Fundamentals of Nursing NCLEX Practice Questions Quiz Set 8| 75 Questions

Fundamentals of Nursing NCLEX Practice Questions Quiz Set 8| 75 Questions 1. 1. Question The best explanation of what Title VI of the Civil Rights Act mandates is the freedom to: o A. Pick any physician and insurance company despite one’s income. o B. Receive free medical benefits as needed within the county of residence. o C. Have equal access to all health care regardless of race and religion. o D. Have basic care with a sliding scale payment plan from all healthcare facilities. Incorrect Correct Answer: C. Have equal access to all health care regardless of race and religion. Title VI of the Civil Rights Act of 1964 states that “No person in the United States shall, on the ground of race, color, or national origin, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving Federal financial assistance.” • Option A: The Affordable Care Act puts consumers back in charge of their health care. Under the law, a new “Patient’s Bill of Rights” gives the American people the stability and flexibility they need to make informed choices about their health. Through this bill, the client may choose the primary care physician he wants from his plan’s network. • Option B: Since the Patient’s Bill of Rights was enacted, the Affordable Care Act has provided additional rights and protections. The health care law covers preventive care at no cost. Clients may be eligible for recommended preventive health services without a copayment. • Option D: Under the Patient’s Bill of Rights, a client’s premium dollars are ensured to be spent on primary healthcare, not on administrative costs. Also, the bill removes insurance company barriers to emergency services that are outside of their health plan’s network. 2. 2. Question Which statement would best explain the role of the nurse when planning care for a culturally diverse population? The nurse will plan care to: • A. Include care that is culturally congruent with the staff from predetermined criteria. • B. Focus only on the needs of the client, ignoring the nurse’s beliefs and practices. • C. Blend the values of the nurse that are for the good of the client and minimize the client’s individual values and beliefs during care. • D. Provide care while aware of one’s own bias, focusing on the client’s individual needs rather than the staff’s practices. Incorrect Correct Answer: D. Provide care while aware of one’s own bias, focusing on the client’s individual needs rather than the staff’s practices Without understanding one’s own beliefs and values, a bias or preconceived belief by the nurse could create an unexpected conflict or an area of neglect in the plan of care for a client (who might be expecting something totally different from the care). During assessment values, beliefs, practices should be identified by the nurse and used as a guide to identify the choices by the nurse to meet specific needs/outcomes of that client. Therefore identification of values, beliefs, and practices allows for planning meaningful and beneficial care specific for this client. • Option A: As nurses strive to learn more about becoming culturally sensitive nurses, they should also let others know what they are doing and why. Encourage co-workers to provide more culturally competent care. Approach sharing awareness with openness and positivity, rather than from a critical point of view. • Option B: Cultural competency in the health care sector supports positive patient outcomes and improves medical research accuracy. Cultural competence is learning about how cultural differences may impact healthcare decisions and being able to modify care to align with that patient’s culture. • Option C: Active listening in the healthcare community is imperative, especially when individuals of different racial or cultural backgrounds are involved. It’s important that patients feel heard and validated, particularly when they are in a vulnerable position. 3. 3. Question Which factor is least significant during assessment when gathering information about cultural practices? • A. Language, timing • B. Touch, eye contact • C. Biocultural needs • D. Pain perception, management expectations Incorrect Correct Answer: C. Biocultural needs Cultural practices do not influence biocultural needs because they are inborn risks that are related to a biological need and not a learned cultural belief or practice. Culturally competent healthcare professionals learn about different groups and the values that drive them. They develop nonjudgmental acceptance of cultural and noncultural differences in patients and coworkers, using diversity as a strength that empowers them to achieve mutually acceptable healthcare goals. • Option A: When a patient doesn’t speak English and there is no interpreter, spend more time visiting to allay patients’ anxiety. Learn key phrases from the family and use flashcards to enhance communication. When all else fails, sign language does work. Remember that making the effort shows the patient that you care. You are using the language of the heart and building trust. • Option B: Both the clinician and the interpreter must pay particular attention to nonverbal feedback during communication with the patient to ensure understanding of the patient’s concerns and desires. During the exchange, the clinician and the interpreter must be able to convey caring and support to gain patients’ confidence and trust, particularly when they are revealing sensitive information. • Option D: Culture influences patients’ perceptions of illness, pain, and healing. These perceptions may conflict with clinicians’ views based on the medical model. Keep an open mind and listen actively to what patients say about their illness. 4. 4. Question Transcultural nursing implies: • A. Using a comparative study of cultures to understand similarities and differences across human groups to provide specific individualized care that is culturally appropriate. • B. Working in another culture to practice nursing within their limitations. • C. Combining all cultural beliefs into a practice that is a non-threatening approach to minimize cultural barriers for all clients’ equality of care. • D. Ignoring all cultural differences to provide the best-generalized care to all clients. Incorrect Correct Answer: A. Using a comparative study of cultures to understand similarities and differences across human groups to provide specific individualized care that is culturally appropriate Transcultural care means that by understanding and learning about specific cultural practices the nurse can integrate these practices into the plan of care for a specific individual client who has the same beliefs or practices to meet the client’s needs in a holistic manner of care. • Option B: Nurses should explore new ways of providing cultural care in multicultural societies, understand how culture affects health-illness definitions, and build a bridge for the gap between the caring process and the individuals in different cultures. • Option C: The individuals’ beliefs about health, attitudes, and behaviors, past experiences, treatment practices, in short, their culture, play a vital role in improving health, preventing and treating diseases. Health workers must collect cultural data to understand the attitudes of coping with illness, health promotion, and protection. • Option D: Nurses should offer acceptable and affordable care for the individuals under the conditions of the day. Knowing what cultural practices are done in the target communities and identifying the cultural barriers to offering quality health care positively affects the caring process. 5. 5. Question What should the nurse do when planning nursing care for a client with a different cultural background? The nurse should: • A. Allow the family to provide care during the hospital stay so no rituals or customs are broken. • B. Identify how these cultural variables affect the health problem. • C. Speak slowly and show pictures to make sure the client always understands. • D. Explain how the client must adapt to hospital routines to be effectively cared for while in the hospital. Incorrect Correct Answer: B. Identify how these cultural variables affect the health problem. Without assessment and identification of the cultural needs, the nurse cannot begin to understand how these might influence the health problem or health care management. Culture is influential at many levels in health, ranging from the formation of new diagnostic groups to the diagnosis of disease to the determination of what is called a disease or no symptoms and disease cues • Option A: The transcultural approach should be considered in a wide range of subjects, starting from asking if there are any religious practices to be followed or done by the patient during the hospitalization, and writing the signs in the hospital in two different languages. • Option C: Health culture is concerned with every individual’s or the society’s patterns of living, celebrating, being happy in life, suffering, and dying. It is not enough for the individual to acquire only health-related information, but basic skills such as comprehending health-related values, developing a healthy lifestyle, and self-evaluation must be developed. • Option D: The environment is an integral part of the culture. Individuals as physical, ecological, sociopolitical, and cultural beings are continuously interacting with each other. Nurses may have to intervene in the patient and family relationship because of frequent bureaucratic arrangements and procedures. 6. 6. Question Which activity would not be expected by the nurse to meet the cultural needs of the client? • A. Promote and support attitudes, behaviors, knowledge, and skills to respectfully meet the client’s cultural needs despite the nurse’s own beliefs and practices. • B. Ensure that the interpreter understands not only the language of the client but feelings and attitudes behind cultural practices to make sure an ethical balance can be achieved. • C. Develop structure and process for meeting cultural needs on a regular basis and means to avoid overlooking these needs with clients. • D. Expect the family to keep an interpreter present at all times to assist in meeting the communication needs all day and night while hospitalized. Incorrect Correct Answer: D. Expect the family to keep an interpreter present at all times to assist in meeting the communication needs all day and night while hospitalized It is not the family’s responsibility to assist in the communication process. Many families will leave someone to help at times, but it is the hospital’s legal obligation to find an interpreter for continued understanding by the client to make sure the client is fully informed and comprehends in his or her primary language. • Option A: When caring for a patient from a culture different from the nurse’s own, she needs to be aware of and respect his cultural preferences and beliefs; otherwise, he may consider the nurse insensitive and indifferent, possibly even incompetent. But beware of assuming that all members of any one culture act and behave in the same way; in other words, don’t stereotype people. • Option B: Establishing an environment where cultural differences are respected begins with effective communication. This occurs not just from speaking the same language, but also through body language and other cues, such as voice, tone, and loudness. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) requires facilities to have interpreters available, so every facility should make a list available. • Option C: Thinking about one’s beliefs and recognizing one’s own cultural bias and worldview will help understand differences and resolve cultural and ethical conflicts one may face. But while caring for this patient, promote open dialogue and work with him, his family, and health care providers to reach a culturally appropriate solution. For example, a patient who refuses a routine blood transfusion might accept an autologous one. 7. 7. Question Ethical principles for professional nursing practice in a clinical setting are guided by the principles of conduct that are written as the: • A. American Nurses Association’s (ANA’s) Code of Ethics • B. Nurse Practice Act (NPA) written by state legislation • C. Standards of care from experts in the practice field • D. Good Samaritan laws for civil guidelines Incorrect Correct Answer: A. American Nurses Association’s (ANA’s) Code of Ethics This set of ethical principles provides the professional guidelines established by the ANA to maintain the highest standards for ideal conduct in practice. As a profession, the ANA wanted to establish rules and then incorporate guidelines for accountability and responsibility of each nurse within the practice setting. • Option B: Every state and territory in the US sets laws to govern the practice of nursing. These laws are defined in the Nursing Practice Act (NPA). The NPA is then interpreted into regulations by each state and territorial nursing board with the authority to regulate the practice of nursing care and the power to enforce the laws. Fifty states, the District of Columbia and 4 United States (US) territories, have state boards of nursing (BON) that are responsible for regulating their individual NPA. • Option C: Professional standards describe the competent level of care in each phase of the nursing process. They reflect a desired and achievable level of performance against which a nurse’s actual performance can be compared. The main purpose of professional standards is to direct and maintain a safe and clinically competent nursing practice. • Option D: Good Samaritan laws have their basis on the idea that consensus agreement favors good “public policy” to limit liability for those who voluntarily perform care and rescue in emergency situations. It is well known that medical emergencies outside of the umbrella “medical setting” or “clinical environment” are common. 8. 8. Question A bioethical issue should be described as: • A. The physician’s making all decisions of client management without getting input from the client. • B. A research project that included treating all the white men and not treating all the black men to compare the outcomes of specific drug therapy. • C. The withholding of food and treatment at the request of the client in a written advance directive given before a client acquired permanent brain damage from an accident. • D. After the client gives permission, the physician’s disclosing all information to the family for their support in the management of the client. Incorrect Correct Answer: B. A research project that included treating all the white men and not treating all the black men to compare the outcomes of specific drug therapy. The ethical issue was the inequality of treatment based strictly upon racial differences. Secondly, the drug was deliberately withheld even after results showed that the drug was working to cure the disease process in white men for many years. So after many years, the black men were still not treated despite the outcome of the research process that showed the drug to be effective in controlling the disease early at the beginning of the research project. Therefore harm was done. Nonmaleficence, veracity, and justice were not followed. • Option A: Patients have a right to make their own decisions about their healthcare, guided by the advice of health professionals. This guidance means making sure one fully understands his medical treatment options so one can weigh up options along with the benefits and risks before making a decision. This is called shared decision-making. It ensures that the patient and the doctor are making treatment and healthcare decisions together. • Option C: Advance care planning can help the people close to the patient and those caring for him know what is important to him about the level of healthcare and quality of life he would want if, for some reason, the patient is unable to participate in the discussions. • Option D: Information about medical conditions and treatments is more available than ever before, thanks largely to health websites on the internet. But despite this easy access to health information, it is hard to know what is relevant and appropriate for each patient. Everyone is different and only health professionals can provide the right health information that relates to an individual medical condition. 9. 9. Question When the nurse described the client as “that nasty old man in room 201,” the nurse is exhibiting which ethical dilemma? • A. Gender bias and ageism • B. HIPAA violation • C. Beneficence • D. Code of ethics violation Incorrect Correct Answer: A. Gender bias and ageism Stereotyping an “old man” as “nasty” is a gender bias and an ageism issue. The nurse is verbalizing a negative descriptor about the client. Anyone who lives long enough is at risk of experiencing ageism. In Western, industrialized countries, older people are often perceived as unproductive and as using too much of society’s resources (Gullette 2004). As countries’ demographics shift toward larger percentages of older citizens (due to declines in birth rates and increases in longevity), aging is often framed in public policy debates as a social problem, and the hyperbolic language that is frequently used (e.g., “the gray tsunami”) to describe shifting demographics contributes to ageism. • Option B: The Health Insurance Portability and Accountability Act of 1996 is a landmark piece of legislation that was introduced to simplify the administration of healthcare, eliminate wastage, prevent healthcare fraud, and ensure that employees could maintain healthcare coverage when between jobs. A HIPAA violation is a failure to comply with any aspect of HIPAA standards and provisions detailed in 45 CFR Parts 160, 162, and 164. • Option C: Beneficence is defined as an act of charity, mercy, and kindness with a strong connotation of doing good to others including moral obligation. All professionals have the foundational moral imperative of doing right. • Option D: Serious ethical violations are acts that not only disregard codes of medical ethics, but also risk directly harming patients and subjecting the wrongdoer to criminal, tort, or medical board actions. 10. 10. Question The distribution of nurses to areas of “most need” in the time of a nursing shortage is an example of: • A. Utilitarianism theory • B. Deontological theory • C. Justice • D. Beneficence Incorrect Correct Answer: C. Justice Justice is defined as the fairness of the distribution of resources. However, guidelines for a hierarchy of needs have been established, such as with organ transplantation. Nurses are moved to areas of greatest need when shortages occur on the floors. No floor is left without staff, and another floor that had five staff will give up two to go help the floor that had no staff. • Option A: Utilitarianism is a theory of morality, which advocates actions that foster happiness or pleasure and opposes actions that cause unhappiness or harm. When directed toward making social, economic, or political decisions, a utilitarian philosophy would aim for the betterment of society as a whole. • Option B: In contemporary moral philosophy, deontology is one of those kinds of normative theories regarding which choices are morally required, forbidden, or permitted. In other words, deontology falls within the domain of moral theories that guide and assess our choices of what we ought to do (deontic theories), in contrast to those that guide and assess what kind of person we are and should be (aretaic [virtue] theories). • Option D: Beneficence is defined as an act of charity, mercy, and kindness with a strong connotation of doing good to others including moral obligation. All professionals have the foundational moral imperative of doing right. 11. 11. Question Nurses are bound by a variety of laws. Which description of a type of law is correct? • A. Statutory law is created by an elected legislature, such as the state legislature that defines the Nurse Practice Act (NPA). • B. Regulatory law includes prevention of harm for the public and punishment for those laws that are broken. • C. Common law protects the rights of the individual within society for fair and equal treatment. • D. Criminal law creates boards that pass rules and regulations to control society. Incorrect Correct Answer: A. Statutory law is created by an elected legislature, such as the state legislature that defines the Nurse Practice Act (NPA). Statutory law is created by the legislature. It creates statutes such as the NPA, which defines the role of the nurse and expectations of the performance of one’s duties and explains what is contraindicated as guidelines for breach of those regulations. • Option B: Federal and state regulations influence everything from the air we breathe to the fine print on credit card agreements. Regulatory law involves creating and/or managing the rules and regulations created by federal and state agencies. • Option C: Common law is a body of unwritten laws based on legal precedents established by the courts. Common law influences the decision-making process in unusual cases where the outcome cannot be determined based on existing statutes or written rules of law. • Option D: Criminal law, as distinguished from civil law, is a system of laws concerned with the punishment of individuals who commit crimes. Thus, wherein a civil case of two individuals dispute their rights, a criminal prosecution involves the government deciding whether to punish an individual for either an act or an omission. 12. 12. Question Besides the Joint Commission on Accreditation of Healthcare Organizations (JACHO), which governing agency regulates hospitals to allow continued safe services to be provided, funding to be received from the government, and penalties if guidelines are not followed? • A. Board of Nursing Examiners (BNE) • B. Nurse Practice Act (NPA) • C. American Nurses Association (ANA) • D. Americans With Disabilities Act (ADA) Incorrect Correct Answer: D. Americans With Disabilities Act (ADA) If the hospital fails to follow ADA guidelines for meeting special needs, the facility loses funding and status for receiving low-income loans or reimbursement of expenses. ADA protects the civil rights of disabled people. It applies to both the hospital clients and hospital staff. Privacy issues for persons who are positive for human immunodeficiency virus (HIV) have been one issue in relation to getting information when hospital staff has been exposed to unclean sticks. The ADA allows the infected client the right to choose whether or not to disclose that information. • Option A: Boards of nursing are state governmental agencies that protect the public’s health by overseeing and ensuring safe nursing practice. They establish standards for safe nursing care and issue licenses to practice nursing, monitor licensees’ compliance to state laws, and take action against the licenses of nurses who have exhibited unsafe nursing practice. Most boards also review and approve or accredit nursing education programs to ensure that graduates are prepared for safe, effective practice. • Option B: Every state and territory in the US sets laws to govern the practice of nursing. These laws are defined in the Nursing Practice Act (NPA). The NPA is then interpreted into regulations by each state and territorial nursing board with the authority to regulate the practice of nursing care and the power to enforce the laws. Fifty states, District of Columbia and 4 United States (US) territories, have state boards of nursing (BON) that are responsible for regulating their individual NPA. • Option C: The American Nurses Association (ANA) is the premier organization representing the interests of the nation’s 4 million registered nurses. ANA is at the forefront of improving the quality of health care for all. Founded in 1896, and with members in all 50 states and U.S. territories, ANA is the strongest voice for the profession. 13. 13. Question When a client is confused, left alone with the side rails down, and the bed in a high position, the client falls and breaks a hip. What law has been broken? • A. Assault • B. Battery • C. Negligence • D. Civil tort Incorrect Correct Answer: C. Negligence Knowing what to do to prevent injury is a part of the standards of care for nurses to follow. Safety guidelines dictate raising the side rails, staying with the client, lowering the bed, and observing the client until the environment is safe. As a nurse, these activities are known as basic safety measures that prevent injuries, and to not perform them is not acting in a safe manner. Negligence is conduct that falls below the standard of care that protects others against unreasonable risk of harm. • Option A: Assault is the intentional act of making someone fear that the nurse will cause them harm. One does not have to actually harm them to commit assault. Threatening them verbally or pretending to hit them are both examples of assault. • Option B: Battery is the intentional act of causing physical harm to someone. Unlike assault, one doesn’t have to warn the victim or make him fearful before they hurt them for it to count as a battery. If a nursing home attendant surprises the patient and pushes the patient from behind, that would qualify as a battery. • Option D: Torts are civil laws that address the legal rights of patients and the responsibilities of the nurse in the nurse-patient relationship. Some torts specific to nursing and nursing practice include things like malpractice, negligence, and violations relating to patient confidentiality. 14. 14. Question When signing a form as a witness, your signature shows that the client: • A. Is fully informed and is aware of all consequences. • B. Was awake and fully alert and not medicated with narcotics. • C. Was free to sign without pressure. • D. Has signed that form and the witness saw it being done. Incorrect Correct Answer: D. Has signed that form and the witness saw it being done Your signature as a witness only states that the person signing the form was the person who was listed in the procedure. A witness’s signature can be useful for evidentiary purposes. If a party to the agreement later says they did not sign, the person who witnessed the party signing can be called to confirm it. The witness can confirm that the specific person signed and that was the sign they made. • Option A: In a legal contract, a witness is someone who watches the document is signed by the person they are being a witness for and who verifies its authenticity by singing their own name on the document as well. • Option B: Having a witness helps to reinforce the validity and authenticity of a document by adding another layer of security should the contract ever be questioned in court. • Option C: Though witnesses aren’t always a requirement for executing a legal document, they can help solidify and authenticate a contract by providing proof that the signatures are legitimate and consensual. 15. 15. Question Which criterion is needed for someone to give consent to a procedure? • A. An appointed guardianship • B. Unemancipated minor • C. Minimum of 21 years or older • D. An advocate for a child Incorrect Correct Answer: A. An appointed guardianship A guardian has been appointed by a court and has full legal rights to choose management of care. A situation may arise in which a patient cannot make decisions independently but has not designated a decision-maker. In this instance, the hierarchy of decision-makers, which is determined by each state’s laws, must be sought to determine the next legal surrogate decision-maker. If this is unsuccessful, a legal guardian may need to be appointed by the court. • Option B: An exception to this rule is a legally emancipated child who may provide informed consent for himself. Some, but not all, examples of an emancipated minor include minors who are (1) under 18 and married, (2) serving in the military, (3) able to prove financial independence, or (4) mothers of children (married or not). • Option C: Children (typically under 17) cannot provide informed consent. As such, parents must permit treatments or interventions. In this case, it is not termed “informed consent” but “informed permission.” Legislation regarding minors and informed consent is state-based as well. It is important to understand the state laws. • Option D: An advocate for the child is not legally appointed by the court. Several exceptions to the requirement for informed consent include (1) the patient is incapacitated, (2) life-threatening emergencies with inadequate time to obtain consent, and (3) voluntary waived consent. If the patient’s ability to make decisions is questioned or unclear, an evaluation by a psychiatrist to determine competency may be requested. 16. 16. Question Which of the following statement is correct? • A. “Consent for medical treatment can be given by a minor with a sexually transmitted disease (STD)”. • B. “A second-trimester abortion can be given without state involvement.” • C. “Student nurses cannot be sued for malpractice while in a nursing clinical class.” • D. “Nurses who get sick and leave during a shift are not abandoning clients if they call their supervisor and leave a message about their emergency illness.” Incorrect Correct Answer: A. “Consent for medical treatment can be given by a minor with a sexually transmitted disease (STD).” Anyone, at any age, can be treated without parental permission for an STD infection. The client is “advised” to contact sexual partners but is not “required” to give names. Permission from parents is not needed, based upon current privacy laws. According to the CDC, as of 2020, all jurisdictions have laws that explicitly allow a minor of a particular age (as defined by each state) to give informed consent to receive STD diagnosis and treatment services. In some jurisdictions, a minor might be legally allowed to give informed consent to receive specific STD or HIV services, including PrEP, even if the law is silent on those disease-related services. • Option B: Abortion is legal throughout the United States and its territories, although restrictions and accessibility vary from state to state. Abortion is a controversial and divisive issue in the society, culture, and politics of the U.S., and various anti-abortion laws have been in force in each state since at least 1900. • Option C: One very important point is that student nurses are personally responsible for their own negligent acts. Student nurses are responsible for providing care to their patients, and students are held to the same standards as a licensed professional nurses when performing the duties of a nurse (Pozgar, 2016). • Option D: North Dakota Board of Nursing defines “abandonment” as accepting the client assignment and disengaging the nurse and client relationship without giving notice to a qualified person. Behavior that demonstrates professional misconduct includes abandoning a client who is in need of or receiving nursing care and may be grounds for disciplinary action. 17. 17. Question Most litigation in the hospital comes from the: • A. Nurse abandoning the clients when going to lunch. • B. Nurse following an order that is incomplete or incorrect. • C. Nurse documenting blame on the physician when a mistake is made. • D. Supervisor watching a new employee check his or her skills level. Incorrect Correct Answer: B. Nurse following an order that is incomplete or incorrect The nurse is responsible for clarifying all orders that are illegible, unreasonable, unsafe, or incorrect. The failure of the nurse to question the physician about an order creates an area of liability on the nurse’s part because this is perceived as a medical action and not the role of the nurse to write orders. Some RNs do have prescriptive privileges based upon advanced degrees and certification. Therefore the nurse who cannot correct the order must document that the physician was called and clarification or a new order was given to correct the unclear or illegible one that was currently on the chart. Contact of the staff’s chain of command should also be specifically stated for the proof of the responsibilities being followed according to hospital policy. • Option A: North Dakota Board of Nursing defines “abandonment” as accepting the client assignment and disengaging the nurse and client relationship without giving notice to a qualified person. Behavior that demonstrates professional misconduct includes abandoning a client who is in need of or receiving nursing care and may be grounds for disciplinary action. • Option C: Phone calls, follow-up, and lack of follow-up by the physician should also be documented if there is a problem with getting the information in a timely manner. The nurse must show the sequence of events of a situation in a clear manner if there is any conflict or question about any orders or procedures that were not appropriate. Assessments and documentation of the client’s status should also be included if there is a potential risk for harm present. • Option D: The competence of new RN graduates, both at the point of joining the workforce on graduation and as they gain experience, is an important dimension of quality and safety. Thus each nursing school and prospective employer has a vested interest in ensuring that the initial skills and competency of the new graduate and the conditions for the transition and the ongoing development of the new graduate RN are optimized. 18. 18. Question The nurse places an aquathermia pad on a client with a muscle sprain. The nurse informs the client the pad should be removed in 30 minutes. Why will the nurse return in 30 minutes to remove the pad? • A. Reflex vasoconstriction occurs. • B. Reflex vasodilation occurs. • C. Systemic response occurs. • D. Local response occurs. Incorrect Correct Answer: A. Reflex vasoconstriction occurs. If heat is applied for 1 hour or more, blood flow is reduced by reflex vasoconstriction. Vasoconstriction is the opposite of the desired effect of heat application. An aquathermia (Aqua-K) pad, which produces dry heat, is used to treat muscle sprains and mild inflammations and for pain relief. Temperature-controlled, distilled water flows through the waterproof pad. • Option B: Aquathermia pad is used as a heating pad for various parts of the body. This heating pad is used on the upper side of the body because it cannot be placed on the underside of the body part. There is a specific time period, beyond which blood vessels will start shrinking leading to increased blood pressure. • Option C: Hot aquathermia pad is applied for 20 to 40 minutes and then it should be removed to avoid vasoconstriction. The human body cannot tolerate this heating aquathermia pad for more than 40 minutes, if it exceeds 40 minutes, the patient will start feeling a burning sensation and the blood vessels will constrict leading to further complications. • Option D: Increased temperature of aquathermia pad may burn the skin and the blood vessels may constrict. Due to vasoconstriction, blood pressure may rise. So there is a specific temperature that should be maintained. The ideal temperature set for adults is 45°C. A thin cloth or pillowcase should be placed between a hot aquathermia pad and skin, as it prevents direct heat action on the skin. 20 to 40 minutes is the ideal time for the application of these pads and they should not be placed for more than 40 minutes. 19. 19. Question A client has recently been told he has terminal cancer. As the nurse enters the room, he yells, “My eggs are cold, and I’m tired of having my sleep interrupted by noisy nurses!” The nurse may interpret the client’s behavior as: • A. An expression of the anger stage of dying. • B. An expression of disenfranchised grief. • C. The result of a maturational loss. • D. The result of previous losses. Incorrect Correct Answer: A. An expression of the anger stage of dying. In the anger stage of Kubler-Ross’s stages of dying, the individual resists the loss and may strike out at everyone and everything, in this case, the nurse. Anger, as Kubler-Ross pointed out, is commonly experienced and expressed by patients as they concede the reality of a terminal illness. It may be directed, as with blame of medical providers for inadequately preventing the illness, of family members for contributing to risks of not being sufficiently supportive, or of spiritual providers or higher powers for the diagnosis’ injustice. • Option B: Grief can be caused by situations, relationships, or even substance abuse. Children may grieve a divorce, a wife may grieve the death of her husband, a teenager might grieve the ending of a relationship, or one might have received terminal medical news and are grieving pending death. • Option C: Maturational loss happens as a person develops and goes through the cycle of life, where developmental changes can create a loss specific to every stage of life. It’s a form of anticipatory loss — a type of loss that people anticipate happening at every stage. • Option D: Losses will occur in everyone’s life at different stages and under different circumstances. The pain of loss is universally acknowledged by all people. It’s the loss itself that can be categorized in a couple of different ways. Throughout lifetimes, people can be expected to experience two types of losses, called maturational losses and situational losses. 20. 20. Question When helping a person through grief work, the nurse knows: • A. Coping mechanisms that were effective in the past are often disregarded in response to the pain of a loss. • B. A person’s perception of a loss has little to do with the grieving process. • C. The sequencing of stages of grief may occur in order, they may be skipped, or they may recur. • D. Most clients want to be left alone. Incorrect Correct Answer: C. The sequencing of stages of grief may occur in order, they may be skipped, or they may recur. Grief is manifested in a variety of ways that are unique to an individual and based on personal experiences, cultural expectations, and spiritual beliefs. The sequencing of stages or behaviors of grief may occur in order, they may be skipped, or they may recur. The amount of time to resolve grief also varies among individuals. • Option A: Coping mechanisms are the strategies people often use in the face of stress and/or trauma to help manage painful or difficult emotions. Coping mechanisms can help people adjust to stressful events while helping them maintain their emotional well-being. • Option B: When a person loses someone close to them, it is natural to grieve. This process takes time and involves many different emotions and behaviors. People with cancer and their families may also grieve other cancer-related losses. These may include the loss of a breast, the loss of fertility, or the loss of independence. • Option D: There is no specific time period suggested for any of these stages. Someone may experience the stages fairly quickly, such as in a matter of weeks, where another person may take months or even years to move through to a place of acceptance. 21. 21. Question A client is hospitalized in the end stage of terminal cancer. His family members are sitting at his bedside. What can the nurse do to best aid the family at this time? • A. Limit the time visitors may stay so they do not become overwhelmed by the situation. • B. Avoid telling family members about the client’s actual condition so they will not lose hope. • C. Discourage spiritual practices because this will have little connection to the client at this time. • D. Find simple and appropriate care activities for the family to perform. Incorrect Correct Answer: D. Find simple and appropriate care activities for the family to perform. It is helpful for the nurse to find simple care activities for the family to perform, such as feeding the client, washing the client’s face, combing hair, and filling out the client’s menu. This helps the family demonstrate their caring for the client and enables the client to feel their closeness and concern. a. Older adults often become particularly lonely at night and may feel more secure if a family member stays at the bedside during the night. • Option A: The nurse should allow visitors to remain with dying clients at any time if the client wants them. It is up to the family to determine if they are feeling overwhelmed, not the nurse. Provide family-focused interventions that assist parents in connecting or reconnecting with their existing families, friends, and networks of support as a means of re-establishing coherence and meaning as they go forward. • Option B: Truthful and open communication between the healthcare provider and patient is essential for trust in the relationship and for respect for autonomy. Withholding pertinent medical information from patients in the belief that disclosure is medically contraindicated creates a conflict between the healthcare provider’s obligations to promote patient welfare and to respect patient autonomy. • Option C: It is important to keep in mind that there are numerous individual, familial, and cultural differences that make responding appropriately to another person’s grief anything but a formula. The United States, as most Western countries, has a variety of cultural, religious, and ethnic variations that mediate and modulate the experience of grief and mourning. 22. 22. Question When caring for a terminally ill client, it is important for the nurse to maintain the client’s dignity. This can be facilitated by: • A. Spending time to let clients share their life experiences. • B. Decreasing emphasis on attending to the client's appearance because it only increases their fatigue. • C. Making decisions for clients so they do not have to make them. • D. Placing the client in a private room to provide privacy at all times. Incorrect Correct Answer: A. Spending time to let clients share their life experiences. Spending time to let clients share their life experiences enables the nurse to know clients better. Knowing clients then facilitates the choice of therapies that promote client decision-making and autonomy, thus promoting a client’s self-esteem and dignity. Regarding emotional needs, a review found that important actions for healthcare professionals providing end-of-life care include communicating, listening, conveying empathy, and involving patients in decision-making. Furthermore, good communication between the patient and their partner about their feelings should be promoted. • Option B: Regarding physical needs, when trying to enhance and preserve dignity, a systematic review found that symptom control and being placed in the correct environment are important in delivering dignified end-of-life care 5. Good management of physical symptoms such as pain, dyspnoea, constipation, nausea, and respiratory secretions may allow for opportunities to work through unfinished emotional, psychological, and spiritual issues, and promote a sense of closure towards the end of life. • Option C: Dignity can be upheld by measures such as symptom control 5; promoting independence, privacy, social support, and a positive tone of care; listening, giving appropriate information, having a caring bedside manner; and showing respect, empathy and companionship. Spiritual care has been shown to be facilitated by having sufficient time, employing effective communication, and reflecting on one’s personal experiences. • Option D: Other measures found to promote dignity include enabling the management of finances, facilitating activities such as reading or watching television, allowing the patient to spend time with their family, providing choices regarding the place of death, remembering the dignity of the family after the death of the individual, and offering emotional support. 23. 23. Question What are the stages of dying according to Elizabeth Kubler-Ross? • A. Numbing; yearning and searching; disorganization and despair; and reorganization. • B. Accepting the reality of loss, working through the pain of grief, adjusting to the environment without the deceased, and emotionally relocating the deceased and moving on with life. • C. Anticipatory grief, perceived loss, actual loss, and renewal. • D. Denial, anger, bargaining, depression, and acceptance. Incorrect Correct Answer: D. Denial, anger, bargaining, depression, and acceptance. The most commonly taught system for understanding the process of dying was introduced by Dr. Elizabeth Kubler-Ross in her 1969 book, On Death and Dying. The book explored the experience of dying through interviews with terminally ill patients and described Five Stages of Dying: Denial, Anger, Bargaining, Depression, and Acceptance (DABDA). The model, which was the result of a qualitative and experiential study, was purposely personal and subjective and should not be interpreted as natural law. Rather, the stages provide a heuristic for patterns of thought and behavior, common in the setting of terminal illness, which may otherwise seem atypical. • Option A: Bowlby and Parkes proposed a reformulated theory of grief based in the 1980s. Their work is based on Kubler-Ross’ model. Their model has 4 stages and emphasizes that the grieving process is not linear. • Option B: Woden’s model of grief does not rely on stages but instead states that 4 tasks must be completed by the patient to complete bereavement. These tasks do not occur in any specific order. The grieving person may work on a task intermittently until it is complete. This model is more applicable to the grief of a survivor but may also be applied to a patient-facing death. • Option C: Anticipatory grief is the name given to the tumultuous set of feelings and reactions that occur when someone is expecting the death of a loved one. These emotions can be just as intense as the grief felt after a death. The most important thing to remember is that anticipatory grief is a normal process, even if it’s not discussed as often as regular grief. 24. 24. Question Bereavement may be defined as: • A. The emotional response to loss. • B. The outward, social expression of loss. • C. Postponing the awareness of the reality of the loss. • D. The inner feeling and outward reactions of the survivor. Incorrect Correct Answer: D. The inner feeling and outward reactions of the survivor. Bereavement is the state of loss when someone close to an individual has died. The death of a loved one is one of the greatest sorrows that can occur in one’s life. People’s responses to grief will vary depending upon the circumstances of the death, but grief is a normal, healthy response to loss. Feelings of bereavement can also accompany other losses, such as the decline of one’s health or the health of a close other, or the end of an important relationship. • Option A: Grief is the psychological, physical, and emotional experience and reaction to loss. People may experience grief in various ways, but several theories, such as Kübler-Ross stages of loss theory, attempt to explain and understand the way people deal with grief. • Option B: Physical expressions of grief may include poor sleep, aches and pains, weakness and fatigue, loss of appetite, more crying, and other stress-related symptoms. Emotional expressions of grief may include feels of sadness, numbness, anger, fear, irritability, guilt, regret, and loneliness. • Option C: Talk about death. This will help the surviving individuals understand what happened and remember the deceased in a positive way. When coping with death, it can be easy to get wrapped up in denial, which can lead to isolation and a lack of a solid support system. 25. 25. Question A client who had a “Do Not Resuscitate” order passed away. After verifying there is no pulse or respirations, the nurse should next: • A. Have family members say goodbye to the deceased. • B. Call the transplant team to retrieve vital organs. • C. Remove all tubes and equipment (unless organ donation is to take place), clean the body, and position appropriately. • D. Call the funeral director to come and get the body. Incorrect Correct Answer: C. Remove all tubes and equipment (unless organ donation is to take place), clean the body, and position appropriately. The body of the deceased should be prepared before the family comes into view and says their goodbyes. This includes removing all equipment, tubes, supplies, and dirty linens according to protocol, bathing the client, applying clean sheets, and removing trash from the room. In a home care, the nurse would ask the family if it was alright to remove any tubes or catheters from the patient, and if they would like to assist in bathing/preparing the patient for transport to the funeral home. The nurse would assist the family in removing any jewelry or other items from the patient. Be sure to maintain the highest dignity and respect for the deceased patient during this post-mortem care. • Option A: When the death is imminent, the family must be informed that death is near. As mentioned before, sometimes this is shocking to the family, despite knowing that their loved one is dying. This has to be communicated to the family in a sensitive and calm manner. Each nurse will have their own way to exchange this information, but it is very important that the family be told that death can occur at any time so that they can prepare. There may be a family in the area or out of town that would like to come and see the patient and who is waiting until the patient gets closer to death. • Option B: Correct information given to a family clearly, sensitively, and in a professional manner can accommodate relatives’ understanding of why their loved one is in a critical condition, which can help them accept death and therefore consider the option of organ donation. Nurses must acquire through regular training specific skills and knowledge in order to practice efficiently and adhere to the needs of a dying patient’s family. • Option D: Following the death of a patient, the nurse should offer their condolences to the family and extend assistance with contacting any other family members or individuals the family requests. Depending on the location of the death, the nurse would contact the medical examiner to notify them of the death, as well as the physician and other clinicians who were involved with the patient. The nurse can also contact the funeral home for the family as requested. 26. 26. Question A client’s family member says to the nurse, “The doctor said he will provide palliative care. What does that mean?” The nurse’s best response is: • A. “Palliative care is given to those who have less than 6 months to live.” • B. “Palliative care aims to relieve or reduce the symptoms of a disease.” • C. “The goal of palliative care is to affect a cure of a serious illness or disease.” • D. “Palliative care means the client and family take a more passive role and the doctor focuses on the physiological needs of the client. The location of death will most likely occur in the hospital setting.” Incorrect Correct Answer: B. “Palliative care aims to relieve or reduce the symptoms of a disease.” The goal of palliative care is the prevention, relief, reduction, or soothing of symptoms of disease or disorders without effecting a cure. Palliative care improves the quality of life of patients and that of their families who are facing challenges associated with life-threatening illness, whether physical, psychological, social, or spiritual. The quality of life of caregivers improves as well. • Option A: Palliative care is required for a wide range of diseases. The majority of adults in need of palliative care have chronic diseases such as cardiovascular diseases (38.5%), cancer (34%), chronic respiratory diseases (10.3%), AIDS (5.7%), and diabetes (4.6%). Many other conditions may require palliative care, including kidney failure, chronic liver disease, multiple sclerosis, Parkinson’s disease, rheumatoid arthritis, neurological disease, dementia, congenital anomalies, and drug-resistant tuberculosis. • Option C: Palliative care is an approach that improves the quality of life of patients (adults and children) and their families who are facing problems associated with life-threatening illnesses. It prevents and relieves suffering through the early identification, correct assessment, and treatment of pain and other problems, whether physical, psychosocial, or spiritual. • Option D: Addressing suffering involves taking care of issues beyond physical symptoms. Palliative care uses a team approach to support patients and their caregivers. This includes addressing practical needs and providing bereavement counseling. It offers a support system to help patients live as actively as possible until death. 27. 27. Question Which of the following is not included in evaluating the degree of heritage consistency in a client? • A. Gender • B. Culture • C. Ethnicity • D. Religion Incorrect Correct Answer: A. Gender The term heritage consistency is used to describe how much or how little a person’s lifestyle reflects his or her traditional culture. If one is very “consistent” with their heritage, then one maintains more of the core values, beliefs, attitudes, and behaviors of one’s cultural heritage. • Option B: Acculturation is necessary to survival so it is involuntary. The degree to which one becomes acculturated and the speed of the process is affected by an individual’s circumstances and choices. Children, who can easily avail themselves of socialization via public schools, tend to acculturate quickly in the U.S. They have an easier time learning a new language. • Option C: Many European Americans today – Irish Americans, Italian Americans, French Americans, etc. – are disconnected from their cultural heritage. Exploring the assimilation experience of one’s forebears can be very eye-opening. America’s history is truly a history of immigration, acculturation, and assimilation (with notable exceptions/variations). • Option D: Along with the socio-economic factors of poverty, literacy, and health literacy, culturally responsive care takes into account the heritage consistency of individual patients within the context of family dynamics. In an effort to avoid applying cultural generalizations too rigidly, providers explore the indicators of cultural consistency with their patients from different cultural backgrounds to understand how closely each individual adheres to the traditional culture in which they were raised. 28. 28. Question When providing care to clients with varied cultural backgrounds, it is imperative for the nurse to recognize that: • A. Cultural considerations must be put aside if basic needs are in jeopardy. • B. Generalizations about the behavior of a particular group may be inaccurate. • C. Current health standards should determine the acceptability of cultural practices. • D. Similar reactions to stress will occur when individuals have the same cultural background. Incorrect Correct Answer: B. Generalizations about the behavior of a particular group may be inaccurate. Nurses can pay close attention to their own biases and how they react to people whose backgrounds and cultural experiences differ from their own. For example, a person who becomes conscious that they think of immigrants as illegal aliens achieves cultural awareness of that particular bias. • Option A: Often, individual beliefs and values do not correspond to their behavior and actions. Nurses can work to acknowledge that this disconnect exists and view knowledge as an important element of developing cultural competence. Research has shown that people who score low on prejudice tests may still use labels such as “illegal alien.” • Option C: Nurses put their awareness, attitude, and knowledge into practice by repeating culturally competent behaviors until they become integrated into their daily interactions. These behaviors include effective and respectful communication and body language. Among various cultures, nonverbal communication methods, such as gestures, can mean very different things. • Option D: Once nurses tap into awareness, they can actively analyze their increased awareness and internal belief systems. Using the above example, the person can examine their background, beliefs, and values to understand their cultural bias regarding immigrants. 29. 29. Question To respect a client’s personal space and territoriality, the nurse: • A. Avoids the use of touch. • B. Explains nursing care and procedures. • C. Keeps the curtains pulled around the client's bed. • D. Stands 8 feet away from the bed, if possible. Incorrect Correct Answer: B. Explains nursing care and procedures The respect of territory and personal space represents an ethical and respectful approach to patients, which can permit them to maintain their dignity even under vulnerable conditions, favoring their recovery, as most studies have highlighted. The patients reported that requesting permission to manipulate their body, to examine them, or to perform other care/procedures shows consideration and attention on the part of the professional, which makes the patient feel valued and in control of the situation. This approach may minimize the effects of the invasion and the feeling of being seen as an object. • Option A: The greater perception of territorial invasion is probably due to the fact that patients are somehow prepared for personal invasion in the hospital as they are aware that the approximation by unknown people to perform procedures and to touch their body is part of the treatment. However, territorial invasion is less tolerated since the instinctive drive is stronger, directing the control to personal possessions. • Option C: Touching the patient’s possessions without permission, changing the bedside table to a position that cannot be reached, and raising or lowering the window blinds without consulting the patient are attitudes of the nursing staff that cause much discomfort. Healthcare providers need to be more attentive to the patient’s space and respect the territoriality established by them, often with their personal objects and possessions. • Option D: In the hospital setting, most procedures and interventions are performed at this distance, the intimate zone, often without due affectivity and permission. Within this context of the cultural and personal use of space, healthcare providers need to know and respect the limits of the physical distance that should be maintained in different situations of interaction with the patient so that both feel comfortable. 30. 30. Question To be effective in meeting various ethnic needs, the nurse should: • A. Treat all clients alike. • B. Be aware of the client's cultural differences. • C. Act as if he or she is comfortable with the client’s behavior. • D. Avoid asking questions about the client’s cultural background. Incorrect Correct Answer: B. Be aware of the client’s cultural differences. Nurses can pay close attention to their own biases and how they react to people whose backgrounds and cultural experiences differ from their own. For example, a person who becomes conscious that they think of immigrants as illegal aliens achieves cultural awareness of that particular bias. • Option A: Once nurses tap into awareness, they can actively analyze their increased awareness and internal belief systems. Using the above example, the person can examine their background, beliefs, and values to understand their cultural bias regarding immigrants. • Option C: Often, individual beliefs and values do not correspond to their behavior and actions. Nurses can work to acknowledge that this disconnect exists and view knowledge as an important element of developing cultural competence. Research has shown that people who score low on prejudice tests may still use labels such as “illegal alien.” • Option D: Nurses put their awareness, attitude, and knowledge into practice by repeating culturally competent behaviors until they become integrated into their daily interactions. These behaviors include effective and respectful communication and body language. Among various cultures, nonverbal communication methods, such as gestures, can mean very different things. 31. 31. Question The most important factor in providing nursing care to clients in a specific ethnic group is: • A. Communication • B. Time orientation • C. Biological variation • D. Environmental control Incorrect Correct Answer: A. Communication The ability to communicate effectively with patients and families is paramount for good patient care. This practice point reviews the importance of communicating effectively in cross-cultural encounters. The LEARN (Listen, Explain, Acknowledge, Recommend, Negotiate) model is a framework for cross-cultural communication that helps build mutual understanding and enhance patient care. • Option B: One way of looking at cultural attitudes to time is in terms of time orientation, a cultural or national preference toward past, present, or future thinking. The time orientation of a culture affects how it values time, and the extent to which it believes it can control time. • Option C: Biological variations in transcultural nursing relate to the genetic difference between cultures that may or may not predispose certain groups to specific diseases. This dimension may also include variations of “pain tolerance and deficiencies and predilections in nutrition” (Albougami, Pounds, & Alotaibi, 2016). • Option D: Environmental control refers to how the patient “perceives society and its internal and external factors, such as beliefs and understandings regarding how illness occurs, how it should be treated, and how health is uplifted and maintained” (Albougami, Pounds, & Alotaibi, 2016). 32. 32. Question A health care issue often becomes an ethical dilemma because: • A. A client's legal rights coexist with a health professional's obligation. • B. Decisions must be made quickly, often under stressful conditions. • C. Decisions must be made based on value systems. • D. The choices involved do not appear to be clearly right or wrong. Incorrect Correct Answer: D. The choices involved do not appear to be clearly right or wrong. Advances in medicine, increasing economic stress, a rise of patient self-determination, and differing values between healthcare workers and patients are among the many factors contributing to the frequency and complexity of ethical issues in healthcare. • Option A: Nurses are required to administer prescribed medicine, but patients, at the same time, can refuse them. Patient autonomy can go against medical directives, despite clearly defined needs. Patients have a right to refuse all medical care. ANA highlights that it is important for nurses and nurse managers to understand patient backgrounds and individual circumstances to inform the patient of the medical necessity. • Option B: Nurses can also benefit by surrounding themselves with well-seasoned nurses as well as experienced nurse managers. They can rely on the guidance of nurse managers when it comes to situations they may not know how to address. Nurse managers can cultivate educational environments, in which they regularly discuss ethical issues with the nurses in their units. By having open dialogues about ethical issues, nurses can learn from the mistakes others have made and learn how to approach ethical issues and challenges. • Option C: Healthcare, which is science-based and results-driven, can impede religious or personal beliefs. Some religions restrict medical interventions and lifesaving techniques. Nurses focus on providing medical care to reduce suffering and to allow patients to concentrate on self-care. For patient