NURSE 420 / NURSE420 EXAM 2 LEADERSHIP
NURSE 420 / NURSE420 EXAM 2 LEADERSHIP.
1.	A client states: “ I do not want to be awakened for breakfast-I didn’t sleep at all last night.” What is the first action for the RN to take?
a.	Notify the client’s provider
b.	Talk with the client to work out a mutual plan
c.	Consult with the patient’s family to get suggestions
d.	Contact the dietitian
2.	An elderly client who has a documented history of dementia is intermittently alert and can currently tell you her name. Who should sign the client’s informed consent for an invasive diagnostic procedure?
a.	The client’s husband, who is blind
b.	The client herself, who has an advance directive
c.	The client’s friend who has durable power of attorney for health care for the client
d.	The client’s daughter, who is competent and visiting her mother from out of state
3.	Nursing staff members are in the lounge on their morning break. A nursing assistant thinks that a unit secretary has acquired HIV and then tells the staff that the secretary probably caught it from her husband who is a drug addict. Which legal tort has she violated?
4.	When referring to the standard of care, which phrase best describes the meaning of a nursing standard of care?
a.	The belief that nurses will always behave in a wise/prudent manner.
b.	The directive that ensures all nurses will always act in ways that help patients get better
c.	The ethical principle that states that a nurse shall do no harm
d.	The minimal level of nursing care and expertise that is expected to be delivered to a patient.
5.	Which one of the following characteristics describes a “reasonable and prudent RN?
a.	At least 5 years of applicable RN experience
b.	Specialized RN skills for the assigned nursing area
c.	Average RN judgment and skill level in delivering patient care
d.	A BSN degree
6.	An RN witnesses an assistive personnel (AP) under her supervision reprimand an elderly client for spilling urine form his urinal on the bed sheets. The AP verbally threatens to put a diaper on the client if he does use the urinal more carefully next time. Which one of the following wrong doings is the AP committing?
a.	False imprisonment
c.	Invasion of Privacy
7.	An RN accidentally sticks her hand with the syringe needle after administering an IM injection to a client. Which one of the following should the nurse do first?
a.	Notify the charge nurse of the incident
b.	Go to employee health services
c.	Complete an incident report
d.	Wash hand thoroughly with soap and water.
8.	An RN notes that the toes on the casted left foot of her post-surgical client are cold and turning blue. The RN has notified the healthcare provides’ answering service every hour for the past two hours, yet the healthcare provider has not yet responded to the calls. The client is now complaining to extreme pain. What is the most important action for the nurse to take right now?
a.	Continue to call the healthcare provider’s answering service every 15 minutes until a response is obtained.
b.	Report the situation to the nursing supervisor so she can elevate the patient’s situation to the appropriate head/chief physician for the service.
c.	Continue to record the assessment finding, the time of each phone call and content reported each time to the healthcare provider
d.	Have the family file an immediate complaint with the Medical Staff Office against the physician.
9.	Which statement best describes the value of clinical pathways (also known as care paths or critical pathways)?
a.	They provide a means of standardizing care for clients with similar diagnoses.
b.	They determine justifiable differences/variances among clients
c.	They decrease the amount of paperwork required for reimbursement
d.	They reduce administrative costs.
10.	An RN overhears two care providers discussing a hospitalized client while getting coffee at the coffee bar in hospital lobby where many visitors can hear them. Which nursing action below is most appropriate for the RN to take first?
a.	Report the incident to their nurse manager
b.	Quickly engage them in a different conversation to change the subject.
c.	Quietly pull the two staff members aside and remind them about client confidentiality.
d.	Wait until they get their coffee and head back to the nursing lounge; then tell the care providers that the conversation was not appropriate.
11.	A client who is admitted for suspected abuse is quiet and withdrawn. Which of the following should the nurse implement to promote client communication?
a.	Invite a family member to be present for the nursing history
b.	Provide basic wound care for obvious physical injuries
c.	Probe the client to offer an actual account of the abuse
d.	Provide privacy and be direct and honest when communicating with the client
12.	Which behavior is a priority to minimize an RN’s risk for a malpractice claim?
a.	Maintain positive nurse-patient relationships
b.	Function within the state’s nursing practice act.
c.	Maintain sufficient professional liability insurance to cover you if you are sued
d.	Ask for assistance from other RNs when engaged in high risk procedures
13.	A RN in the emergency department is assessing an elderly client. The client’s son states that the client has glaucoma, is extremely hard of hearing, and has been experiencing severe abdominal cramping and diarrhea for the past 24 hours. Which of the following actions is most appropriate for the nurse to do first?
a.	Ask the client if he is wearing or has with him a hearing aid
b.	Ask the patient if he has taken any medication for the diarrhea in the past 24 hours
c.	Using a numeric 1-10 rating scale, ask the client to rate his abdominal pain
d.	Ask the client if he has talked to his physician yet about his condition.
14.	Which of the following is a principle of ethical decision making that refers to the idea of doing “good”?
15.	The expense of buying a new MRI machine would most likely be included in which type of a budget?
a.	Contingency budget
b.	Operating budget
c.	Capital budget
d.	Minor equipment budget
16.	The nurse is caring for a combative patient who has been placed in soft wrist restraints. The nurse notes that the client has been cooperative and non-combative for the past two hours. Which of the following measures will the nurse take next?
a.	Continue to assess the patient’s wrists every 15 minutes
b.	Compliment the patient for cooperating and return in 4 hours
c.	Remove one wrist restraint at a time and assess the patient’s behavior
d.	Maintain the restraints for the next 24 hours
17.	A nurse calls the physician regarding a new medication prescription because the dosage prescribed is higher than the recommended dosage. The nurse has called the physician several times without reaching him, and the medication is due to be administered. Which action should the nurse take first?
a.	Administer the prescribed dose now
b.	Continue trying to reach the physician and document attempts made.
c.	Inform the nursing supervisor
d.	Administer the recommended dose until the physician can be contacted.
18.	Nursing staff sometimes need support and guidance when facing challenging patient care ethical dilemmas. Nurse Managers can support staff in working through ethical dilemmas by consulting which of the following?
a.	American Nurses Association (ANA) Social Policy Statement
b.	Joint Commission Standards
c.	Patient Bill of Rights
d.	Hospital/Healthcare Agency’s Ethics Committee
19.	Which phrase best describe the meaning of the standard of care?
a.	The directive that ensures that all nurses will act prudently
b.	The minimal level of expertise that may be delivered to a patient
c.	The intentions that the nurse will behave in a prudent manner
d.	The law the states that a nurse shall do not harm
20.	The Board of Registered Nurses’ role includes the protection of citizens. Which of the following is NOT a way that the BRN protects citizens?
a.	Monitoring of RN educational standards and accrediting nursing schools
b.	Hiring and firing RNs involved in unethical practice
c.	Issuing, suspending, and revoking RN Licenses
d.	Overseeing RN continuing education requirements/CE Provider Approval
21.	A nurse is caring for several clients in a walk-in clinic. Which client should the nurse have the provider see immediately?
a.	A diaphoretic, obese middle-aged man with epigastric pain
b.	A disruptive teenager with alcohol on her breath who is vomiting profusely
c.	A crying toddler with a forehead scrape wound that is bleeding
d.	A young adult presenting with extremely painful sunburned face.
22.	Information technology makes client care easier as well as more challenging for nurses. Which action by the nurse demonstrates compliance with HIPAA?
a.	Log-in with user name and password and log-out once every shift.
b.	Allow a physician to use the nurses’ computer access information to read lab data only.
c.	Minimize a computer screen with patient health information when speaking with someone not authorized to view it
d.	Allow clergy to visit all patients on the nursing unit
23.	Police found an unconscious man alone in a back ally with no identification. No witnesses were present. An ambulance brought the patient to the Emergency Department where he was determined to have life threatening internal injuries requiring surgery. What type of consent is needed for a physician to treat the patient?
a.	Approved consent
b.	Informed consent
c.	Implied consent
d.	Expressed consent
24.	Where can a nurse manager find standards of ethical behavior specifically written for the nursing profession?
a.	The Joint Commission
b.	Department of Health Services
c.	American Nurses Association
d.	Centers for Medicare/Medicaid Services (CMS)
25.	A client voluntarily admits himself to a hospital’s mental health unit with the diagnosis of suicidal ideation, but is not on a legal hold. The client has been on the unit for two days and states, “I demand to be released now!” The appropriate response from the RN should be which of these statements?
a.	“Let’s discuss your decision to leave and then we can prepare you for discharge.”
b.	“You have a right to sign out as soon as we get the health care provider’s discharge order.”
c.	“You cannot be released because you are still at risk of being suicidal.”
d.	“You can be released only if you sign a no suicide contract before you leave.”
26.	There are two types of torts. These are intentional and unintentional. Which of the following is an example of an unintentional tort?
a.	False imprisonment
b.	Assault and battery
c.	Professional negligence
d.	Defamation of character
27.	Which of the following statements made by a senior nursing student to his nursing instructor about an incident/unusual occurrence report indicates a need for further education?
a.	When a patient is involved in an incident, a copy of the incident report should be placed in the patient’s medical record for hospital staff reference only.
b.	Because these reports are considered confidential and privileged information for the organization, no mention of an incident report should be made to patients or visitors
c.	The primary purpose of incident reports is not to blame persons involved but to correct unsafe or high risk situations.
d.	These reports help to document incident details/persons involved that could be used for legal purposes at some future time should an organization be involved in a lawsuit.
28.	When a RN receives what he/she feels is an unsafe assignment, which of the following actions is most appropriate to do initially?
a.	File a written complaint regarding unsafe staffing with the appropriate hospital administrator (Assignment Despite Objection).
b.	Bring the inappropriate assignment to the attention of the charge nurse and negotiate a new assignment.
c.	Place a call to the nursing director to discuss the unsafe staffing situation
d.	Do not accept the assignment and inform your supervisor that you are going home
29.	A RN is planning care for a client this shift who was placed last night in wrist restraints for a behavior change that threatened the safety of others. Which one of the following actions should the RN do FIRST?
a.	Release the restraints and perform bilateral range of motion
b.	Document the client current behavior in the medical record
c.	Discuss the importance to client observation with the assigned sitter
d.	Assess the patient and review current laboratory data.
30.	A RN is assessing four clients on a Medical-Surgical unit. Which one of the following clients should the RN attend to first?
a.	A client who has diarrhea and requests clear liquids for breakfast
b.	A client who has type 1 diabetes mellitus and has a blood glucose level of 280 mg/dL
c.	A client who has a cast on her left forearm and report numbness and paresthesia in her fingers
d.	A client who has pneumonia and has an axillary temperature of 38 degrees Centigrade (101 degrees Fahrenheit).
31.	What area of a healthcare organization’s budget generally accounts for largest portion of expenditures?
a.	Capital budget
b.	Supplies budget
c.	Contingency budget
d.	Personnel budget
32.	A nurse is convicted for false representation and illegal practice as a nurse practitioner. The nurse is sentenced to five years in a state penitentiary. Which of the following courts has processed this nurse’s sentence?
a.	Criminal court
b.	Civil court
c.	Administrative Court
d.	Board of Registered Nursing Court
33.	A client is receiving patient-controlled analgesia (PCA). A client complains to a RN that the button has been pushed several times but here is no pain relief. The RN checks the pump and determines it is problem for 3 hours. Which is the safest action for the RN to take?
a.	Call the Central Service Department to replace the old pump with a new one. Place the old pump in the soiled utility room.
b.	Place a sign on the old pump to inform Biomedical Engineering about the nature of the equipment malfunction. Remove/isolate the old pump so no one else can use it.
c.	Call the PCA pump vendor to remove the pump in question and have them bring you a new one that functions properly.
d.	Report the pump malfunction to the supervisor and have him/her call Biomedical Engineering to pick up.
34.	When orienting a nurse manager to the budgeting process, what should the nursing director tell the nurse manager is the second largest budget expenditure for health-care organizations?
a.	Short-term capital acquisition budget
b.	Fixed operating budget
c.	Supplies budget
d.	Personnel budget
35.	A nurse manager is explaining the importance and guidelines for use of incident reports to new graduate RNs during their orientation. In assessing their understand of what she has told them, which of the following statements would indicate that more explanation/reinforcement is needed about incident reports?
a.	A manager usually reviews the incident report and investigates the incident before sending it on to the risk manager for follow-up.
b.	Incident reports should not be shared with the client and the family
c.	A copy of the incident report should be made by the person who initiates the report for future reference if there is a lawsuit.
d.	Only a factual description of the event should be documented in the client’s health care record without any mention of an incident report
36.	A nurse has received morning report on the following four clients. Which client should the nurse see first?
a.	A client who has blood glucose of 68 mg/dL and reports mild sweating and is hungry
b.	A client who has acute glomerulonephritis and reports reddish-brown urinary output
c.	A client who has a calcium level of 10 mg/dL and reports have headache
d.	A client who has cellulitis of the left lower leg and reports pain in the affected area.
37.	A nursing staff of a Medical-Surgical unit is asked to make a recommendation regarding an installation of a computer work station. Which factor is a priority for staff ergonomics?
a.	Availability of the chart rack and dictation equipment for healthcare providers
b.	Distance from clients’ room s and number of chairs
c.	Height of the counter top and adjustable task chairs
d.	Location of the elevator relevant to the entrance of the nurse’s station
38.	A nurse who keeps her promise and returns to a patient’s room to answer the patient’s questions on her next rounds is demonstrating the ethical principle of:
39.	A charge nurse receives a phone call from the emergency room where a client is being admitted. The admission diagnosis of the client is renal failure. The client is also confused and restless. Which is the safest room assignment for this client?
a.	A semi-private room 50 feet from the nurse’s station
b.	A small, private room at the end of the hallway
c.	A seclusion room that is monitored by a camera for client safety
d.	A large private room within view of the nurse’s station
40.	A client is brought into the ED with a history of alcohol abuse. The client presents confused and disoriented. Wrist restraints were placed on the patient. After six hours has passed, the client requested to leave. The nurse refused to remove the wrist restraints. The client informed the nurse that he was going to report her to her supervisor. Which term below best describes the intentional tort that the client will be reporting?
b.	Invasion of privacy
d.	False imprisonment
41.	A client has just joined a health care maintenance organization (HMO) and asks for information about the payment obligations with this plan. The most accurate description of health care costs is that the client will be charged in which manner?
a.	A pre-determined fee for all services
b.	The usual and customary fee for services
c.	Only for services provided by specialists
d.	One flat rate for each service rendered
42.	A physician orders a medication that the registered nurse believes will harm the patient. Which statement accurately states the legal consequences of carrying out, or refusing to carry out, the procedure?
a.	The RN cannot be held legally liable for any harm to the patient if the medication is given in accordance with the physician’s order
b.	The RN can be held legally liable for any harm to the patient if the medication is given without questioning the order in accordance with hospital policies
c.	The RN refusing to carry out the physician’s order will be held accountable for overstepping the boundaries of physician/nurse scope of practice.
d.	The RN is lilely to lose his/ her license by refusing to carry out the procedure.
43.	After signing an informed surgical consent form, a client states, “ I have changed my mind and do not want to have the operation.” Which of the following should the RN do first?
a.	Notify the physician that the client wishes to withdraw informed consent for the procedure
b.	Remind the client that a signed informed consent form is a legally binding document
c.	Call the department where the procedure will be done to cancel the procedure
d.	Explore with the client reasons for withdrawing his consent
44.	A nurse should initiate discharge planning for a client at what time period?
a.	Immediately after a client’s condition is stabilized on the assigned unit
b.	When the client or family demonstrate readiness to learn self-care modalities
c.	Upon admission to a hospital unit or the emergency room
d.	When a date for discharge has been determined
45.	A healthcare worker anonymously reports through his organization’s Corporate hotline that coworkers are steeling supplies and taking them home for their own use. This reporting would be called:
a.	Laternal whistle blowing
b.	External whistle blowing
c.	Vertical whistle blowing
d.	Internal whistle blowing
46.	RNs who unintentionally fail to meet professional standards of care and do not act in a prudent and reasonable manner may be accused of which one of the following?
47.	Following change of shift report, which client should the RN see first?
a.	A client who has threatened a lawsuit regarding his call light not being answered in a timely manner.
b.	A client who is to be discharged in one hour who needs additional information about managing his new gastrostromy tube at home
c.	A client who is complaining of incisional pain 9/10
d.	A client who has sudden left sided weakness and slurred speech after getting up to the commode.
48.	A RN is assessing a client’s home situation, support systems and resources in preparation for discharge. Which of these observations should be given priority consideration?
a.	Financial status overall
b.	Location of entries, exits, stairs
c.	Distance to the nearest hospital/emergency care
d.	Family’s understanding of the client’s needs
49.	What is the primary purpose of laws and legislation?
a.	To protect the nurse and the patient
b.	To guarantee patient privacy
c.	To ensure nursing compliance with the law
d.	To prevent medical errors
50.	What statement made by a new nurse manager would indicate to her nursing director that he/she needs more budget training/coaching?
a.	A budget contains an estimate of both income and expensed for a year
b.	A budget followed exactly as prepared will always achieve a good financial outcome
c.	A budget allowed for an institution to plan for the effective use of its resources
d.	Patient care supply usage is a variable expense within a budget.