NCLEX CANDIDATES’ PREPARATION
NCLEX POOL- Q & A
A+ GUARANTEED
The Safe & Effective Care Environment: The Management of Care Practice Questions
1. You are caring for a client at the end of life. The client tells you that they
are grateful for having considered and decided upon some end of life
decisions and the appointments of those who they wish to make decisions
for them when they are no longer able to do so. During this discussion with
the client and the client’s wife, the client states that “my wife and I are
legally married so I am so glad that she can automatically make all
healthcare decisions on my behalf without a legal durable power of attorney
when I am no longer able to do so myself” and the wife responds to this
statement with, “that is not completely true. I can only make decisions for
you and on your behalf when these decisions are not already documented
on your advance directive.” How should you, as the nurse, respond to and
address this conversation between the husband and wife and the end of
life?
A. You should respond to the couple by stating that only unanticipated treatments
and procedures that are not included in the advance directive can be made by the
legally appointed durable power of attorney for healthcare decisions.
B. You should be aware of the fact that the wife of the client has a knowledge deficit
relating to advance directives and durable powers of attorney for healthcare decisions
and plan an educational activity to meet this learning need.
C. You should be aware of the fact that the client has a knowledge deficit relating to
advance directives and durable powers of attorney for healthcare decisions and plan an
educational activity to meet this learning need.
D. You should reinforce the wife’s belief that legally married spouses automatically
serve for the other spouse’s durable power of attorney for health care decisions and
that others than the spouse cannot be legally appointed while people are married
Correct Response: A
1
,You should respond to the couple by stating that only unanticipated treatments and
procedures that are not included in the advance directive can be made by the legally
appointed durable power of attorney for healthcare decisions.
Both the client and the client’s spouse have knowledge deficits relating to advance
directives. Legally married spouses do not automatically serve for the other spouse’s
durable power of attorney for health care decisions; others than the spouse can be
legally appointed while people are married.
2. The Patient Self Determination Act of the United States protects clients in
terms of their rights to what? Select all that apply.
A. Privacy and to have their medical information confidential unless the client
formally approves the sharing of this information with others such as family members.
B. Make healthcare decisions and to have these decisions protected and
communicated to others when they are no longer competent to do so.
C. Be fully informed about all treatments in term of their benefits, risks and
alternatives to them so the client can make a knowledgeable and informed decision
about whether or not to agree to having it
D. Make decisions about who their health care provider is without any coercion or
undue influence of others including healthcare providers.
Correct Response: B, D
The Patient Self Determination Act, which was passed by the US Congress in 1990, gives
Americans the right to make healthcare decisions and to have these decisions protected
and communicated to others when they are no longer competent to do so. These
decisions can also include rejections for future care and treatment and these decisions
are reflect in advance directives. This Act also supports the rights of the client to be free
of any coercion or any undue influence of others including healthcare providers.
The Health Insurance Portability and Accountability Act (HIPAA) supports and upholds
the clients’ rights to confidentially and the privacy of their medical related information
regardless of its form. It covers hard copy and electronic medical records unless the
client has formally approved the sharing of this information with others such as family
members.
The elements of informed consent which includes information about possible
treatments and procedures in terms of their benefits, risks and alternatives to them so
the client can make a knowledgeable and informed decision about whether or not to
agree to having it may be part of these advanced directives, but the law that protects
these advance directives is the Patient Self Determination Act.
3. Your client is in the special care area of your hospital with multiple trauma
and severe bodily burns. This 45 year old male client has an advance
2
,directive that states that the client wants all life saving measures including
cardiopulmonary resuscitation and advance cardiac life support, including
mechanical ventilation. As you are caring for the client, the client has a
complete cardiac and respiratory arrest. This client has little of no chance for
survival and they are facing imminent death according to your professional
judgement, knowledge of pathophysiology and your critical thinking. You
believe that all life saving measures for this client would be futile. What is
the first thing that you, as the nurse, should do?
A. Call the doctor and advise them that the client’s physical status has significantly
changed and that they have just had a cardiopulmonary arrest.
B. Begin cardiopulmonary resuscitation other emergency life saving measures.
C. Notify the family of the client’s condition and ask them what they should be done
for the client.
D. Insure that the client is without any distressing signs and symptoms at the end of
life.
Correct Response: B
You must immediately begin cardiopulmonary resuscitation and all life saving measures
as requested.by the client in their advance directive despite the nurse’s own beliefs and
professional opinions. Nurses must uphold the client’s right to accept, choose and reject
any and all of treatments, as stated in the client’s advance directive.
You would not call the doctor first; your priority is the sustaining of the client’s life; you
would also not immediately notify the family for the same reason and, when you do
communicate with the family at a later time, you would not ask them what should or
should not be done for the client when they wishes are already contained in the client’s
advance directive.
Finally, you would also insure that the client is without pain and all other distressing
signs and symptoms at the end of life, but the priority and the first thing that you would
do is immediately begin cardiopulmonary resuscitation and all life saving measures as
requested by the client in their advance directive, according to the ABCs and Maslow’s
Hierarchy of Needs.
4. You are caring for a high risk pregnant client who is in a life threatening
situation. The fetus is also at high risk for death. Clinical decisions are being
made that concern you because some of these treatments and life saving
measures promote the pregnant woman’s life at the same time that they
3
, significantly jeopardize the fetus’ life and viability and other decisions can
preserve the fetus’s life at the expense of the pregnant woman’s life. Which
role of the nurse is the priority at this time?
A. Case manager
B. Collaborator
C. Coordinator of care
D. Advocacy
Correct Response: D
The priority role of the nurse is advocacy. The nurse must serve as the advocate for both
the fetus and the mother at risk as the result of this ethical dilemma where neither
option is desirable. As an advocate, the nurse would seek out resources and people,
such as the facility’s ethicist or the ethics committee, to resolve this ethical dilemma.
5. A nurse who organizes and establishes a political action committee (PAC)
in their local community to address issues relating to the accessibility and
affordability of healthcare resources in the community is serving in which
capacity and role of the registered nurse?
A. Client advocate
B. Collaborator
C. Politician
D. Entrepreneur
Correct Response: A
A nurse who organizes and establishes a political action committee (PAC) in their local
community to address issues relating to the accessibility and affordability of healthcare
resources in the community is serving as the client advocate. As you should know, the
definition of “client” includes not only individual clients, and families as a unit, but also
populations such as the members of the local community.
Although the nurse, as the organizer of this political action committee (PAC), will have
to collaborate with members of the community to promote the accessibility and
affordability of healthcare resources in the community, this is a secondary role rather
than the primary role.
Additionally, although the nurse is serving in a political advocacy effort, the nurse is not
necessarily a politician and there is no evidence that this nurse is an entrepreneur.
6. Which of the following are the five Rights of Supervision?
4
NCLEX POOL- Q & A
A+ GUARANTEED
The Safe & Effective Care Environment: The Management of Care Practice Questions
1. You are caring for a client at the end of life. The client tells you that they
are grateful for having considered and decided upon some end of life
decisions and the appointments of those who they wish to make decisions
for them when they are no longer able to do so. During this discussion with
the client and the client’s wife, the client states that “my wife and I are
legally married so I am so glad that she can automatically make all
healthcare decisions on my behalf without a legal durable power of attorney
when I am no longer able to do so myself” and the wife responds to this
statement with, “that is not completely true. I can only make decisions for
you and on your behalf when these decisions are not already documented
on your advance directive.” How should you, as the nurse, respond to and
address this conversation between the husband and wife and the end of
life?
A. You should respond to the couple by stating that only unanticipated treatments
and procedures that are not included in the advance directive can be made by the
legally appointed durable power of attorney for healthcare decisions.
B. You should be aware of the fact that the wife of the client has a knowledge deficit
relating to advance directives and durable powers of attorney for healthcare decisions
and plan an educational activity to meet this learning need.
C. You should be aware of the fact that the client has a knowledge deficit relating to
advance directives and durable powers of attorney for healthcare decisions and plan an
educational activity to meet this learning need.
D. You should reinforce the wife’s belief that legally married spouses automatically
serve for the other spouse’s durable power of attorney for health care decisions and
that others than the spouse cannot be legally appointed while people are married
Correct Response: A
1
,You should respond to the couple by stating that only unanticipated treatments and
procedures that are not included in the advance directive can be made by the legally
appointed durable power of attorney for healthcare decisions.
Both the client and the client’s spouse have knowledge deficits relating to advance
directives. Legally married spouses do not automatically serve for the other spouse’s
durable power of attorney for health care decisions; others than the spouse can be
legally appointed while people are married.
2. The Patient Self Determination Act of the United States protects clients in
terms of their rights to what? Select all that apply.
A. Privacy and to have their medical information confidential unless the client
formally approves the sharing of this information with others such as family members.
B. Make healthcare decisions and to have these decisions protected and
communicated to others when they are no longer competent to do so.
C. Be fully informed about all treatments in term of their benefits, risks and
alternatives to them so the client can make a knowledgeable and informed decision
about whether or not to agree to having it
D. Make decisions about who their health care provider is without any coercion or
undue influence of others including healthcare providers.
Correct Response: B, D
The Patient Self Determination Act, which was passed by the US Congress in 1990, gives
Americans the right to make healthcare decisions and to have these decisions protected
and communicated to others when they are no longer competent to do so. These
decisions can also include rejections for future care and treatment and these decisions
are reflect in advance directives. This Act also supports the rights of the client to be free
of any coercion or any undue influence of others including healthcare providers.
The Health Insurance Portability and Accountability Act (HIPAA) supports and upholds
the clients’ rights to confidentially and the privacy of their medical related information
regardless of its form. It covers hard copy and electronic medical records unless the
client has formally approved the sharing of this information with others such as family
members.
The elements of informed consent which includes information about possible
treatments and procedures in terms of their benefits, risks and alternatives to them so
the client can make a knowledgeable and informed decision about whether or not to
agree to having it may be part of these advanced directives, but the law that protects
these advance directives is the Patient Self Determination Act.
3. Your client is in the special care area of your hospital with multiple trauma
and severe bodily burns. This 45 year old male client has an advance
2
,directive that states that the client wants all life saving measures including
cardiopulmonary resuscitation and advance cardiac life support, including
mechanical ventilation. As you are caring for the client, the client has a
complete cardiac and respiratory arrest. This client has little of no chance for
survival and they are facing imminent death according to your professional
judgement, knowledge of pathophysiology and your critical thinking. You
believe that all life saving measures for this client would be futile. What is
the first thing that you, as the nurse, should do?
A. Call the doctor and advise them that the client’s physical status has significantly
changed and that they have just had a cardiopulmonary arrest.
B. Begin cardiopulmonary resuscitation other emergency life saving measures.
C. Notify the family of the client’s condition and ask them what they should be done
for the client.
D. Insure that the client is without any distressing signs and symptoms at the end of
life.
Correct Response: B
You must immediately begin cardiopulmonary resuscitation and all life saving measures
as requested.by the client in their advance directive despite the nurse’s own beliefs and
professional opinions. Nurses must uphold the client’s right to accept, choose and reject
any and all of treatments, as stated in the client’s advance directive.
You would not call the doctor first; your priority is the sustaining of the client’s life; you
would also not immediately notify the family for the same reason and, when you do
communicate with the family at a later time, you would not ask them what should or
should not be done for the client when they wishes are already contained in the client’s
advance directive.
Finally, you would also insure that the client is without pain and all other distressing
signs and symptoms at the end of life, but the priority and the first thing that you would
do is immediately begin cardiopulmonary resuscitation and all life saving measures as
requested by the client in their advance directive, according to the ABCs and Maslow’s
Hierarchy of Needs.
4. You are caring for a high risk pregnant client who is in a life threatening
situation. The fetus is also at high risk for death. Clinical decisions are being
made that concern you because some of these treatments and life saving
measures promote the pregnant woman’s life at the same time that they
3
, significantly jeopardize the fetus’ life and viability and other decisions can
preserve the fetus’s life at the expense of the pregnant woman’s life. Which
role of the nurse is the priority at this time?
A. Case manager
B. Collaborator
C. Coordinator of care
D. Advocacy
Correct Response: D
The priority role of the nurse is advocacy. The nurse must serve as the advocate for both
the fetus and the mother at risk as the result of this ethical dilemma where neither
option is desirable. As an advocate, the nurse would seek out resources and people,
such as the facility’s ethicist or the ethics committee, to resolve this ethical dilemma.
5. A nurse who organizes and establishes a political action committee (PAC)
in their local community to address issues relating to the accessibility and
affordability of healthcare resources in the community is serving in which
capacity and role of the registered nurse?
A. Client advocate
B. Collaborator
C. Politician
D. Entrepreneur
Correct Response: A
A nurse who organizes and establishes a political action committee (PAC) in their local
community to address issues relating to the accessibility and affordability of healthcare
resources in the community is serving as the client advocate. As you should know, the
definition of “client” includes not only individual clients, and families as a unit, but also
populations such as the members of the local community.
Although the nurse, as the organizer of this political action committee (PAC), will have
to collaborate with members of the community to promote the accessibility and
affordability of healthcare resources in the community, this is a secondary role rather
than the primary role.
Additionally, although the nurse is serving in a political advocacy effort, the nurse is not
necessarily a politician and there is no evidence that this nurse is an entrepreneur.
6. Which of the following are the five Rights of Supervision?
4
