves chanting and burning some substances that will result in small amount of smoke. Nina knows burning substances is against the facility's policy and she is concerned about what other clients will think, but she wants to respect her client's wishes. Can Nina help her client? A) No, burning substances is against the facility's policy so there is nothing Nina can do. B) Yes, Nina can look for ways to honour the client's request

B Nina's commitment to client-centred care prompts her to explore ways of meeting the client's needs within the limits of the practice setting policy. By attending to the client's request, Nina will develop a collaborative partnership with him that respects his needs, values and beliefs. Nina's actions demonstrates respect and interest for her client.

I am a nurse manager for a practice setting that provides palliative-care services. Recently, a nurse struggled with a client's choice for end-of-life care. What role do I play in such ethical issues? Choose the most appropriate response. A) Nurse administrators are expected to direct nurses to research current laws on this issue and share their conclusions with the team. B) Nurse administrators are expected to support nurses in developing the skills to recognize and manage ethical issues.

B Nurse administrators are expected to help staff understand and identify ethical conflicts, and discuss ways to resolve ethical issues. For example, the nurse administrator could provide individual support to the nurse and also organize monthly meetings for staff to discuss ethical issues.

Choose the most appropriate response. A) The nurses should have documented the refused medication on the MAR sheet and stopped the medication order at the pharmacy. B) The nurses should have addressed the issue of the client's refusal to take the medication, brought it to the attention of the health care team and looked for solutions to the problem.

B Nurses are accountable to advocate for their clients and are held accountable for their actions and decisions. In this situation, the nurses should have explored solutions with the client and the health care team. In addition, they should have documented the issue, including the client's perspective and the actions taken by the nurses.

Kai has a few questions about an upcoming procedure that a physician will perform. The nurse has been asked to obtain written consent. Should the nurse obtain consent before the physician answers Kai's questions? a) Yes b) No

B The health care professional proposing the treatment is required to obtain consent from the client. The nurse is accountable for advocating on Kai's behalf to ensure that he receives the information that's relevant in making an informed choice. The nurse should inform the physician that Kai requires additional information before he can provide consent.

Ling is asked by the nurse manager to work in another area. She has never worked in this area before and worries that she will be unable to provide safe care to the clients. Ling tells her manager that she does not feel competent to work in that area of practice. The manager tells Ling that some aspects of her experience can be used, therefore she must go. Choose the most appropriate response. A) No, Ling has never worked in this area so she does not have to go. B) Yes, if there are aspects of care that Ling can safely provide then she must work on that unit.

B Yes. Ling has an accountability to her employer and the clients; she was scheduled for a shift and her employer is counting on her to provide care. Ling is accountable for telling her manager that she is not competent to provide all aspects of the care and for being specific about what care she can provide. Ling's assignment should be modified to enable her to provide the elements of care that she is competent to do.

A registered practical nurse (RPN) has recently obtained a baccalaureate degree in business administration (BBA) When signing documentation what should her signature include to meet college requirements a) RPN, BBA b) BBA. RPN c) RPN

C

Under the Health Care Consent Act, one of the following is not included in the rules for when consent is required a) Treatment b) Admission to a care facility c) Personal assistance services d) Property

D

A nurse working in an immunization clinic is required to save client data on portable electronic device and later take the device to her employer's office. Which of the following is the most important factor to safeguard client data? a) encrypt the information being stored on the device b) store the device in a locked area until she is ready to take it to the office c) keep the information password-protected

a

Client care may be at risk when documentation systems that support information-sharing and decision-making within the circle of care and not in place a) true b) false

a

A client tells a nurse "Ive never had surger before and im sor of nervous about it" the nurse documents the client's statement in his chart. The client's statement is an example of a) objective data b) subjective data c) third party reporting

b

A client writes to the College of Nurses stating that a nurse assaulted him during care. What action may the College take in this situation? A. Report the nurse to the employer B. Investigate the allegation C. Request that the nurse's employment be terminated D. Refer the complaint to local law enforcement

b

A nurse practicing in the community takes temporary notes on relevant client information. When he returns to the office he enters the information into the client's permanent health record. what should he do with the temporary documentation ? a) he should not use temporary documentation b) he should ensure the temporary documentation is destroyed in a secure way, such as shredding c) he should dile the temporary documentation for later retrieval

b

What would be the ideal findings in your 19-year-old female patient admitted with pneumonia? a) 91% oxygen saturation, respiratory rate of 27, symmetrical chest expansion with decreased air entry to the bases bilaterally b) 98% oxygen saturation, respiratory rate of 16, symmetrical chest expansion with air entry equal and adequate to the bases bilaterally c) 95% oxygen saturation, respiratory rate of 10, symmetrical chest expansion with air entry equal and adequate to the bases bilaterally d) 100% oxygen saturation on 5L of oxygen via nasal prongs, respiratory rate of 22, symmetrical chest expansion with air entry equal and adequate to the bases bilaterally

b

when correcting an error in documentation a nurse should: a) also correct any errors made by other nurses b) correct the error, leaving the orginal entry visible and sign the entry c) permanently erase the error

b

A father expresses concerns about his son's upcoming surgery. The nurse listens to the father's concerns and validates his feelings. What component of the nurse-client relationship is the nurse demonstrating? A. Trust B. Respect C. Empathy D. Professional intimacy

c

A nurse gives a double dose of acetaminophen (Tylenol) to a client who only requires a single dose. What, if anything, must the nurse do? A. Ask a colleague to help assess the client B. Withhold the client's next dose of Tylenol C. Report the error as soon as possible D. Nothing, because this is an over-the-counter medication

c

A nurse has started in a new role at a new facility. As she reviews the agency's documentation policy. She notices hat it does not follow the college's documentation, revised 2008 practice document. the nurse should: a) disregard the new employer's policy and follow the policy of her old employer b) disregard the agency's policy and follow the clinical instruction provided in her nursing program c) raise her concerns with her new employer and advocate for changes to the organization's policy d) follow the agency's policy because it is the most applicable to that practice setting

c

Under what circumstances is a nurse permitted to document for other members of health care team? a) when working as a team b) when working with an unregulated care provider c) when the nurse has been designated the recorder d) when a coworker has forgotten an entry and is off shift

c

A 68 yo male had asked his oldest nephew to be his POA for personal care. The man had discussed his wishes should he become incapable of providing care. The nephew, based on his own religious beliefs, disagrees with what the uncle would have wanted. • Question: What if the SDM does not agree with the patient's prior capable wishes?

you would follow the client's previous wishes because they constitute his advanced directive, and he already made his decision; for future healthcare decisions outside the scope of what he outlined when he was capable, informed, etc., then u defer to the SDM. Otherwise you take it to the consent n capacity board.

A 17 yo girl has received chemotherapy for two years for cancer. The cancer is still not in remission. The medical team advises that another round of chemo will give her a 30% chance of survival. The parents say to give the tx. The girl refuses care. The HCT can: • Accept the pt's decision or have the mom act as the SDM

• Answer: accept the pt's decision

A man, who was never partnered nor had any children, fell off a ladder and became confused and unable to understand material. The HCT tried to find a SDM. The man had two nieces. • Question: Can the role of the SDM be shared with another person? What if the two nieces disagree over the tx?

• SDM can be shared between two people (e.g. relatives, siblings); if disagreement, try to work out with family but can go to CCB • If SDM disagrees, SDM should still try to honour patient's wishes