The Safe & Effective Care Environment: The Management of Care Practice Questions

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 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 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. 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 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 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 6. Which of the following are the five Rights of Supervision? A. The right task, the right circumstances, the right person, the right competency, and the right supervision or feedback B. The right task, the right circumstances, the right person, the right direction or communication, and the right supervision or feedback C. The right competency, the right education and training, the right scope of practice, the right environment and the right client condition D. The right competency, the right person, the right scope of practice, the right environment and the right client condition 7. The registered nurse, prior to the delegation of tasks to other members of the nursing care team, evaluates the ability of staff members to perform assigned tasks for the position as based on which legal consideration? A. The American Nurses Association’s Scopes of Practice B. The American Nurses Association’s Standards of Care C. State statutes D. Federal law 8. The best way to objectively evaluate the effectiveness of an individual staff member’s time management skills in a longitudinal manner is to: A. Observe the staff member during an entire shift of duty to determine whether or not the nurse has accurately and appropriately established priorities. B. Observe the staff member during an entire shift of duty to determine whether or not the nurse has accurately and appropriately completed priority tasks. C. Ask the staff member how they feel like they have been able to employ their time management skills for the last six months. D. Collect outcome data over time and then aggregate and analyze this data to determine whether or not the staff member has completed reasonable assignments in the allotted time before the end of their shift of duty. Correct Response: D The best way to objectively evaluate the effectiveness of an individual staff member’s time management skills in a longitudinal manner is to collect outcome data over time, and then aggregate and analyze this data to determine whether or not the staff member has completed reasonable assignments in the allotted time before the end of their shift of duty. Another way to perform this longitudinal evaluation is to look at the staff member’s use of over time, like the last six months, when the unit was adequately staffed. Observing the staff member during an entire shift of duty to determine whether or not the nurse has accurately and appropriately established priorities is a way to evaluate the short term abilities for establishing priorities and not assignment completion and observing the staff member during an entire shift of duty to determine whether or not the nurse has accurately and appropriately completed priority tasks is a way to evaluate the short term abilities for completing established priorities and not a complete assignment which also includes tasks that are not of the highest priority. Lastly, asking the staff member how they feel like they have been able to employ their time management skills for the last six months is the use of subjective rather than objective evaluation. 9. Which of the following patient care tasks is coupled with the appropriate member of the nursing care team in terms of their legal scope of practice? A. An unlicensed staff member who has been “certified” by the employing agency to monitor telemetry: Monitoring cardiac telemetry B. An unlicensed assistive staff member like a nursing assistant who has been “certified” by the employing agency to insert a urinary catheter: Inserting a urinary catheter C. A licensed practical nurse: The circulating nurse in the perioperative area D. A licensed practical nurse: The first assistant in the perioperative area 10. You are providing care to a permanently disabled Iraqi war veteran who is 28 years of age. When he returned home from the war at the age of 24 years of age 2 years ago he was deemed permanently disabled by both the Veterans Administration (VA) and the Social Security Administration. He receives a substantial monthly service connected disability check from the Veterans Administration and he has no spouse or legal dependents. Which type of governmental health insurance is he now entitled to? A. Only the VA health care services because he is not 65 years of age B. Medicare because he has been deemed permanently disabled for 2 years C. Medicaid because he is permanently disabled and not able to work D. Choices B and C 11. You are a registered nurse who is performing the role of a case manager in your hospital. You have been asked to present a class to newly employed nurses about your role, your responsibilities and how they can collaborate with you as the case manager. Which of the following is a primary case management responsibility associated with reimbursement that you should you include in this class? A. The case manager’s role in terms of organization wide performance improvement activities B. The case manager’s role in terms complete, timely and accurate documentation C. The case manager’s role in terms of the clients’ being at the appropriate level of care D. The case manager’s role in terms of contesting denied reimbursements 12. Select the nurse case management model used for patient care delivery that is accurately paired with one of its descriptors: A. The ProACT Model: Registered nurses perform the role of the primary nurse in addition to the related coding and billing functions B. The Collaborative Practice Model: The registered nurse performs the role of the primary nurse in addition to the role of the clinical case manager with administrative, supervisory and fiscal responsibilities C. The Case Manager Model: The management and coordination of care for clients throughout a facility who share the same DRG or medical diagnosis D. The Triad Model of Case Management: The joint collaboration of the social worker, the nursing case manager, and the utilization review team 13. Which of these case management methods employs the intrinsic use of multidisciplinary plans of care that are based on the client’s current condition, and reflect interventions and expected outcomes within a pre-established time line? A. The Case Manager Model B. The ProACT Model C. The Collaborative Practice Model D. The Triad Model of Case Management 14. Which type of legal consent is indirectly given by the client by the very nature of their voluntary acute care hospitalization? A. An opt out consent B. An implicit consent C. An explicit consent D. No consent at all is given 15. You are asked by your supervisor to take photographs of the residents and their family members who are attending a holiday dinner and celebration at your long term care facility. What should you do? A. Take the photographs because these photographs are part of the holiday tradition at this facility B. Take the photographs because all of the residents are properly attired and in a dignified condition C. Refuse to take the photographs unless you have the consent of all to do so D. Refuse to take the photographs because this is not part of the nurse’s role 16. Select the law that is accurately paired with its description in terms of client rights. A. The Patient Self Determination Act: The client’s right to choose the level of care B. The Patient Self Determination Act: The clients’ right to healthcare insurance coverage for mental health disorders C. The Mental Health Parity Act: The privacy and security of technological psychiatric information D. The Health Insurance Portability and Accountability Act (HIPAA): The privacy and security of technological medical information 17. Select the member of the multidisciplinary team that you would most likely collaborate with when the client is at risk for falls due to an impaired gait. A. The physical therapist B. The occupational therapist C. The podiatrist D. The nurse practitioner 18. Select the member of the multidisciplinary team that you would most likely collaborate with when the client can benefit from the use of adaptive devices for cutting food? A. The physical therapist B. The occupational therapist C. The dietician D. The podiatrist Correct Response: B The member of the multidisciplinary team that you would most likely collaborate with when the client can benefit from the use of adaptive devices for eating is the occupational therapist. Occupational therapists assess, plan, implement and evaluate interventions including those that facilitate the patient’s ability to achieve their highest possible level of independence in terms of their activities of daily living such as bathing, grooming, eating and dressing. Many of these interventions include adaptive devices such as special eating utensils and grooming aids. Physical therapists are licensed healthcare professionals who assess, plan, implement and evaluate interventions including those related to the patient’s functional abilities in terms of their gait, strength, mobility, balance, coordination, and joint range of motion. They also provide patients with assistive aids like walkers and canes and exercise regimens. Dieticians assess, plan, implement and evaluate interventions including those relating to dietary needs of those patients who need regular or therapeutic diets. They also provide dietary education and work with other members of the healthcare need when a client has dietary needs secondary to physical disorders such as dysphagia; and podiatrists care for disorders and diseases of the foot. 19. What is the primary goal of multidisciplinary case conferences? A. To fulfill the nurse’s role in terms of collaboration B. To plan and provide for optimal client outcomes C. To solve complex multidisciplinary patient care problems D. To provide educational experiences for experienced nurses 20. Which member of the multidisciplinary team would you most likely collaborate with when your pediatric client has had a traumatic amputation one or more months ago? A. A Pedorthist B. A pediatric nurse practitioner C. A trauma certified clinical nurse specialist D. A prosthetist 21. Conflicts, according to Lewin, include which types of conflict? Select all that are accurate. A. Conceptualization conflicts B. Avoidance - Avoidance conflicts C. Approach - Approach conflicts D. Resolvable conflicts E. Unresolvable conflicts F. Double Approach - Avoidance conflicts G. Approach-Avoidance conflicts 22. Select the types and stages of conflict that are accurately paired with their description. Select all that apply. A. Frustration: The phase of conflict that is characterized with personal agendas and obstruction B. Conceptualization: The phase of conflict that occurs when contending parties have developed a clear and objective understanding of the nature of the conflict and factors that have led to it C. Taking action: The phase of conflict that is characterized with individual responses to and feelings about the conflict D. Resolution: The type of conflict that can be resolved E. Avoidance-Avoidance: A stage of conflict that occurs when there are NO alternatives that are acceptable to the contending parties F. Approach- Approach Conflicts: The type of conflict that occurs when the people involved in the conflict want more than one alternatives or actions that could resolve the conflict. G. Approach-Avoidance Conflicts: The type of conflict that occurs when the people involved in the conflict believe that all of the alternatives are NEITHER completely satisfactory nor completely dissatisfactory. Correct Response: C, F, G Taking action is the phase of conflict that is characterized with individual responses to and feelings about the conflict; Approach- Approach conflicts are a type of conflict that occurs when the people involved in the conflict want more than one alternatives or actions that could resolve the conflict; and Approach-Avoidance conflicts are a type of conflict that occurs when the people involved in the conflict believe that all of the alternatives are NEITHER completely satisfactory or completely dissatisfactory. Frustration is the phase of conflict that occurs when those involved in the conflict believe that their goals and needs are being blocked and not met, and not necessarily characterized with personal agendas and obstruction; conceptualization is the phase of conflict that occurs when those involved in the conflict begin to understand what the conflict is all about and why it has occurred. This understanding often varies from person to person and this personal understanding may or may not be accurate, clear or objective, and not a clear and objective understanding of the nature of the conflict and factors that have led to it; resolution is a phase of conflict resolution, not a type of conflict, that is characterized when the contending parties are able to come to some agreement using mediation, negotiation or another method; an Avoidance-Avoidance conflict is a type of conflict and not a phase of conflict, that occurs when there are NO alternatives that are acceptable to any the contending parties; Approach- Approach conflicts occur when the people involved in the conflict want more than one alternative or action that could resolve the conflict; and lastly, Double Approach - Avoidance is a type of conflict and not a stage of conflict that occurs when the people involved in the conflict are forced to choose among alternatives and actions, all of which have BOTH positive and negative aspects to them. 23. You are the chair person for the healthcare facility’s newly formed multidisciplinary Safety Committee. During the Forming stage of this group’s development major conflicts have arisen. Which technique of conflict resolution should you use to resolve these conflicts? A. Passivity B. Compromise C. Competition D. Accommodating Others 24. The stages of conflict and conflict resolution in the correct sequential order are: A. Conceptualization B. Frustration C. Resolution D. Taking action 25. Which federal law is most closely associated with the highly restrictive “need to know”? A. The Patient Self Determination Act B. The Mental Health Parity Act C. The Health Insurance Portability and Accountability Act D. The Americans with Disabilities Act of 1990 26. Which of the following personnel do not have the “right to know” medical information? A. The facility’s Performance Improvement Director who is not a healthcare person and who has no direct contact with clients B. A nursing student who is caring for a client under the supervision of the nursing instructor C. The facility’s Safety Officer who is not a healthcare person and who has no direct contact with clients D. A department supervisor with no direct or indirect care duties 27. You are the Nurse Manager for the trauma unit. Which of these staff comments or statements indicate the need for you to provide an educational activity relating to confidentiality and information security? A. “A computer in the hallway was left unattended and a client’s medical record was visible to me.” B. “I just saw a nursing student looking at the medical record for a client that they are NOT caring for during this clinical experience.” C. “As I was walking past the nursing station, I saw a dietician reading the progress notes written by members of the laboratory department in addition to other dieticians’ progress notes.” D. “I refused the nursing supervisor’s request to share my electronic password for the new nurse on the unit.” Correct Response: C 28. Which of the following terms is used to describe the sound, timely, smooth, unfragmented and seamless transition of the client from one level of acuity to another? A. Case management B. Continuity of care C. Medical necessity D. Critical pathway 29. The Joint Commission on the Accreditation of Healthcare Organizations mandates standardized “hand of” change of shift reporting. Which of the following is a standardized “hand off” change of shift reporting system that you may want to consider for implementation on your nursing care unit? A. The Four P's B. UBAR C. ISBAR D. MAUMAR 30. Select the standardized “hand off” change of shift reporting system that is accurately paired with its elements. A. SBAR: Symptoms, background, assessment and recommendations B. ISBAR: Interventions, symptoms, background, assessment and recommendations C. The Five Ps: The patient, plan, purpose, problems and precautions D. BATON: Background, assessment, timing, ownership and next plans Correct Response: C The Five Ps are the patient, plan, purpose, problems and precautions. The elements of the other standardized reporting systems are listed below: SBAR stands for: • S: Situation: The patient’s diagnosis, complaint, plan of care and the patient's prioritized needs • B: Background: The patient’s code or DNR status, vital Signs, medications and lab results • A: Assessment: The current assessment of the situation and the patient’s status and • R: Recommendations: All unresolved issues including things like pending diagnostic testing results and what has to be done over the next few hours ISBAR stands for: • I: Introduction: The introduction of the nurse, the nurse’s role in care and the area or department that you are from • S: Situation: The patient’s diagnosis, complaint, plan of care and the patient's prioritized needs • B: Background: The patient’s code or DNR status, vital Signs, medications and lab results • A: Assessment: The current assessment of the situation and the patient’s status and • R: Recommendations: All unresolved issues including things like pending diagnostic testing results and what has to be done over the next few hours BATON stands for: • B: Background: Past and current medical history, including medications • A: Actions: What actions were taken and/or those actions that are currently required • T: Timing: Priorities and level of urgency • O: Ownership: Who is responsible for what? and • N: Next: The future plan of care IPASS stands for: • Introduction: The introduction of the nurse, the nurse’s role in care and the area or department that you are from • P: Patient: The patient’s name, age, gender, location and other demographic data • A: Assessment: The current assessment of the situation and the patient’s status • S: Situation: The patient’s diagnosis, complaint, plan of care and the patient's prioritized needs and • S: Safety concerns: Physical, mental and social risks and concerns 31. Number the priority of the following conditions using the numbers # 1 through # 6 with # 1 as the greatest priority and # 6 as the least priority. 1. Atrial fibrillation 2. First degree heart block 3. Shortness of breath upon exertion 4. An obstructed airway 5. Fluid needs 6. Respect and esteem by others A. 3,4,2,1,5,6 B. 3,4,5,1,2,6 C. 2,3,5,1,4,6 D. 3,2,4,1,5,6 32. The 2nd priority needs according to the MAAUAR method of priority setting include which of the following? A. Assessment B. Movement C. Understanding level D. Risks 33. Which of these skills is most closely related to successfully meeting the established priority needs of a group of clients? A. Time management skills B. Communication skills C. Collaboration skills D. Supervision skills 34. Which is most closely aligned with ethics? A. Morals B. Laws C. Statutes D. Client rights 35. Select the ethical term that is accurately paired with it brief description. A. Deontology: The school of ethical of thought that requires that only the means to the goal must be ethical. B. Utilitarianism: The school of ethical of thought that requires that only the end goal must be ethical. C. Deontology: The school of ethical of thought that requires that only the end goal must be ethical. D. Utilitarianism: The school of ethical of thought that requires that only the means to the goal must be ethical. 36. What ethical principle below is accurately paired with a way that ethical principle is applied into nursing practice? A. Justice: Equally dividing time and other resources among a group of clients B. Beneficence: Doing no harm during the course of nursing care C. Veracity: Fully answering the client’s questions without any withholding of information D. Fidelity: Upholding the American Nurses Association’s Code of Ethics 37. You have been asked to teach an inservice class for nurses in your facility about ethics. Which of the following should you consider during the planning of this educational activity? A. Planning a way to evaluate the effectiveness of the class by seeing a decrease in the amount of referrals to the facility’s Ethics Committee B. Establishing educational objectives for the class that reflect the methods and methodology that you will use to present the class content C. The need to exclude case studies from the class because this would violate client privacy and confidentiality D. Some of the most commonly occurring bioethical concerns including genetic engineering into the course content 38. One of the roles of the registered nurse in terms of informed consent is to: A. Serve as the witness to the client’s signature on an informed consent. B. Get and witness the client’s signature on an informed consent. C. Get and witness the durable power of attorney for health care decisions’ signature on an informed consent. D. None of the above 39. Which of the following is most closely aligned with the principles and concepts of informed consent? A. Justice B. Fidelity C. Self determination D. Nonmalficence 40. Which of the following is NOT an essential minimal component of the teaching that occurs prior to getting an informed consent? A. The purpose of the proposed treatment or procedure B. The expected outcomes of the proposed treatment or procedure C. Who will perform the treatment or procedure D. When the procedure or treatment will be done 41. Legal prohibitions against sharing passwords are legally based on: A. The Security Rule B. The American Nurses Association’s Code of Ethics C. The American Hospital’s Patients’ Bill of Rights D. The Autonomy Rule 42. Which of these statements related to information technology is accurate? A. Social networks and cell phone cameras pose low risk in terms of information technology security and confidentiality. B. The security of technological data and information in healthcare environments is most often violated by those who work there. C. The security of technological data and information in healthcare environments is most often violated by computer hackers. D. Computer data deletion destroys all evidence of the data. 43. Select the legal term that is accurately paired with its description. A. Assault: Touching a person without their consent B. Battery: Threatening to touch a person without their consent C. Slander: False oral defamatory statements. D. Slander: False written defamatory statements. 44. You have loosely applied a bed sheet around your client’s waist to prevent a fall from the chair. What have you done? A. Ensured the client’s safety which is a high patient care priority B. Violated Respondeat Superior C. Violated the client’s right to dignity D. Committed a crime 45. Which statement about Respondeat Superior is accurate? A. Respondeat Superior does not mean that a nurse cannot be held liable. B. Respondeat Superior does not mean that a nurse cannot be held libel. C. Respondeat Superior is an ethical principle. D. Respondeat Superior is a law. 46. Which of these choices contains the six elements necessary for malpractice? A. Causation, foreseeability, damages to the patient, a duty that was owed to the client and this duty was breached, and direct rather than indirect harm to the client. B. Causation, foreseeability, damages to the patient, a duty that was owed to the client and this duty was breached, and direct and/or indirect harm to the client. C. Causation, correlation, damages to the patient, a duty that was owed to the client and this duty was breached, and direct and/or indirect harm to the client. D. Causation, foreseeability, damages to the patient, a duty that was owed to the client and this duty was breached, and a medical license. 47. The current focus of performance improvement activities is to facilitate and address: A. Sound structures like policies and procedures B. Processes and how they are being done C. Optimal client outcomes D. Optimal staff performance 48. What is the term that is used to describe a healthcare related incident or accident that may have possibly led to client harm? A. An adverse event B. A root cause C. A healthcare acquired event D. A sentinel event 49. The primary purpose of root cause analysis is to: A. Discover a process flaw B. Determine who erred C. Discover environmental hazards D. Determine basic client needs 50. Which question is asked more than any other root cause analysis activity? A. What? B. Why? C. Who? D. When? Correct Response: B 51. The primary distinguishing characteristic of risk management when compared and contrasted to performance improvement is that risk management activities focus on: A. Historical data and performance improvement activities focus on current data. B. Current data and performance improvement activities focus on historical data. C. Decreasing financial liability and performance improvement activities focus on process improvements. D. Decreasing falls and performance improvement activities focus on process improvements. 52. Which statement about referrals is accurate? A. Referrals complement the healthcare teams’ abilities to provide optimal care to the client. B. Referrals simply allow the client to be discharged into the community with the additional care they need. C. Nurses facilitate referrals to only the resources within the facility. The Safe & Effective Care Environment: Safety & Infection Control Practice Questions 1. Your client has an allergy to both penicillin and latex. Which of these pathophysiological facts should you apply when you are providing to this client? A. The sensitizing dose of penicillin can lead to anaphylaxis. B. The second dose of penicillin can lead to distributive shock. C. You should be aware of the fact that about 10% of the population has an allergy to both penicillin and latex. D. You should be aware of the fact that about 20% of the population has an allergy to both penicillin and latex. Correct Response: B 2. Which of these clients is at greatest risk for falls? A. A 77 year old female client in a client room that has low glare floors. B. An 87 year old female client in a client room that has low glare floors. C. A 27 year old sedated male client. D. A 37 year old male client with impaired renal perfusion. 3. Which statement about environmental safety is accurate? A. The nurse should advise clients in a smoke filled room to open the windows. B. The first thing that the nurse should do when using a fire extinguisher to put out a small fire is to aim the fire extinguisher at the base of the fire. C. Rapidly lift and move a client away from the source of the fire when their slippers are on fire. D. The home health care nurse should advise the client that the best fire extinguisher to have in the home is an ABC fire extinguisher. 4. Which of the following is considered an internal disaster? A. A tornado that has touched down on the healthcare facility B. A severe cyclone that has destroyed nearby homes C. A massive train accident that brings victims to your facility D. An act of bioterrorism in a nearby factory 5. After your assessment of your client and the need to transfer your client from the bed to the chair, what is the best and safest way to transfer this paralyzed client when you suspect that you will need the help of another for the client’s first transfer out of bed? A. Use a slide board. B. Use a mechanical lift. C. Use a gait belt. D. Notify the client's doctor that the client cannot be safely transferred by you. 6. You are serving as the preceptor for a newly graduated nurse. As you observe the new nurse for their application of body mechanics principles into client care, you observe that the nurse spreads her legs apart during a transfer with a client. What should you do? A. Advise the nurse that the legs must be close together for stability during lifting and transfers. B. Advise the nurse that the legs should be one in front of the other and not spread apart during a transfer. C. Validate the nurse’s competency in terms of the application of body mechanics principles during a transfer. D. Validate the nurse’s competency in terms of the application of ergonomics principles during a transfer. 7. You are serving as the supervisory nurse for a home healthcare agency in the community. You are doing an admission assessment for a 76 year old male client who resides with his elderly wife. Which of the following assessments would indicate that the couple needs some education relating to home safety? A. The client has refrigerated foods labelled with an expiration date. B. You assess that the home is free of scatter rugs that many use to protect the feet against hard floors. C. The client uses the FIFO method for insuring food safety. D. The client assures you that the smoke alarm batteries are replaced annually to insure that they work. 8. Which characteristic of carbon monoxide makes it a particularly dangerous gas? A. It is clear? B. It is damaging to the lungs. C. It is damaging to the spleen and the liver. D. It leads to the over production of hemoglobin. 9. The lack of necessary supplies and equipment to adequately and safely care for patients is an example of a (n): A. Sentinel event. B. System variance. C. Adverse effect. D. Provider variance. 10. The first thing that you should do immediately after a client accident is to: A. Notify the doctor. B. Render care. C. Assess the cleint. D. Notify the nurse manager. Correct Response: C 11. You have collected, aggregated and analyzed data which reflects the frequency of your staff returning medical equipment to the appropriate department because the staff members thought it was too unsafe to use. After the experts in the medical equipment inspect and test the equipment they report back to you, as the nurse manager, whether or not the equipment was indeed unsafe. This data indicates that 83% of the returns that were made by your staff were deemed safe and operable. What should you do? A. Counsel the staff about their need to stop wasting the resources of this department. B. Check the equipment yourself to determine the accuracy of this equipment department. C. Ignore it because everyone can make an innocent mistake. D. Plan an educational activity about determining what equipment to send for repairs. 12. Which of the following is an essential component for insuring that medical equipment is being used safely and properly by those who you supervise? A. Education and training on all pieces of equipment B. Pilot testing new equipment C. Reading all the manufacturer’s instructions D. Researching the equipment before recommending its purchase 13. Which of the following security concerns is also a sentinel event that must be reported? A. A possible vulnerability of the facility’s information technology to hacking B. The assisted suicide of a client in your facility by the spouse of the client C. Vulnerability to computer hacking D. Potential information theft 14. Which of the following is an effective security plan that you may most likely want to consider for implementation within your facility? A. Training all nurses to serve as a part of a security response team B. Training all clerical staff to be a part of a security response team C. The restriction of visitors in a special care area D. Bar coded client identification bands to insure proper identification 15. Select the basic sterile asepsis procedures that are accurate. Select all that apply: A. Sterile items ONLY are placed on the sterile field. B. The nurse must keep the sterile field below waist level. C. Coughing or sneezing over the sterile field contaminates the sterile field. D. The nurse must maintain a 1/2 inch border around the sterile field that is not sterile. E. Moisture and wetness contaminate the sterile field. F. Sterile masks are used by staff and the client when a sterile field is being set up and/or maintained 16. Select the term which is most completely and accurately paired with its definition. A. A physical restraint: A physical restraint is a manufactured device that is used, when necessary, to prevent falls. B. A physical restraint: A physical restraint is any mechanical device, material, or equipment attached to or adjacent to the resident’s body that the individual cannot remove easily which restricts freedom of movement or normal access to one’s body. C. A chemical restraint: A chemical restraint is a drug used for sedation to prevent falls. D. A chemical restraint: A chemical restraint is a drug used for discipline or convenience and not required to treat medical symptoms. 17. Which of the following is NOT an essential component of a restraint order? A. Informed consent for the restraint B. The reason for the restraint C. The type of restraint to be used D. Client behaviors that necessitated the restraints 18. Place the phases or stages of the inflammatory response in the correct sequential order, do NOT include any phases that is NOT part of the inflammatory process. 1. The vascular phase 2. The prodromal phase 3. The incubation phase 4. The initial injury 5. The exudate phase 6. The convalescence phase A. 4,2,1 B. 4,1,5 C. 4,5,1 D. 4,2,5 Health Promotion & Maintenance Practice Questions 1. You are caring for an infant who is just about 12 months old. Which assessment data is normal for the infant at this age? A. The infant had doubled their birth weight at twelve months. B. The infant had tripled their birth weight at twelve months. C. The mother reports that the infant is drinking 60 mLs per kilogram of its body weight. D. The infant had grown ¼ inch since last month. 2. You are the nursing supervisor in a long term care facility. One of the major considerations that you apply into your practice is strict infection control prevention measures because you are knowledgeable about the fact that the normal aging process is associated with the deterioration of the body’s normal defenses. Which theory of aging supports your belief that strict infection control prevention measures are necessary? A. The Programmed Longevity Theory B. The Immunological Theory of Aging C. The Endocrine Theory D. The Rate of Living Theory 3. You are caring for a group of elderly clients, many of whom are affected with multiple chronic disorders and are also, at times, affected with some acute disorders that require medical and nursing attention. As you are caring for these clients some will need a new medication regimen for an acute disorder. You should consider that fact that the elderly population is at risk for more side effects, adverse drug reactions, and toxicity and over dosages of medications because the elderly have a (n): A. Increased creatinine clearance. B. Impaired immune system. C. Decreased hepatic metabolism. D. Increased bodily fat. 4. What is the expected date of delivery for your pregnant client when her last menstrual period was on 10/20/2016? A. 7/7/2017 B. 8/7/2017 C. 6/7/2017 D. 8/1/2017 5. As you are assessing the fetus during labor you are determining and the fetal lie, presentation, attitude, station and position. Your client asks you what all these assessments are. Among other things, how should you respond to the mother? A. You should explain that fetal lie is where the fetus’ presenting part is within the birth canal during labor, among other information about the other assessments. B. You should explain that fetal presentation is the relationship of the fetus’s spine to the mother’s spine, among other information about the other assessments. C. You should explain that fetal attitude is the relationship of the fetus’ presenting part to the anterior, posterior, right or left side of the mother’s pelvis, among other information about the other assessments. D. You should explain that fetal station is the level of the fetus’ presenting part in relationship to the mother’s ischial spines, among other information about the other assessments. 6. You are working in a community pediatric health clinic. Which developmental task should you apply into your practice? A. You should apply the principles of initiative when caring for preschool children. B. You should apply the principles of sensorimotor thought when caring for preschool children. C. You should apply the principles of intimacy when caring for the adolescent. D. You should apply the principles of concrete operations when caring for the adolescent. 7. You are working in a community pediatric health clinic. Which expected life transition should you apply into your practice for these pediatric clients as you are caring for pediatric clients of all ages? A. Pregnancy B. Puberty C. Childhood immunizations D. Separation anxiety 8. Registered nurses care for clients in many settings and environments. These clients can be individual clients, couples, families, populations and communities. You have decided to use the Dimensions Model of Health model to assess, monitor and evaluate the health status of the community. Which of these dimensions is NOT an element of this Dimensions Model of Health model? A. The Biophysical Dimension B. The Psychological and Emotional Dimension C. The Spiritual Dimension D. The Health Systems Dimension 9. You are the registered nurse in a multi ethnic community health department clinic. In this role you are asked to identify clients who have genetic risk factors related to ethnicity in order to screen them for some commonly occurring diseases and disorders. You would identify a client who is of: A. Mediterranean ethnicity for cystic fibrosis. B. African American ethnicity for Tay Sachs disease. C. British Isles ethnicity for psychiatric mental health disorders. D. Saudi Arabian ethnicity for sickle cell anemia. Correct Response: D You would identify a client who is of Saudi Arabian ethnicity for sickle cell anemia. Other ethnicities at greatest risk for sickle cell anemia include those who are African, Latin Americans, Southern Europeans and some clients from some Mediterranean nations. Other disorders and diseases and the ethnicities associated with them are listed below • Thalassemia: Clients with a Mediterranean ethnicity • Tay Sachs Disease: Ashkenazi Jewish people • Cystic Fibrosis: Clients with a European ethnicity • Psychiatric Mental Health Disorders: African Americans and Native Americans • Hypertension: African Americans, Pacific Islanders , Native Americans, Alaskan natives, Hispanic and Caribbean clients • Diabetes: African Americans, Caribbeans, Native Americans and clients from India, Pakistan and Bangladesh 10. Which statement about targeted assessments is accurate? A. The need for a targeted assessment is based on the application of the nurse’s knowledge of pathophysiology and the presenting symptoms. B. The need for a targeted assessment is based on the application of the nurse’s knowledge of developmental needs and developmental delays. C. Targeted assessment is done on an annual basis for existing clients rather than a complete assessment that is done for new clients. D. Targeted assessments consist of a brief medical history and a complete assessment consists of a complete health history and a complete physical assessment. 11. You are fully aware of the fact that some risk factors are correctable or modifiable and other risk factors are innate and not modifiable. Which of the following risk factors is the most likely able to be correctable? A. Genetic predisposition B. Lifestyle choices C. High risk behaviors D. An external locus of control Correct Response: B Life style choices are the risk factors that are most likely able to be corrected. Poor life style choices place a person at risk and they are often considered also risky behaviors. As discussed before, some risks are preventable and correctable and others are not. For example, genetics, age and gender are NOT modifiable risks, but the risks associated with life style choices are modifiable, correctable and able to be eliminated when the person changes their behavior in reference to these risky behaviors. Some risky life style choices include: • Excessive sun exposure • The lack of regular exercise • A poor diet • Cigarette smoking and the use of other tobacco products • Alcohol use • Illicit drug use • Unprotected sex • Avocational and hobby choices such as rock climbing • Inadequate sleep and rest Genetic predisposition is an innate and not correctable risk factor and an external locus of control can lead to poor life style choices, however, this is not the most likely correctable risk factor. 12. Your family, as the client, now has four children and the parents do not want any other children at this time. The mother has a history of deep vein thrombosis and cigarette smoking; and both parents have a history of the lack of adherence to medical regimens. Which form of contraception would you recommend for this couple? A. A transdermal contraceptive patch B. A diaphragm C. A vaginal contraceptive ring D. None of the above 13. Your 87 year old client has a history of heart disease and fibromyalgia. This client has an internal pacemaker and is also a diabetic client. During your annual visit with this client, the client tells you that they would like to begin some alternative and homeopathic health care practices. What should you include in your teaching plan for this client? A. Information about the lack of scientific evidence regarding the effectiveness of all herbs. B. Data to support the fact that magnets can be effective in terms of fibromyalgia pain, and as such, may be a good choice for this client. C. Research that suggests that prayer is an effective alternative method to relieve pain and stress that can be helpful to this client. D. Information that contraindicates the use of biofeedback because this alternative, complementary health practice can interfere with the client’s pacemaker functioning. 14. You assess your family as having a deficit in terms of their instrumental activities of daily living (ADLs). Which healthcare professional would you most likely refer this family to in order to address this deficit? A. A social worker B. A physical therapist C. An occupational therapist D. A speech therapist Correct Response: A 15. Select all of the cranial nerves that are accurately paired with its distinguishing characteristics and description. Again, select all that apply. A. Olfactory Cranial Nerve: The sensory nerve that transmits the sense of smell to the olfactory foramina of the nose B. Optic Cranial Nerve: This sensory nerve transmits the sense of vision from the retina to the brain. C. Oculomotor Cranial Nerve: This motor and sensory nerve controls eye movements and visual acuity. D. Trochlear Cranial Nerve: This motor nerve innervates eye ball movement and the superior oblique muscle of the eyes. E. Abducens Cranial Nerve: This motor nerve innervates and controls the abduction of the eye using the lateral rectus muscle. F. Facial Cranial Nerve: This motor nerve controls facial movements, some salivary glands and gustatory sensations from the anterior part of the tongue. G. Glossopharyngeal Cranial Nerve: This sensory nerve This nerve gives us the sense of taste from the posterior tongue, and it also innervates the parotid glands 16. The sense of hearing is assessed using which standardized test? A. The Taylor test B. The Rinne test C. The Babinski test D. The APGAR test 17. Which of the following steps is the final step that is used during the physical assessment of the abdomen? A. Inspection B. Light palpation C. Deep palpation D. Percussion 18. Which sound should you expect to hear when you percuss the liver during a complete physical assessment? A. Resonance B. Flatness C. Tympany D. Dullness Correct Response: 19. A comprehensive health assessment includes: A. A complete medical history, a general survey and a complete physical assessment. B. A complete medical history, a general survey and a focused physical assessment. C. A client interview, a significant other interview, a general survey and a complete physical assessment. D. A client interview, a significant other interview, a general survey and a focused physical assessment. 20. Select the sound that is heard with percussion with its description. A. Tympany: A hollow sound B. Dullness: A thud like sound C. Dullness: A hollow sound D. Resonance: A booming sound Psychosocial Integrity Practice Questions 1. Which couple is at greatest risk for domestic violence? A. A couple which consists of a husband and wife both of whom are affected with Alzheimer’s disease B. A poverty stricken couple without any healthcare resources in the community C. A pregnant woman and a husband who was physically abused as a young child D. A wealthy couple with feelings that they are immune from punishment and above the law 2. You are caring for a client who has been assessed as having a past history of violent and dangerous behaviors towards others. You, as the nurse, are concerned about this client’s past history and the dangers that may adversely affect others including staff, visitors and other clients on the unit. What is the first thing that you should do to prevent violence towards others? A. Restrain the client B. Place the client in seclusion C. Get an order for a sedating medication D. Establish trust with the client. 3. You are caring for a client who has been taking illicit amphetamines and states that they continue to use this illicit drug because they “suffer and feel lousy” when they try to stop taking it. Which nursing diagnosis is the most appropriate for this client? A. Psychological dependence secondary to amphetamine use B. Substance abuse secondary to amphetamine use C. Addiction secondary to amphetamine use D. Physical dependence secondary to amphetamine use Correct Response: A The appropriate nursing diagnosis for this client is “Psychological dependence secondary to amphetamine use”. Psychological dependence is defined as the person’s need to continue the use of the substance to avoid any unpleasant feelings and experiences that can occur when the substance is not taken. Amphetamines and hallucinogenic drugs like LSD are often associated with psychological dependence. Substance abuse, simply defined, is one’s overindulgence of an addictive substance which can be alcohol, prescription drugs and/or illicit, illegal drugs. Substance abuse does not include prescribed medications, such as narcotic pain medications, that are being used for medical reasons; however, these same medications when used after there is no longer a medical need to use them is considered substance abuse. Addiction is defined as the unending and constant need for the person to have the chosen substance even when the use of the substance causes the client to have serious physical, psychological, social and/or economic consequences and harm including a loss of control over the substance abuse and use. Contrary to popular opinion, addiction can occur with and without physical dependence. Physical dependence occurs when the cessation of a drug causes adverse physical effects; these ill effects are typically greater and more intense when the cessation of the drug is rapid and abrupt. Some of the drugs that are most often associated with physical dependence include cocaine, opioid drugs, alcohol and benzodiazepines. As previously stated, physical dependence does not necessarily indicate addiction; addiction can be present with or without any physical dependency. 4. You are the supervising nurse in a physical rehabilitation center that has the philosophy that clients have the need to cope with their disabilities and its limitations are the result of a discrepancy between the client’s abilities and the limitations of the physical and social environment within which the client lives. Which model of disability is this philosophy based on? A. Orem’s Self Care Model B. Nagi's Model C. A cognitive model of disability D. A biomedical model of disability 5. Place the following phases of crisis in the correct sequential order. Order each response with a number from first to last, with #1 as the first phase of crisis to #4 which is the fourth phase of crisis. 1. The signs and symptoms of the General Adaptation Syndrome 2. Detachment and disorientation 3. Trying alternative methods of coping 4. The use of psychological ego defense mechanisms A. 3,2,1,4 B. 1,2,3,4 C. 4,3,2,1 D. 4,3,1,2 Correct Response: D The characteristics of the stages or phases of crisis, in the correct sequential order, are: • Level 1 Crisis Signs and Symptoms: Patients experiencing a level one crisis typically experience anxiety and they also typically begin to use one or more psychological ego defense mechanisms. • Level 2 Crisis Signs and Symptoms: Patients experiencing a level two crisis most likely exhibit some loss of their ability to function. They may also try to experiment with alternative methods of coping in order to deal with the crisis that is not being effectively coped with using one’s currently used coping mechanisms. • Level 3 Crisis Signs and Symptoms: Patients experiencing a level three crisis show the signs and symptoms of the General Adaptation Syndrome which is characterized with fight, flight and panic as discussed above under the section entitled “Coping Mechanisms: Introduction”. • Level 4 Crisis Signs and Symptoms: Clients experiencing a level four crisis exhibit severe signs and symptoms such as being totally detached and removed from others, feeling overwhelmed, becoming disoriented, and even with thoughts of violence toward self and others. 6. Your client in crisis is detaching from self. Which psychological ego defense mechanism is this client most likely using? A. Displacement B. Sublimation C. Dissociation D. Reaction formation 7. You are the Assistant Director of Nursing in a multiethnical and culturally diverse inner city acute care facility. You will be chairing a committee to develop a philosophy of nursing that addresses these facility characteristics and the characteristics of the clients. Which theoretical framework would you recommend that this committee should consider when addressing mutiethnicity and the culturally diverse nature of this facility for this philosophy? A. Jean Watson's B. Martha Rogers' C. Nagi's theory D. Madeleine Leininger’s theory Correct Response: D 8. You are working as a National Board for Certification of Hospice and Palliative Nurses certified hospice and palliative care nurse who is caring for your clients in their home. Which of the following nursing diagnoses or client goal would be the most likely appropriate and expected for the vast majority of these clients? A. The client will accept impending death B. Guilt related to past transgressions C. Spiritual distress related to guilt D. Pain related to end of life symptoms 9. You are caring for a hospice client who is at the end of life. Based on this client’s signs and symptoms, the client is comatose, dehydrated, free of pain, constipated, without distress and expected to die in a day or two. Which of the following is an appropriate client outcome or an appropriate intervention for this client? A. The client will be free of constipation B. The client will remain free of pain and distress C. The administration of an antiemetic to prevent vomiting and further dehydration D. The administration of an enema to correct the constipation 10. Based on the fact that you family unit client is experiencing a situational crisis that has led to dysfunctional communication within the family unit, you have recommended that the entire nuclear family and members of the extended family who live in the family’s home begin family therapy. The grandparents tell you that it is their grandson, rather than their son, who is addicted to prescription pain killers, is the cause of the problem; therefore, they do not have to participate in this group therapy. How should you respond to these grandparents? A. “You should try to come to a few sessions at least because they may be very informative to you”. B. “You are probably correct. This really is not your problem”. C. “Despite the fact that it is your grandson’s drug addiction, situations such as this affect all members of the family including grandparents who live in the home.” D. "You should attend because the doctor has ordered family therapy for you as extended family members”. 11. You are a hospice nurse who, as part of your role, does follow up counseling and care for the significant others of deceased spouses for one year after their loss. Whose theory of grief and loss would you most likely integrate into your practice as you perform this role? A. Engel's theory B. Kubler Ross' theory C. Lewin's theory D. Warden's theory Correct Response: D The theory of grief and loss would you most likely integrate into your practice as you perform this role is Warden’s Four Tasks of Mourning. This theory has four tasks that people go through after the loss of a loved one. These tasks are accepting the loss, coping with the loss, altering, modifying and changing the environment to cope with and accommodate for the absence of the lost person, and, finally, resuming one’s life while still having a healthy connection with the loved one. Engel’s Stages of Grieving include stages both prior to and after a loss and these stages are: • Shock and disbelief • Developing awareness • Restitution • Resolving the loss • Idealization • Outcome Kubler Ross’s Stages of Grieving occur prior to the death and these stages include: 12. As the nurse in a primary care clinic, which cultural concern would you integrate into your psychological assessments of your clients? A. The concern related to the client’s cultural reluctance to report psychological symptoms because of some possible culturally based stigma associated with psychiatric mental health disorders B. Concerns revolving around the lack of financial and health insurance resources to pay for psychological care C. Concerns related to the compliance with psychological treatment regimens because of the client’s lack of social support systems D. The concern related to the culturally based client apathy about nursing care and nursing assessments 13. You are caring for a group of clients who are adversely affected with phobias. Which form of group therapy will you most likely employ to treat these clients? A. Cognitive psychotherapy B. Behavioral psychotherapy C. Cognitive behavioral psychotherapy D. Psychoanalysis 14. Select the client religion that is the most pertinent to the role of the admissions coordinator of hospital who assigns the rooms and beds of clients who will be admitted. A. Hinduism B. Buddhism C. Islam D. Mormonism Correct Response: C The client religion that is the most pertinent to the role of the admissions coordinator of hospital who assigns the rooms and beds of clients who will be admitted is the Islam religion which requires that the followers face Mecca for daily prayer, therefore, Islam clients should be placed in a room that faces the holy city of Mecca. Although most religions impact on the care of the client, only Islam is pertinent to the admissions coordinator. Other religions practices and their impact on health care are shown below: • Christians: End of life rituals like the Sacrament of the Sick, baptisms for newborns, fasting, and the Eucharist. • Judaism: Religious based circumcisions, a kosher diet which separates dairy foods from meat based foods, and death rituals called a Shiva. • Hinduism: Many followers are vegetarian; personal hygiene is paramount and they also have death rituals without the prolongation of life. • Mormonism: Baptism for the newborn, last rites at the time of death, communion, and burials of the dead. Additionally, the Mormon religion prohibits alcohol, tobacco, and caffeine. • Jehovah’s Witnesses: Prohibitions against blood transfusions, foods containing blood, homosexuality, sex before marriage, abortion, suicide, gambling, alcoholic beverages, tobacco and illicit drugs. 15. You are caring for an acute care adult client in the medical unit who has no history of a psychiatric mental health disorder. This 76 year old client has suddenly and abruptly started to exhibit episodic and intermittent periods of time vacillating between periods of impaired cognition and periods of mental clarity. The client reports to you that they are seeing clowns in their room. This client is dehydrated and has just begun taking an anticholinergic medication. Which of the following is the most appropriate nursing diagnosis for this client? A. Psychotic symptoms related to sensory overload B. Psychotic symptoms related to a previously undiagnosed psychosis C. Visual disturbances related to dementia D. Visual disturbances related to delirium Correct Response: D “Visual disturbances related to delirium”