Professional Nursing Concepts Practice questions

The unit manager returns from a vacation to find a half dozen variance reports waiting for review. The manager angrily berates the charge nurse who filled in during this time for the many problems. The manager realizes later that which approach would have been better? A. Ask the charge nurse how things went. B. Wait several days before approaching the charge nurse. C. Determine if the charge nurse needs more education. D. Call in the staff members and ask what went wrong.

A. Ask the charge nurse how things went. The most beneficial way to provide feedback, especially when the feedback is not positive, is to start by asking the other person for his or her opinion about how things went or how things are going. Next, the manager (or peer) should give credit for what the other person does well. Finally, discuss the problem areas and include the other person in a discussion of how the problem can be resolved. This method approaches the other person with respect and also demonstrates the opinion that the other person is a professional, with knowledge and skill. Problems should be resolved as soon as possible. Waiting several days may cause the charge nurse to forget important details. It is also important to resolve the interpersonal issue as quickly as possible. Soliciting information from other staff members may give valuable insight. Without knowing more about the situation, the manager cannot determine if the charge nurse needs more education.information, but asking them what went wrong sets a very negative tone from the beginning. It is also best to start with the person the manager left in charge rather than the staff.

The nurse believes that a patient who states he is in pain is "faking it" and is hoping to get "high." The nurse decides to give the patient a placebo instead of the pain medication that was ordered. Which principle(s) of ethics is the nurse violating? (Select all that apply.) Select all that apply. A. Autonomy B. Beneficence C. Veracity D. Dilemmas E. Utilitarianism

A. Autonomy B. Beneficence D. Veracity Autonomy is the principle of respect for the individual person; the nurse does not respect someone upon whom the nurse is inflicting harm. Beneficence is providing benefit to others by promoting their welfare. In general terms, to be beneficent is to promote goodness, kindness, and charity. By taking the patient's pain medication and substituting saline, the nurse did harm, not good, for the patient. Veracity is truth-telling. The nurse misled the patient to believe he/she was receiving a dose of pain medication. Utilitarianism is the principle that assumes that an action is right if it leads to the greatest possible balance of good consequences or to the least possible balance of bad consequences. Because the patient's pain medication was taken away, the consequences were all bad. Dilemmas are not included as a principle of ethics.

A nurse manager is working on a unit that is undergoing drastic changes in the way patient care is provided. The nursing staff members are angry and bitter, and they fight and complain about little things. Patient satisfaction is decreasing. Which is the best action by the manager? A. Brainstorm with staff to identify major sources of frustration and plausible solutions. B. Inform the staff that their behavior is inexcusable and put their pay raises in jeopardy. C. Enlist the help of upper management to reinforce the need and reason for this change. D. Spend more time on the floor watching staff perform nursing care for the patients.

A. Brainstorm with staff to identify major sources of frustration and plausible solutions. The staff members are expressing anger at the changes that are occurring in the workplace. The nurse manager needs to remain assertive but assist with problem solving. If the staff can identify some major sources of frustration and devise solutions that still fit within the mandated change, this will help diffuse their anger and keep the change on track. The other options negate and dismiss the emotions and frustrations of the staff and are not likely to be helpful.

A unit manager wants to improve the way unit meetings are run. What idea(s) should the manager implement? (Select all that apply.) Select all that apply. A. Have someone function as a timekeeper. B. Send committee reports out via e-mail. C. Appoint someone to read all the reports. D. Allow an open agenda for everyone's ideas. E. Wait until needed to schedule another meeting.

A. Have someone function as a timekeeper. C. Appoint someone to read all the reports. To keep everyone on track, a timekeeper is useful at meetings. Sending reports out by e-mail allows the staff to read them ahead of time, which creates more working time during the meeting. The timeline for the next meeting should be established at the end of the current meeting. Meetings need to be planned ahead to be successful. Every agenda item should have a clear purpose and require action by the group. Reports should not be read at meetings because they do not require action.

A nurse working in a free clinic has recognized the need for health promotion for pregnant teenagers. The nurse works to develop a consortium of healthcare experts from several disciplines across the region to work toward improving the nutrition of pregnant teenagers. This is an example of what type of collaboration? A. Interorganizational collaboration B. Intraprofessional collaboration C. Nurse-nurse collaboration D. Nurse-patient collaboration

A. Interorganizational collaboration Interorganizational collaboration occurs between regional, national, or international organizations to achieve a common goal. Nurse-patient collaboration occurs when a nurse is working directly with a patient. Nurse-nurse collaboration occurs between nurses and among professionals in nursing management projects. Intraprofessional collaboration occurs among members of a professional discipline.

The health care team responsible for deciding whether to move a critically ill patient out of the ICU so that a new patient may be admitted to the unit is faced with what principle of an ethical dilemma? A. Justice B. Veracity C. Autonomy D. Deontology

A. Justice The principle of justice is involved in the allocation of scarce and/or expensive health care resources, and it is the duty of the health care team to treat all patients fairly, without regard to age, socioeconomic status, or other variables. Veracity involves truth telling. Autonomy is a patient's right to self-determination and implies the freedom to make choices and decisions about one's own care without interference, even if those decisions are not in agreement with those of the health care team. The deontology approach to ethical decision making represents beliefs about intrinsic good that are moral absolutes revealed by God. This approach reasons that all persons are worthy of respect and thus should be treated the same.

An experienced nurse is precepting a new graduate. Prior to charting, the preceptor instructs the new nurse to do which of the following? A. Look up the facility's list of "do not use" abbreviations. B. Use only abbreviations seen in other nurses' charting. C. Do not use any abbreviations at all in patients' charts. D. Abbreviate as much as possible to keep records short.

A. Look up the facility's list of "do not use" abbreviations. Each facility should have a list of abbreviations that are not allowed, which should include but not replace the list compiled by The Joint Commission. The new nurse should be instructed to look at this list up and become familiar with it. Although abbreviations are allowed, the nurse should only use facility-approved abbreviations. The nurse should not just copy what is seen in others' charting. The new nurse should not abbreviate as much as possible but should only use facility-approved abbreviations.

A nurse is preparing to give an IM injection. This nurse has read several recent articles disputing the necessity of aspirating air when giving IM injections. Which action by the nurse is best? A. Look up the facility's policy on giving IM injections. B. Ask the charge nurse for advice on what to do. C. Do not aspirate, as this appears to be the best practice. D. Call the state board of nursing for their opinion.

A. Look up the facility's policy on giving IM injections. The nurse should look up and follow the facility's policy when giving IM injections. The charge nurse may or may not be a reliable source of information. The best action is to look up the policy. The nurse should not follow the recommendations in the article if they are contrary to policy; however, the nurse could refer this issue to the policy committee. The state board would likely refer the nurse to the institution's policies.

A committee chair has noticed a member who has become distracted, seems stressed, is often ill, and is not doing committee assignments well or on time. Which action by the chair is best? A. Offer to help the person with committee duties for a while. B. Review members' responsibilities at the next group meeting. C. Ask the unit manager to replace the person with someone else. D. Discuss the problem and give the person a deadline to improve.

A. Offer to help the person with committee duties for a while. Group processes are affected by individual group members' skills, talents, emotional status, and rapport with other members. If this is a new behavior, members of the group should express support and offer to help manage the member's responsibilities for a while to allow the person time to regain her or his equilibrium. Reviewing responsibilities will probably not be helpful because this person likely does not see a problem. If the person does realize that there is a problem, this does not help him or her make improvements. The member may need to be replaced at some point, but this does not give the person help to improve or support. Giving the person a deadline for improvement without supportive behaviors is likely to fail.

A student nurse studying delegation explains to another student about the Five Rights of Delegation. Which of the following does the first student include? (Select all that apply.) Select all that apply. A. Right person B. Right supervision C. Right task D. Right circumstances E. Right license

A. Right person B. Right supervision C. Right task D. Right circumstances The Five Rights of Delegation include right task, under the right circumstance, to the right person, with the right directions and communication, and with the right supervision and evaluation. "Right license" is not one of the five rights.

A nurse is in the process of confirming medications for a patient but is interrupted to take a call from a physician. Which action by the nurse is best? A. Start the medication confirmation process over. B. Finish confirming the medications and then give them. C. Delegate the confirmation process to another nurse. D. Hurry up and complete the medication administration.

A. Start the medication confirmation process over. The nurse should be very cautious when interrupted during a procedure. The most prudent thing for the nurse to do would be to start the process over again. Delegation may be necessary if the timing of the medications is critical and the phone call is going to take a long time and cannot wait. Beginning the process where it was left could lead to errors if the nurse is mistaken in where the process got interrupted. Hurrying increases the likelihood of making an error.

A nurse is caring for a postoperative patient whose orders include taking vital signs every 2 hours. The patient's baseline blood pressure was 142/86 mm Hg. After 2 hours, it is 112/60 mm Hg. Which action by the nurse is most appropriate? A. Take the patient's blood pressure again in 15 minutes. B. Call the physician, report the findings, and obtain new orders. C. Document the patient's blood pressure in the chart. D. Continue to take the vital signs every 2 hours as ordered.

A. Take the patient's blood pressure again in 15 minutes. Failure to monitor a patient appropriately and according to his or her status could lead to malpractice claims. This patient's blood pressure has changed significantly, so the nurse needs to increase the frequency of monitoring. Before calling the physician, the nurse should determine the patient's baseline blood pressure, which may make a call to the physician unnecessary. Documentation should be done, but more action is required.

Which statement about leaders or leadership is true? A. Task leaders will communicate the most effective ways to accomplish the work. B. Autocratic leaders value feedback from their followers. C. Leaders who have little communication with their staff are socioemotional leaders. D. Communication is the least important function of leadership.

A. Task leaders will communicate the most effective ways to accomplish the work. All answers except "Task leaders will communicate the most effective ways to accomplish the work" are false because communication is the most important function of leadership. Autocratic leaders do not seek feedback from their followers, because they make all the decisions. Socioemotional leaders communicate frequently to gage followers' feelings and emotions.

The nurse manager observes a new nurse caring for a patient and evaluating how well the patient understood information about an upcoming diagnostic test. The nurse manager interprets this as which role? A. Teacher B. Advocate C. Manager D. Counselor

A. Teacher The teacher provides information to patients about a multitude of things, such as diagnostic exams, conditions, medication regimens, and healthy lifestyles. Inherent in this role is evaluating the patient's understanding and tailoring this information to the patient's learning styles and understanding. Advocates protect the patient, often by speaking on the patient's behalf. Counselor is not a nursing role. Managers organize patient care.

A leader exhibiting the attribute of change is best portrayed by which descriptions? A. The leader communicates the vision and goals of the organization and how the departmental goals will serve these goals. B. The leader develops goals for the department that will promote the department at the cost of other departments' goals. C. The leader tells the staff that they must comply with the implementation of a new program. D. The annual plan for the department is not changed, so the department will not have additional work.

A. The leader communicates the vision and goals of the organization and how the departmental goals will serve these goals. Aspects of leadership that influence change are communication, understanding the organizational culture, and considering alternate paths to achieve a goal. In telling staff that they must comply with a new program, the leader does not value communication and alternate paths to achieve a goal. The leader who develops goals for the department that will promote the department at the cost of others' goals does not value organizational culture. The leader who does not change the annual plan for the department does not value change and does not strive to achieve the goals of the organization.

A woman with long QT syndrome becomes pregnant. Long QT syndrome causes an abnormality of the heart and any rush of adrenaline may be fatal for the woman.The pregnant patient states, "I want to have this baby." What ethical principle applies to this situation? A. Utilitarianism B. Veracity C. Deontology D. Autonomy

A. Utilitarianism Utilitarianism is an approach that is rooted in the assumption that an action or practice is right if it leads to the greatest possible balance of good consequences or to the least possible balance of bad consequences. An attempt is made to determine which actions will lead to the greatest ratio of benefit to harm for all persons involved in the dilemma. Veracity is telling the truth in personal communication as a moral and ethical requirement. Deontology is an approach that is rooted in the assumption that an action or practice is right if it leads to the greatest possible balance of good consequences or to the least possible balance of bad consequences. Autonomy is the principle of respect for the individual person. All persons have unconditional intrinsic value. People are self-determining agents who are entitled to decide their own destiny.

The nurse is educating a group of students on the influence of Florence Nightingale. Which statement(s) indicates that teaching has been effective? (Select all that apply.) Select all that apply. A. "She came from a wealthy Victorian family." B. "She studied nursing secretly to avoid family conflict." C. "She entered nursing after a career in teaching." D. "She wrote the Nightingale Pledge while bedridden." E. "She developed schools of nursing that many other schools in Europe and America emulated."

A., B., E. There are many myths and legends about Nightingale, but some facts about her include that she came from a wealthy Victorian family, at one point studied nursing in secret and developed schools of nursing that many other schools in Europe and America emulated. Florence Nightingale did not have an early career as a teacher nor did she write the Nightingale Pledge; Lystra Gretter did.

Match the category of direct care with the specific direct care activity. 1. Counseling ___ 2. Lifesaving measure ____ 3. Physical care technique ___ 4. Activity of daily living ____ a. Assisting patient with oral care b. Discussing a patient's options in choosing palliative care c. Protecting a violent patient from injury d. Using safe patient handling during positioning of a patient

Answer: 1 b, 2 c, 3 d, 4 a.

A nurse on a hospital unit is preparing to hand off care of a patient being discharged to a home health nurse. Match the activities (1-6) with the hand-off report categories (A-B). Activities Categories 1. Use a standard checklist for the report. 2. Encourage questions and clarification. 3. Offer specific information on how to reduce patient's risks. 4. Give report at time when shift has ended and other nurses are requesting information. 5. Explain how patient's discharge was delayed by insufficient numbers of staff. 6. Organize time by preparing in advance what to report. A. Strategy for Effective Hand-off B. Strategy for Ineffective Hand-of

Answer: 1A, 2A, 3A, 4B, 5B, 6A.

An 82-year-old patient who resides in a nursing home has the following three nursing diagnoses: Risk for Fall, Impaired Physical Mobility related to pain, and Imbalanced Nutrition: Less Than Body Requirements related to reduced ability to feed self. The nursing staff identified several goals of care. Match the goals with the appropriate outcome statements . Goals Outcomes 1. _____ Patient will ambulate independently in 3 days. 2. _____ Patient will be injury free for 1 month. 3. _____ Patient will achieve 5-pound weight gain in 1 month. 4. _____ Patient will achieve pain relief by discharge. a. Patient expresses fewer nonverbal signs of discomfort within 24 hours. b. Patient increases caloric intake to 2500 calories daily. c. Patient walks 20 feet using a walker in 24 hours. d. Patient identifies barriers to remove in the home within 1 week.

Answer: 1c, 2d, 3b, 4a.

Match the elements for correct identification of outcome statements with the SMART acronym terms below. 1. Specific 2. Measurable 3. Attainable 4. Realistic 5. Timed a. Mutually set an outcome that a patient agrees to meet. b. Set an outcome that a patient can meet based upon his or her physiological, emotional, economic, and sociocultural resources. c. Be sure an outcome addresses only one patient behavior or response. d. Include when an outcome is to be met. e. Use a term in an outcome statement that allows for observation as to whether a change takes place in a patient's status.

Answer: 1c; 2e; 3a; 4b; 5d.

A nurse asks an AP to help the patient in Room 418 walk to the bathroom right now. The nurse tells the AP that the patient needs the assistance of one person and the use of a walker. The nurse also tells the AP that the patient's oxygen can be removed while he goes to the bathroom but to make sure that when it is put back on the flowmeter is still at 2 L. The nurse also instructs the AP to make sure the side rails are up and the bed alarm is reset after the patient gets back in bed. Which of the following components of the "Five Rights of Delegation" were used by the nurse? (Select all that apply.) 1. Right task 2. Right circumstance 3. Right person 4. Right directions and communication 5. Right supervision and evaluation

Answer: 1, 2, 3, 4. The nurse provided 4 of the 5 components but did not provide the right supervision and evaluation. The nurse delegated the task of a patient to the bathroom to the AP, which is in the scope of an AP's duties and responsibilities and matched to the AP skill level. The nurse did provide clear directions by describing the task and the time period to complete the task. The nurse did not use "please" and "thank you" in the request. The nurse did not ask whether there were any questions, which would provide the AP an opportunity to get clarification if needed. The nurse did not ask the AP to follow up on how the patient did or whether there were any problems. The nurse did not provide appropriate monitoring, evaluation, intervention as needed, or feedback.

Which measures does a nurse follow when being asked to perform an unfamiliar procedure? (Select all that apply.) 1. Checks scientific literature or policy and procedure 2. Determines whether additional assistance is needed 3. Collects all necessary equipment 4. Delegates the procedure to a more experienced nurse 5. Considers all possible consequences of the procedure

Answer: 1, 2, 3, 5. A more experienced nurse can assist, but unless there is an emergency and there is no time to prepare, you would not delegate. Instead you would learn how to perform the procedure. When performing an unfamiliar procedure, check policy and procedure, determine whether assistance is needed, prepare supplies and equipment, and consider all possible consequences of the procedure.

Which of the following statements indicate that the new nursing graduate understands ways to remain involved professionally? (Select all that apply.) 1. "I am thinking about joining the health committee at my church." 2. "I need to read newspapers, watch news broadcasts, and search the Internet for information related to health." 3. "I will join nursing committees at the hospital after I have completed orientation and better understand the issues affecting nursing." 4. "Nurses do not have very much voice in legislation in Washington, DC, because of the nursing shortage." 5. "I will go back to school as soon as I finish orientation."

Answer: 1, 2, 3. Nurses need to be actively involved in their communities and be aware of current issues in health care. Staying abreast of current news and public opinion through the media is essential. Nurses need to join nursing committees to be involved in decision making. Nurses have a powerful voice in the legislature.

A nurse is conferring with another nurse about the care of a patient with a stage II pressure injury. The two decide to review the clinical practice guideline of the hospital for pressure injury care. The use of a clinical practice guideline achieves which of the following? (Select all that apply.) 1. Allows nurses to act more quickly and appropriately 2. Sets a level of clinical excellence for practice 3. Eliminates need to create an individualized care plan for the patient 4. Incorporates evidence-based interventions for stage II pressure injury 5. Provides for access to patient care information within the electronic health record

Answer: 1, 2, 4. A clinical practice guideline is a systematically developed set of statements about appropriate health care for specific health care problems or clinical situations. Evidence-based research provides the basis for sound clinical practice guidelines. A nurse individualizes how to apply nursing interventions for each unique patient. Standard interventions are developed for the more common health problems; thus standard interventions assist nurses to intervene more quickly and appropriately. An individualized plan of care is always necessary. The use of standard interventions aids in capturing sharable patient and care information within the electronic medical record.

The nurse manager from the surgical unit was awarded the nursing leadership award for practice of transformational leadership. Which of the following are characteristics or traits of transformational leadership displayed by the award winner? (Select all that apply.) 1. The nurse manager regularly rounds on staff to gather input on unit decisions. 2. The nurse manager sends thank-you notes to staff in recognition of a job well done. 3. The nurse manager sends memos to staff about decisions that the manager has made regarding unit policies. 4. The nurse manager has an "innovation idea box" to which staff are encouraged to submit ideas for unit improvements. 5. The nurse manager develops a philosophy of care for the staff.

Answer: 1, 2, 4. Nurse managers who practice transformational leadership are focused on change and innovation. They motivate and empower their staff with the focus on team development. The manager will spend time on the unit with the staff sharing ideas and listening to staff input. The manager is enthusiastic about opportunities to enhance the team and shows appreciation and recognizes team members for good work. The manager holds the team accountable and provides support for the team members in the stressful health care environment. The manager shares the philosophy of care developed by the nurse executive of the organization.

A nurse working the evening shift has five patients and is teamed up with an assistive personnel. One of the assigned patients has just returned from surgery, three others are stable and resting, and one has requested a pain medication. The patient in pain has two analgesics ordered prn for pain and has been using cold applications on his surgical site for pain relief. The last time an analgesic was given was 4 hours ago. The patient is scheduled for a physical therapy visit in 2 hours. Which of the following demonstrate good clinical decision making during intervention? (Select all that apply.) 1. The nurse reviews the options for pain relief for the patient. 2. The nurse assesses whether the prn medication, ordered every 4 to 6 hours and last given 4 hours ago, is effective and whether a new type of medication is needed. 3. The nurse reviews the policy and procedure for the cold application. 4. The nurse considers how the patient might react if the pain medication is held until an hour before physical therapy. 5. The nurse delegates vital sign assessment of the patient returning from surgery to the assistive personnel.

Answer: 1, 2, 4. The nurse exercises critical judgment in decision making by reviewing the set of all possible nursing interventions for a patient's problem, reviewing possible consequences associated with each possible nursing action, determining the probability of all possible consequences, and judging the value of the consequence to the patient. Clinical decision making is not in play simply by accessing a resource. Decision making would be applied if the nurse revises or adapts how to perform the cold application. Delegation of vital signs in a potentially unstable patient is not good clinical decision making.

A new nurse graduate is in orientation on a surgical unit and is being mentored by an experienced nurse. Which action completed by the new nurse graduate requires intervention by the experienced nurse? (Select all that apply.) 1. The new nurse stops documenting about a dressing change to take a patient some water. 2. The new nurse gathered the medications for two different patients at the same time. 3. The new nurse asked an AP to help transfer a patient from the bed to a wheelchair before discharge. 4. The new nurse educates a patient about pain management when administering a pain medication to a patient. 5. The new nurse gathers all equipment necessary to start a new IV site before entering a patient's room.

Answer: 1, 2. Organizational skills help a nurse deliver care safely and effectively. In answer choice 1, the nurse interrupts documentation to attend to a basic patient need. In this situation, the nurse could have asked an AP to get the water or completed documentation and then gotten the water for the patient. Limiting interruptions is important in preventing errors. In answer choice 2, the nurse gathers medications for two patients at one time. Nurses should prepare medications for only one patient at a time to prevent medication errors.

The ethics of care suggests that ethical dilemmas can best be solved by attention to relationships. How does this differ from other approaches to ethical problems? (Select all that apply.) 1. Ethics of care pays attention to the context in which caring occurs. 2. Ethics of care is used only by nurses because it is part of the Nursing Code of Ethics. 3. Ethics of care requires understanding the relationships between involved parties. 4. Ethics of care considers the decision maker's relationships with other involved parties. 5. Ethics of care is an approach that suggests a greater commitment to patient care. 6. Ethic of care considers the decision maker to be in a detached position outside the ethical problem.

Answer: 1, 3, and 4. The ethics of care emphasizes attention to the context in which an ethical problem occurs and the relationships between involved parties, including relationships with the decision maker. No approach to ethical problems is exclusive to a single discipline, and no approach is superior to the others nor does any approach demonstrate a higher level of commitment to the patient, so options 2 and 5 are incorrect. Option 6 is true of principle-based approaches such as deontology but not true of the ethics of care.

Setting priorities for a patient's nursing diagnoses or health problems is an important step in planning patient care. Which of the following statements describe elements to consider in planning care? (Select all that apply.) 1. Priority setting establishes a preferential order for nursing interventions. 2. In most cases wellness problems take priority over problem-focused problems. 3. Recognition of symptom patterns helps in understanding when to plan interventions. 4. Longer-term chronic needs require priority over short-term problems. 5. Priority setting involves creating a list of care tasks.

Answer: 1, 3. Priority setting is the ordering of nursing diagnoses or patient problems to establish a preferential order for nursing interventions. Generally, actual needs and problems take priority over wellness, possible risk, and health promotion problems. Short-term acute patient care needs and problems typically take priority over longer-term chronic needs. Priority setting is not the ordering of a list of care tasks, but an organization of the desired outcomes for a patient. Symptom pattern recognition from your patient assessment and certain knowledge triggers help you understand which diagnoses require intervention and the associated time frame to intervene effectively

Which of the following actions, if performed by a registered nurse, could result in both criminal and administrative law sanctions against the nurse? (Select all that apply.) 1. Reviewing the electronic health record of a family member who is a patient in the same hospital on a different unit 2. Refusing to provide health care information to a patient's child 3. Reporting suspected abuse and neglect of children 4. Applying physical restraints without a written order 5. Completing an occurrence report on the unit

Answer: 1, 4. Viewing a family member's electronic health record violates the patient's rights provided by HIPAA. A physical restraint can be applied only on the written order of a health care provider based on The Joint Commission and Medicare guidelines.

A patient is in skeletal traction and has a plaster cast due to a fractured femur. The patient experiences decreased sensation and a cold feeling in the toes of the affected leg. The nurse observes that the patient's toes have become pale and cold but forgets to document this because one of the nurse's other patients experienced cardiac arrest at the same time. Two days later the patient in skeletal traction has an elevated temperature, and he is prepared for surgery to amputate the leg below the knee. Which of the following statements regarding a breach of duty apply to this situation? (Select all that apply.) 1. Failure to document a change in assessment data 2. Failure to provide discharge instructions 3. Failure to provide patient education about cast care. 4. Failure to use proper medical equipment ordered for patient monitoring 5. Failure to notify a health care provider about a change in the patient's condition

Answer: 1, 5. The failure to document a change in assessment data and the failure to notify a health care provider about a change in patient status reflect a breach of duty to the patient.

You are floated to work on a nursing unit where you are given an assignment that is beyond your capability. Which is the best nursing action to take first? 1. Call the nursing supervisor to discuss the situation. 2. Discuss the problem with a colleague. 3. Leave the nursing unit and go home. 4. Say nothing and begin your work.

Answer: 1. Alerting the nursing supervisor as a representative of the hospital administration is the first step in providing notice that a problem may exist related to insufficient staffing. This notice serves to share the burden of knowledge of the staffing inequity issues that may create an unsafe patient situation for the hospital and nursing staff.

The nurse is caring for a patient who needs a liver transplant to survive. This patient has been out of work for several months, does not have health insurance, and cannot afford the procedure. Which of the following statements speaks to the ethical elements of this case? 1. The health care team should select a plan that considers the principle of justice as it pertains to the distribution of health care resources. 2. The patient should enroll in a clinical trial of a new technology that can do the work of the liver, similar to the way dialysis treats kidney disease. 3. The social worker should look into enrolling the patient in Medicaid, since many states offer expanded coverage. 4. A family meeting should take place in which the details of the patient's poor prognosis are made clear to his family so that they can adopt a palliative approach.

Answer: 1. The principle of justice as it pertains to the distribution of health care resources is the ethical element present in option 1. Options 2, 3, and 4 are all potential strategies for assisting this patient, but they do not address the ethical elements of the case.

The nurse administers a tube feeding via a patient's nasogastric tube. This is an example of which of the following? 1. Physical care technique 2. Activity of daily living 3. Indirect care measure 4. Lifesaving measure

Answer: 1. This is an example of a physical care technique.

A nurse is calling a patient's health care provider about a problem the patient is having following surgery. The health care organization uses the SBAR system in reporting patient problems. Put the statements in order according to the SBAR system. 1. Would it be possible to give the patient an antiemetic to help with the patient's nausea and comfort? 2. The patient is experiencing nausea right now. The nausea has worsened over the past hour. He states he feels as though he is going to get sick. 3. The patient had surgery earlier today to remove a tumor in the colon. He was admitted to the surgical unit 4 hours ago. He has a nasogastric (NG) tube in place. There is no postoperative order for an antiemetic. 4. The patient denies pain and vital signs are stable. B/P 114/68; pulse 76; respiratory rate 20; temperature 98.6° F. The surgical dressing is dry and intact. The NG tube is intact and draining light brown fluid. It flushes well, and placement was confirmed using pH testing of gastric contents. The patient does not want to roll onto his side because of the nausea.

Answer: 2, 3, 4, 1. SBAR provides a consistent way to communicate patient problems. In this example, the Situation (S) is that the patient is experiencing nausea. Next the nurse provides the Background (B) about the patient's surgery and current orders. Then the nurse provides Assessment (A) data about the patient's current status. Finally, the nurse provides a Recommendation (R) to administer an antiemetic medication.

At 1200 the registered nurse (RN) says to the assistive personnel (AP), "You did a good job walking Mrs. Taylor by 0930. I saw that you recorded her pulse before and after the walk. I saw that Mrs. Taylor walked in the hallway barefoot. For safety, the next time you walk a patient, you need to make sure that the patient wears slippers or shoes. Please walk Mrs. Taylor again by 1500." Which characteristics of positive feedback did the RN use when talking to the AP? (Select all that apply.) 1. Feedback is given immediately. 2. Feedback focuses on one issue. 3. Feedback offers concrete details. 4. Feedback identifies ways to improve. 5. Feedback focuses on changeable things. 6. Feedback is specific about what is done incorrectly only

Answer: 2, 3, 4, 5. These are characteristics of good feedback. The nurse gives feedback on the process of the AP monitoring and ambulating a patient. The other options are not appropriate because the RN did not provide feedback immediately (the AP performed the task in the morning, but the feedback was not given until the afternoon), and you should give both positive feedback as well as feedback to improve the incorrectly done tasks.

A nurse is assigned to five patients, including one who was recently admitted and one returning from a diagnostic procedure. It is currently mealtime. The other three patients are stable, but one has just requested a pain medication. The nurse is working with an assistive personnel. Which of the following are appropriate delegation actions on the part of the nurse? (Select all that apply.) 1. The nurse directs the assistive personnel to obtain a set of vital signs on the patient returning from the diagnostic procedure. 2. The nurse directs the patient care technician to go to the patient in pain and to reposition and offer comfort measures until the nurse can bring an ordered analgesic to the patient. 3. The nurse directs the patient care technician to set up meal trays for patients. 4. The nurse directs the patient care technician to gather a history from the newly admitted patient about his medications. 5. The nurse directs the patient care technician to assist one of the stable patients up in a chair for his meal.

Answer: 2, 3, 5. The nurse can delegate repetitive, noninvasive tasks such as vital signs on a stable patient, assisting a mobile patient with ambulation, and setting up meal trays. It is inappropriate for the nurse to delegate aspects of the nursing process, such as collecting a medication history. The nurse also should not delegate vital signs if a patient might be unstable from returning from a diagnostic test.

A patient diagnosed with colon cancer has been receiving chemotherapy for 6 weeks. The patient visits the outpatient infusion center twice a week for infusions. The nurse assigned to the patient is having difficulty accessing the patient's intravenous (IV) port used to administer the chemotherapy. Despite attempts to flush the port, it is obstructed. This also occurred 2 weeks earlier. What steps should the nurse follow to make a consultation with a member of the IV infusion team? (Select all that apply.) 1. Ask the IV nurse to come to the infusion center at a time when the nurse starts care for a second patient. 2. Specifically identify the problem of port obstruction, and attempt to flush the port to resolve the problem. 3. Explain to the IV nurse the frequency in which this port has obstructed in the past. 4. Tell the IV nurse the problem is probably related to the physician who inserted the port. 5. Describe to the IV nurse the type and condition of the port currently in use.

Answer: 2, 3, 5. When making a consult, identify the general problem area (obstructed port). Provide a consultant with relevant information about the problem area (type and condition of port). Provide a summary of the problem, the methods used to resolve the problem so far, and outcomes of these methods (port flushing, port remains obstructed). Do not prejudice or influence consultants (physician to blame). Be available to discuss a consultant's findings and recommendations. The consultant is not there to take over the problem but to help you resolve it.

The nurse enters a patient's room and finds that the patient was incontinent of liquid stool. Because the patient has recurrent redness in the perineal area, the nurse worries about the risk of the patient developing a pressure injury. The nurse cleanses the patient, inspects the skin, and applies a skin barrier ointment to the perineal area. The nurse consults the ostomy and wound care nurse specialist for recommended skin care measures. Which of the following correctly describe the nurse's actions? (Select all that apply.) 1. The application of the skin barrier is a dependent care measure. 2. The call to the ostomy and wound care specialist is an indirect care measure. 3. The cleansing of the skin is a direct care measure. 4. The application of the skin barrier is an instrumental activity of daily living. 5. Inspecting the skin is a direct care activity

Answer: 2, 3. Application of the skin barrier is a direct, independent care measure. It is not an instrumental activity of daily living. Inspecting the skin is an assessment step. The other two interventions are described correctly.

A nurse sends a text message to the oncoming nurse to report that a patient refuses to take medication as ordered. What should the oncoming nurse do? (Select all that apply). 1. Add this information to the board hanging at the patient's bedside. 2. Tell the nurse who sent the text that the text is a HIPAA violation. 3. Inform the nursing supervisor. 4. Forward the text to the charge nurse. 5. Thank the nurse for sending the information.

Answer: 2, 3. The Health Insurance Portability and Accountability Act (HIPAA) and Health Information Technology Act provide rules about how and with whom nurses can share patient health information. Sending a text message to another nurse about a patient is a violation of these acts. Report violations of the privacy of patient health information to your supervisor or manager.

A nurse is visiting a patient who lives alone at home. The nurse is assessing the patient's adherence to medications. While talking with the family caregiver, the nurse learns that the patient has been missing doses. The nurse wants to perform interventions to improve the patient's adherence. Which of the following will affect how this nurse will make clinical decisions about how to implement care for this patient? (Select all that apply.) 1. Reviewing the family caregiver's availability during medication administration times 2. Determining the value the patient places on taking medications 3. Reviewing the number of medications and time each is to be taken 4. Determining all consequences associated with the patient missing specific medicines 5. Reviewing the therapeutic actions of the medications

Answer: 2, 4. Adherence is related to how a patient values a particular treatment and whether negative consequences are perceived if the treatment is not followed. Reviewing the family caregiver availability will be useful if the nurse cannot help the patient adhere better. Reviewing the number of medications will not change adherence unless the nurse consults with the physician about simplifying the regimen. Reviewing therapeutic actions of medication ensures safer administration but not better adherence.

When designing a plan for pain management for a patient following surgery, the nurse assesses that the patient's priority is to be as free of pain as possible. The nurse and patient work together to identify a plan to manage the pain. The nurse continually reviews the plan with the patient to ensure that the patient's priority is met. If the nurse's actions are driven by respect for autonomy, what aspect of this scenario best demonstrates that? 1. Assessing the patient's pain on a numeric scale every 2 hours 2. Asking the patient to establish the goal for pain control 3. Using alternative measures such as distraction or repositioning to relieve the pain 4. Monitoring the patient for oversedation as a side effect of his pain medication

Answer: 2. Asking the patient to establish the goal for pain control is a demonstration of respect for autonomy. Assessing, monitoring, and using alternative measures are interventions that address pain but that are not necessarily grounded in the principle of autonomy.

A nurse received change-of-shift report on these four patients and starts rounding. Which patient does the nurse need to focus on as a priority? 1. The patient who had abdominal surgery 2 days ago who is requesting pain medication 2. A patient admitted yesterday with atrial fibrillation who now has a decreased level of consciousness 3. A patient with a wound drain who needs teaching before discharge in the early afternoon 4. A patient going to surgery for a mastectomy in 3 hours who has a question about the surgery

Answer: 2. This patient is of high priority. The patient is experiencing the physiological problem of decreased level of consciousness that is an immediate threat to the patient's survival and safety. The nurse must intervene promptly and notify the health care provider of the life-threatening problem.

A nurse performs the following four steps in delegating a task to an AP. Place the steps in the order of appropriate delegation. 1. Do you have any questions about walking Mr. Malone? 2. Before you take him for his walk to the end of the hallway and back, please take and record his pulse rate. 3. In the next 30 minutes please assist Mr. Malone in Room 418 with his afternoon walk. 4. I will make sure that I check with you in about 40 minutes to see how the patient did.

Answer: 3, 2, 4, 1. This is the sequence of effective delegation. The nurse delegated the task of walking a patient to the AP, which is in the scope of the AP's duties and responsibilities and matched to the AP's skill level. The nurse provided clear directions by describing the task (the walk, taking and recording the pulse), the desired outcome (walk to the end of the hallway and back), and the time period (within the next 30 minutes). The nurse explains the process of follow-up with the AP to check how the patient did. The nurse asks whether the AP has any questions to provide the AP the opportunity to ask questions for clarification.

A nursing student is providing a hand-off report to a registered nurse (RN) who is assuming her patient's care at the end of the clinical day. The student states, "The patient had a good day. His intravenous (IV) fluid is infusing at 124 mL/hr with D5½NS infusing in left forearm. The IV site is intact, and no complaints of tenderness. I ambulated him twice during the shift; he tolerated walking to the visitors lounge and back with no shortness of breath, respirations 14, heart rate 88 after exercise. He uses his walker without difficulty, gait normal. The patient ate ¾ of his dinner with no gastrointestinal complaints. For the goal of improving the patient's activity tolerance, which expected outcomes were shared in the hand-off? (Select all that apply.) 1. IV site not tender 2. Uses walker to walk 3. Walked to visitors lounge 4. No shortness of breath 5. Tolerated dinner meal

Answer: 3, 4. In this case, outcomes to determine whether a patient is tolerating activity include measures of exercise tolerance, including respiratory status and distance walked. Using a walker is an intervention; the fact that the walker is used without difficulty is a measure of mobility, not activity tolerance. The IV site being nontender is an outcome for Risk of Infection. Tolerating a dinner meal could be an outcome for appetite problem or nausea.

While administering medications, a nurse realizes that a prescribed dose of a medication was not given. The nurse acts by completing an incident report and notifying the patient's health care provider. Which of the following is the nurse exercising? 1. Authority 2. Responsibility 3. Accountability 4. Decision making

Answer: 3. Accountability is nurses being answerable for their actions. It means nurses accept the commitment to provide excellent patient care and the responsibility for the outcomes of the actions in providing that. Following institutional policy for reporting medication errors demonstrates the nurse's commitment to safe patient care.

The application of deontology does not always resolve an ethical problem. Which of the following statements best explains one of the limitations of deontology? 1. The emphasis on relationships feels uncomfortable to decision makers who want more structure in deciding the best action. 2. The single focus on power imbalances does not apply to all situations in which ethical problems occur. 3. In a diverse community it can be difficult to find agreement on which principles or rules are most important. 4. The focus on consequences rather than on the "goodness" of an action makes decision makers uncomfortable.

Answer: 3. Deontology is an approach to ethics that identifies the correct action as that which is supported by fundamental principles and duties. The disadvantage of this approach is that its application relies on consensus around what the primary duties and principles are. Option 1 describes a limitation of the ethics of care. Option 2 describes a limitation of feminist ethics, while option 4 describes a limitation of utilitarianism.

Which example demonstrates a nurse performing the skill of evaluation? 1. The nurse explains the side effects of the new blood pressure medication ordered for the patient. 2. The nurse asks a patient to rate pain on a scale of 0 to 10 before administering a pain medication. 3. After completing a teaching session, the nurse observes a patient drawing up and administering an insulin injection. 4. The nurse changes a patient's leg ulcer dressing using aseptic technique.

Answer: 3. Evaluation is one of the most important aspects of clinical care coordination, involving the determination of patient outcomes. Observing a patient do a return demonstration of teaching is evaluation to ensure that patient has understood teaching. Option 2 is not evaluation because it occurs before administering a pain medication. The other options are interventions.

A home health nurse notices significant bruising on a 2-year-old patient's head, arms, abdomen, and legs. The patient's mother describes the patient's frequent falls. What is the best nursing action for the home health nurse to take? 1. Document her findings and treat the patient. 2. Instruct the mother on safe handling of a 2-year-old child. 3. Contact a child abuse hotline. 4. Discuss this story with a colleague.

Answer: 3. Nurses are mandated reporters of suspected child abuse. These assessment findings possibly indicate child abuse.

A nurse received bedside report at the change of shift with the night-shift nurse and the patient. The nursing student assigned to the patient asks to review the patient's medical record. The nurse lists patients' medical diagnoses on the message boards in the patients' rooms. Later in the day the nurse discusses the plan of care for a patient who is dying with the patient's family. Which of these actions describes a violation of the Health Insurance Portability and Accountability Act (HIPAA)? 1. Discussing patient conditions at the bedside at the change of shift 2. Allowing the nursing student to review the assigned patient's chart before providing care during the clinical experience 3. Posting medical information about the patient on a message board in the patient's room 4. Releasing patient information regarding terminal illness to family when the patient has given permission for information to be shared

Answer: 3. Posting the medical condition of a patient on a message board in the patient's room is not necessary for the patient's treatment. Doing so can result in this information being accessed by persons who are not involved in the patient's treatment

A nursing student is providing a hand-off report to the RN assuming her patient's care. She explains, "I ambulated him twice during the shift; he tolerated walking to end of hall each time and back with no shortness of breath. Heart rate was 88 and regular after exercise. The patient said he slept better last night after I closed his door and gave him a chance to have some uninterrupted sleep. I changed the dressing over his intravenous (IV) site and started a new bag of D5½NS. Which intervention is a dependent intervention? 1. Providing hand-off report at change of shift 2. Enhancing the patient's sleep hygiene 3. Administering IV fluids 4. Taking vital signs

Answer: 3. The only intervention that requires a physician or health care provider order is IV fluid administration. All other interventions are independent.

Which principle is most important for a nurse to follow when using a clinical practice guideline for an assigned patient? 1. Knowing the source of the guideline 2. Reviewing the evidence used to develop the guideline 3. Individualizing how to apply the clinical guideline for a patient 4. Explaining to a patient the purpose of the guideline

Answer: 3. Whenever a nurse applies a practice guideline, it is essential to consider the patient's unique needs and how to adapt and deliver the guideline. Knowing the source and reviewing the evidence are helpful in knowing the strength of any guideline. Explaining the purpose keeps a patient informed but is not the most important principle.

A woman has severe life-threatening injuries, is unresponsive, and is hemorrhaging following a car accident. The health care provider ordered two units of packed red blood cells to treat the woman's anemia. The woman's husband refuses to allow the nurse to give his wife the blood for religious reasons. What is the nurse's responsibility? 1. Obtain a court order to give the blood. 2. Convince the husband to allow the nurse to give the blood. 3. Call security and have the husband removed from the hospital. 4. Gather more information about the wife's preferences and determine whether the husband is her power of attorney for health care.

Answer: 4. Adult patients such as those with specific religious objections are able to refuse treatment for personal religious reasons. Because this patient is unresponsive, it is important for the nurse to better understand the patient's preferences and know if the woman has a power of attorney for health care before following the husband's wishes. However, there needs to be clear directions on who can make the decision.

A nurse assesses a 78-year-old patient who weighs 108.9 kg (240 lb) and is partially immobilized because of a stroke. The nurse turns the patient and finds that the skin over the sacrum is very red and the patient does not feel sensation in the area. The patient has had fecal incontinence on and off for the past 2 days. The nurse identifies the nursing diagnosis of Risk for Impaired Skin Integrity. Which of the following outcomes is appropriate for the patient? 1. Patient will be turned every 2 hours within 24 hours. 2. Patient will have normal formed stool within 48 hours. 3. Patient's ability to turn self in bed improves. 4. Erythema of skin will be mild to none within 48 hours.

Answer: 4. Reduced erythema is the only outcome that measurably assesses condition of patient's skin and within a set time frame. It is realistic. The ability to turn self is an outcome measuring mobility status. Normal formed stools is an outcome focused on improving bowel incontinence. Turning a patient is an intervention and not an outcome.

A man who is homeless enters the emergency department seeking health care. The health care provider indicates that the patient needs to be transferred to the city hospital for care before assessing the patient. This action is most likely a violation of which of the following laws? 1. Health Insurance Portability and Accountability Act (HIPAA) 2. Americans with Disabilities Act (ADA) 3. Patient Self-Determination Act (PSDA) 4. Emergency Medical Treatment and Active Labor Act (EMTALA)

Answer: 4. The EMTALA requires that an emergency situation needs to be established and that the patient needs to be stabilized before a transfer is appropriate.

The following are steps in the process to help resolve an ethical problem. What is the best order of these steps to achieve resolution? 1. List all the possible actions that could be taken to resolve the problem. 2. Articulate a statement of the problem or dilemma that you are trying to resolve. 3. Develop and implement a plan to address the problem. 4. Gather all relevant information regarding the clinical, social, and spiritual aspects of the problem. 5. Take time to clarify values and identify the ethical elements, such as principles and key relationships involved. 6. Recognize that the problem requires ethics.

Answer: 6, 4, 5, 2, 1, 3. This order reflects a systematic approach to ethical problems, similar to the nursing process.

A nurse has just finished turning a bed-fast patient who begins screaming at the nurse, yelling "How dare you move me! I'm going to sue you!" When discussing this issue with the unit manager, the manager should respond in which fashion? A. "We should call the hospital attorney for an opinion." B. "Did you harm the patient? If there is no harm, there is no suit." C. "Don't worry. This patient always says she's going to sue." D. "This patient can't sue you; you had consent to turn."

B. "Did you harm the patient? If there is no harm, there is no suit." There are four elements of malpractice required for a successful lawsuit: duty, breach of duty, causation, and harm. If the nurse did not harm the patient, the patient has no grounds to sue for malpractice. Stating that the patient always makes this claim and the nurse should not worry does not take into account the four elements. Even with consent, a breach in any of the four elements can lead to a lawsuit. The manager should understand them well enough to realize that a call to the attorney is not warranted.

A student nurse is listening to a lecture on theories of management. Which statement by the student nurse indicates an adequate understanding of this topic? A. "The behavioral manager sets strict rules, with defined rewards and punishments for action." B. "The contingency manager makes decisions after considering what motivates people." C. "The bureaucratic manager decides how procedures will be done on a unit." D. "The systems manager makes decisions without considering the impact on the entire facility."

B. "The contingency manager makes decisions after considering what motivates people." The contingency theory (or motivational theory) is a blend of other theories; it seeks to determine what motivates people to work effectively in order to do the job at hand. The systems theory considers a work unit as part of a whole, influenced by and influencing inputs, transformation of material, outputs, and feedback. The behavioral theory states that to maintain a stable and satisfied workforce, the humanistic needs of workers must be considered. The bureaucratic theory uses strict adherence to rules and a defined chain of command and hierarchy to accomplish work goals.

A nurse is the chairperson of the research-based practice council on her unit. Most members work well together and complete their assignments on time, but one nurse seems disorganized, can't meet deadlines, and often strays "off topic" during meetings. Which action by the chairperson would be the most helpful? A. Give this nurse small, easy to complete projects with strict deadlines. B. Ask the nurse to lead a brainstorming session for new council projects. C. Enlist the help of the unit manager to reinforce council responsibilities. D. Speak privately with the nurse and ask if council participation is desired.

B. Ask the nurse to lead a brainstorming session for new council projects. This nurse may be right-brain dominant. Right-brain dominant people resist following rules and schedules but have the ability to look at projects as a whole and think creatively, often "outside the box." Having this nurse use these talents to lead a brainstorming session would be a win-win solution for all involved. Reinforcing responsibilities associated with council membership and strict deadlines would only tend to increase everyone's frustration because these play into the types of activities that the right-brained person does not typically do well with. Asking the nurse if he or she wants to be on the council may be helpful but does not give the nurse a chance to contribute in a meaningfully or personally satisfying way.

A nurse mentor is explaining the benefits of collaborative practice to a nurse new to a facility. Which research-based benefits should the nurse identify as likely positive outcomes of collaboration? (Select all that apply.) Select all that apply. A. Decreased use of pain medications B. Decreased staff resignations C. Increased reimbursement from insurance carriers D. Increased patient follow-up appointments after discharge E. Decreased length of stay for patients F. Increased job satisfaction of the staff

B. Decreased staff resignations E. Decreased length of stay for patients F. Increased job satisfaction of the staff Documented positive outcomes from collaboration include a shortened length of stay, increased job retention and decreased staff turnover, increased job satisfaction for registered nurses, and improved problem-solving skills. Identified research has not demonstrated less use of pain medication, increased reimbursement, or better follow-up by patients after discharge.

A nurse is concerned about possible burnout. Which action should the nurse perform first? A. Look for another job in a facility that has a less stressful workload. B. Determine if the cause of burnout is internal, external, or both. C. Volunteer to join a committee that impacts patient-care practices. D. Begin reading self-help books on maintaining a balanced lifestyle.

B. Determine if the cause of burnout is internal, external, or both. The first step in analyzing possible burnout is to determine if the cause of the burnout is internal, external, or both. Internal factors leading to burnout can be mediated with self-help strategies and by living a more balanced lifestyle. External factors such as conditions in a place of employment may not be amenable to change, and the nurse may have to find other employment. But prior to taking any action such as reading self-help books, looking for another job, or volunteering to be on a committee, the nurse should first determine where the stress is coming from. In fact, if the nurse is already overextended at work, joining a committee may add to his or her distress.

A nurse is embroiled in what he considers an ethical conflict involving several parties. The nurse has identified possible ethical issues of the situation. Which action by the nurse is best? A. Request an ethics committee consult. B. Determine the facts of the situation. C. Refuse to take care of this patient. D. Consider possible actions to take.

B. Determine the facts of the situation. In the ethical decision-making model, determining the facts of the situation comes first. Refusing to care for the patient might be appropriate if the nurse has moral objections to the situation and the facility has a policy on such assignments. However, this should not occur before the nurse has the chance to determine the facts of the case and possible ethical issues. An ethics committee consult could be helpful, but first the nurse should use the steps of the ethical decision-making model. After identifying the possible ethical issues (the second step), the nurse should determine possible actions to take and their possible outcomes.

A nurse is writing a telephone order for medication. Which written order does the nurse interpret as written appropriately? A. Furosemide (Lasix) 10 mg bid PO B. Furosemide (Lasix) 10 mg two times a day orally C. Furosemide (Lasix) 10.0 mg b.i.d. D. Furosemide (Lasix) 10 mg 2×/day by mouth

B. Furosemide (Lasix) 10 mg two times a day orally The clearest example of a well-written medication order is the one in which all items are spelled out and the numerical (dose) value is written properly. It should be "furosemide (Lasix) 10 mg two times a day orally." Medication orders need to be completely clear. The option of 2×/day might be misread if written sloppily. The option of 10.0 has a trailing zero, which should not be used (easy to mistake as 100). The abbreviation "b.i.d." also should not be used. The option with "bid" contains the abbreviation "PO."

A nurse works rotating shifts and always feels fatigued and irritable and complains of insomnia. What actions should the nurse take to relieve these symptoms of burnout? (Select all that apply.) Select all that apply. A. Exercise for 30 to 45 minutes before going to bed for the day. B. Keep the bedroom temperature warmer than other rooms. C. Cut down on the amount of carbohydrates you eat each day. D. Turn off phones, computers, and other electronic devices. E. Wear an eye shield and keep your bedroom dark with shades.

B. Keep the bedroom temperature warmer than other rooms. D. Turn off phones, computers, and other electronic devices. Suggestions for good sleep, especially when circadian rhythms are disrupted, such as seen in shift work, can be found in Box 2.1. They include using the bedroom only for sleeping and avoiding watching TV or using the computer in bed, engaging in a routine of quiet, relaxing activities prior to bedtime, keeping the bedroom cool and dark (e.g., use a ceiling fan for air movement and for some noise; use window shades or eye shields to darken the room), using other white noise generators, maintaining a quiet environment by turning off phones and electronic devices and sleeping with earplugs, if necessary, and altering your diet to include more protein and less carbohydrates. Exercising just before bedtime and keeping the bedroom warmer are not recommended techniques.

A nursing unit has a lot of interpersonal strife, medication errors, and hospital-acquired infections. The unit nursing manager, who is considered a transformational leader, would take which step(s) to improve this situation? (Select all that apply.) Select all that apply. A. Work some shifts to see the staff nurses' perspectives. B. Make a session on intragroup communication a fun activity. C. Question the staff about what they think is causing the problems. D. Remind staff of hospital policies regarding infection control. E. Assess the staff to find gaps in knowledge or vision.

B. Make a session on intragroup communication a fun activity. D. Remind staff of hospital policies regarding infection control. Although all options might be good answers, given the situation, the transformational leader believes that people do the right things when they are given the right support, information, and direction. Assessing the nursing staff to find gaps in knowledge or vision addresses information and vision. Working some shifts allows the nurse leader to provide support based on staff nurse perceptions. Making a session on intragroup communication or reminding nursing staff of hospital policies may be helpful; however, these activities do not specifically reflect transformational leadership.

A student nurse complains about writing "endless" care plans. The faculty explains how this teaches one of the nursing roles in addition to preparing the student to care for patients, and that all hospitals must demonstrate the use of the nursing process. Which nursing role is the faculty referring to? A. Colleague B. Manager C. Advocate D. Teacher

B. Manager Organizing nursing care so that other nurses can continue caring for the patient in one's absence is the essence of the earliest version of the nurse manager role. In addition to helping the student prepare to care for a particular patient, writing down directions (or entering the information into a computer) for patient care ensures consistency among the staff. The teacher provides patients with information. The advocate protects patients and, on occasion, speaks for them. The colleague works within interdisciplinary relationships for better patient care; nursing care plans are not used by other disciplines.

A nurse has finished getting shift report. Which patient should the nurse see first? A. Patient who needs to get out of bed and ambulate B. Patient just transferred from the emergency department C. Postoperative patient requesting pain medication D. Pneumonia patient getting respiratory treatment

B. Patient just transferred from the emergency department Hand-offs are particularly dangerous times during a health care stay. The nurse should see this patient first; hopefully, the ED nurse is still with the patient, waiting to give a face-to-face report. Otherwise, the nurse should assess this patient, review the orders, facilitate their input into the system, and call the ED nurse for questions. The nurse should see the ED patient first. The patient who needs to ambulate can wait, or the nurse could delegate a nursing assistant to help this patient. The pneumonia patient is with another professional (respiratory therapy). The postoperative patient requesting pain medications needs to be seen soon, but the nurse could either delegate this task to another nurse or get the pain medication as quickly as possible after seeing the new patient.

A patient is insistent on leaving the emergency department against medical advice. The emergency room physician tells the nurse to call security and have them restrain the patient if necessary. Which action by the nurse is best? A. Call security and ask them to restrain the patient if needed. B. Tell the physician that this could be considered assault and battery. C. Document the physician's order before implementing it. D. Inform the physician that this could be considered false imprisonment.

B. Tell the physician that this could be considered assault and battery. Assault is the nonconsensual threat of touch, whereas actually touching the person against his or her will is battery. The nurse should inform the physician of these facts. You cannot restrain a competent adult unless clearly protecting the safety of others. Merely charting the order before implementing it does not absolve the nurse of legal duties to patients. False imprisonment is making a person feel as if he or she cannot leave a place; this is potentially a case of assault and battery.

A nurse is preparing to transfer a client who is 72 hr postoperative to a long term care facility. Which of the following information should the nurse include in the transfer report? (Select all that apply). A. Type of anesthesia used B. Advance directives status C. VS on day of admission D. Medical diagnosis E. Need for specific equipment

B., D., E.

A nurse who has just assumed the role of unit manager is examining the skills necessary for interprofessional collaboration. Which of the following actions support the nurse's interprofessional collaboration? (Select all that apply.) A. Use aggressive communication when addressing the team. B. Recognize the knowledge and skills of each member of the team. C. Ensure that a nurse is assigned to serve as the group facilitator for all interprofessional meetings. D. Encourage the client and family to participate in the team meeting. E. Support team member requests for referral.

B., D., E.

Which of the following is the best example of assertive communication? A. "You are always late and that means I can't go home on time!" B. "I am really angry at you because you can't get to work on time." C. "I get angry when you are late to work so often and I can't go home." D. "Why are you so disrespectful of my time that you are always late?"

C. "I get angry when you are late to work so often and I can't go home." Assertive communication is objective, focuses on behavior, and uses "I" statements. This statement uses an I statement, an objective description of the behavior, and descriptions of the consequence of the behavior. Asking why someone is so disrespectful is focusing on the person's personal traits and not the problematic behavior. Using "all or nothing" statements or words like "never" and "always" is exaggerating and makes it appear that the person cannot do anything right, which may put him or her on the defensive. Yelling is aggressive, not assertive. Saying "You can't get to work on time" implies that the person is never on time.

Which is characteristic of the formal nursing leadership model? A. Uses one leadership style throughout the organization B. Always has a chief nursing officer position to lead the nursing staff C. Adapts to the size and needs of the healthcare system D. Has the same structure in any healthcare organization

C. Adapts to the size and needs of the healthcare system The size and complexity of the nursing leadership team depend on the size and needs of the healthcare agency. Using the same structure in any healthcare organization does not adjust for the specific needs of the healthcare agency. Using one leadership style throughout the organization does not adjust for the specific needs of the departments in the healthcare agency. Always having a chief nursing officer position to lead the nursing staff does not adjust to the specific needs of the healthcare agency.

A nurse is frustrated because many e-mails sent to the supervisor go unanswered. What advice does an experienced nurse, known to be a good communicator, give? (Select all that apply.) Select all that apply. A. Do not send too many e-mails, especially if they are repetitive. B. Watch the emotional tone of the e-mail; do not show hostility. C. Always use correct English grammar and spelling. D. Keep e-mails short and concise; you may need to request a meeting. E. Do not use a subject line if you think the supervisor will ignore it.

C. Always use correct English grammar and spelling. D. Keep e-mails short and concise; you may need to request a meeting. E. Do not use a subject line if you think the supervisor will ignore it. Communication with a supervisor, especially when in writing, needs to be formal and includes a salutation and the supervisor's title. When sending e-mails (or other written communication), always use proper English and grammar and correct spelling. Refrain from sending multiple e-mails, especially if they are about the same topic. E-mails should be kept brief and to the point; if there is a lot to discuss, a personal meeting is probably better. E-mails should not contain angry outbursts or statements indicating hostility or threats. Always use a subject line when e-mailing a supervisor or when writing a work-related e-mail to anyone.

A nursing manager notices discord among the nursing staff on the unit. Which action would be the most helpful? A. Have a series of staff meetings focusing on professionalism at work. B. Try to separate the conflicting groups from each other, if possible. C. Compile data on the different generations working on the unit. D. Single some nurses out as informal leaders to set a good example.

C. Compile data on the different generations working on the unit. As many as four different generations are in the workplace today. The members of each generation have their own way of responding to the work environment, and they have different expectations of their employer and coworkers. To determine the cause of conflict, the manager should assess the generational characteristics of the nurses employed on the unit to see if this is a possible contributing factor. The other options might occur at some point, but without understanding the nature of the problem, resolving the problem is unlikely.

A student nurse is reading about Pareto's 80/20 rule and is trying to explain it to a classmate. Which explanation is best? A. Most of your success can be accomplished by a smaller amount of effort. B. Eighty percent of your time should be spent on 20% of your daily to-do list. C. Concentrating even 20% of your efforts on high-priority items leads to greater success. D. You should spend 80% of your time on important tasks and 20% on the remainder.

C. Concentrating even 20% of your efforts on high-priority items leads to greater success. According to Pareto (an early 1900 economist), concentrating 20% of your effort on high-priority items leads to proportionately greater success (and produces 80% of the results). This illustrates the concept of prioritizing tasks that need to be done and concentrating on high-payoff items. This doesn't mean that a person should spend 80% of his or her time on 20% of a list of tasks needing to be completed, or that expending a smaller effort will create more success, or that spending 80% of your time on important tasks is best.

The registered nurse delegates the following task to an unlicensed assistive personnel: "Mr. Smith in room 408 is very unsteady on his feet. Each time you are in the room, please make sure the call light is in reach and his bed alarm is turned on." Four hours later, the nurse asks the aide if Mr. Smith is doing all right and goes on break. While at dinner, Mr. Smith falls and breaks his hip. When reviewing this incident, the nurse determines which part of the delegation process was not done correctly? A. Right directions and communication B. Right task C. Right supervision and evaluation D. Right circumstance

C. Right supervision and evaluation The problem with the delegation in this case is that the nurse never evaluated the job done by the nurse's assistant, so the right supervision and evaluation is missing. Placing a call light in reach and ensuring that a bed alarm is on are tasks that a nurse's aide should be qualified to do; nothing in the question indicates that this was a new aide or one not familiar with the equipment. The patient does not have any unusual circumstances that would make the aide the wrong person to do this job. The directions are clear.

A nurse is preparing to discharge a patient who speaks very little English. Which action by the nurse is best? A. Teach a family member the discharge instructions. B. See if a family member can interpret the instructions. C. Use a professional interpreter to give the instructions. D. Print the instructions in the patient's native language.

C. Use a professional interpreter to give the instructions. Using a professional interpreter is required in health care settings. Some facilities have language banks and professional interpreters on staff. There are also phone systems that allow speaking with an interpreter. Printing the instructions in the patient's native language is a good idea, and many computer programs allow this option, but this is not the best choice because the nurse doesn't know if the patient is literate or the patient's level of health literacy. Using a family member is also not a good option. The family member may include cultural biases in interpreting, which might lead to miscommunication, and the family member also may not know enough about the health care condition to educate the patient. The family member (and patient!) may also be embarrassed about the nature of the material provided. Teaching a family member and omitting the patient could be a breach of confidentiality. It is also not the best option because the patient needs to understand the directions.

The new unit manager is doing an annual performance evaluation on a nursing assistant (NA) hired 1 year ago. Several nurses have complained about this NA's skill level, even for basic care tasks. Which action by the manager is the best? A. Send the NA to the skills practice and evaluation lab. B. Remind the NA of the skills and tasks within the job description. C. Show the NA documentation of prior poor performance. D. Ask if the NA has ever been evaluated before now.

D. Ask if the NA has ever been evaluated before now. There are several sources of performance weaknesses, including unclear expectations, lack of feedback, educational needs, need for additional supervision and direction, and personal characteristics. The manager should ask the NA how things are going and lead into the discussion of the poor performance by asking if the NA has ever been evaluated before and what the results of that evaluation were. Because the manager is new, he or she may be unfamiliar with how the outgoing manager evaluated new employees. The other action may need to occur, but the manager needs to know the NA's evaluation history first.

A charge nurse provides directions for patient care to a nursing assistant who has floated from another unit for the shift. The charge nurse gives the assistant patients for whom to do a list of tasks and parameters for reporting specific items to the assigned registered nurse. Which other action by the charge nurse is important? A. Determine if the aide has taken vital signs before. B. Inform the aide of his or her break time for the shift. C. Tell the aide to call if he or she has any further questions. D. Ask if the directions are clear and understood.

D. Ask if the directions are clear and understood. We may think our directions are clear, concise, correct, and complete (the Four Cs), but only the person we are giving directions to can evaluate how concise they are. This affects patient safety. A hospital aide experienced enough to float should know how to take vital signs. Informing the aide of his or her break time and providing a contact for questions are good actions but are not as important as determining if the directions were adequate before leaving the aide to do his or her work. Because many people are hesitant to ask questions, they should be asked directly if they understand, if they are confused, or if they have enough information to do the job.

A charge nurse is the chair of a committee at work. One member constantly tells the group that their ideas won't work, that staff members won't accept their plans, and that this has all been tried before. Which action by the chair would be best? A. Tell the person that she or he needs to be a positive member of the group. B. Have this person as the chair to lead the group in better directions. C. Give each person a specific amount of time to speak at meetings. D. Ask the person to prepare a summary of why other ideas failed.

D. Ask the person to prepare a summary of why other ideas failed. This person is known as a "conservative critic," one who is consistently negative and critical of the group's work. It is important to learn from past mistakes, however, so instead of simply cutting this person off, it would be better to take advantage of some knowledge he or she has. If the person prepares a summary of why other ideas failed, it may be beneficial, and it gives the person a constructive role. If the person cannot become a productive member of the committee, the chair may be forced to ask him or her to leave; however, limiting the amount of time each person has to speak does not solve the problem. A person with a negative attitude will not make a good chairperson. Simply telling the person to become positive does not help the person change behaviors.

A nurse and health care provider are talking in the hallway about a patient's condition. The health care provider says that the patient needs an x-ray. Which action by the nurse is most appropriate? A. Repeat the order to the health care provider and document it in the chart. B. Inform the health care provider that verbal orders are prohibited now. C. Document the order and facilitate the patient having the x-ray. D. Explain that you will call x-ray when the health care provider inputs the order.

D. Explain that you will call x-ray when the health care provider inputs the order. Verbal orders should only be taken during an emergency situation or when it is physically difficult for the physician to write or put in the order himself or herself, such as during a sterile procedure. Because neither is the case here, the nurse should explain that as soon as the order is properly put into the system, he or she will facilitate the study. The nurse should not document the order or say that verbal orders are prohibited because there are circumstances in which they are still appropriate.

Which statement about leadership made by a new nurse requires further explanation? A. Clinical leaders are needed in every setting to ensure that quality patient care is delivered and that new evidence and research findings are adopted to improve patient care. B. It is important for nurses who aspire to be leaders. C. Leaders are made, not born. D. Leadership in health care is an act reserved only for designated administrators and managers.

D. Leadership in health care is an act reserved only for designated administrators and managers. "Leaders are made, not born" is true because leaders must continuously develop leadership skills. Leadership skills in every setting will improve the quality of patient care. Nursing leaders are vitally important to improve patient care at the bedside.

A homeless man presents to the emergency room with hypothermia. He tells the nurse that he is positive for human immunodeficiency virus (HIV) and sought revenge by deliberately having sex with his mate, who does not know of his HIV status. What ethical principle is this patient violating? A. Beneficence B. Veracity C. Autonomy D. Nonmaleficence

D. Nonmaleficence Nonmaleficence means to abstain from injuring others and to help others further their own well-being by removing harm and eliminating threats. The patient is definitely violating this principle through his actions. Veracity is telling the truth in personal communication. Beneficence is promoting goodness, kindness, and charity. Autonomy is the principle of respect for the individual person. This concept maintains that all persons have unconditional intrinsic value.

Which ethical term matches this statement: "A problem for which in order to do something right you have to do something wrong"? A. Ethical dilemma B. Veracity C. Fidelity D. Justice

A. Ethical dilemma An ethical dilemma involves a problem for which in order to do something right you have to do something wrong. Justice involves upholding moral and legal principles. Veracity means telling the truth as a moral and ethical requirement. Fidelity is the principle that requires a person to act in ways that are loyal. In the role of a nurse, such action includes keeping promises, doing what is expected of you, performing your duties, and being trustworthy.

The charge nurse on a medical unit has noticed one of the seasoned and experienced nurses acting irritable and having critical angry outbursts at work. Which action by the charge nurse would be the most helpful? A. Explore the nurse's use of self-care measures and leisure activities. B. Ask what other people are doing to make him or her so angry. C. Send the nurse to Employee Assistance for anger management. D. Help the nurse work on better communication techniques.

A. Explore the nurse's use of self-care measures and leisure activities. This nurse is displaying some early signs of burnout. The most helpful response by the charge nurse is to explore how the nurse is caring for herself or himself and whether he or she engages in any leisure activities. These are two strategies that can decrease or mitigate burnout. Better communication techniques don't seem to be the priority because this behavior is something the charge nurse has just recently noticed. Anger management is also probably not warranted; again, this behavior is recent, and anger management alone will not help solve the nurse's burnout. The nurse needs to take responsibility for his or her actions, so placing blame on others is not appropriate.

A student nurse is conflicted after seeing reports of a mass casualty situation and reading about the concept of disaster triage, in which some patients are allowed to die (or are not treated) so that many others can be saved. Which ethical concept does the nursing faculty advise the student to study more? A. Justice B. Nonmaleficence C. Veracity D. Beneficence

A. Justice Justice demands that all patients be treated the same, despite differences in personal characteristics, such as socioeconomic status. In a setting in which health care resources are scarce, such as in a mass disaster situation, not all patients can be saved and scientific principles related to emergency medicine are used to determine which category of patient will not be treated. Beneficence is to do good. Nonmaleficence is to do no harm. Veracity is telling the truth.

Which behavior by a nurse indicates the effective strategy for collaboration with other professionals? A. Negotiates with others B. Avoids conflict C. Aggressively presents a personal view of a situation D. Strongly defends own professional role

A. Negotiates with others Conflicts may arise during collaboration, requiring the skill of negotiation. Strongly defending the professional role does not allow for input from other disciplines. Avoiding conflict does not allow proper representation of the nursing role. Collaboration should not be based on personal views.

A nurse is assigned to care for six patients at the beginning of the night shift. The nurse learns that the floor will be short by one registered nurse (RN) as a result of a call-in. A patient care technician from another area is coming to the nursing unit to assist. Because the unit requires hourly rounds on all patients, the nurse begins to make rounds on a patient who recently asked for a pain medication. The nurse is interrupted by another registered nurse who asks about another patient. Which factors in this nurse's unit environment will affect the ability to set priorities? (Select all that apply.) 1. Policy for conducting hourly rounds 2. Staffing level 3. Interruption by staff nurse colleague 4. Type of hospital unit 5. Competency of patient care technician

Answer 2, 3, 5. Many factors within the health care environment affect a nurse's ability to set priorities, including availability of resources (staffing), interruptions from care providers, and RN experience and technician competency. The type of hospital unit is not a factor, but the way a unit is organized and its model of care can be factors. A policy for conducting rounds in itself does not affect ongoing priority setting.

A nurse working the evening shift has five patients and is teamed up with an assistive personnel. One of the assigned patients has just returned from surgery, one is newly admitted, and one has requested a pain medication. The patient who has returned from surgery just minutes ago has a large abdominal dressing, is still on oxygen by nasal cannula, and has an intravenous line. One of the other patients has just called out for assistance in setting up a meal tray. Another patient is stable and resting comfortably. Which patient is the nurse's current greatest priority? 1. Patient in pain 2. Patient newly admitted 3. Patient who returned from surgery 4. Patient requesting assistance with meal tray

Answer 3. The patient returning from surgery is likely the most physiologically unstable, requiring the nurse to perform an assessment and ensure the patient is managed appropriately. The patient in pain is likely to be the next priority, depending on the severity of the patient's reported pain. The newly admitted patient will require a nursing history, which takes time. The nurse can have the assistive personnel assist with the meal tray

Which of the following factors should be considered when choosing an intervention for a patient's plan of care? (Select all that apply.) 1. The specific patient outcome against which to judge effectiveness of interventions 2. The timing of care activities routinely conducted on the care unit 3. The scientific evidence available in support of an intervention 4. The amount of time required for implementation in consideration of patient's condition 5. The patient's values and beliefs regarding the intervention

Answer: 1, 3, 4, 5. When choosing interventions, consider six important factors: (1) desired patient outcomes, (2) characteristics of the nursing diagnosis, (3) research base knowledge for the intervention, (4) feasibility for doing the intervention, (5) acceptability to the patient, and (6) your own competency

A nurse is planning care for a patient going to surgery. Who is responsible for informing the patient about the surgery along with possible risks, complications, and benefits? 1. Family member 2. Surgeon 3. Nurse 4. Nurse manager

Answer: 2. The person performing the procedure is responsible for informing the patient about the procedure and its risks, benefits, and possible complications.

Which task is appropriate for a registered nurse (RN) to delegate to an AP? 1. Explaining to the patient the preoperative preparation before the surgery in the morning 2. Administering the ordered antibiotic to the patient before surgery 3. Obtaining the patient's signature on the surgical informed consent 4. Helping the patient to the bathroom before leaving for the operating room

Answer: 4. Assisting the patient with toileting activities is within the scope of an AP's duties. The other activities require the skill and knowledge of the RN.

During a new nurse' orientation to the unit, a nurse explains why collaboration is valued. Which outcome is a key patient care outcome that occurs when collaboration is correctly used? A. Ongoing education is not needed, because other specialties contribute to care decisions. B. There are fewer errors that occur in patient care. C. Agencies can offer higher salaries due to the cross-training of staff. D. Governmental accrediting agencies give more favorable reviews to the agency.

B. There are fewer errors that occur in patient care. Collaboration results in fewer errors in patient care due to the interactions between health providers of all disciplines and patient involvement in planning. A positive accreditation review benefits the agency directly and the patient only indirectly. Collaboration is not the same as cross-training, and ongoing education is an expectation of all professions.

Which statement by a nursing student demonstrates an understanding of collaboration? A. "Collaboration with patients has been used by nurses throughout the history of nursing." B. "Collaboration is a new way of interacting with physicians." C. "Collaboration is an outdated concept that has been replaced by managed care." D. "Collaboration means that the care team can make all of the decisions for the patient."

A. "Collaboration with patients has been used by nurses throughout the history of nursing." History shows that from the time of Florence Nightingale, nurses have worked with patients to assess their needs and wants. Collaboration with fellow care providers such as physicians is not a new concept; it is becoming more prevalent. To correctly use collaboration, the team does not make decisions without including the patient.

A patient and her husband used in vitro fertilization to become pregnant. The unused sperm were frozen so the couple could have more children later. They bore a little girl who was diagnosed with leukemia when she was 5 years old. The child now needs a bone marrow transplant (BMT). The best chance of a match for the BMT is a sibling. The couple would like to use the sperm to have another child so that they can increase the likelihood of a match. The nurse realizes that the unborn child poses an ethical dilemma involving which principle? A. Human dignity B. Beneficence C. Justice D. Veracity

A. Human dignity Human dignity is the inherent worth and uniqueness of a person. Human rights are the basic rights of each individual. Beneficence is defined as promoting goodness, kindness, and charity. In ethical terms, beneficence means to provide benefit to others by promoting their welfare. Justice involves upholding moral and legal principles. Veracity is truth-telling.

A nurse tells a patient, "I will be back in one hour to check on you." The nurse returns in 1 hour and assesses the patient. Which ethical principle has guided this action? A. Beneficence B. Fidelity C. Nonmaleficence D. Veracity

B. Fidelity Fidelity is the duty to keep commitments. The nurse, in this case, made a commitment to return in 1 hour. Beneficence means to do good. Nonmaleficence is to do no harm. Veracity is telling the truth.

A staff nurse on the unit has a great deal of influence on others' opinions and actions. Which type of power does the nurse educator interpret this behavior has? A. Legitimate B. Information C. Referent D. Reward

C. Referent A person with referent power is liked and admired by others; this positive feeling helps to shape the opinions and actions of others. Reward power is the ability to give or withhold rewards. Some people in positions with legitimate power also have reward power, but not all. A person with information power has some knowledge that is needed by others so they can do their jobs. Legitimate power comes from a position, such as charge nurse or manager.

A student nurse is participating in an interactive session on nursing history in which the students can interview any figure from nursing's past. Which question is appropriate? A. Lilian Wald: "How did you avoid becoming ill while nursing soldiers in the Crimean War?" B. Sophia Palmer: "What made you realize that correspondence courses for nurses would work?" C. Lystra Gretter: "What encouraged you to form the first school of nursing in America?" D. Mildred Montag: "How do you feel about the BSN as the entry point to nursing now?"

D. Mildred Montag: "How do you feel about the BSN as the entry point to nursing now?" Mildred Montag developed the Associate Degree program of nursing education. This question would be an appropriate one, matching a person with interest. Sophia Palmer rejected the idea of correspondence courses and home study programs for nurses. Lillian Wald did not work in the Crimea. Lystra Gretter composed the Nightingale Pledge.

A nurse turns a patient every 2 hours to prevent pressure ulcers, even though turning the patient is uncomfortable. Which ethical principle guides this action? A. Veracity B. Autonomy C. Justice D. Nonmaleficence

D. Nonmaleficence Nonmaleficence means to do no harm. Temporary discomfort outweighs the possibility of painful and difficult-to-treat pressure ulcers. Autonomy is self-determination. Justice is treating all patients fairly. Veracity is telling the truth.

The student of nursing history interprets, which of the following is an influence on nursing from early European history? A. Nursing education beginning at early European universities B. Changing emphasis on caring for victims of disasters C. Likelihood of surviving military wounds greatly increased D. War widows finding purpose and means of living by nursing

D. War widows finding purpose and means of living by nursing Because of the frequent nature of military conflicts, widows were common in the early European times. In order to survive, many widows joined the nuns and became nurses. Caring for disaster victims emerged as a 21st-century concern. Soldiers became more likely to survive their wounds starting in the Crimean War, but this was also noted as a trend during the Civil War. Baccalaureate education is a fairly recent trend; in 1919, there were only nine BSN programs.

A nurse witnesses an assistive personnel (AP) they are supervising reprimanding a client for not using the urinal properly. The AP threatens to put a diaper on the client if the urinal is not used more carefully next time. Which of the following torts is the AP committing? A. Assault B. Battery C. False imprisonment D. Invasion of privacy

A. Assault Assault is conduct that makes a person fear they will be harmed.

A nurse is hired to replace a staff member who has resigned. After working on the unit for several weeks, the nurse notices that the unit manager does not intervene when there is conflict between team members, even when it escalates. Which of the following conflict resolution strategies is the unit manager demonstrating? A. Avoidance B. Smoothing C. Cooperating D. Negotiating

A. Avoidance The goal in resolving conflict is a win-win situation. The unit manager is using an ineffective strategy, avoidance, to deal with this conflict. Although the unit manager is aware of the conflict, they are not attempting to resolve it.

A nurse manager is developing an orientation plan for newly licensed nurses. Which of the following information should the manager include in the plan? (Select all that apply.) A. Skill proficiency B. Assignment to a preceptor C. Budgetary principles D. Computerized charting E. Socialization into the unit culture F. Facility policies and procedures

A., B., D., E., F. The purpose of orientation is to assist the newly licensed nurse to transition from the role of student to the role of employee and licensed nurse. Include evaluation of skill proficiency and provide additional instruction as indicated.

An RN on a med-surg unit is making assignments at the beginning of the shift. Which of the following tasks should the nurse delegate to the PN? A. Obtain VS for a client who is 2 hr postprocedure following a cardiac catheterization B. Administer a unit of packed red blood cells (RBCs) to a client who has cancer. C. Instruct a client who is scheduled for discharge in the performance of wound care. D. Develop a plan of care for a newly admitted client who has pneumonia.

A. Obtain VS for a client who is 2 hr postprocedure following a cardiac catheterization. It is within the scope of practice of the PN to monitor a client who is 2 hr postprocedure for a cardiac catheterization, because the client is considered stable.

A nurse manager is observing the actions of a nurse they are supervising. Which of the following actions by the nurse requires the nurse manager to intervene? (Select all that apply). A. Reviewing the health care record of a client assigned to another nurse B. Making a copy of a client's most current laboratory results for the provider during rounds C. Providing information about a client's condition to hospital clergy D. Discussing a client's condition over the phone with an individual who has provided the client's information code E. Participating in walking rounds that involve the exchange of client related information outside clients' rooms

A., B., C., E.

A nurse manager is providing information about the audit process to members of the nursing team. Which of the following information should the nurse manager include? (Select all that apply.) A. A structure audit evaluates the setting and resources available to provide care. B. An outcome audit evaluates the results of the nursing care provided. C. A root cause analysis is indicated when a sentinel event occurs. D. Retrospective audits are conducted while the client is receiving care. E. After data collection is completed, it is compared to a benchmark.

A., B., C., E.,

A nurse is serving as a preceptor to a newly licensed nurse and is explaining the role of the nurse as advocate. Which of the following situations illustrates the advocacy role? (Select all that apply). A. Verifying that a client understands what is done during a cardiac catheterization B. Discussing treatment options for a terminal diagnosis C. Informing members of the health care team that a client has DO NOT resuscitate status D. Reporting that a health team member on the previous shift did not provide care as prescribed E. Assisting a client to make a decision about their care based on the nurse's recommendations

A., C., D.

A nurse is assisting with the discharge planning for a client. Which of the following actions should the nurse take? (Select all that apply). A. Determine the client's need for home medical equipment. B. Provide a list of all the medications the client received in the facility. C. Obtain printed instructions for medication self-administration. D. Provide the family with a list of community agencies that can provide assistance. E. Discuss the importance of attending follow-up appointments.

A., C., E.

Which statements properly apply an ethical principle to justify access to health care? (Select all that apply.) 1. Access to health care reflects the commitment of society to principles of beneficence and justice. 2. If low income compromises access to care, respect for autonomy is compromised. 3. Access to health care is a privilege in the United States, not a right. 4. Poor access to affordable health care causes harm that is ethically troubling because nonmaleficence is a basic principle of health care ethics. 5. If a new drug is discovered that cures a disease but at great cost per patient, the principle of justice suggests that the drug should be made available to those who can afford it.

Answer: 1, 2, and 4. Access to health care services can be justified through the application of the principles of justice, beneficence, respect for autonomy, and nonmaleficence. While option 3 is an opinion that can be justified with ethical analysis, no justification is offered in this statement, so this option is not correct. Option 5 again describes a point of view, but no ethical principles are described that support this view. Option 6 is incorrect because justice refers to fairness in the distribution of resources and basing access to medication only on income may not be fair.

Which statements reflect the difficulty that can occur for agreement on a common definition of the word quality when it comes to quality of life? (Select all that apply.) 1. Community values influence definitions of quality, and they are subject to change over time. 2. Individual experiences influence perceptions of quality in different ways, making consensus difficult. 3. The value of elements such as cognitive skills, ability to perform meaningful work, and relationship to family is difficult to quantify using objective measures. 4. Statistical analysis is difficult to apply when the outcome cannot be quantified. 5. Whether a person has a job is an objective measure, but it does not play a role in understanding quality of life.

Answer: 1, 2, and 4. These statements describe why a single definition for the term quality of life is challenging. Options 3 and 5 are true statements, but they do not explain why the definition of quality of life is difficult to agree on, which is what the question asks for.

Resolution of an ethical problem involves discussion with the patient, the patient's family, and participants from appropriate health care disciplines. Which statement best describes the role of the nurse in the resolution of ethical problems? 1. To articulate the nurse's unique point of view, including knowledge based on clinical and psychosocial observations 2. To study the literature on current research about the possible clinical interventions available for the patient in question 3. To hold a point of view but realize that respect for the authority of administrators and physicians takes precedence over personal views 4. To allow the patient and the physician private time to resolve the dilemma on the basis of ethical principles

Answer: 1. The ideal process for resolving ethical problems engages the perspectives of all involved, and nurses, as members of the health care team, have a valuable and unique point of view to share. Option 2 is a strategy that assists in answering a clinical question but does not address ethics. Options 3 and 4 are incorrect because both suggest that the nurse disengage from her own values and critical thinking and follow an action driven by the points of views of others

Match the following actions (1 through 4) with the terms (a through d) listed below: a. Advocacy b. Responsibility c. Accountability d. Confidentiality 1. You see an open medical record on the computer and close it so that no one else can read the record without proper access. 2. You administer a once-a-day cardiac medication at the wrong time, but nobody sees it. However, you contact the provider and your head nurse and follow agency procedure. 3. A patient at the end of life wants to go home to die, but the family wants every care possible. The nurse contacts the primary care provider about the patient's request. 4. You tell your patient that you will return in 30 minutes to give him his next pain medication.

Answer: 1d, 2c, 3a, 4b. Action 1 corresponds with option d. Preventing unnecessary access to a patient's health care information protects the patient's right to confidentiality. Action 2 corresponds to option c, accountability. Accountability refers to taking ownership of one's actions, which includes acknowledging errors. Action 3 corresponds to option a, advocacy. Sharing the patient's stated wish with other members of the health care team is an example of using your voice to benefit another person, in this case the patient. Action 4 corresponds with option b, responsibility. By following through on an established plan in caring for the patient, the nurse demonstrates responsibility.

A nurse is participating in a quality improvement study of a procedure frequently performed on the unit. Which of the following information will provide data regarding the efficacy of the procedure? A. Frequency with which procedure is performed B. Client satisfaction with performance of procedure C. Incidence of complications related to procedure D. Accurate documentation of how procedure was performed

C. Incidence of complications related to procedure The incidence of complications related to the procedure is an outcome measure directly related to the efficacy of the procedure.

What is the best response for the nurse to give if a patient asks the nurse to send a photo of an x-ray to him via a messaging tool in a social media site? 1. Yes, if you remove all patient identifiers before sending 2. No, because the patient's x-ray results should be discussed with a provider 3. Yes, because respect for autonomy means honoring this patient's request 4. No, because health information of any kind should not be shared on social media

Answer: 4. Patient information should not be shared over social media. While the patient does have a right to obtain health records, this is not the best mechanism by which to share the information. Even without specific identifiers, the information could be seen by others and attributed to the patient.

A case manager is discussing critical pathways with a group of newly hired nurses. Which of the following statements indicates understanding? A. "The time to fill out the pathways often increases the cost of care." B. "The pathway shows an estimate of the number of days the client will be hospitalized." C. "Deviance from the pathway is a sign of improved care quality." D. "The pathway includes information about the client's history."

B. "The pathway shows an estimate of the number of days the client will be hospitalized." Critical pathways are specific to a client diagnosis and show the average length of stay a client with the diagnosis type will have.

A newly licensed nurse is preparing to insert an IV catheter in a client. Which of the following sources should the nurse use to review the procedure and the standard at which it should be performed? A. Website B. Institutional policy and procedure manual C. More experienced nurse D. State nurse practice act

B. Institutional policy and procedure manual The institutional policy and procedure manual will provide instructions on how to perform the procedure that is consistent with established standards. This is the resource that should be used.

A nurse is caring for a client who has chest pain. The client says, "I am going home immediately." Which of the following actions should the nurse take? (Select all that apply). A. Notify the client's family of their intent to leave the facility. B. Document the client's intent to leave the facility against medical advice (AMA). C. Explain to the client the risks involved if they choose to leave. D. Ask the client to sign a form relinquishing responsibility of the facility. E. Prevent the client from leaving the facility until the provider arrives.

B., C., D.

A nurse enters the room of a client and finds the client lying on the floor. Which of the following actions should the nurse take first? A. Call the provider B. Ask a staff member for assistance getting the client back in bed C. Inspect the client for injuries D. Instruct the client to ask for help if they need to get out of bed

C. The first action to take using the nursing process is to assess the client in order to determine which interventions the client will need.

A PN ending their shift reports to the RN that a newly hired AP has not calculated the intake and output for several clients. Which of the following actions should the RN take? A. Complete an incident report B. Delegate this task to the PN C. Ask the AP if they need assistance D. Notify the nurse manager

C. Ask the AP if they need assistance Find out what the AP knows about performing the task and provide education for the AP if indicated.

A nurse is caring for a client who is scheduled for surgery. The client hands the nurse information about advance directives and states, "Here, I don't need this. I am too young to worry about life sustaining measures and what I want done for me." Which of the following actions should the nurse take? A. Return the papers to the admitting department with a note stating that the client does not wish to address the issue at this time. B. Explain to the client that you never know what can happen during surgery and to fill the papers out just in case. C. Contact a client representative to talk with the client and offer additional information about the purpose of advance directives. D. Inform the client that surgery cannot be conducted unless the advance directives forms are completed.

C. Contact a client representative to talk with the client and offer additional information about the purpose of advance directives. The nurse should advocate for the client by ensuring that the client understands the purpose of advance directives. Seeking the assistance of a client representative to provide information to the client is an appropriate action.

Hospital leadership seeking Magnet™ status implemented a new governance structure, including a clinical nursing council that governs clinical nursing standards and care for the organization. This is an example of which leadership style? A. Autocratic leadership B. Transformational leadership C. Shared leadership D. Democratic leadership

C. Shared leadership In shared leadership, employees are empowered to make decisions for the organization. In transformational leadership, the leader provides the vision. In democratic leadership, the leader involves the followers in decision making. The leader still makes the final decision. In autocratic leadership, the leader makes all the decisions.

A nurse is caring for a child who is being treated in the emergency department following a head contusion from a fall. History reveals the child lives at home with one parent. The provider's discharge instructions include waking the child every hour to assess for indications of a possible head injury. In which of the following situations should the nurse intervene and attempt to prevent discharge? A. The parent states they do not have insurance or money for a follow up visit. B. The child states, "My head hurts and I want to go home." C. The nurse smells alcohol on the parent's breath. D. The parent verbalizes fear about taking the child home and requests they be kept overnight.

C. The nurse smells alcohol on the parent's breath. It would be unsafe to discharge a child who requires hourly monitoring with a parent who might be chemically impaired.

A nurse is caring for a client who is medically unstable. The client's adult child informs the nurse that the client has a DNR prescription with their primary care provider. Which of the following actions should the nurse take? A. Assume that the client does not want to be resuscitated, and take no action if they experience cardiac arrest. B. Write a note on the front of the provider prescription sheet asking that the DNR be represcribed. C. Write a DNR prescription in the client's medical record. D. Call the provider to verify the existence of an active DNR prescription.

D. Call the provider to verify the existence of an active DNR prescription. The nurse should immediately call the primary provider to validate whether the client has a current DNR order in place.

A nurse manager is providing information to the nurses on the unit about ensuring client rights. Which of the following regulations outlines the rights of individuals in health care settings? A. American Nurses Association Code of Ethics B. HIPAA C. Patient Self Determination Act D. Patient Care Partnership

D. Patient Care Partnership The Patient Care Partnership is a document that addresses clients' rights when receiving care.