The Nursing Process Prepu Questions
A client has a nursing diagnosis of Risk for injury related to adverse effects of potassium-wasting diuretics. What is a correctly written client outcome for this nursing diagnosis? "By discharge, the client correctly identifies three potassium-rich food sources." "Before discharge, the client knows which food sources are high in potassium." "The client understands all complications of the disease process." "The client knows the importance of consuming potassium-rich foods daily."
Correct response: "By discharge, the client correctly identifies three potassium-rich food sources." Explanation: A client outcome must be measurable, objective, concise, realistic for the client, and attainable through nursing management. For each client outcome, the nurse should include only one client behavior. The nurse should express that behavior in terms of client expectations and should indicate a time frame in which to accomplish it. Knowing the importance of consuming potassium-rich foods and knowing which foods are high in potassium aren't measurable outcomes. Understanding all complications of a disease process isn't measurable or specific to the nursing diagnosis listed.
A nurse overhears another nurse say to a client, "If you do not stop spitting, I'm going to leave you outside in your wheelchair so that you miss your dinner." What is the most appropriate response by the nurse who overhears this conversation? "Could you clarify for me whether you were joking with the client?" "I will have to report you for unprofessional behavior toward a client." "I think you need to review therapeutic communication techniques." "Your verbal threats to the client are legally considered assault."
Correct response: "Your verbal threats to the client are legally considered assault." Explanation: Assault is conduct that makes a person fearful and produces a reasonable apprehension of harm. The nurse's behavior in legal terms is assault.
The charge nurse on a hematology/oncology unit is reviewing the policy for using abbreviations with the staff. The charge nurse should emphasize which information about why dangerous abbreviations need to be eliminated? Select all that apply. to make data entry into a computerized health record easier to ensure efficient and accurate communication to ensure client safety to make it easier for clients to understand the medication prescription to prevent medication errors
Correct response: to ensure efficient and accurate communication to prevent medication errors to ensure client safety Explanation: Abbreviations can be misinterpreted and all health care professionals should avoid the use of easily misunderstood abbreviations. The purpose of avoiding abbreviations is not to make it easier for clients to understand the medication prescriptions or to make data entry easier.
A bedridden client is scheduled to receive subcutaneous injections of heparin at 8:00 a.m. and 8:00 p.m. each day. The client's medication administration record would present these times as 800 and 2200 0800 and 2200 0800 and 1200 0800 and 2000
Correct response: 0800 and 2000 Explanation: 8:00 a.m. is 0800 in military time and 8:00 p.m. is 2000.
While giving report to the oncoming night shift, the charge nurse smells alcohol on the breath of one of the nurses. The charge nurse should: assess the nurse's behavior for signs of intoxication. report this to the nursing supervisor immediately. report this to the head nurse in the morning. ask the nurse if she has been drinking.
Correct response: report this to the nursing supervisor immediately. Explanation: This situation should be reported immediately to the nursing supervisor or manager at the time. The nurse is liable to report a suspicious situation that could create an unsafe situation for the clients. Reporting a suspicious situation does not imply actual guilt; it implies identification of a high-risk situation. The supervisor will then follow the correct procedure for management and follow-up of the situation. This situation requires immediate attention and cannot be delayed until the head nurse is available on the day shift. The charge nurse, or another staff nurse, should not confront the nurse; this is the responsibility of the nursing supervisor. Assessment of the nurse's behavior is not the nurse's responsibility; reporting the potentially unsafe situation is.
A nurse who works on a palliative care unit has participated in several clinical scenarios that have required the application of ethics. Ethics is best defined as moral values are considered to be universal the laws that govern acceptable and unacceptable behavior the principles that determine whether an act is right or wrong the relationship between law and culture
Correct response: the principles that determine whether an act is right or wrong Explanation: Ethics involves moral or philosophical principles that direct actions as being either right or wrong. Laws are often rooted in ethics but the two terms are not synonymous. Similarly, morals and values are closely associated with ethics but these do not constitute the definition of ethics. Ethics are not universally agreed upon, as many different applications exist.
A nurse manager overhears a nurse caring for a client with an I.V. make this statement: "If you don't stop playing with your I.V., I will tie your hand to the side rail." What is the most appropriate response by the nurse manager to address this situation? "You will save the client from another I.V. insertion by restraining the client's hand." "You need to think of a more creative way to stop the client from playing with the I.V." "I need to inform you that your behavior is within the definition of assault." "I'm sure the client knows you were joking, but it was still inappropriate to say."
Correct response: "I need to inform you that your behavior is within the definition of assault." Explanation: The nurse's response is threatening and could legally be interpreted as assault. The manager must intervene in the best interest of the client and take the opportunity to educate the nurse regarding the comments and potential actions. The other options do not represent appropriate interventions for the scenario described.
The nurse managers of a home healthcare office wish to maximize nurses' freedom to characterize and record client conditions and situations in the nurses' own terms. Which documentation format is most likely to promote this goal? charting by exception narrative notes SOAP notes focus charting
Correct response: narrative notes Explanation: One of the advantages of a narrative notes model of documentation is that it allows nurses to describe clinical encounters in their own terms, as they understand them. Other documentation formats, such as SOAP notes, focus charting, and charting by exception, are more rigidly delineated and allow nurses less latitude in their documentation.
The nurse's responsibility concerning informed consent is reflected in which client statement? "If I am declared mentally incompetent, I can give informed consent if I am in the hospital under a mental health regulatory law." "I must be fully informed about treatments, tests, alternative treatments, and the risks and benefits of each." "The healthcare provider and the nurse must each obtain informed consent from me." "My 14-year-old child may give informed consent to all medical and nursing procedures without my consent."
Correct response: "I must be fully informed about treatments, tests, alternative treatments, and the risks and benefits of each." Explanation: Before informed consent is given, the physician performing the procedure must tell the client about the treatment, tests, alternative treatments, and the risks and benefits of each. A professional nurse involved in the informed consent process witnesses the consent and does not actually obtain the consent. The physician is responsible for obtaining consent. Only a minor who is married or emancipated may give informed consent. A client must be mentally competent to legally give informed consent for procedures.
A nurse is caring for a client who is receiving hospice care at home. The client's neighbors have been calling the nurse to inquire about the client's condition. What should the nurse tell the neighbors? "The client is in a coma now." "Please call the client's sister" "Please call the oncologist." "The client is not expected to live much longer."
Correct response: "Please call the client's sister" Explanation: The family is in the best position to give the information they elect to disclose to friends and community members. The hospice nurse and the oncologist must maintain client confidentiality and follow privacy guidelines for release of confidential information. Therefore, disclosing any information about the client's condition would be inappropriate.
The nurse is instructing the unlicensed assistive personnel (UAP) on how to position the wheelchair to assist a client with left-sided weakness transfer from the bed to a wheelchair using a transfer belt. Which statement by the UAP tells the nurse that the UAP has understood the instructions for placing the wheelchair? "I'll place the wheelchair behind the client." "The wheelchair should be placed on the right side of the bed." "As long as I assist the client with the belt, it doesn't matter where the wheelchair goes." "The wheelchair should be placed at the head of the bed."
Correct response: "The wheelchair should be placed on the right side of the bed." Explanation: When assisting a client with a weakness out of bed, it is important that the client always move toward the stronger side. This allows the client to assist in the move as much as possible. In this case, the client will need to move toward the right side of the bed to maximize the use of the strong arm and leg. Placing the wheelchair at the head of the bed or behind the client does not allow for a safe transfer of the client. The transfer belt is used to help the client balance and provide safety, not to lift the client; the transfer should be made with the least amount of work for both the client and the UAP while ensuring the safety of the client.
A client who has type 1 diabetes is being prepared to have a craniotomy to remove a tumor. The nurse is evaluating the client's understanding of the informed consent before witnessing the client's signature on the operative consent form. Which statement from the client indicates that the nurse needs to contact the surgeon for further communication with the client? "I will die if the tumor is not removed from my brain." "There are no major risks from this surgery." "The surgeon explained how the craniotomy was done." "We talked about the effect of my diabetes on healing."
Correct response: "There are no major risks from this surgery." Explanation: There are risks with both the surgical procedure and the general anesthesia required for a craniotomy. The risks involved in the procedure are a part of the informed consent. Therefore, if the client states a belief that there are no major risks from a craniotomy, the health care provider needs to provide further teaching. Other information that is part of an informed consent includes potential complications, expected benefits, inability of the surgeon to predict results, irreversibility of the procedure (if applicable), and other available treatments. Talking about the effects of the diabetes on healing, explaining how the craniotomy is performed, and explaining the consequences of declining treatment (e.g., death if the tumor is not removed) represent appropriate actions to provide information to the client.
The nurse is performing discharge teaching for a client who experienced a recent heart attack. The client reports feeling excited and ready to go home and "get on with life." What response by the nurse is most appropriate? "Do you recall the teaching done by the physiotherapist related to your heart attack?" "What are your plans for when you get home and back to getting on with your life?" "You sound excited to be recovering from your heart attack! A positive attitude is important" "While I am happy you are going home, your lifestyle will have to change considerably."
Correct response: "What are your plans for when you get home and back to getting on with your life?" Explanation: When preparing the client for discharge, the nurse investigates the client's understanding of the teaching and readiness for discharge by asking open-ended questions when possible. Closed questions such as "do you remember" could result in a "yes" response. Instead, the nurse reframes the client's comment while gathering more information about what activities may be planned and engages the client further depending on the response. The nurse should not lecture the client about lifestyle changes or simply praise the client for having a positive attitude.
The nurse is performing discharge teaching for a client who experienced a recent heart attack. The client reports feeling excited and ready to go home and "get on with life." What response by the nurse is most appropriate? "While I am happy you are going home, your lifestyle will have to change considerably." "What are your plans for when you get home and back to getting on with your life?" "You sound excited to be recovering from your heart attack! A positive attitude is important" "Do you recall the teaching done by the physiotherapist related to your heart attack?"
Correct response: "What are your plans for when you get home and back to getting on with your life?" Explanation: When preparing the client for discharge, the nurse investigates the client's understanding of the teaching and readiness for discharge by asking open-ended questions when possible. Closed questions such as "do you remember" could result in a "yes" response. Instead, the nurse reframes the client's comment while gathering more information about what activities may be planned and engages the client further depending on the response. The nurse should not lecture the client about lifestyle changes or simply praise the client for having a positive attitude.
A nurse in a rural community completed a workshop on traditional Chinese culture and how to incorporate traditional Chinese values into one's healthcare practice. One nurse notes caring for a client with Chinese heritage who did not act the way the nurse would anticipate based on the workshop. The nurse asks why the client's behavior differs from what is being taught. What is the most appropriate response by the presenter? "It is possible that your client did not grow up with a strong tie to cultural roots." "You have to remember that not all members of a culture share identical beliefs." "Many clients of other cultural backgrounds try to fit in with Western culture so they get equal treatment." "Clients behave in different ways depending on their health conditions."
Correct response: "You have to remember that not all members of a culture share identical beliefs." Explanation: The nurse is assuming that all members of a culture behave in a manner that reflects the same values and beliefs. This is not accurate and relies on stereotyping. Regardless of a client's diagnoses or health concerns, cultural practices will vary within groups. The upbringing of the client will influence cultural practices and preferences, but this is not the only factor that results in variation between people within a specific culture. Stating the client is trying to "fit in" is an assumption and should not be stated as a factor unless the nurse has assessed this to be true for this specific client. In a culturally safe environment, clients do not have to try to fit in.
A nurse is caring for a client who speaks only French. The client's grandchild is bilingual and assists with translating, but the nurse needs to provide the client with discharge instructions. Which option would be best for the nurse and the client? Provide the information to the grandchild, and have the grandchild translate in the nurse's presence. Document on the medical record that discharge instruction was not provided due to a language barrier. Ask the manager to find an interpreter who is able to provide the discharge instructions. Provide written instructions in English, and ask the grandchild to translate them at home.
Correct response: Ask the manager to find an interpreter who is able to provide the discharge instructions. Explanation: The best option would be for an interpreter to provide translation and for the nurse to document the health teaching and discharge instructions. The two can work together to provide the instructions verbally and in writing and answer the client's questions. There is no means for the English-speaking nurse to know whether the grandchild has translated the information accurately and whether the information was understood. The other option does not provide for competent nursing care.
The nurse is unable to find the health record (chart) for a client who has arrived for a clinic visit. Which is the best action by the nurse? Advise the client that the appointment will have to be rescheduled due to the fact that the medical record cannot be located. Document the information about the visit on paper, and transcribe these notes into the client's medical record once it is located. Call one of the client's other healthcare providers to request that a copy of the medical records for the client be sent to the clinic. Begin a new medical record with all client identifiers to document the current visit and merge this document into the medical record later.
Correct response: Begin a new medical record with all client identifiers to document the current visit and merge this document into the medical record later. Explanation: Documentation is an essential and legal component of providing care to clients. Information must be documented as it is collected. The nurse should not send the client away without the client getting the care that was to be provided. Therefore, the nurse creates a new record that contains all the client's appropriate identifiers so this can be added to the client's primary medical record when it is located. The nurse should be truthful about the missing records and should avoid transcribing notes whenever possible to avoid data errors. Another healthcare provider's records are not a substitute for the health record specific to this clinic. Requesting records from another provider would only be appropriate if relevant to the client's current reason for the visit and if the client consented to the transfer of this information.
An unlicensed nursing personnel (UAP) recorded a client's 0600 blood glucose level as 126 mg/dL (7 mmol/L) instead of 216 mg/dL (12 mmol/L). The UAP did not recognize the error until 0900 but reported it to the nurse right away. What should the nurse do first? Wait and observe the client for symptoms of hyperglycemia. Call the health care provider (HCP). Reprimand the UAP for the error. Complete an incident report.
Correct response: Call the health care provider (HCP). Explanation: The error should be reported to the HCP promptly; the HCP may write additional prescriptions. The nurse should complete an incident report because a potentially dangerous event happened during the client's care. The nurse should observe the client for symptoms of hyperglycemia but first must call the HCP and complete an incident report. The UAP does not need to be reassigned for this error. The nurse does not need to reprimand the UAP for the error because the UAP already knows an error was made and has reported it to the nurse.
Client 1: 1300 - After lunch toileting Client 2: 1300 - Dressing change to left heel wound Client 3: 1300 - Intravenous piggyback (100 cc) every 6 hours Client 4: 1300 - Soonest time for requested post-operative pain medication The nurse is reviewing this worksheet with the unlicensed assistive personnel (UAP) when prioritizing afternoon nursing care. What is the priority order for the nurse's administration of client care at 1300 hours? Client 4, Client 3, Client 2, Client 1 Client 2, Client 1, Client 3, Client 4 Client 3, Client 1, Client 2, Client 4 Client 4, Client 1, Client 3, Client 2
Correct response: Client 4, Client 3, Client 2, Client 1 Explanation: It is important for the nurse to prioritize care in an efficient manner. The highest priority for the afternoon is administering requested pain medication for a postoperative client. Next, the intravenous piggyback would be initiated; the wound dressing could be changed while the IV is infusing. A client on a toileting schedule would be taken to the restroom as the last priority; this task that could also be delegated.
The nurse-manager on the oncology unit wants to improve documentation of the effectiveness of analgesia medication within 30 minutes after administration. What should the nurse-manager do first? Change the policy of documentation to 45 minutes. Consult the pharmacist. Consult the nurses on the evening shift where documentation of analgesia is the greatest problem. Complete a brief quality improvement study and chart audit to document the rate of adherence to the policy and the pattern of documentation over shifts.
Correct response: Complete a brief quality improvement study and chart audit to document the rate of adherence to the policy and the pattern of documentation over shifts. Explanation: To determine the cause of this problem, a quality improvement study should be conducted along with a chart audit. Before implementing solutions to a problem, the precise issues in the hospital system must be observed and documented. Changing the time to chart from 30 minutes to 45 minutes does not solve the problem. It is not the pharmacist's role to provide consultation about documentation of drugs administered by nurses. Consulting the evening nurses may be helpful, but this is a systems issue of the entire unit and involves every registered nurse (RN) administering analgesia.
The nurse-manager on a gynecologic surgical unit is addressing reports from clients that they have to wait too long on the night shift for their pain medication. Which course of action should the nurse-manager take first? Change the staffing schedule on nights to include a medication nurse. Consult the nursing supervisor. Complete a quality improvement study with the night nurses to document the waiting times for pain medication and other data, including staffing and patient acuity. Consult the nurses on the evening shift about their evaluation of the night nurses regarding these concerns.
Correct response: Complete a quality improvement study with the night nurses to document the waiting times for pain medication and other data, including staffing and patient acuity. Explanation: To determine the cause of this problem, a quality improvement study should be conducted. Before implementing solutions to a problem, the precise issues in the hospital system must be observed and documented. Consulting with the evening nurses may result in biased observations because the evening nurses are not conducting care under the same environment as the night nurses. Including a medication nurse is not the first step in understanding the problem and may be an unrealistic or expensive solution. The supervisor is not directly involved with the problem and should only be consulted if the problem cannot be solved by those involved.
A nurse is caring for a client with a central venous pressure (CVP) of 4 mm Hg. Which nursing intervention is appropriate? Re-zero the equipment and take another reading. Call the physician and obtain an order for a fluid bolus. Continue to monitor the client as ordered. Call the physician and obtain an order for a diuretic.
Correct response: Continue to monitor the client as ordered. Explanation: Normal CVP ranges from 3 to 7 mm Hg. The nurse doesn't need to take any action other than to monitor the client. It isn't necessary to re-zero the equipment. Calling a physician and obtaining an order for a fluid bolus would be an appropriate intervention if the client has a CVP less than 3 mm Hg. Administering a diuretic would be appropriate if the client had excess fluid, as demonstrated by a CVP greater than 7 mm Hg.
A couple visiting the infertility clinic for the first time states that they have been trying to conceive for the past 2 years without success. After a history and physical examination of both partners, what would be the most appropriate outcome for the couple to accomplish by the end of this visit? Describe each of the potential causes and possible treatment modalities. Discuss alternative methods of having a family, such as adoption. Choose an appropriate infertility treatment method. Acknowledge that only 50% of infertile couples achieve a pregnancy.
Correct response: Describe each of the potential causes and possible treatment modalities. Explanation: By the end of the first visit, the couple should be able to identify potential causes and treatment modalities for infertility. If their evaluation shows that a treatment or procedure may help them to conceive, the couple must then decide how to proceed, considering all of the various treatments before selecting one. Treatments can be difficult, painful, or risky. The first visit is not the appropriate time to decide on a treatment plan because the couple needs time to adjust to the diagnosis of infertility, a crisis for most couples. Although the couple may be in a hurry for definitive therapy, a thorough assessment of both partners is necessary before a treatment plan can be initiated. The success rate for achieving a pregnancy depends on both the cause and the effectiveness of the treatment, and in some cases it may be only as high as 30%. The couple may desire information about alternatives to treatment, but insufficient data are available to suggest that a specific treatment modality may not be successful. Suggesting that the couple consider adoption at this time may inappropriately imply that the couple has no other choice. If a specific therapy may result in a pregnancy, the couple should have time to consider their options. After a thorough evaluation, adoption may be considered by the couple as an alternative to the costly, time-consuming, and sometimes painful treatments for infertility.
The nurse manager on the orthopedic unit is reviewing a report that indicates that in the last month, five clients were diagnosed with pressure ulcers. What should the nurse manager do? Ask the staff education department to conduct an educational session about preventing pressure ulcers. Conduct a chart audit to determine which nurses on which shifts were giving nursing care to the clients with pressure ulcers. Use benchmarking procedures to compare the findings with other nursing units in the hospital. Institute a quality improvement plan that identifies contributing factors, proposes solutions, and sets improvement outcomes.
Correct response: Institute a quality improvement plan that identifies contributing factors, proposes solutions, and sets improvement outcomes. Explanation: The problem of pressure ulcers in hospitalized clients is best addressed by using quality improvement techniques to identify the problem, determining strategies for improvement, and setting goals for outcomes. Benchmarking for comparison will indicate where this nursing unit compares with other units, but does not address the problem for this unit; having clients with pressure ulcers on any unit is not acceptable. Educational programs are more effective after there is an understanding of the problem. Chart audits and blaming do not solve the problem or address quality improvement measures.
A couple visiting the infertility clinic for the first time states that they have been trying to conceive for the past 2 years without success. After a history and physical examination of both partners, what would be the most appropriate outcome for the couple to accomplish by the end of this visit? Discuss alternative methods of having a family, such as adoption. Choose an appropriate infertility treatment method. Acknowledge that only 50% of infertile couples achieve a pregnancy. Describe each of the potential causes and possible treatment modalities.
Correct response: Describe each of the potential causes and possible treatment modalities. Explanation: By the end of the first visit, the couple should be able to identify potential causes and treatment modalities for infertility. If their evaluation shows that a treatment or procedure may help them to conceive, the couple must then decide how to proceed, considering all of the various treatments before selecting one. Treatments can be difficult, painful, or risky. The first visit is not the appropriate time to decide on a treatment plan because the couple needs time to adjust to the diagnosis of infertility, a crisis for most couples. Although the couple may be in a hurry for definitive therapy, a thorough assessment of both partners is necessary before a treatment plan can be initiated. The success rate for achieving a pregnancy depends on both the cause and the effectiveness of the treatment, and in some cases it may be only as high as 30%. The couple may desire information about alternatives to treatment, but insufficient data are available to suggest that a specific treatment modality may not be successful. Suggesting that the couple consider adoption at this time may inappropriately imply that the couple has no other choice. If a specific therapy may result in a pregnancy, the couple should have time to consider their options. After a thorough evaluation, adoption may be considered by the couple as an alternative to the costly, time-consuming, and sometimes painful treatments for infertility.
When maintaining medical records for a client, the nurse knows that a medical record also serves as legally admissible evidence. What should the nurse do to ensure legally defensible charting? Use abbreviations wherever possible. Ensure that the client's name appears on all pages. Record all facts and subjective interpretations. Leave spaces between entries and signature.
Correct response: Ensure that the client's name appears on all pages. Explanation: The nurse should ensure that the client's name appears on all pages to ensure legally defensible charting. The nurse should not leave spaces between entries and signature so that the document is legally acceptable. The nurse should use only abbreviations approved by the facility, and not use abbreviations wherever possible. The nurse should record all facts but not any subjective interpretations to ensure that the document is legal evidence.
A public health nurse is working in a community immunization clinic. Client information gathered at the clinic is stored and transported to the health unit on a portable memory device. Which action must the nurse take to protect the confidentiality of the information? Lock the memory device at all times. Have a backup copy on a portable computer. Make sure the nurse's computer is password protected. Ensure that the information on the memory device is protected.
Correct response: Ensure that the information on the memory device is protected. Explanation: The only way to ensure the information remains confidential is to encrypt it. The other options do not provide enough security if the device is lost or stolen. Passwords can be bypassed and the device can be stolen even from a locked area.
The child of an alert and oriented elderly client asks what parent's most recent blood glucose level was. What is the nurse's best response? Have the child sign a "Disclosure of Health Information" form prior to giving the child the information. Tell the client's child the blood glucose level because this test is performed on the nursing unit. Explain that this information cannot be disclosed without the client's permission. Ask the client's child if she has her parent's permission to access the parent's health information.
Correct response: Explain that this information cannot be disclosed without the client's permission. Explanation: The Health Insurance Portability and Accountability Act in the United States, and the Canadian Privacy Act and the Personal Information Protection and Electronic Documents Act (and often provincial/territorial legislation) prevents family members or friends from acquiring health information without consent of the client involved. Whether the test was performed on the nursing unit or others had given the client's child this information is irrelevant; the client's test results are still protected health information. The nurse should not ask the client's child if the child has permission, the client should be asked. If a disclosure of health information form is signed, it should be the client signing, not the daughter. (Note: the caregiver of a client who is incapacitated CAN be given healthcare information.)
The child of an alert and oriented elderly client asks what parent's most recent blood glucose level was. What is the nurse's best response? Tell the client's child the blood glucose level because this test is performed on the nursing unit. Explain that this information cannot be disclosed without the client's permission. Have the child sign a "Disclosure of Health Information" form prior to giving the child the information. Ask the client's child if she has her parent's permission to access the parent's health information.
Correct response: Explain that this information cannot be disclosed without the client's permission. Explanation: The Health Insurance Portability and Accountability Act in the United States, and the Canadian Privacy Act and the Personal Information Protection and Electronic Documents Act (and often provincial/territorial legislation) prevents family members or friends from acquiring health information without consent of the client involved. Whether the test was performed on the nursing unit or others had given the client's child this information is irrelevant; the client's test results are still protected health information. The nurse should not ask the client's child if the child has permission, the client should be asked. If a disclosure of health information form is signed, it should be the client signing, not the daughter. (Note: the caregiver of a client who is incapacitated CAN be given healthcare information.)
A newly admitted client in a skilled nursing facility has diabetes and is experiencing episodes of hypoglycemia. Place in the order the manner in which the nurse should provide evening care to the resident. All options must be used. Click an option, hold and drag it to the desired position, or click an option to highlight it and move it up or down in the order using the arrows to the left. 1Assess percentage of the meal eaten. 2Administer 20 units of insulin aspart. 3Identify the client using two identifiers. 4Assess the client's blood glucose level. 5Provide an evening snack. 6Provide an evening meal.
Correct response: Identify the client using two identifiers. Assess the client's blood glucose level. Provide an evening meal. Assess percentage of the meal eaten. Administer 20 units of insulin aspart. Provide an evening snack. Explanation: The order for the nurse to follow is to first identify the client using two identifiers, assess the client's blood glucose level, provide the client with an evening meal, assess the percentage of the meal the client has eaten, administer 20 units of insulin aspart, and provide an evening snack. This order will include assessments and prevent administering insulin if resident does not eat.
A family member of a resident in a long-term care facility reports to the nurse that her mother's diamond ring is missing. Another resident reported a day earlier that a twenty-dollar bill was missing from his/her night table. What should the nurse do in this situation? Remind the residents and family members not to leave valuables unattended. Notify the supervisor and call the police. Pass the information on to the doctor and the next shift staff. Report the incidents to the facility's lawyer.
Correct response: Notify the supervisor and call the police. Explanation: The supervisor should be made aware of the situation and the police should be called to investigate the potential theft. The other answers do not advocate for the clients and their families. It is the responsibility of the nurse to take action because the nurse was the person to receive the information. This is known as due diligence.
Which measure should a home healthcare nurse implement to minimize the potential for lawsuits? Have the client sign a waiver prior to the entry phase of a visit. Apply more conservative interventions than those used in a hospital setting. Perform thorough, accurate, and timely documentation. Integrate the client's learning needs and goals into plans of care.
Correct response: Perform thorough, accurate, and timely documentation. Explanation: The need for thorough documentation is especially high in home healthcare settings, both to ensure continuity of care and to provide a legally acceptable record of what occurred during nurse-client interactions. The nurse should not implement more conservative interventions solely to minimize liability, and a waiver of rights is not a component of home healthcare. The client's learning needs and goals should indeed by integrated into plans of care but this action does not protect against lawsuits.
The nurse discusses with the parents how best to raise the IQ of their child with Down syndrome. Which intervention would be most appropriate? Let the child play with more able children. Serve hearty, nutritious meals. Provide stimulating, nonthreatening life experiences. Give vasodilator medications as prescribed.
Correct response: Provide stimulating, nonthreatening life experiences. Explanation: Nonthreatening experiences that are stimulating and interesting to the child have been observed to help raise IQ. Practices such as serving nutritious meals or letting the child play with more able children have not been supported by research as beneficial in increasing intelligence. Vasodilator medications act to increase oxygenation to the tissues, including the brain. However, these medications do not increase the child's IQ.
A nurse arriving for duty notes that an unlicensed assistive personnel (UAP) has been assigned to a complex client with treatments involving sterile technique. What is the responsibility of the nurse regarding the assignment of the UAP? Supervise the UAP during the treatments involving sterile technique. Make sure the UAP has practiced sterile technique on at least one other occasion. Provide the UAP with a list of resources to guide the implementation of care. Reassign the UAP to a client requiring basic tasks that the UAP has mastered.
Correct response: Reassign the UAP to a client requiring basic tasks that the UAP has mastered. Explanation: The nurse is accountable for the delegation of tasks to UAPs. The nurse delegates tasks to UAPs consistent with their level of expertise and education, the job description, agency policy, legislation, and personal need. UAPs should not be assigned to clients who are complex or require skills that involve a higher level of knowledge. Based on the choices offered, if the nurse is confident that the UAP has the appropriate knowledge regarding basic tasks, the tasks can be delegated. The other options are incorrect, as they do not ensure that the UAP has the knowledge and skill to provide the care or carry out the task.
A postmenopausal client is scheduled for a bone density scan. What should the nurse instruct the client to do? Report any significant pain to the health care provider at least 2 days before the test. Remove all metal objects on the day of the scan. Consume foods and beverages with a high content of calcium for 2 days before the test. Ingest 600 mg of calcium gluconate by mouth for 2 weeks before the test.
Correct response: Remove all metal objects on the day of the scan. Explanation: Metal will interfere with the test. Metallic objects within the examination field, such as jewelry, earrings, and dental amalgams, may inhibit organ visualization and can produce unclear images. Ingesting foods and beverages days before the test will not affect bone mineral status. Short-term calcium gluconate intake will also not influence bone mineral status. The client may already have had chronic pain as a result of a bone fracture or from osteoporosis.
A nurse suspects that a coworker is taking and using narcotics from the medication cart. What would the nurse do first? Keep track of the quantity of medications in the cart throughout the shift. Discuss the suspicion directly with the coworker. Monitor the coworker's behaviors. Report the suspicion to the nurse manager.
Correct response: Report the suspicion to the nurse manager. Explanation: The nurse should report the suspicion to the nurse manager. The American Nurses Association does not advise confronting coworkers in these situations. Monitoring the coworker's behavior or keeping track of the quantity of medications in the cart do not solve these problem. These actions allow the coworker to continue working with clients while possibly under the influence of drugs, which is not safe.
A healthcare facility plans to evaluate and revise the plan of care for a client based on the client's medical records. The physician, dietitian, and nurse involved in the client's care are required to collate all information for easy access. Which style do you think the agency is following to record the client details? SOAP charting focus charting narrative charting PIE charting
Correct response: SOAP charting Explanation: In SOAP charting, everyone involved in a client's care makes entries in the same location in the chart. Narrative charting is time-consuming to write and read, as it involves sorting through the lengthy notation for specific information that correlates the client's problems with care and progress. Focus charting follows a DAR model. PIE charting is a method of recording the client's progress under the headings of problem, intervention, and evaluation.
The nursing student is having difficulty obtaining a mobile computer for the purpose of administering medications using the electronic medical record. The student has been reprimanded for delivering medications late in the past and wants to ensure timely administration. What action should the student take? Speak to the instructor about the unavailability of mobile computers for medication administration, and request assistance in obtaining one. Wait for a mobile computer to become available, and explain to the instructor that the reason for late administration was related to adhering to safety policy. Print a copy of the medication record at the nurse's station to use at the bedside in order to administer the medications on time. Use the medication dispensing terminal to prepare the medications, and print a dispensing receipt to use for patient identification at the beside.
Correct response: Speak to the instructor about the unavailability of mobile computers for medication administration, and request assistance in obtaining one. Explanation: When equipment is not readily available, it can be tempting to use work-arounds. Although down-time procedures may exist that allow for printing of the medication record, this is not the problem the student is facing. The student should make every effort to obtain the computer so the electronic medication record can be used appropriately for medication administration. Speaking to the instructor in advance, rather than afterwards, demonstrates superior communication and problem solving skills.
The nurse is providing care to several clients. In which situation would the nurse be able to accept a verbal order from the healthcare provider? The client reports new onset headache and has a blood pressure of 90/50 mm Hg. The client is hemorrhaging from a surgical wound. The client has just been admitted to the unit from the emergency department. The client is being transported to the cardiac catheterization department.
Correct response: The client is hemorrhaging from a surgical wound. Explanation: In most facilities, the only circumstance in which an attending healthcare provider may issue orders verbally is in a medical emergency, when the healthcare provider is present but finds it impossible to write the order. The postoperative hemorrhage is the only scenario that could be considered an emergency. Although the one client's blood pressure is low, there is no evidence there this is a potentially life-threatening situation. When clients are transferred between facilities or departments, there is time to write prescriptions, so the healthcare provider should enter these directly into the medical record as the safest form of documentation.
During the process of restraining a client, a staff member was injured. The nurse manager would decide that a peer support program has been helpful for the injured staff member if which outcome has been achieved? Select all that apply. Legal action has been taken against the client. The injured staff member has debriefed with other staff involved in the restraint. A plan has been arranged to facilitate the return of the injured staff member to work. The injured staff member has had the opportunity to express feelings with a support group. The injured staff member has decided whether to talk to the assaultive client.
Correct response: The injured staff member has debriefed with other staff involved in the restraint. The injured staff member has had the opportunity to express feelings with a support group. The injured staff member has decided whether to talk to the assaultive client. A plan has been arranged to facilitate the return of the injured staff member to work. Explanation: Talking with other staff and his personal support system help diminish fears and anger about being injured. It is appropriate to facilitate the injured staff member's return to work to decrease the chance of resignation or difficulties in performing duties. Talking with the assaultive client can be helpful if the client is apologetic but is not required. Legal action against a client is controversial and not always appropriate depending on the client's illness.
A home care nurse is caring for a paralyzed client who needs regular position changes and back massages. A person identifying themself as a family friend inquires if they can be of any help to the family. What should be the nurse's response be? The nurse should refer the person to the local social worker. The nurse should invite the person to learn the caring techniques. The nurse should state that the family does not need any help. The nurse should ask the person to talk to the family directly.
Correct response: The nurse should ask the person to talk to the family directly. Explanation: The nurse should ask the person to talk to the family directly. Revealing information about the client's care is a violation of the client's privacy. The nurse should not invite the person for a learning session because doing so would be a breach of the client's right to privacy. Referring the person to a social worker is not an appropriate choice.
An older adult client is being admitted to same-day surgery for cataract extraction. The client has several diamond rings. What information should the nurse give the client about how the rings will be secured during surgery? The rings will be locked in the narcotics box. The nursing supervisor will hold onto the rings until the client returns from the recovery room. The rings will be taped on the fingers before the surgery. The rings will be placed in an envelope, the client will sign the envelope, and the envelope will be placed in a safe.
Correct response: The rings will be placed in an envelope, the client will sign the envelope, and the envelope will be placed in a safe. Explanation: Under the policy for valuables, the nurse documents the description on an envelope with the client, the client and nurse sign the envelope, and the valuables envelope is locked in the safe. The other options increase the risk of loss or damage to the client's valuables.
An older adult alert and oriented client is admitted to the hospital for treatment of cellulitis of the left shoulder. Which fall prevention strategy is most appropriate for this client? Keep all the lights on in the room at all times. Use a night-light in the bathroom. Use a medical alert system. Keep all four side rails up at all times.
Correct response: Use a night-light in the bathroom. Explanation: Many falls occur when older clients attempt to get to the bathroom at night. The risk is even greater in an unfamiliar environment. Use of a nightlight in the bathroom enables the older adult client to see the way to the bathroom. Keeping the lights on in the room at all times may contribute to sensory overload and prevent adequate rest. Raised side rails paradoxically contribute to falls when the older client tries to climb over them to get to the bathroom. The upper side rails may be raised, but it is not recommended that all four side rails be elevated. Camera monitoring can be used but does nothing to prevent a fall.
A "read-back" procedure has been implemented on a nursing unit to prevent discrepancies in telephone prescriptions and reports. When should this procedure be implemented? When the float nurse gives a written report to the oncoming nurse When the lab report shows up on the computerized medical record When the nurse receives a critical lab value via phone or in-person from the lab When the unit clerk takes a telephone prescription for a stat lab test
Correct response: When the nurse receives a critical lab value via phone or in-person from the lab Explanation: For any verbal or telephone prescription or result, it is important to read back the information to assure its accuracy. It is also important to document that it was read back according to facility policy. It is not necessary to use "read-back" procedures when data are entered on the computerized medical record. The Unit clerk is not a licensed health care worker and should not take telephone prescriptions. When giving a written report, it is not necessary to "read back," but the nurse should always clarify if there is any question.
The nurse on the postpartum unit is caring for four couplets. There will be a new admission in 30 minutes. The new client is a G4 P4, Spanish-speaking only client with an infant who is in the special care nursery (SCN) for respiratory distress. The nurse should place the new client in a room with which client? a G1 P1 who is 1 day postpartum with an infant in the SCN a G1 P1 who is a non-English speaking client with infant in SCN for fetal distress a G4 P4 who is 2 days postpartum with infant, Spanish speaking only a G6 P6 who gave birth 4 hours ago by C/S for fetal distress, infant at bedside
Correct response: a G4 P4 who is 2 days postpartum with infant, Spanish speaking only Explanation: The ability to communicate with a person of the same language would be an advantage, an opportunity for socialization and support for the new mother who speaks Spanish. If a Spanish-speaking mother were placed with the client who also had a baby in SCN, she would have no communication opportunity, and the same would apply for rooming with the mother who has had a cesarean section. The client who is non-English speaking does not identify the language spoken, and the nurse cannot assume that it is Spanish.
The labor and birth nurse is assigned to triage for the day. There are four clients already in rooms, and reports have been received about each of these clients. To provide the safest care and best manage time, the nurse should plan to see which client first? a client with no prenatal care, occasional contractions, BP 148/90 mm Hg, and swollen feet a client who is at 42 weeks' gestation with bloody show, no contractions, rupture of membranes 1 hour ago leaking green fluid a primipara in active labor at 5 cm asking to be admitted and wanting an epidural a primipara who is 100% effaced, 8 cm dilated, + 2 station with nausea
Correct response: a client who is at 42 weeks' gestation with bloody show, no contractions, rupture of membranes 1 hour ago leaking green fluid Explanation: The client at 42 weeks' gestation is the greatest concern, and the nurse should make rounds on this client first based on the length of the pregnancy and the green color of the amniotic fluid. Bloody show is a normal sign of impending labor as the cervix may be beginning to dilate. Not having contractions after rupture of membranes is not unusual within a 1-hour time frame. The green amniotic fluid indicates that fetal distress has recently occurred to the point that the fetus had a bowel movement in utero. This occurrence, along with the 42-week gestation, places this fetus at greatest risk. The nurse can see the primipara in active labor at 5-cm dilation last; this client is in pain, but nothing about her situation indicates anything but a normal labor process, and as a primipara, her labor process will be slow. The client who is completely effaced, 8-cm dilated, and at +2 station is also a primipara, and thus will move through labor at a slower pace than a multiparous client. She is experiencing nausea that is an expected situation as a laboring client enters transition. The client with no prenatal care is a cause for concern because the nurse knows nothing about her background. Her blood pressure is elevated, an indicator of mild preeclampsia, but there are no other indications of worsening preeclampsia, such as headache, visual disturbances, or epigastric pain.
After completing assessment rounds, which client should the nurse discuss with the health care provider (HCP) first? a client with hepatitis whose pulse was 84 bpm and regular and is now 118 bpm and irregular a client with cirrhosis who is depressed and has refused to eat for the past 2 days a client with stable vital signs that has been receiving IV cipro following a cholecystectomy for 1 day and has developed a rash on the chest and arms a client with pancreatitis whose family requests to speak with the HCP regarding the treatment plan
Correct response: a client with hepatitis whose pulse was 84 bpm and regular and is now 118 bpm and irregular Explanation: A change in a client's baseline vital signs should be brought to the HCP's attention immediately. In this case, the client's heart rate has increased, and the rhythm appears to have changed; the HCP may prescribe an ECG to determine if treatment is necessary. The nurse should also have a complete set of current vital signs as well as a physical assessment before providing the HCP information using the SBAR format. The nutritional as well as psychological needs of a client must be addressed but are not first priority. A rash that develops after a new antibiotic is started must be brought to the HCP attention; however, this client is stable and is not the first priority. The nurse is responsible to facilitate discussion between the client, the client's family, and the HCP but only after all of the immediate physical and psychological needs of all clients have been met.
A client has been placed in an isolation room and family members have stated that access to the client seems restricted. Which actions would be appropriate for the nurse to take to address this situation? Select all that apply. acknowledgement of the family's concerns a communication plan for the family and client a thorough explanation of the isolation procedures discontinued isolation procedures at the family's request free access to the client for immediate family
Correct response: a communication plan for the family and client a thorough explanation of the isolation procedures acknowledgement of the family's concerns Explanation: To ensure that everyone complies with the isolation procedures, the nurse should develop a communication plan with the family and client, provide thorough explanations about the importance of complying with the isolation procedures, and address family and client concerns. Allowing free access or discontinuing isolation procedures at the family's request would be a safety violation.
What is a priority for the nurse developing a plan with a client admitted to the hospital with an acute exacerbation of rheumatoid arthritis? continuing to work on a positive self image because joint deformities are common in this disease achieving a controlled level of pain and fatigue throughout the day. accepting and working toward understanding long-term chronic illness always performing activities of daily living independently
Correct response: achieving a controlled level of pain and fatigue throughout the day. Explanation: Symptoms of rheumatoid arthritis include localized pain, stiffness, and decreased joint mobility after a period of rest, such as after sleeping. This can be more localized, which causes symptoms such as pain or stiffness. Lack of mobility over a period of time can increase the symptoms. Other answers are incorrect because they do not reflect management of care. Working on a positive self image is about self esteem. Always performing activities of daily living does not reflect promoting management; clients do not need to be independent. Accepting and working toward understanding is not about management.
When prioritizing a client's care plan based on Maslow's hierarchy of needs, a nurse's first priority would be ambulating the client in the hallway. administering pain medication. allowing family members to visit a newly admitted client. placing wrist restraints on the client.
Correct response: administering pain medication. Explanation: In Maslow's hierarchy of needs, pain relief is on the first layer. Love and belonging, as in allowing family members to visit, are on the third layer. Activity, as in ambulation, is on the fifth layer. Safety, as in placing wrist restraints on the client, is on the second layer.
A client, diagnosed with acute pancreatitis 5 days ago, is experiencing respiratory distress. Which finding should the nurse report to the health care provider (HCP)? lack of adventitious lung sounds arterial oxygen level of 46 mm Hg (6.1 kPa) oxygen saturation of 96% on room air respirations of 12 breaths/min
Correct response: arterial oxygen level of 46 mm Hg (6.1 kPa) Explanation: Manifestations of adult respiratory distress syndrome (ARDS) secondary to acute pancreatitis include respiratory distress, tachypnea, dyspnea, fever, dry cough, fine crackles heard throughout lung fields, possible confusion and agitation, and hypoxemia with arterial oxygen level below 50 mm Hg. The nurse should report the arterial oxygen level of 46 mm Hg (6.1 kPa) to the HCP. A respiratory rate of 12 is normal and not considered a sign of respiratory distress. Adventitious lung sounds, such as crackles, are typically found in clients with ARDS. Oxygen saturation of 96% is satisfactory and does not represent hypoxemia or low arterial oxygen saturation.
A hospitalized client fell on the floor and sustained a small laceration on the hand that requires stitches. The intern will suture the client's hand at the client's bedside and asks for bupivacaine with epinephrine and a suture kit in order to suture the laceration. Which issue should be resolved before proceeding with suturing? the cosmetic effect from not having a plastic surgeon do the suturing. the intern's ability to suture. bupivacaine with epinephrine used as the local anesthetic. the client's room as an aseptic environment.
Correct response: bupivacaine with epinephrine used as the local anesthetic. Explanation: The nurse should question the use of a local anesthetic agent with epinephrine on the hands or feet because the epinephrine is a vasoconstrictor and can cause ischemia and gangrene of extremities. The nurse should suggest that the intern use bupivacaine without epinephrine as the local anesthetic agent. An intern should be trained in suturing small superficial incisions, and the cosmetic effect should be acceptable. The client's room should be a sufficiently aseptic environment because there is no other client in the room.
What would be important environmental assessments for the home care nurse to explore with a client who is being discharged home? checking access to the home with a walker, access and safety measures in the bathroom, and access to food preparation in the kitchen, and ensuring safety in the sleeping environment ordering a wheelchair, special utensils, and a raised toilet seat and rearranging the furniture in the home checking the cleanliness of the home, ensuring removal of clutter, and organizing all essentials on one level of the house reinforcing the importance of having renovations done before discharge to enable wheelchair access and accessibility to all needs for daily living
Correct response: checking access to the home with a walker, access and safety measures in the bathroom, and access to food preparation in the kitchen, and ensuring safety in the sleeping environment Explanation: Safety and access in the client's home are important to assess before discharge to ensure that the client can manage at home.
A child with spastic cerebral palsy is to begin botulinum toxin type A injections. Which treatment goals should the health care team set for the child related to botulinum toxin? Select all that apply. improved nutritional status decreased pain from spasticity reduced caregiver strain decreased speech impediments enhanced self-esteem improved motor function
Correct response: decreased pain from spasticity improved motor function enhanced self-esteem reduced caregiver strain Explanation: Botulinum toxin injections can be used to improve many aspects of quality of life for the child with cerebral palsy. The injections can help decrease pain from spasticity. Injections improve motor status by reducing rigidity and allowing for more effective physical therapy to improve range of motion. Decreased spasms enhance self-esteem. Improved motor status facilitates the ability to provide some aspects of care, especially transfers. Botulinum does not significantly affect nutritional status or speech.
A healthcare agency has set a plan to apply for accreditation. A nurse on the accreditation committee has been assigned to audit clients' medical records for appropriate documentation. What information would the nurse assess in the audit? evidence of home care and nursing follow-up for 6 weeks following discharge evidence that nurses have set goals for improving future practice evidence that nursing interventions have been evaluated in terms of the client's response evidence of self-reflection from nursing and other care providers about the quality of their care
Correct response: evidence that nursing interventions have been evaluated in terms of the client's response Explanation: The medical record serves multiple purposes, including a role in accreditation. Accreditors look for evidence of evaluation following interventions. The medical record is not the correct venue for nurses' self-reflection or personal goal-setting. Many clients do not require community-based follow-up after they have been discharged.
A healthcare agency has set a plan to apply for accreditation. A nurse on the accreditation committee has been assigned to audit clients' medical records for appropriate documentation. What information would the nurse assess in the audit? evidence that nursing interventions have been evaluated in terms of the client's response evidence of self-reflection from nursing and other care providers about the quality of their care evidence of home care and nursing follow-up for 6 weeks following discharge evidence that nurses have set goals for improving future practice
Correct response: evidence that nursing interventions have been evaluated in terms of the client's response Explanation: The medical record serves multiple purposes, including a role in accreditation. Accreditors look for evidence of evaluation following interventions. The medical record is not the correct venue for nurses' self-reflection or personal goal-setting. Many clients do not require community-based follow-up after they have been discharged.
A nurse on a night shift entered an elderly client's room during a scheduled check and discovered the client on the floor beside the bed after falling when trying to ambulate to the washroom. After assessing and assisting the client back to bed, the nurse has completed an incident report. What is the primary purpose of this particular type of documentation? protecting the nurse and the hospital from litigation identifying risks and ensuring future safety for clients gauging the nurse's professional performance over time following up on the incident with other members of the care team
Correct response: identifying risks and ensuring future safety for clients Explanation: Incident reports are used for quality improvement by identifying risks and should not be used for disciplinary action against staff members. They are not primarily motivated by the need to protect care providers or institutions from legal action and they are not commonly used to communicate within the interdisciplinary team.
The client had an ostomy created 3 days prior. The nurse is planning to teach the client how to empty the ostomy pouch. What is the best time for the nurse to conduct the teaching? the time that the nurse and client mutually agree upon before the client's lunch at the time the nurse perceives he or she will have time to conduct the teaching just prior to the end of the nurse's shift
Correct response: the time that the nurse and client mutually agree upon Explanation: The time to conduct the teaching should be mutually agreed upon by the nurse and client in order for the teaching to be most effective. Performing the teaching just prior to the end of the nurse's shift does not take into account when the client would feel most comfortable with the teaching. While it is important that the nurse has the time to conduct the teaching, it is also important that the client feels it is a good time for the teaching to occur. Conducting the teaching right before lunch does not take into account the client's feelings on when is a good time for the teaching to occur. Additionally, if the client is hungry, attention to the teaching might be hindered. Teaching is most effective when it occurs during a mutually agreed upon time.
The nurse manager is developing a "read-back" procedure to reduce medication administration errors. What are purposes of the "read-back" requirement? Select all that apply. to make sure that prescriptions and test results that are communicated verbally or by telephone are confirmed by the individual giving the information to minimize the risk of nonauthorized personnel from giving prescriptions which are communicated verbally or by telephone to make sure that prescriptions and test results that are communicated verbally or by telephone are clear to the receiver of the information to encourage the use of electronic medical records to prohibit prescriptions and test results from being communicated verbally or by telephone
Correct response: to make sure that prescriptions and test results that are communicated verbally or by telephone are clear to the receiver of the information to make sure that prescriptions and test results that are communicated verbally or by telephone are confirmed by the individual giving the information Explanation: A National Patient Safety Goal of The Joint Commission is to improve the effectiveness of communication among caregivers. The requirement for verbal or telephone prescriptions, or for telephonic reporting of critical test results, is to verify the complete prescription or test result by having the person receiving the information record and "read-back" the complete prescription or test result. Effective communication which is timely, accurate, complete, unambiguous, and understood by the recipient reduces error and results in improved client safety. "Read-back" procedures are not intended to discourage or prohibit telephone communications among health care providers (HCPs) or to promote use of electronic medical records. Safety procedures, such as provider identification codes, are in place for HCPs to give verbal or telephone prescriptions.
