unit IV PU
What does the Code of Ethics for Registered Nurses include? a) Tips for correctly performing a procedure in the hospital environment. b) Regulations stating criteria for nursing licensure. c) Bylaws that state clients' rights. d) A code of ethics that states the nurse's obligation and responsibility to the client.
d
A client on the genitourinary floor has refused all medications for 3 days. A nurse caring for this client asks why he isn't complying with his medication. The client states, "I don't want to take those pills anymore." The nurse informs the client that he must take all the medication the physician orders. With this statement, the nurse has violated the: a) client's right to refuse medication. b) client's right to accurate medication administration. c) client's privacy. d) client's advance directive.
a
A client who's a member of Jehovah's Witnesses refuses a blood transfusion based on his religious beliefs and practices. His decision must be followed based on which ethical principle? a) Autonomy of the client b) Advance directive c) The right to die d) Substituted judgment
a
The nurse is planning an education for new nurses on psychiatric units. Which topic should be given priority? a) Breach of confidentiality b) Assault c) Neglect d) Battery
a
The nurse is planning care for a client with severe postoperative pain. There is a prescription for morphine written as "10 mg MSO4" on the medical record. What should the nurse do first? a) Contact the health care provider (HCP) who prescribed the medication. b) Prepare the medication for administration. c) Contact the pharmacy department. d) Obtain an intravenous infusion system.
a
While reviewing the day's charts, a nurse who's been under a great deal of personal stress realizes that she forgot to administer insulin to client with diabetes mellitus. She's made numerous errors in the past few weeks and is now afraid her job is in jeopardy. What is her best course of action? a) Report the error, complete the proper paperwork, and meet with the unit manager. b) Administer the medication immediately and chart it as given on time. c) Contact the physician and follow his instructions. d) Report the error and request a private meeting with the unit manager.
a
The team leader has noticed a sharp increase in medication errors associated with IV antibiotic administration over the last 2 months. The group that could offer resources for tracking medication errors and improving care outcomes is the: a) Ethics Committee. b) Quality Improvement and Risk Management Department. c) Pharmacy and Products Office. d) Infection Control Committee.
b
A client arrives at the emergency department after falling in the home. The nurse performing the assessment notes the presence of pediculosis corpus. The client's skin and clothing are dirty. The client reports that his children work and no one has time to assist him with his self-care activities. The nurse should: a) Call the police. b) Contact the nursing supervisor. c) Advise the family of the client's accusations. d) Do nothing and continue to monitor the client's situation.
b
A family member visiting an acute care psychiatric unit approaches the nurses' station and reports that an elderly client is walking in the hall without her clothing. The nurse doesn't assist the client and suggests that the family member inform the nurse assigned to that client. Which term describes the nurse's action? a) Compassionate b) Negligent c) Sensitive d) Organized
b
A client undergoes total hip replacement. After surgery, the client questions why he must go to a rehabilitation center because he has family who can care for him. Which response by the nurse is best? a) 1."You'll need help with your bath and meals for quite some time." b) "The physician wants you to go to the rehabilitation center until you're fully recovered and able to care for yourself." c) "The rehabilitation staff can provide you with better care." d) "The rehabilitation staff can evaluate your progress and make sure that you exercise without risking injury."
dd
Which intervention is an example of primary prevention? a) Administering digoxin to a client with heart failure b) Obtaining a Papanicolaou (Pap) test to screen for cervical cancer c) Administering a measles, mumps, and rubella immunization to an infant d) Using occupational therapy to help a client cope with arthritis
c
Which of the following measures should a home healthcare nurse implement to minimize the potential for lawsuits? a) Integrate the client's learning needs and goals into plans of care. b) Apply more conservative interventions than those used in a hospital setting. c) Perform thorough, accurate, and timely documentation. d) Have the client sign a waiver prior to the entry phase of a visit.
c
A client with esophageal cancer decides against placement of a jejunostomy tube. Which ethical principle is a nurse upholding by supporting the client's decision? a) Veracity b) Fidelity c) Nonmaleficence d) Autonomy
d
A nurse caring for an 8-month-old infant diagnosed with respiratory syncytial virus is unable to read a medication dosage written in the infant's medical record. What is the only ethical and responsible solution for the nurse? a) Call the physician and ask for a verbal order to clarify the dosage. b) Erase the original order and rewrite it more clearly. c) Ask another nurse what she thinks the dosage should be. d) Ask the mother what dosage the infant takes at home.
a
A nurse gives a client the wrong medication. After assessing the client, the nurse completes an incident report. Which statement describes what will happen next? a) The incident report will provide a basis for promoting quality care and risk management. b) The nurse will be suspended and, possibly, terminated from employment at the facility. c) The facility will report the incident to the state board of nursing for disciplinary action. d) The incident will be documented in the nurse's personnel file.
a
A nurse is caring for a client with end-stage heart failure. Which statement by the client best demonstrates a good understanding of an advance directive? a) "A living will allows my decisions for health care to be known if I can't speak for myself." b) "A health care power of attorney will allow my daughter to use my funds to pay for my health care costs, if I can't do so." c) "Once I decide on an advance directive, I cannot change my mind." d) "I will rely on my doctor to know about my preferences."
a
A nurse on a night shift entered an elderly client's room during a scheduled check and discovered the client on the floor beside her 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? a) Identifying risks and ensuring future safety for clients. b) Gauging the nurse's professional performance over time. c) Protecting the nurse and the hospital from litigation. d) Following up the incident with other members of the care team.
a
A client's breathing stops after receiving the wrong medication. The nurse initiates the code protocol, and the client is emergently intubated. As soon as the client's condition stabilizes, the nurse completes an incident report. What should the nurse do next? a) Document in the nurses' notes that an incident report was completed. b) Document the incident in the nurses' notes. c) Place the incident report on the client's chart. d) Make a copy of the incident report for the client.
b
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: a) The laws that govern acceptable and unacceptable behavior. b) The principles that determine whether an act is right or wrong. c) The relationship between law and culture. d) Moral values are considered to be universal.
b
A client with metastatic brain cancer is admitted to the oncology floor. According to the Self-Determination Act of 1991 concerning the execution of an advance directive, the hospital is required to: a) respect individuals' moral rights. b) advise clients not to execute their advance directives because they limit treatment options. c) decide on a treatment plan if the client can't. d) inform the client or legal guardian of their rights to execute an advance directive.
d
A client with terminal breast cancer is being cared for by a long-time friend who is a physician. The client has identified her sister as the agent in her health care power of attorney. The client loses decision-making capacity, and the sister tells the nurse, "A different physician will be caring for my sister now. I've dismissed her friend." In response, the nurse should: a) inform the sister that she doesn't have the authority to assign a different physician. b) ask the dismissed physician if the client ever stated that she wanted a different physician. c) politely ignore the sister's statement and continue to call the dismissed physician for orders. d) abide by the wishes of the sister who holds the durable power of attorney.
d
A nurse is preparing to administer cardiac medications to two clients with the same last name. She checks the medication three times before entering the room to administer medications to the first client. While leaving the room, the nurse realizes she didn't check the client's identification before administering the medication. Which action should the nurse take first? a) Return to the room, check the client's identification against the medication administration record, and complete a variance report if needed. b) Alert the charge nurse that she made a medication error. c) Check the second client's identification and administer the remaining medication to him. d) Document the medication error and completion of the variance report in the client's chart and notify the physician.
a
A physician writes an order for a nurse to administer an IV medication which, according to the hospital policy, is not a nursing protocol. The nurse informs the physician that it is not a nursing protocol, and the physician states, "Give it, and I will cover you." What should the nurse do in this situation? a) Refuse to administer the medication. b) Administer the medication as ordered. c) Call another nurse to see if he/she would give it. d) Give the medication but have the physician sign for it.
a
An elderly client has been admitted to the medical-surgical unit from the postanesthesia care unit. While the nurse is off the floor, the client falls out of bed and fractures his right leg and right wrist. The nurse finding him states, "The side rails were down and the bed was in the high position." The client's family files legal charges against the nurse and the hospital. Which charge most accurately reflects the nurse's actions? a) Negligence b) Battery c) Comparative negligence d) Collective liability
a
It is important for nurses to communicate with clients about their health care because: a) the media provides misleading information. b) clients are more demanding that their rights be respected. c) consumers of health care cannot keep up with rapid advances in science. d) health care services are often specialized and fragmented.
d
Which statement is a guideline to help nurses protect themselves from liability? a) Obtain malpractice insurance. b) Practice within the scope of the nursing standards of practice.. c) Follow all physician's orders. d) Do what the client desires even though the nurse may disagree.
b
A group of nurses has established a focus group and pilot study to examine the potential application of personal data assistants (PDAs) in bedside care. This study is a tangible application of: a) Electronic medical records. b) Computerized documentation. c) Telemedicine. d) Nursing informatics.
d
Using the nursing process to make ethical decisions involves following several steps. Which step is the nurse implementing when he or she reflects on the decision-making process and the role it will play in making future decisions? a) Implementing. b) Evaluating. c) Diagnosing. d) Planning.
b
PT states: "Doctor says his cancer cannot be treated. He is afraid of dying." A nurse is caring for a client with advanced cancer. Based on the accompanying nursing progress notes, what should be the nurse's next intervention? a) Explain that an advance directive can express the client's wishes. b) Reread the document on patient/client rights to the client. c) Call the client's spouse to discuss the client's statements. d) Tell the client that he can receive adequate pain relief only in the hospital.
a
The nurse finds a client lying on the floor next to the bed. After returning the client to bed, assessing for injury, and notifying the health care provider (HCP), the nurse fills out an incident report. What should the nurse do next? a) Give the incident report to the nurse-manager. b) Call the family to inform them. c) Place the incident report on the medical record. d) Omit mentioning the fall in the medical record documentation.
a
As an adolescent is receiving care, he's inadvertently injured with a warm compress. The nurse completes an incident report, knowing the report's goal is to: a) reprimand staff for their actions. b) record facts surrounding each incident. c) protect the nurse from a lawsuit. d) place the blame on the adolescent.
b
A nurse caring for a client who had a stroke is using the unit's new computerized documentation system. The nurse uses the information technology appropriately when she: a) documents medications before administration. b) e-mails information about a client to a friend at home. c) determines a client's identity from a computer chart. d) documents medications after administration.
d
A nurse finds that a colleague is intoxicated while on duty. What appropriate action should the nurse take? a) Inform the physician. b) Watch the colleague closely during the shift. c) Tell the colleague to take a 30-minute break. d) Inform the nursing supervisor.
d
A nurse uses the computer to access health records of the clients. What care should the nurse take when using a computer to access health records? a) The password and access number should be shared only with the client. b) The password and access number should be shared only with the auditors. c) The password and access should be shared only with the physician. d) The password and access number should be kept secret and changed regularly.
d
The daughter of an alert and oriented elderly client asks what her father's most recent blood glucose level was. What is the nurse's best response? a) Tell the client's daughter his blood glucose level because this test is performed on the nursing unit. b) Ask the client's daughter if she has her father's permission to have access to his health information. c) Explain that this information cannot be disclosed without the client's permission. d) Have the daughter sign a "Disclosure of Health Information" form prior to giving her the information.
c
The parent of an 18-year-old with chronic renal disease states, "My son has so many problems. I'm really worried that he will not get the right care if he gets sick at college." The nurse should tell the parent: a) "Your son is going to need to learn to manage his own disease." b) "Make sure your son always carries his nephrologist's phone number." c) "Your son can make an e-health history to facilitate his care if he gets sick away from home." d) "I can have his records sent to the school's health center."
c
When making ethical decisions about caring for preschoolers, a nurse should remember to: a) do what she would do for her own child or loved ones. b) make decisions that will prevent legal trouble. c) provide beneficial care and avoid harming the child. d) be sure to do what the physician says.
c
Which guidelines define and regulate what the nurse may and may not do as a professional? a) State legislature b) Facility policies and procedures c) Nurse practice act d) Standards of care
c
A client is refusing to take the prescribed oral medication. Which of the following measures by the nurse can be used to get the client to take the medication? Select all that apply. a) Suggesting a liquid form of the medication instead of a pill b) Asking the client the reason for not taking the medication c) Crushing the medication and hiding it in apple sauce d) Explaining the purpose of the medication to the client e) Having a family member give the medication
a b d
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 of the following documentation formats is most likely to promote this goal? a) Charting by exception. b) Narrative notes. c) SOAP notes. d) Focus charting.
b
A nurse has completed 4 hours of his 8-hour shift on a medical-surgical unit when he receives a phone call from the nursing supervisor. The nursing supervisor informs the nurse that he needs to give report to the other two nurses on the medical-surgical unit and immediately report to the telemetry unit to assist with staff needs on that unit. The nurse informs the supervisor that he has been busy with his client assignment and feels this will overwhelm the nurses on the medical-surgical unit. The supervisor informs the nurse that the need is greater on the telemetry unit. This is an example of which type of ethical problem? a) Conflicts concerning new technology. b) Allocation of scarce nursing resources. c) Deception. d) Advocacy in a market-driven economy.
b
A nurse in the pediatric intensive care unit is caring for the only survivor of a house fire that killed seven people. Reporters from local newspapers and television stations are at the hospital, trying to obtain information about the child's condition. How should the nurse best handle this situation? a) The nurse may disclose the child's condition, but not his name. b) The nurse may not disclose information regarding the child's condition. c) The nurse may make a statement about how sad she feels for the little boy's family and friends. d) The nurse should contact a lawyer because of the legal issues involved in caring for the child.
b
A nurse is caring for a client diagnosed with myocardial infarction. A person identifying himself as the client's friend asks the nurse for the client's records, but the nurse refuses. Who among the following is entitled to access client records? a) Close friends of the client. b) Those directly involved in the client's care. c) Healthcare professionals of the facility. d) Any family member of the client.
b
A worried mother confides in the nurse that she wants to change primaryhealth care providers (HCP's) because her infant is not getting better. What is the nurse's best response? a) "This primary care provider has been on our staff for 20 years." b) "You always have an option to change. Tell me about your concerns." c) "Your infant's condition takes time to heal." d) "I know you are worried, but the primary care provider has an excellent reputation."
b
In the delivery of care, the nurse acts in accordance with nursing standards and the code of ethics and reports a medication error that she has made. The nurse is most clearly demonstrating which of the following professional values? a) Human dignity. b) Integrity. c) Social justice. d) Altruism.
b
Primary prevention of osteoporosis includes: a) using a professional alert system in the home in case a client falls when she's alone. b) optimal calcium intake and estrogen replacement therapy. c) installing grab bars in the bathroom to prevent falls. d) placing items within the client's reach.
b
Professional regulations and laws that govern nursing practice are in place for which of the following reasons? a) To ensure that practicing nurses are of good moral standing b) To protect the safety of the public c) To limit the number of nurses in practice d) To ensure that enough new nurses are always available
b
The nurse is caring for a client with end-stage cancer whose health status is declining. A prescription is written by the attending health care provider (HCP) to withhold all fluid, but the health care team cannot locate a family member or guardian. The nurse requests an ethics consultation. Which information is true of an ethics consultation? Select all that apply. a) Requests for ethics consultations may only be made by the HCP or nurse. b) The recommendations of ethics consultants are advisory only. c) Ethics consultations may prevent poor outcomes in cases involving ethical problems. d) Ethics consultation is intended to provide legal advice on client care. e) Persons requesting an ethics consultation may do so without intimidation or fear of reprisal.
b c e
A client diagnosed with metastatic cancer is preparing for discharge. The physician orders morphine sulfate controlled-release tablets 100 mg every 12 hours as needed after discharge. What legal rights and responsibilities should the nurse address when teaching the client about morphine sulfate use? a) "If you no longer require the morphine sulfate controlled-release tablets for your cancer pain, do not take any leftover pills for other disorders." b) "You must avoid driving or other activities that require alertness while taking controlled-release morphine sulfate." c) "Federal law prevents refills of this medication. Your physician will give you a new prescription when you need more medicine." d) "Morphine sulfate is an opioid and you may develop a tolerance to it. This is an expected response and is not harmful."
c
A client is scheduled for a right lower lobectomy for lung cancer. During the admission assessment, the client asks for information about a living will and advance directive. The nurse knows that the client understands teaching about the living will and advanced directive when he says: a) "The living will allows me to identify a person who can make health care decisions for me if I become too ill to make them myself." b) "If I appoint a health care power of attorney, that person can override my wishes even if I'm still competent." c) "The advance directive allows me to state my health care wishes while I'm still able to do so." d) "I understand that in some states (provinces) a living will and health care power of attorney are the same."
c
A nurse is conducting a physical assessment on an adolescent who doesn't want her parents informed that she had an abortion in the past. Which statement best describes the information security measures the nurse can implement in this situation? a) Discussing the adolescent's medical history with her parents and thoroughly document it in the medical record. b) Because the adolescent is a minor, inform her parents about her medical history. c) Respect the adolescent's wishes and maintain her confidentiality. d) Before agreeing to maintain confidentiality, determine whether the adolescent is an emancipated minor.
c
A nurse manager of the pediatric unit is responsible for making sure that each staff member reviews the unit policies annually. What policy should the nurse manager emphasize with the clerical support staff? a) Proper documentation of a verbal order from a physician b) New education materials for the management of diabetes c) Logging off a computer containing client information d) Policy changes in the administration of opioids
c
A nurse who works on a psychiatric unit arrives to work disheveled, unkempt in appearance, and smelling of alcohol. What is the best approach for the nurse's colleague on the night shift to manage this situation? a) Monitor the behavior during the shift and follow up if anything is forgotten with client care or shift responsibilities. b) Encourage the nurse to report in as sick and hope the unit can get a replacement. c) Immediately report the concern to the appropriate leader or manager in charge. d) Support the coworker because the nurse in question is a professional and responsible.
c
A nurse-manager is reviewing incidents that occurred recently. For which of the following events will the manager need to make a report to the board of nursing? a) A client falls from bed when the nurse did not raise the side rails after providing care. b) A client develops a urinary tract infection after several days with an indwelling catheter. c) A nurse documents administering narcotics to a client while personally using the medication. d) A home health nurse notifies a primary care provider of a decline in client health.
c
During rounds, a nurse finds that a client with hemiplegia has fallen from the bed because the nursing assistant failed to raise the side rails after giving a back massage. The nurse assists the client to the bed and assesses for injury. As per agency policies, the nurse fills out an incident report. Which of the following activities should the nurse perform after finishing the incident report? a) Highlight the mistake in the client's records. b) Mention the name of the nursing assistant in the client records. c) Include the time and date of the incident. d) Attach a copy to the client's records.
c
Performance improvement is an important component of continuous quality improvement. Which action should an effective nurse-manager take when conducting performance evaluations? a) Whenever possible, delegate responsibility for conducting performance evaluations to primary nurses to help them achieve professional growth. b) Conduct performance evaluations in a group setting so input from peers and subordinates influences evaluation of a staff member's effectiveness. c) Provide feedback on strengths as well as areas for improvement and clarify what she expects the staff member to accomplish before the next performance evaluation. d) Provide written documentation of areas for improvement. Areas of strength needn't be documented because these areas are complimentary and don't describe actions the staff member must take to improve.
c
A physician enters a computer order for a nurse to irrigate a client's nephrostomy tube every 4 hours to maintain patency. The nurse irrigates the tube using sterile technique. After irrigating the tube, the nurse decides that she can safely use the same irrigation set for her 8-hour shift if she covers the set with a paper, sterile drape. This action by the nurse is: a) appropriate because the irrigation just checks for patency. b) inappropriate because the sterile drape must be cloth, not paper. c) appropriate because the irrigation set will be used only during an 8-hour period. d) inappropriate because irrigation requires strict sterile technique.
d
A physician has signed a do-not-resuscitate (DNR) form at the request of a client with pancreatic cancer. Which of the following actions should the nurse take? a) Assure the client's family that everything possible will be done for the client. b) Inform the client's family of the client's decision. c) Urge the client to agree to the proposed treatment regimen. d) Ensure that a copy of the medical record includes a signed DNR form.
d
A staff member on the transplant unit is having problems logging into the computer to chart client information. The staff member asks a nurse for her personal identification number (PIN) to log in. What is the nurse's best response? a) "You know that isn't appropriate." b) "Sure. Just be sure to destroy the information after you are finished charting." c) "I'll log you in. Be sure to log out when you are finished charting." d) "I'll be happy to contact Information Services to assist you with the problem."
d
An employer establishes a physical exercise area in the workplace and encourages all employees to use it. This is an example of which level of health promotion? a) Secondary prevention b) Tertiary prevention c) Passive prevention d) Primary prevention
d
As a client is being admitted to the facility, her husband asks the nurse why she must sign a statement confirming that she has been told of her rights to communicate her wishes about life support and resuscitation. How should the nurse respond? a) "Everyone who is admitted to this facility must sign this. We need to know what we should do in case something unexpected happens." b) "I hate talking about this because it may upset you. Federal law requires your wife to sign this and there is nothing we can do about that." c) "Hospital policy requires us to have your wife sign this. That doesn't mean that we expect anything to go wrong." d) "We make sure our clients know they have the right to specify advance directives and appoint someone to speak for them."
d
