57.A signed consent form indicated a client should have an electromyogram, but a
myelogram was performed instead. Though the myelogram revealed the cause of the
client's back pain, which was subsequently treated, the client filed a lawsuit against the
nurse and healthcare provider for performing the incorrect procedure. The court is likely
to rule in favor of the plaintiff because these events represent what infraction?
A. A quasi-intentional tort because a similar mistake can happen to anyone.
B. Failure to respect client autonomy to choose based on intentional tort law.
C. Assault and battery with deliberate intent to deviate from the consent form.
D. An unintentional tort because the client benefited from having the myelogram.
57.
The client was not properly informed of the procedure, and failure to obtain
informed consent constitutes assault and battery (C). (A) is injury to economics
and dignity, such as invasion of privacy or defamation of character. This is not
an incident of failure to respect the client's autonomy (B). An unintentional tort
(D) is an act in which the outcome was not expected, such as negligence or
, malpractice.
Correct Answer: C
34.The nurse overhears the healthcare provider explaining to the client that the tumor
removed was non-malignant and that the client will be fine. However, the nurse has read
in the pathology report that the tumor was malignant and that there is extensive
metastasis. Who should the nurse consult with first regarding the situation?
A. Healthcare provider.
B. Client's family.
C. Case manager.
D. Chief of staff.
34.
The nurse should address the healthcare provider with the written report and
discuss why he/she did not tell the client the truth--this may be at the family's
request (A). (B, C, and D) may be indicated, but first the nurse should confer
with the healthcare provider to obtain all needed information.
Correct Answer: A
86.A healthcare provider is performing a sterile procedure at a client's bedside. Near the
end of the procedure, the nurse observes the healthcare provider contaminate a sterile
glove and the sterile field. What is the best action for the nurse to implement?
A. Report the healthcare provider for the violation in aseptic technique.
B. Allow the completion of the procedure.
C. Ask if the glove and sterile field are contaminated.
D. Identify the break in surgical asepsis and provide another set of sterile supplies.
, 86.
Any possible break in surgical asepsis that is identified when others are
unaware should be considered contaminated and new sterile supplies added
to maintain the sterile field (D). Reporting the healthcare provider is not
indicated (A). When sterility is suspect during aseptic technique, it should not
be questioned (C) but all members of the team should move forward with
reestablishing a sterile field. Allowing the procedure to progress under
unsterile conditions (B) places the client at risk for infection and is an act of
omission (negligence) by the nurse and other healthcare team members.
Correct Answer: D
22.When preparing to administer an intravenous medication through a central venous
catheter, the nurse aspirates a blood return in one of the lumens of the triple lumen
catheter. Which action should the nurse implement?
A. Flush the lumen with the saline solution and administer the medication through the
lumen.
B. Determine if a PRN prescription for a thrombolytic agent is listed on the medication
record.
C. Clamp the lumen and obtain a syringe of a dilute heparin solution to flush through the
tubing.
D. Withdraw the aspirated blood into the syringe and use a new syringe to administer the
medication.
22.
Aspiration of a blood return in the lumen of a central venous catheter
indicates that the catheter is in place and the medication can be administered.
The nurse should flush the tubing with the saline solution, administer the
medication (A), then flush the lumen with saline again. (B and C) are not
necessary. The aspirated blood can be flushed back through the closed
system into the client's bloodstream, but does not need to be withdrawn (D).
Correct Answer: A
, 58.A nurse observes a student nurse taking a copy of a client's medication administration
record. When questioned, the student states, Another student is scheduled to administer
medications for this client tomorrow, so I am going to make a copy to help my friend
prepare for tomorrow's clinical. What response should the nurse provide first?
A. Ask the nursing supervisor to meet with the students.
B. Notify the student's clinical instructor of the situation.
C. Ask the student if permission was obtained from the client.
D. Explain that the records are hospital property and may not be removed.
Give this one a try later!
58.
The nurse should deal with the issue immediately and explain that a client's
records are the property of the hospital and cannot be removed (D), even
with the client's permission (C). Next, the clinical instructor should be notified
(B)so that all students can be educated regarding copying and removing
clinical records from the healthcare agency. The nursing supervisor (A) should
also be alerted to ensure appropriate supervision of students as well as
protection of client information.
Correct Answer: D
5.A nurse is becoming increasingly frustrated by the family members' efforts to
participate in the care of a hospitalized client. What action should the nurse implement to
cope with these feelings of frustration?
A. Suggest that other cultural practices be substituted by the family members.
B. Examine one's own culturally based values, beliefs, attitudes, and practices.
C. Explain to the family that multiple visitors are exhausting to the client.
D. Allow the situation to continue until a family member's action may harm the client.
Give this one a try later!
myelogram was performed instead. Though the myelogram revealed the cause of the
client's back pain, which was subsequently treated, the client filed a lawsuit against the
nurse and healthcare provider for performing the incorrect procedure. The court is likely
to rule in favor of the plaintiff because these events represent what infraction?
A. A quasi-intentional tort because a similar mistake can happen to anyone.
B. Failure to respect client autonomy to choose based on intentional tort law.
C. Assault and battery with deliberate intent to deviate from the consent form.
D. An unintentional tort because the client benefited from having the myelogram.
57.
The client was not properly informed of the procedure, and failure to obtain
informed consent constitutes assault and battery (C). (A) is injury to economics
and dignity, such as invasion of privacy or defamation of character. This is not
an incident of failure to respect the client's autonomy (B). An unintentional tort
(D) is an act in which the outcome was not expected, such as negligence or
, malpractice.
Correct Answer: C
34.The nurse overhears the healthcare provider explaining to the client that the tumor
removed was non-malignant and that the client will be fine. However, the nurse has read
in the pathology report that the tumor was malignant and that there is extensive
metastasis. Who should the nurse consult with first regarding the situation?
A. Healthcare provider.
B. Client's family.
C. Case manager.
D. Chief of staff.
34.
The nurse should address the healthcare provider with the written report and
discuss why he/she did not tell the client the truth--this may be at the family's
request (A). (B, C, and D) may be indicated, but first the nurse should confer
with the healthcare provider to obtain all needed information.
Correct Answer: A
86.A healthcare provider is performing a sterile procedure at a client's bedside. Near the
end of the procedure, the nurse observes the healthcare provider contaminate a sterile
glove and the sterile field. What is the best action for the nurse to implement?
A. Report the healthcare provider for the violation in aseptic technique.
B. Allow the completion of the procedure.
C. Ask if the glove and sterile field are contaminated.
D. Identify the break in surgical asepsis and provide another set of sterile supplies.
, 86.
Any possible break in surgical asepsis that is identified when others are
unaware should be considered contaminated and new sterile supplies added
to maintain the sterile field (D). Reporting the healthcare provider is not
indicated (A). When sterility is suspect during aseptic technique, it should not
be questioned (C) but all members of the team should move forward with
reestablishing a sterile field. Allowing the procedure to progress under
unsterile conditions (B) places the client at risk for infection and is an act of
omission (negligence) by the nurse and other healthcare team members.
Correct Answer: D
22.When preparing to administer an intravenous medication through a central venous
catheter, the nurse aspirates a blood return in one of the lumens of the triple lumen
catheter. Which action should the nurse implement?
A. Flush the lumen with the saline solution and administer the medication through the
lumen.
B. Determine if a PRN prescription for a thrombolytic agent is listed on the medication
record.
C. Clamp the lumen and obtain a syringe of a dilute heparin solution to flush through the
tubing.
D. Withdraw the aspirated blood into the syringe and use a new syringe to administer the
medication.
22.
Aspiration of a blood return in the lumen of a central venous catheter
indicates that the catheter is in place and the medication can be administered.
The nurse should flush the tubing with the saline solution, administer the
medication (A), then flush the lumen with saline again. (B and C) are not
necessary. The aspirated blood can be flushed back through the closed
system into the client's bloodstream, but does not need to be withdrawn (D).
Correct Answer: A
, 58.A nurse observes a student nurse taking a copy of a client's medication administration
record. When questioned, the student states, Another student is scheduled to administer
medications for this client tomorrow, so I am going to make a copy to help my friend
prepare for tomorrow's clinical. What response should the nurse provide first?
A. Ask the nursing supervisor to meet with the students.
B. Notify the student's clinical instructor of the situation.
C. Ask the student if permission was obtained from the client.
D. Explain that the records are hospital property and may not be removed.
Give this one a try later!
58.
The nurse should deal with the issue immediately and explain that a client's
records are the property of the hospital and cannot be removed (D), even
with the client's permission (C). Next, the clinical instructor should be notified
(B)so that all students can be educated regarding copying and removing
clinical records from the healthcare agency. The nursing supervisor (A) should
also be alerted to ensure appropriate supervision of students as well as
protection of client information.
Correct Answer: D
5.A nurse is becoming increasingly frustrated by the family members' efforts to
participate in the care of a hospitalized client. What action should the nurse implement to
cope with these feelings of frustration?
A. Suggest that other cultural practices be substituted by the family members.
B. Examine one's own culturally based values, beliefs, attitudes, and practices.
C. Explain to the family that multiple visitors are exhausting to the client.
D. Allow the situation to continue until a family member's action may harm the client.
Give this one a try later!
