PROFESSIONAL ADJUSTMENT AND NURSING CARE
MANAGEMENT PRACTICE EXAM ANSWER KEY WITH
RATIONALES
1. The nurse is explaining the Bill of Rights for psychiatric
patients to a client who has voluntarily sought admission to an inpatient
psychiatric facility. Which of the following rights should the nurse include
in the discussion? Select all that apply:
__Right to select health care team members
__Right to refuse treatment
__Right to a written treatment plan
__Right to obtain disability
__Right to confidentiality
__Right to personal mail
RATIONALE: An inpatient client usually receives a copy of the Bill of Rights
for psychiatric patients, where they would find options 2, 3, 5, and 6 in writing.
However, a client in an inpatient setting can't select health team members. A client
may apply for disability as a result of a chronic, incapacitating illness; however,
disability isn't a patient right, and members of a psychiatric institution don't decide
who should receive it.
2. In the emergency department, a client reveals to the nurse a
lethal plan for committing suicide and agrees to a voluntary admission to
the psychiatric unit. Which information will the nurse discuss with the
client to answer the question, "How long do I have to stay here?" Select all
that apply:
__"You may leave the hospital at any time unless you are suicidal."
__"Let's talk more after the health team has assessed you."
__"Once you've signed the papers, you have no say."
__"Because you could hurt yourself, you must be safe before being
discharged."
__"You need a lawyer to help you make that decision."
__"There must be a court hearing before you leave the hospital."
RATIONALE: A person who is admitted to a psychiatric hospital on a
voluntary basis may sign out of the hospital unless the health care team determines
that the person is harmful to himself or others. The health care team evaluates the
client's condition before discharge. If there is reason to believe that the client is
harmful to himself or others, a hearing can be held to determine if the admission
status should be changed from voluntary to involuntary. Option 3 is incorrect
because it denies the client's rights; option 5 is incorrect because the client doesn't
need a lawyer to leave the hospital; and option 6 is incorrect because a hearing isn't
mandated before discharge. A hearing is held only if the client remains unsafe and
requires further treatment.
3. The nurse has developed a relationship with a client who has an
addiction problem. Which information would indicate that the therapeutic
interaction is in the working stage? Select all that apply:
__The client addresses how the addiction has contributed to family
distress.
__The client reluctantly shares the family history of addiction.
__The client verbalizes difficulty identifying personal strengths.
__The client discusses the financial problems related to the addiction.
__The client expresses uncertainty about meeting with the nurse.
__The client acknowledges the addiction's effects on the children.
, RATIONALE: Options 1, 3, and 6 are examples of the nurse-client working
phase of an interaction. In the working phase, the client explores, evaluates, and
determines solutions to identified problems. Options 2, 4 and 5 address what
happens during the introductory phase of the nurse-client interaction.
4. If parents or legal guardians aren't available to give consent for
treatment of a life-threatening situation in a minor child, which of the
following statements is most accurate?
A. onsent may be obtained from a neighbor or close friend of the family.
B. Consent may not be needed in a life-threatening situation.
C. Consent must be in the form of a signed document; therefore, parents
or guardians must be contacted.
D. Consent may be given by the family physician.
RATIONALE: In emergencies, including danger to life or possibility of
permanent injury, consent may be implied, according to the law. In some books, sabi,
ung attending physician sa ER na ung mag-aako ang consent. Obviouslly, wala dun
ang family physician kc emergency nga. Parents have full responsibility for the minor
child and are required to give informed consent whenever possible. Verbal consent
may be obtained.
5. You're admitting a 15-month-old boy who has bilateral otitis
media and bacterial meningitis. Which room arrangements would be best
for this client?
A. In isolation off a side hallway
B. A private room near the nurses' station
C. A room with another child who also has meningitis
D. A room with two toddlers who have croup
RATIONALE: With meningitis, the child should be isolated for the first day
but be close to where he can be observed frequently. In isolation off a side hallway is
too far away for frequent observation. Putting the client in a room with another child
who has meningitis or with two toddlers who have croup present an infectious hazard
to the other children.
6. Which of the following points should a team leader consider
when delegating work to team members in order to conserve time?
A. Assign unfinished work to other team members.
B. Explain to each team member what needs to be done.
C. Relinquish responsibility for the outcome of the work.
D. Assign each team member the responsibility to obtain dietary trays.
RATIONALE: When all team members know what needs to be done, they
can work together on the most efficient plan for accomplishing necessary tasks.
Delegation can be flexible, ranging from telling a staff member exactly what needs to
be done and how to do it to allowing team members some freedom to decide how
best to carry out the tasks. Assigning unfinished work to other team members and
assigning each team member the responsibility to obtain dietary trays don't allow for
input from team members. It's the team leader's job to maintain responsibility for the
outcome of a task.
, 7. The nurse is caring for a client admitted to the emergency
department after a motor vehicle accident. Under the law, the nurse must
obtain informed consent before treatment unless:
A. the client is mentally ill.
B. the client refuses to give informed consent.
C. the client is in an emergency situation.
D. the client asks the nurse to give substituted consent.
RATIONALE: The law doesn't require informed consent in an emergency
situation when the client is unable to give consent and no next of kin is present
(NCLEX concept ito, sa Philippines, ang attending doctor sa ER na ang magcoconsent.
A mentally competent client may refuse or revoke consent at any time. Even though
a client who is declared mentally incompetent can't give informed consent, mental
illness doesn't by itself indicate that the client is incompetent to give informed
consent. Although the nurse may act as a client advocate, the nurse can never give
substituted consent. CBQ ito.
8. The nurse is assigned to care for an elderly client who is
confused and repeatedly attempts to climb out of bed. The nurse asks the
client to lie quietly and leaves her unsupervised to take a quick break.
While the nurse is away, the client falls out of bed. She sustains no injuries
from the fall. Initially, the nurse should treat this occurrence as:
A. a quality improvement issue.
B. an ethical dilemma.
C. an informed consent problem.
D. a risk-management incident.
RATIONALE: The nurse should treat this episode as a risk-management
incident; her immediate responsibility is to fill out an incident report and notify the
risk manager. Quality improvement and ethics aren't the nurse's initial concerns. The
facility may choose to look at these types of problems and make changes to deliver a
higher standard of care institutionally. Informed consent isn't a relevant issue in this
incident
9. The nurse receives an assignment to provide care to 10 clients.
Two of them have had kidney transplantation surgery within the last 36
hours. The nurse feels overwhelmed with the number of clients. In addition,
the nurse has never cared for a client who has undergone recent
transplantation surgery. What's the appropriate action for the nurse to
take?
A. Speak to the manager and document in writing all concerns related to
the assignment.
B. Refuse the assignment.
C. Ignore the assignment and leave the unit.
D. Trade assignments with another nurse.
RATIONALE: When a nurse feels incapable of performing an assignment
safely, the appropriate action is to speak to the manager or nurse in charge. Bawal
magmarunong lalo na sa patient care. The nurse should also document the concerns
in writing and ask that the assignment be changed. In the event that the manager
chooses to leave the assignment as given, the nurse should accept the assignment.
The nurse should never abandon the assigned clients by leaving the workplace or
asking another nurse to care for them. The nurse may, however, refuse to perform a
task outside the scope of practice.
MANAGEMENT PRACTICE EXAM ANSWER KEY WITH
RATIONALES
1. The nurse is explaining the Bill of Rights for psychiatric
patients to a client who has voluntarily sought admission to an inpatient
psychiatric facility. Which of the following rights should the nurse include
in the discussion? Select all that apply:
__Right to select health care team members
__Right to refuse treatment
__Right to a written treatment plan
__Right to obtain disability
__Right to confidentiality
__Right to personal mail
RATIONALE: An inpatient client usually receives a copy of the Bill of Rights
for psychiatric patients, where they would find options 2, 3, 5, and 6 in writing.
However, a client in an inpatient setting can't select health team members. A client
may apply for disability as a result of a chronic, incapacitating illness; however,
disability isn't a patient right, and members of a psychiatric institution don't decide
who should receive it.
2. In the emergency department, a client reveals to the nurse a
lethal plan for committing suicide and agrees to a voluntary admission to
the psychiatric unit. Which information will the nurse discuss with the
client to answer the question, "How long do I have to stay here?" Select all
that apply:
__"You may leave the hospital at any time unless you are suicidal."
__"Let's talk more after the health team has assessed you."
__"Once you've signed the papers, you have no say."
__"Because you could hurt yourself, you must be safe before being
discharged."
__"You need a lawyer to help you make that decision."
__"There must be a court hearing before you leave the hospital."
RATIONALE: A person who is admitted to a psychiatric hospital on a
voluntary basis may sign out of the hospital unless the health care team determines
that the person is harmful to himself or others. The health care team evaluates the
client's condition before discharge. If there is reason to believe that the client is
harmful to himself or others, a hearing can be held to determine if the admission
status should be changed from voluntary to involuntary. Option 3 is incorrect
because it denies the client's rights; option 5 is incorrect because the client doesn't
need a lawyer to leave the hospital; and option 6 is incorrect because a hearing isn't
mandated before discharge. A hearing is held only if the client remains unsafe and
requires further treatment.
3. The nurse has developed a relationship with a client who has an
addiction problem. Which information would indicate that the therapeutic
interaction is in the working stage? Select all that apply:
__The client addresses how the addiction has contributed to family
distress.
__The client reluctantly shares the family history of addiction.
__The client verbalizes difficulty identifying personal strengths.
__The client discusses the financial problems related to the addiction.
__The client expresses uncertainty about meeting with the nurse.
__The client acknowledges the addiction's effects on the children.
, RATIONALE: Options 1, 3, and 6 are examples of the nurse-client working
phase of an interaction. In the working phase, the client explores, evaluates, and
determines solutions to identified problems. Options 2, 4 and 5 address what
happens during the introductory phase of the nurse-client interaction.
4. If parents or legal guardians aren't available to give consent for
treatment of a life-threatening situation in a minor child, which of the
following statements is most accurate?
A. onsent may be obtained from a neighbor or close friend of the family.
B. Consent may not be needed in a life-threatening situation.
C. Consent must be in the form of a signed document; therefore, parents
or guardians must be contacted.
D. Consent may be given by the family physician.
RATIONALE: In emergencies, including danger to life or possibility of
permanent injury, consent may be implied, according to the law. In some books, sabi,
ung attending physician sa ER na ung mag-aako ang consent. Obviouslly, wala dun
ang family physician kc emergency nga. Parents have full responsibility for the minor
child and are required to give informed consent whenever possible. Verbal consent
may be obtained.
5. You're admitting a 15-month-old boy who has bilateral otitis
media and bacterial meningitis. Which room arrangements would be best
for this client?
A. In isolation off a side hallway
B. A private room near the nurses' station
C. A room with another child who also has meningitis
D. A room with two toddlers who have croup
RATIONALE: With meningitis, the child should be isolated for the first day
but be close to where he can be observed frequently. In isolation off a side hallway is
too far away for frequent observation. Putting the client in a room with another child
who has meningitis or with two toddlers who have croup present an infectious hazard
to the other children.
6. Which of the following points should a team leader consider
when delegating work to team members in order to conserve time?
A. Assign unfinished work to other team members.
B. Explain to each team member what needs to be done.
C. Relinquish responsibility for the outcome of the work.
D. Assign each team member the responsibility to obtain dietary trays.
RATIONALE: When all team members know what needs to be done, they
can work together on the most efficient plan for accomplishing necessary tasks.
Delegation can be flexible, ranging from telling a staff member exactly what needs to
be done and how to do it to allowing team members some freedom to decide how
best to carry out the tasks. Assigning unfinished work to other team members and
assigning each team member the responsibility to obtain dietary trays don't allow for
input from team members. It's the team leader's job to maintain responsibility for the
outcome of a task.
, 7. The nurse is caring for a client admitted to the emergency
department after a motor vehicle accident. Under the law, the nurse must
obtain informed consent before treatment unless:
A. the client is mentally ill.
B. the client refuses to give informed consent.
C. the client is in an emergency situation.
D. the client asks the nurse to give substituted consent.
RATIONALE: The law doesn't require informed consent in an emergency
situation when the client is unable to give consent and no next of kin is present
(NCLEX concept ito, sa Philippines, ang attending doctor sa ER na ang magcoconsent.
A mentally competent client may refuse or revoke consent at any time. Even though
a client who is declared mentally incompetent can't give informed consent, mental
illness doesn't by itself indicate that the client is incompetent to give informed
consent. Although the nurse may act as a client advocate, the nurse can never give
substituted consent. CBQ ito.
8. The nurse is assigned to care for an elderly client who is
confused and repeatedly attempts to climb out of bed. The nurse asks the
client to lie quietly and leaves her unsupervised to take a quick break.
While the nurse is away, the client falls out of bed. She sustains no injuries
from the fall. Initially, the nurse should treat this occurrence as:
A. a quality improvement issue.
B. an ethical dilemma.
C. an informed consent problem.
D. a risk-management incident.
RATIONALE: The nurse should treat this episode as a risk-management
incident; her immediate responsibility is to fill out an incident report and notify the
risk manager. Quality improvement and ethics aren't the nurse's initial concerns. The
facility may choose to look at these types of problems and make changes to deliver a
higher standard of care institutionally. Informed consent isn't a relevant issue in this
incident
9. The nurse receives an assignment to provide care to 10 clients.
Two of them have had kidney transplantation surgery within the last 36
hours. The nurse feels overwhelmed with the number of clients. In addition,
the nurse has never cared for a client who has undergone recent
transplantation surgery. What's the appropriate action for the nurse to
take?
A. Speak to the manager and document in writing all concerns related to
the assignment.
B. Refuse the assignment.
C. Ignore the assignment and leave the unit.
D. Trade assignments with another nurse.
RATIONALE: When a nurse feels incapable of performing an assignment
safely, the appropriate action is to speak to the manager or nurse in charge. Bawal
magmarunong lalo na sa patient care. The nurse should also document the concerns
in writing and ask that the assignment be changed. In the event that the manager
chooses to leave the assignment as given, the nurse should accept the assignment.
The nurse should never abandon the assigned clients by leaving the workplace or
asking another nurse to care for them. The nurse may, however, refuse to perform a
task outside the scope of practice.
