LPN To RN Transitions 3rd Edition By Claywell – Test Bank
Chapter 01: Honoring Your Past, Planning Your Future
- A nursing advisor is meeting with a student who is interested in earning her RN degree. She knows that LPN/LVNs who enter nursing school to become RNs come into the learning environment with prior knowledge and understanding. Which statement by the nursing advisor best describes her understanding of the effect experience may have on learning?
|a.||“Experience may be a source of insight or a barrier.”|
|b.||“Experience is usually a stumbling block for LPN/LVNs.”|
|c.||“Experience never makes learning more difficult.”|
|d.||“Once something is learned, it can never be truly modified.”|
- There is a test on the cardiovascular system on Friday morning, and it is now Wednesday night. The student has already taken a vacation day from work Thursday night so that she can stay home and study. She is considering skipping her exercise class on Thursday morning to go to the library to prepare for the test. Which response best identifies the student’s outcome priority?
|b.||Going to the library|
|c.||Avoiding work by taking a vacation|
|d.||Doing well on the test on Friday|
- A nurse who has been an LPN/LVN for 10 years is meeting with an advisor to discuss the possibility of taking classes to become an RN. The advisor interprets which statement by the nurse as the driving force for returning to school?
|a.||“I’ll need to schedule time to attend classes.”|
|b.||“I’ll have to budget for paying tuition.”|
|c.||“I’ll have to rearranging my schedule.”|
|d.||“There is a possibility of advancement into administration.”|
- An RN is caring for a diabetic patient. The patient appears interested in changing her lifestyle and has been asking questions about eating better. The nurse can interpret this behavior as which stage of Lewin’s Change Theory?
- An LPN is talking with her clinical instructor about her decision to return to school to become an RN. The clinical instructor interprets the LPNs outcome priority based on which statement?
|a.||“My family wanted me to go back to school.”|
|b.||“I want to better my financial situation.”|
|c.||“I really enjoy school.”|
|d.||“I would like to advance to a teaching role someday.”|
- A nurse notices a posting for a management position for which she is qualified. If the nurse is in the moving phase of Lewin’s Change Theory, which statement reflects the action she is most likely to take?
|a.||Does nothing to obtain the position|
|b.||Applies for the position|
|c.||Identifies that change is needed|
|d.||Settles into the routine of her job|
- An Orthopedic Nurse is contemplating changes in her professional life and identifying goals. Which action should the nurse take if she is interested in pursuing a long-term goal?
|a.||Studies for a telemetry exam scheduled for next week|
|b.||Enrolls in a Nurse Practitioner program|
|c.||Attends a seminar to become a charge nurse|
|d.||Continues to work on the orthopedic floor full-time|
- A group of cardiac nurses with common experiences meet monthly for a staff meeting to discuss ways to improve patient care. This group is known as a:
- Although experience may be a source of motivation for the adult learner, it may also serve as a(n) __________ to new learning.
- A student nurse and the staff RN are discussing recent changes on the nursing unit. Which of the following are examples of change processes? (Select all that apply.)
- A(n) ________ effect experience is one in which movement of the learner toward the desired outcome was constructive.
Chapter 02: Managing Time and Designing Success
- After a particularly challenging examination, a student is overheard in the hallway exclaiming, “That instructor just grades too hard! She only gave me a B on the test!” This student is exhibiting traits of a(n):
|a.||external locus of control.|
|b.||internal locus of control.|
- A student must come back to the learning laboratory to repeat the skills check for insertion of a nasogastric tube. The instructor overhears the student saying, “I know I can do this, I know I can do this!” The instructor interprets this behavior as:
|a.||a self-defeating behavior.|
- A clinical instructor notices that one of her students worries a lot, expects negative outcomes for most situations, strives for perfection, and seems to look for the tiniest faults in her work. The clinical instructor interprets these behaviors as:
|a.||commitment to learning.|
|b.||assuming an external locus of control.|
- A nursing professor is grading an assignment on self-defeating behavior. The professor can expect to find which statement written by the student who has a good understanding of perfectionism?
|a.||Perfection is impossible to attain, and therefore constantly falling short of perfection leads to negative feelings and beliefs about oneself.|
|b.||Perfection is the ultimate goal, and it is not a self-defeating behavior to demand it of oneself.|
|c.||Perfectionism is the only means by which we can truly improve.|
|d.||Perfectionism is a character flaw and cannot be addressed.|
- The nurse understands that there are four key habits for managing the work of success. Which action by the nurse demonstrates her understanding?
|a.||Participating in a yoga class|
|b.||Analyzing case studies on her day off|
|c.||Taking time at the beginning of the work shift to make a plan for her day|
|d.||Setting short- and long-term goals|
- A student has a large reading assignment that must be completed in order to be prepared for the next class. Which action by the student would be ineffective in the planning process?
|a.||Put off the assignment until later so more content is remembered.|
|b.||Examine your schedule to determine time frames for study sessions.|
|c.||Determine a study environment fitting your learning style.|
|d.||Divide the assignment into manageable chunks, and take notes as you read.|
- The roommate of a nursing student buys tickets to the student’s favorite play. The student realizes that the play is the night before her final exam. When the student turns down the tickets, the roommate interprets the student’s dedication to school as:
|a.||dedication to the plan until other mounting responsibilities interfere.|
|b.||total dedication, even in the face of other attractive opportunities.|
|c.||total dedication until resolve begins to wane.|
|d.||discipline to change the plan as needed.|
- A nursing student is learning about effective time management in her first semester of nursing school. Which action by the student indicates that she understands the first critical step?
|a.||Setting goals based on the desired outcome|
|b.||Prioritizing goals in order of simple to complex|
|c.||Prioritizing tasks in chronological order|
|d.||Assessing the reality of the complete situation|
- Stress reduction while in nursing school is an important part of maintaining one’s health. Holistic cognitive theory for stress reduction has four steps. The student shows that he or she understands the first step to achieving awareness by doing which of the following?
|a.||Becomes aware of the early physical signs of stress|
|b.||Concentrates on placing himself or herself as the center of everything|
|c.||Mentally filters perceptions|
|d.||Disqualifies the positive in the experience|
- A student exclaims, “I have to make a 100% on this test because anything less is just like failing in my book. I either know it or I don’t and if I don’t know it now, I never will.” This student is obviously stressed, and the statements represent:
|c.||positive coping mechanisms.|
|d.||acceptance of reality.|
- A lab instructor is observing placement of a Foley catheter by a senior nursing student. If the student is in the active conceptualization phase of Kolb’s Theory of Experiential Learning, what action can the lab instructor expect from the student?
|a.||The student will need to observe placement before proceeding.|
|b.||The student assists the instructor in placing the catheter.|
|c.||The student places the Foley catheter without assistance.|
|d.||The student verbalizes beginning to understand catheter placement.|
- A lab instructor is preparing to teach a group of students. After reading questionnaires filled out by the students in her group, she notes that the students would best learn by reflective observation. What activity should the instructor plan so that the students have the best chance of success?
|a.||Set up stations so that the students can try to “figure it out for themselves.”|
|b.||Allow the students to observe a presentation.|
|c.||Present the information in a lecture while students take notes.|
|d.||Present information and allow the students to be directly involved in a hands-on setting.|
- A nurse is trying to manage success in the workplace. Which action demonstrates that she understands key habits that must be developed and maintained?
|a.||Carefully list and organize the day’s tasks.|
|b.||Complete a task over again because it wasn’t done perfectly the first time.|
|c.||Avoid difficult tasks because they won’t be done correctly.|
|d.||Blame others for lack of organization.|
- A nurse is working with a depressed youth on a psychiatric unit. She knows that her greatest strength is listening. The nurse’s knowledge of herself describes:
- Which actions or statements can the nurse take to eliminate self-defeating behaviors? (Select all that apply.)
|a.||Say, “I know that I can do this.”|
|b.||Accept responsibility for his or her actions.|
|c.||Worry about things that are out of his or her control.|
|d.||Strive for perfection.|
|e.||Believe that his or her actions are out of his or her control.|
- A group of nursing students is discussing how their lives have changed since beginning nursing school. The student who understands the second step of holistic cognitive theory for stress reduction recognizes which comments as descriptive of automatic thoughts? (Select all that apply.)
|a.||“My lab instructor doesn’t like me. I had to repeat my cardiac assessment when no one else did.”|
|b.||“After studying for hours, I finally remembered all the steps to insert a Foley catheter. I will use this method again.”|
|c.||“My child is having behavioral issues in preschool. I know it is because I am in school right now.”|
|d.||“Right after I turned in my test I knew there were at least two answers that I should have changed. I know I failed the test.”|
|e.||“Everything is falling apart in my life. I never should have come to school.”|
- A patient is learning to improve her personal empowerment skills after going through a tough divorce. Which actions can she take to accomplish this? (Select all that apply.)
|a.||Practice positive self-talk.|
|b.||Manage the work of success.|
|c.||Develop an external locus of control.|
|d.||Eliminate self-defeating behaviors.|
|e.||Manage good health.|
- A student has just completed an especially stressful week of work, class, and clinical. She decides that to help reduce stress, a treat of a really funny movie is in order. What kind of coping mechanism has this student chosen? (Select all that apply.)
Match each term with the correct definition.
- Viewing situations from a negative aspect
- Rejecting responsibility for our actions or inactions
- Looking for all imperfections
- Continuously striving to be perfect or do things perfectly
- Being concerned over issues that may or may not be in your control
Chapter 03: Classroom Study Habits That Work
- A first semester student is struggling in class and did not do well on her last exam. She has determined the problem to be her lack of skill in note-taking. What can the student do in order to take more effective notes during lecture?
|a.||Focus on writing key words and phrases.|
|b.||Photocopy someone else’s notes.|
|c.||Write verbatim all that is said.|
|d.||Practice memorization in class instead of taking notes.|
- A student nurse feels that his reading skills are not adequate. Which action would he take in order to have effective reading skills?
|a.||Focus on improving reading speed.|
|b.||Read slowly and thoroughly.|
|c.||Ask his friends and family read to him.|
|d.||Passively engage in reading.|
- A struggling student admits that she is reading the same paragraph over and over when she tries to read the text. The instructor recognizes this as inhibitory to her comprehension of the material. Which suggestion could the instructor make to the student to help correct the situation?
|a.||“Just keep trying. Maybe you need to read it over a few times to get it.”|
|b.||“Maybe you are waiting too late at night to study. Try studying earlier in the day.”|
|c.||“Try putting your finger under the words one at a time.”|
|d.||“If the words are a stumbling block, study them alone first, and then as you read, you will be less likely to stumble over them and regress.”|
- The five-step method of thoroughly studying is composed of which steps in order?
|a.||Scan, skim, survey, read, recite, review.|
|b.||Scan, skim, read, recite, review, reread.|
|c.||Survey, question, read, recite, review.|
|d.||Survey, question, read, review, reread.|
- A nursing student is preparing for her first day of lecture. She knows that in order to succeed, she should:
|a.||skip the first day of class and read the material at home.|
|b.||sit in the front of the room, away from distractions.|
|c.||take notes from the book during lecture time.|
|d.||sit in the back of the class, next to her best friend.|
- A patient comes to the emergency department with complaints of crushing chest pain that radiates down his left arm. While reviewing his health history with the RN, the patient states that he has been getting over a cold. He also has seasonal allergies and is allergic to peanuts. The nurse interprets the major detail for the patient’s ER visit as the patient:
|a.||has a peanut allergy.|
|b.||is experiencing crushing chest pain.|
|c.||is getting over a cold.|
|d.||has seasonal allergies.|
- The RN is performing an assessment on a patient being admitted for back pain. The nurse interprets which of the patient’s statements as a minor detail?
|a.||The patient has not been able to void in 12 hours.|
|b.||The patient ate 90% of his meal.|
|c.||The patient reports being unable to walk.|
|d.||The patient was involved in a car accident 2 days ago.|
- A student has been out of school for a number of years. She is concerned that she may not be able to study effectively. What action can the student take that will increase her ability to focus on her studies?
|a.||Study for 1 hour a night.|
|b.||Study in a loud coffee shop.|
|c.||Stay up all night before tests to make sure she is proficient.|
|d.||Study with the TV off.|
- A student is reviewing new material for an upcoming test. She has decided to highlight so that she can come back later to easily review the material. How can she use highlighting to be successful?
|a.||She should highlight the first time she reads the material.|
|b.||She should highlight no more than 20% of the material.|
|c.||She should use only one method of highlighting.|
|d.||She should highlight the entire chapter.|
- A student is trying to develop better study habits. She knows that for every hour of class, it is advised that she study for ______ hours.
|a.||3 to 4|
|b.||2 to 3|
|c.||4 to 5|
|d.||5 to 6|
- Multiple incorrect options on a test are known as:
- A nursing student knows that effective listening requires attention and preparation. What actions can she take to ensure that she is proficient? (Select all that apply.)
|a.||Read over the assigned material before class begins.|
|b.||Read over the material as soon as class is over.|
|c.||No special attention or preparation is required.|
|d.||Read the material during class.|
|e.||Study independently during discussion time.|
- You are a first semester nursing student and have just received your first reading assignment for class tomorrow. You know that in order to succeed you will need to practice effective listening. Which actions would prepare you for class tomorrow? (Select all that apply.)
|a.||Read over the assigned material tonight.|
|b.||Scan over the material before class, looking at the main points and subpoints.|
|c.||Read the text during class instead of listening to lecture.|
|d.||Review your notes immediately after class.|
|e.||Do not review anything before class.|
- A student is studying for an upcoming test. She has read the assigned text once and is now ready to highlight. Which actions by the student indicate that she understands how to highlight? (Select all that apply.)
|a.||Uses circles to highlight key words or phrases|
|b.||Draws an asterisk next to an important paragraph or sentence|
|c.||Underlines sentences of importance|
|d.||Draws squares around words for emphasis|
|e.||Marks a section with a star for future reference|
- A student has just listened to a lecture on better strategies for studying. Which of the student’s actions indicate understanding? (Select all that apply.)
|a.||Wait until the evening to study.|
|b.||Begin with the most difficult subjects.|
|c.||Create a conducive study environment.|
|d.||Record the lectures and listen to them in your car.|
|e.||Begin to study the day before an exam.|
Chapter 04: Basic Math Review: Preparing for Medication Calculations
Calculate the following dosages.
- What volume of Heparin is one dose?
Ordered: Heparin 12,000 units SC q12h
Available: Heparin 20,000 units/mL
- How many milliliters of KCl will you give?
Ordered: KCl 15 mEq PO BID
Available: 20% KCl labeled 40 mEq/15 mL
- What volume of aminophylline is one dose?
Ordered: aminophylline 175 mg IV q6h
Available: aminophylline ampule labeled 500 mg/20 mL
- What volume of PCN G constitutes one dose?
Ordered: PCN G 750,000 units IV q6h
Available: PCN G vial labeled 200,000 units/mL after reconstitution
- How many tablets of Synthroid will you give for one dose?
Ordered: Synthroid 0.1 mg PO every morning
Available: 50 mcg Synthroid tablets
- What volume of PCN G is in one dose?
Ordered: PCN G 1.25 mil units
Available: Multidose vial labeled 500,000 units/mL after reconstitution
- How many tablets of Zaroxolyn are in one dose?
Ordered: Zaroxolyn 0.005 gm PO q AM
Available: 2.5-mg tablets
- How much is one dose of Lanoxin?
Ordered: Lanoxin 375 mcg IV in the morning
Available: Lanoxin ampule labeled 0.5 mg/2 mL
IV Rate Practice Problems
Calculations with conversion factors required. Round answers to the nearest tenth. Calculate IV rate in mL/hr for each problem.
- 1 L D5W to infuse in 8 hours
- 500 mL D5LR to infuse in 4 hours
- 100 mL Protonix to infuse over 2 hours
- 0.45% NaCl 1000 mL over 6 hours
- 250 mL D10W over 10 hours
- KCl 20 mEq in 150 mL D5W to infuse over 2 hours
- Magnesium sulfate 5 gm in 100 mL D5W to infuse over 3 hours
- 500 mL 0.9 normal saline to infuse over 2 hours
- 1000 mL 0.45 NS to infuse over 8 hours
- 250 mL vancomycin to infuse over 2 hours
Calculate IV rates in gtt/min.
- Give 1000 mL D5½NS q6h. Drop factor is 15 gtt/mL.
- Give 1 unit PRBC over 2 hours. Blood bag states approximate volume is 250 mL. Drop factor is 10 gtt/mL.
- Give D10W 250 mL over 8 hours. Microdrip set delivers 60 gtt/mL.
- Infuse D5W 1 L q12h. Drop factor is 20 gtt/mL.
- Administer 500 mL 0.45 NS over 4 hours. Drop factor is 10 gtt/min.
- Give 1500 mL 0.9 NS with 20 mEq K+ over 12 hours. Drop factor is 15 gtt/min.
- Infuse 1 L lactated Ringers over 10 hours. Drop factor is 25 gtt/ min.
Calculate small volumes to be infused in less than 1 hour in mL/hr.
- Kefzol 500 mg in NS 75 mL over 30 minutes
- Calcium gluconate 10% 16 mEq in 100 mL D5W over 30 minutes
- Zantac 50 mg in ½ NS 50 mL over 15 minutes
- Staphcillin 1 g in 100 mL D5W over 45 minutes
Calculate small volumes to be infused in less than 1 hour in gtt/min.
- Ticar 500 mg IV q6h. Dilute in 75 mL D5W and give over 45 minutes via Buretrol set with a drop factor of 60 gtt/mL.
- Piperacillin 2.5 gm IV q6h. Dilute in 100 mL D5W and infuse over 30 minutes. Secondary set delivers 20 gtt/mL.
- Oxacillin 400 mg in 100 mL D5W over 40 minutes. Secondary set delivers 15 gtt/mL.
- Tagamet 200 mg in D5W 100 mL over 20 minutes. Drop factor is 15 gtt/mL.
- Ancef 250 mg IV piggyback diluted in 100 mL NS over 30 minutes. Drop factor is 10 gtt/min.
Calculate IV rates for medications administered over time. Set the rate in mL/hr. Round answers to the nearest tenth.
- Ordered: Morphine sulfate 10 mg/hr continuous IV
Available: MS 50 mg in 100 mL NS
- Aminophylline 250 mg in 500 mL. Infuse at 30 mg/hr.
- Pronestyl 4 g in 1000 mL D5W. Infuse at 2½ mg/min.
- Heparin 22,000 units in 500 mL NS at 800 units/hr.
Calculate IV rates for medications administered over time, based on body weight. Round answers to the nearest tenth. Set the rate in mL/hr.
- Ordered: Dobutrex 5 mcg/kg/min IV. Client weighs 145 lb.
Available: Dobutrex 250 mg in 250 mL D5W
- Ordered: Infuse nitroprusside 100 mg in 500 mL D5W at 3 mcg/kg/min. Patient weighs 55 kg.
- Ordered: Infuse amrinone 250 mg in 250 mL NS at 5 mcg/kg/min. Patient weighs 165 lb.
- Ordered: Dobutrex 6 mcg/kg/min. Bag is labeled D5W 250 mL with 500 mg Dobutrex added. Patient weighs 198 lb.
Pediatric Practice Problems
To determine whether dosages are appropriate, answer the following questions for each problem:
- What is the appropriate low (therapeutic) to high (safe) range, in milligrams, for each dose of medication for this child?
- What is the safe maximum dose for this child?
- Is the prescribed dose therapeutic and/or safe?
- If answer is yes, how much medication will be given for the ordered dose?
- If answer is no, what will you do?
Round answers to the nearest tenth.
- Ordered: Dilantin 40 mg PO BID
Pediatric dose range: 5 to 7 mg/kg/day
Child’s weight: 6.7 kg
Available: Dilantin 30 mg/5 mL susp
- Ordered: Gantrisin 1.5 g PO QID
Pediatric dose range: 150 to 200 mg/kg/day
Child’s weight: 30.4 kg
Available: Gantrisin 500-mg tablets
- Ordered: Vistaril 10 mg IM q4-6h PRN nausea
Pediatric dose range: 0.5 to 1 mg/kg/dose
Child’s weight: 44 lb
Available: Vistaril 25 mg/mL
- Ordered: Ibuprofen 40 mg PO q6h PRN temp higher than 101.8º F
Pediatric dose range: Child 6 mo to 12 yr, antipyretic: for temp lower than 102.5º F, 5 mg/kg/dose;
for temp higher than 102.5º F, 10 mg/kg/dose
May be given q6-8h: max daily dose of 40 mg/kg/day
Child’s weight: 7-month-old weighs 18.5 lb; temp is 102.4º F.
Available: Ibuprofen susp. 80 mg/5 mL
- Ordered: Nebcin 10 mg IM q8h
Pediatric dose: 2.5 mg/kg/dose
Neonate’s weight: 4000 g
Available: Nebcin 40 mg/mL
Chapter 05: Passing NCLEX-RN®
- A nursing student is giving a presentation on the different organizations that support nurses. She has an adequate understanding of the American Nurses Association when she states, “The American Nurses Association:
|a.||sets the guidelines for entrance into nursing programs.”|
|b.||represents and advocates for nurses.”|
|c.||evaluates and updates licensure exams.”|
|d.||determines who is eligible to take the NCLEX exam.”|
- A graduate nurse is submitting documentation so that she may take the NCLEX-RN within a few months. Which action shows an understanding of the content of the most updated test plan?
|a.||Spending additional study time reviewing health promotion and maintenance|
|b.||Taking a cardiology course before the exam|
|c.||Reviewing notes from previous nursing classes|
|d.||Setting aside time to study pathophysiology of the brain|
- A faculty member is discussing question types found on NCLEX. The faculty member knows that students need more teaching about question types if they select which question type?
- A student is a month into her LPN-RN program. She realizes that proper studying is key to success and passing the NCLEX-RN exam. What would be the most appropriate action for the student to take when it comes to studying?
|a.||She should begin studying at the beginning of her program.|
|b.||She should wait until she learns more about becoming an RN.|
|c.||She should begin studying after graduation, so that she retains information better.|
|d.||She does not have to study for the exam at all; she will learn everything in class.|
- Every 3 years the NCSBN conducts practice analysis to determine the expectations for entry level nurses who are newly licensed. The nurse manager understands and can state that nursing care activities are analyzed in relation to all of the following except:
|a.||frequency of performance.|
|c.||impact on maintaining client safety.|
|d.||client care setting where the activities are performed.|
- A student is studying the KATTS Framework in class. She has offered to tutor a friend who is struggling to grasp the concept of the framework. She knows that her teaching has been effective when her friend states that the KATTS Framework consists of all of the following,except:
|c.||time management skills.|
- When taking an exam the student remains positive, steady, and able to handle tensions that build. The course instructor interprets the student’s behavior as:
- Before beginning the exam, a student stops and reflects on the Five C’s: content, confidence, control, common sense, and comparison. Which statement made by the student indicates her understanding of confidence?
|a.||“I know I can do this.”|
|b.||“I just need to remember what I studied.”|
|c.||“I just need to narrow down the right answer.”|
|d.||“What do I think is the right answer?”|
|e.||“Relax, stay calm and focused.”|
- It is helpful to understand the difference between school exams and the NCLEX-RN in order to ensure that you are prepared to succeed. The student demonstrates adequate understanding of the NCLEX-RN when she makes which statement?
|a.||“The exam content will test only recall and recognition of knowledge.”|
|b.||“The exam will test my critical and higher thinking skills.”|
|c.||“The exam will test my understanding of basic nursing concepts.”|
|d.||“The exam will test my knowledge of how to care for patients in the hospital setting.”|
- Students are applying the KATTS Framework in order to be successful in their nursing program. The instructor knows they are following the framework properly when they report which of the following?
|a.||They are studying 1 hour for every 2 to 3 hours of question drill time.|
|b.||They are studying for 2 hours for every 2 to 3 hours of question drill time.|
|c.||They are studying in group for 3 hours total.|
|d.||They are engaged in question drill time for 2 to 3 hours per study session.|
- When taking the NCLEX-RN, students may pass or fail after completing _____ or up to _____ questions.
- Rigorous and ongoing testing has concluded that Computer Adaptive Testing is both _____ and _____.
- It is critical that students have _____ and believe that they can pass the NCLEX-RN exam.
|a.||good study habits|
|b.||a positive attitude|
|c.||a good support system|
- A student is designing a study plan to prepare for NCLEX. The student analyzes testing processes and determines which goal is the best preparation process?
|a.||Review the medical surgical book 15 minutes each day for each disease process in the book.|
|b.||Answer 2500 to 3000 NCLEX-type questions before taking boards.|
|c.||Make flash cards to study lab values.|
|d.||Outline chapters for exams with a score of less than 80%.|
- Studies have found that students tend to answer questions at a slower pace as they proceed through exams. With this in mind, students should be aware of _____ during school exams as practice for the NCLEX-RN.
|a.||what their classmates are doing|
|b.||the amount of time they are spending on each question|
|c.||the wording of each question|
|d.||which questions they answer first|
- The use of Computer Adaptive Technology (CAT) has drastically changed the process of licensure testing. The graduate nurse understands this process when she makes which statements? (Select all that apply.)
|a.||“The implementation of CAT allows me to choose what study material to use when testing.”|
|b.||“CAT allows me to choose a testing center that is close to my home.”|
|c.||“CAT gives me the flexibility to select a testing time and date that fits into my work schedule.”|
|d.||“CAT implementation allows me to schedule multiple testing dates, in case I cannot make one.”|
|e.||“CAT ensures easier questions than the older written tests.”|
- A student is preparing to begin her final semester of nursing school. She is aware that academic and nonacademic factors can affect her ability to pass the NCLEX-RN. Which statements indicate an understanding of the nonacademic factors? (Select all that apply.)
|a.||“My self-esteem can impact my performance on the exam.”|
|b.||“Having test anxiety can prevent me from testing well.”|
|c.||“My ability to focus on studying can lead to a pass or fail.”|
|d.||“Role strain is a factor in testing success.”|
|e.||“Being good at testing would certainly help me pass.”|
- Students in a nursing class have just finished an exam on the KATTS Framework. The students should know that they can do which of the following, in order to strengthen the knowledge component of the KATTS Framework? (Select all that apply.)
|a.||Complete NCLEX-RN pretests.|
|b.||Review past NCLEX-RN test plans.|
|c.||Create a study plan, and then identify knowledge deficits.|
|d.||Reread textbooks from nursing courses.|
|e.||Focus studying on strong areas of knowledge.|
- A group of nursing students is planning to utilize the KATTS Framework for their group study this week. In order to complete a drill set effectively, they should do which of the following? (Select all that apply.)
|a.||Complete a minimum of 50 questions within 1 hour, and work up to 100 questions in 2 hours.|
|b.||Create a study plan for gaps in knowledge.|
|c.||Understand the rationale for the both the correct and incorrect answers.|
|d.||Analyze the results of the drill set, and look for gaps in knowledge.|
|e.||Complete a minimum of 100 questions in 1 hour, and work up to 200 questions in 2 hours.|
- A graduate nurse is preparing to take the NCLEX-RN exam. She knows that which self-care activities that will help her pass the exam? (Select all that apply.)
|a.||Getting adequate sleep at night|
|b.||Eating a balanced diet|
|c.||Studying all night before the exam|
|d.||Consuming energy drinks to stay awake and focused|
Chapter 06: Distinguishing the RN Role from the LPN/LVN Role
- A nurse manager is discussing the RN’s scope of practice with a new hire. Which statement, made by the new hire, is not true of the RN’s scope of practice?
|a.||“A nurse may be disciplined by the Board of Nursing for practicing beyond his or her scope of practice.”|
|b.||“Scope of practice is legally defined by the American Nurses Association.”|
|c.||“Scope of practice defines the responsibilities of nurses.”|
|d.||“Scope of practice can be found in state nurse practice acts.”|
- The nursing student is reviewing the different organizations that provide services for nurses. She interprets the American Nurses Credentialing Center as:
|a.||an association that provides accreditation for baccalaureate and higher degree nursing education programs.|
|b.||the unifying body for the state boards of nursing.|
|c.||an association that offers certification in many nursing specialties.|
|d.||an organization that offers the national licensure examination.|
- The student is studying the history of nursing education. She is able to identify which nursing degree program as the first one in the United States for RNs?
- Which function falls within the LPN/LVN’s scope of practice?
|a.||Formulating the plan of care|
|c.||Selecting nursing diagnoses|
|d.||Setting goals, objectives, and outcomes|
- Which of the following is an example of professional advocacy in nursing?
|a.||Charting and writing up a medication error|
|b.||Writing up a nursing assistant for excessive absences|
|c.||Writing one’s senator concerning mandatory overtime|
|d.||Mentoring a new graduate RN who is new to the unit|
- The RN is caring for the following patients. Which patient and task are most appropriate to assign to the LPN/LVN?
|a.||A 34-year-old female patient who will need discharge teaching|
|b.||A 40-year-old postoperative male patient who needs a dressing change|
|c.||A 64-year-old female patient who needs a bed bath|
|d.||A 79-year-old patient whose plan of care needs to be updated|
- The charge nurse is creating assignments for the oncoming shift. She notices that today staffing consists of three RNs and one LPN. Which assignment would be most appropriate for the LPN?
|a.||Acute MI: needs preparation for the catheter lab|
|b.||Flu-like symptoms: needs reassessment of vital signs every hour|
|c.||Possible stroke: needs anticoagulation therapy|
|d.||Dehydration: needs IVF boluses and IV antiemetics|
- The RN understands that the National League for Nursing (NLN) delineates three professional roles of the associate degree nurse when she lists all of the following except:
|a.||manager of care.|
|c.||provider of care.|
|d.||member of profession.|
- An LPN/LVN in RN school is experiencing frustration because the expectations of her as a nurse at work are very different from her role as a student in nursing school, and fulfilling both is confusing at times. She has an appropriate understanding of her situation when she states that it is known as:
- A nurse manager is teaching a class about the different role elements of RNs. If she has an adequate understanding, she can state that a care provider is:
|a.||“a nurse who medically manages patients.”|
|b.||“an RN who carries out interventions that assist patients to meet positive outcomes.”|
|c.||“a nurse who seeks out new endeavors.”|
|d.||“a nurse who seeks out positive changes in the best interest of his or her patients.”|
- A student is preparing for an exam on the different role elements of an RN. She is prepared for the exam when she can state that all of the following are elements of the RN role except:
- An RN has called the physician to explain that the patient is having second thoughts about a procedure and would like to learn more about the alternatives before proceeding. In this instance the RN is enacting the element of the RN role known as:
- An RN student is discussing formal role socialization with her nursing professor. The professor believes the RN student has a good understanding when she states that formal role socialization:
|a.||“can occur in any informal setting.”|
|b.||“occurs during patient teaching.”|
|c.||“does not occur in the classroom setting.”|
|d.||“only occurs spontaneously.”|
- The student understands that the LPN/LVN role differs from the RN role in many areas. She shows understanding when she can state that the LPN/LVN and RN are similar in which area?
|d.||Basic psychomotor skills|
- A student in an LPN to RN transition program is at the clinical site and monitoring the vital signs of a patient receiving blood. At 15 minutes into the infusion, the patient begins to complain of itching and shortness of breath. It is evident that the student nurse is developing critical thinking skills when she does which of the following?
|a.||Stops the infusion, calls for the patient’s nurse, and reports a possible reaction to the blood.|
|b.||Calls for the patient’s nurse and asks whether she can slow the infusion down.|
|c.||Continues with routine monitoring and reports the patient’s condition as unremarkable.|
|d.||Calls for the patient’s nurse and asks whether she can speed up the infusion to deliver the blood faster.|
- Which action defines the nurse as a care provider in an inpatient setting?
|a.||Holding an information session on diabetes management and prevention|
|b.||Running a blood pressure screening in the lobby of the hospital|
|c.||Assisting new parents after the delivery of preterm twins|
|d.||Handing out pamphlets on how to lower cholesterol|
- The nurse would assume the care provider role of educator during which action?
|a.||Leading a hand washing initiative to reduce infection rates|
|b.||Answering a new mother’s questions about breastfeeding|
|c.||Working with colleagues to transfer a patient into a rehab center|
|d.||Requesting more pain medications for a patient who is recovering from a total hip replacement|
- A nurse on a postsurgical unit is alarmed by the number of postoperative infections that have been reported for her unit over the last year. The nurse acquires data from other hospitals and begins observing the health care team to determine the hand washing rates. This nurse is functioning in which care provider role?
- The RN utilizes problem-solving skills to do all of the following except:
|a.||establish mutual goals with the patient and family.|
|b.||formulate a care plan.|
|c.||assist patients to achieve expected outcomes in the plan of care.|
|d.||oversee implementation and evaluation of the plan.|
- The registered nurse takes on different care provider roles in the health care setting. Which roles could the nurse assume when caring for a patient who has just been diagnosed with cancer? (Select all that apply.)
|e.||Medical power of attorney|
Chapter 07: The Nurses, Ideas, and Forces That Define the Profession
- It has been said that Florence Nightingale revolutionized nursing. Which example supports this statement?
|a.||She encouraged men to become nurses.|
|b.||She encouraged nurses to serve physicians in order to learn from them.|
|c.||She instituted changes that affected patient survival rates.|
|d.||She organized nursing in America.|
- A student is studying the history of nursing. Which statement made by the student would be correct if she had an adequate understanding of America’s first trained nurse?
|a.||“America’s first trained nurse reduced student nurses’ working hours.”|
|b.||“As America’s first trained nurse, Isabel Hampton Robb promoted licensure exams.”|
|c.||“America’s first trained nurse worked to create associate degree programs.”|
|d.||“America’s first trained nurse was Linda Richards.”|
- Which is the dominant focus of patient care in the current health care environment?
|a.||To increase cost to increase profit|
|b.||To contain rising costs|
|c.||To ignore rising costs|
|d.||To manage care according to cost|
- What is the function of Continuous Quality Improvement?
|a.||To improve staff compliance with training|
|b.||To assist staff in building on nursing skills|
|c.||To assess patient care, from admission to discharge|
|d.||To improve collaboration of staff|
- Florence Nightingale contributed to nursing in many different ways. The student nurse has an understanding of the history of nursing when she does which of the following?
|a.||Educates another student about the efforts of Florence Nightingale to promote research|
|b.||States that Nightingale is responsible for minor contributions to the early education of nurses|
|c.||Believes that Nightingale was not involved in the theory of nursing|
|d.||States that Nightingale did not assist in the development of the nursing process|
- A student understands the contributions of Clara Barton when she states, “Clara Barton
|a.||is known as the Lady with the Lamp.”|
|b.||fought for women’s rights.”|
|c.||is known as the Angel of the Battlefield.”|
|d.||was America’s first trained nurse.”|
- Which action by the nurse shows the use of the nursing process?
|a.||The nurse works with the health care team to set outcomes and plan interventions for the patient.|
|b.||The same nurse admits the patient and then discharges him the next day.|
|c.||The nurse works with the patient to set outcomes and plan interventions.|
|d.||The nurse sends the provider in for an immediate assessment of the patient.|
- What is the major social factor that has developed the role of nursing to what it is today?
|a.||Society’s attitude toward the role of women|
|b.||Society’s lack of qualified health providers|
|c.||Society’s lack of resources to pay for health care|
|d.||Society’s lack of education about health care|
- _____ defined nursing as “that care which puts a person in the best possible condition for nature to restore or to preserve health, and to prevent or to cure disease or injury.”
- The nurse responsible for promotion of associate degree programs is:
- Based on what you know, what events would you select to show the contributions that Isabel Hampton Robb made to nursing? (Select all that apply.)
|a.||Established a visiting nurse service|
|b.||Reduced student working hours|
|c.||Wrote a book on the history of nursing|
|d.||Promoted licensure exams|
|e.||Fought for women’s rights and the right to vote|
- The “graying of America” is estimated to include 65 million older Americans by 2030. What current evidence supports the need for increased nursing knowledge of geriatrics and home health care? (Select all that apply.)
|a.||The elderly utilize more health care dollars per person than younger members of society.|
|b.||The elderly rely minimally on Social Security.|
|c.||The elderly have chronic illnesses.|
|d.||The elderly typically have fewer years of schooling.|
|e.||Some elderly are widowed and need assistance with care.|
Match each nurse with her contribution.
- Organized the American Red Cross
- Established a visiting nurse service
- Organized a frontier nurses organization
- Established nursing as a profession
Chapter 08: Upholding Legal and Ethical Principles
- The nurse who fails to remove a patient from an unsafe situation has violated which bioethical principle?
- The nurse who respects the patient’s right to refuse treatment is following which bioethical principle?
- The student understands the bioethical decision-making theory of utilitarianism when she makes which statement?
|a.||“Utilitarianism is concerned only with duty.”|
|b.||“Utilitarianism is also called Kantian ethics.”|
|c.||“Utilitarianism judges actions based on possible consequences.”|
|d.||“Utilitarianism judges actions based on intent.”|
- Which statement made by the nursing student indicates an accurate understanding of culturally competent care?
|a.||“It means having knowledge of the health-related beliefs and practices of all cultures.”|
|b.||“It is the ability to care only for individuals from one’s own culture.”|
|c.||“It means working within the cultural context of individuals, families, and communities.”|
|d.||“It means avoiding discussing the patient’s practices or beliefs because they may not agree with your own.”|
- The student understands the ANA Code of Ethics for Nurses when she identifies which statement as incorrect? The Code of Ethics for Nurses:
|a.||provides a framework for ethical decision-making.|
|c.||is applicable to most practice settings.|
|d.||helps with professional self-regulation.|
- Which statement is correct about the bioethical decision-making theory of deontology?
|a.||It is concerned only with consequences.|
|b.||It judges actions based on motive or intent.|
|c.||It emphasizes treating others as a means to an end.|
|d.||It cannot be applied to research.|
- The RN student has been studying ethics in health care. Based on what she has learned, how would she explain the bioethical principle of autonomy?
|a.||It states that the physician knows what is best for the patient.|
|b.||It does not apply to informed consent.|
|c.||It refers to patient self-determination.|
|d.||It states that every patient has a right to health care.|
MSC: NCLEX: Safe, Effective Care Environment: Management of Care
- The nursing student knows that ethics is a part of which branch?
- For the RN to practice ethical decision-making, it is most important for him or her to:
|a.||base decision-making on whether an action is right or wrong.|
|b.||base decision-making on possible consequences.|
|c.||accurately assess a situation.|
|d.||seek the assistance of an ethics committee.|
- The RN understands administrative law when she says, “Administrative law governs:
|b.||the operations of government.”|
|c.||the conduct of judges.”|
|d.||the United States Supreme Court.”|
- The nurse working in family practice is assessing an elderly female patient and notices bruises on the patient’s arm and back. Which action is the most appropriate for the nurse to take?
|a.||Ignore the bruises because her daughter tells you that her mother is clumsy.|
|b.||Do nothing because you cannot prove anything.|
|c.||Report the suspected abuse to the appropriate authorities.|
|d.||Confront and accuse the daughter of elder abuse.|
- The nurse threatens to place a verbally abusive patient in restraints. The patient could press charges against the nurse for which of the following?
- Steps the RN can take to reduce the risk of malpractice include all of the following except:
|a.||administer drugs carefully.|
|c.||do not delegate any tasks.|
|d.||think before you speak.|
- A nurse educator is preparing a presentation on professional negligence. The nurse determines that all of the following actions would be considered professional negligence except:
|a.||administering the wrong medication.|
|b.||failure to obtain informed consent.|
|c.||taking a picture of a patient without his or her consent.|
|d.||refusing to permit the patient to walk without assistance.|
- A nurse manager is preparing a presentation on negligence to present at the next staff meeting. She would not consider which as a form of negligence?
- An RN administers an ordered dose of medication over the patient’s refusal. On review, the manager interprets this action to be:
- The nurse accidentally administers the wrong dose of a medication. Her first action would be to:
|a.||notify the physician.|
|b.||fill out an incident report.|
|c.||assess the patient.|
|d.||tell her supervisor.|
- The four elements that must be present for a person to recover damages as the result of alleged malpractice are duty, breach of duty, actual injury, and:
- Which of the following is not considered a major law that governs our society?
- A nurse is working the night shift on a respiratory floor. She is walking toward a patient’s room when she sees a nursing assistant performing patient care with the curtain and door open. The nurse knows that the nursing assistant is violating which legal principle?
|a.||Right to privacy|
|c.||Failure to rescue|
- A nurse is working with a patient who is well known to the public. Shortly before lunch, a news reporter walks into the nursing unit and begins questioning the nurse. The nurse knows that if she gives out patient information without the patient’s consent, she would be failing to comply with which law?
|b.||Health Insurance Portability and Accountability Act (HIPAA) of 1996|
- The nurse manager shows an understanding of preventable medical errors when she makes which statement?
|a.||“There are only a few deaths related to medical errors per year.”|
|b.||“Medical errors are made only by nurses who are not focused.”|
|c.||“About 20,000 patients die each year from preventable medical errors in the United States.”|
|d.||“Each year between 44,000 and 98,000 patients die from preventable medical errors.”|
- The nurse on a busy surgical floor is preparing her patient for surgery. The patient refuses to sign the surgical consent form because he has not spoken to the surgeon regarding the procedure. When the nurse speaks to the surgeon on the phone, he tells her that he is too busy to come to the floor. If the nurse were to insist that the patient sign the consent anyway, she would be violating which of the patient’s rights?
|a.||Right to refuse treatment|
|c.||Right to informed consent|
|d.||Right to privacy|
- A nurse is working in the surgical recovery unit and is caring for a patient who is still under anesthesia. She notes that the patient’s oxygen level is 82% on room air. What would the nurse be guilty of if she were to withhold oxygen from this patient?
|a.||Commission of an act|
|b.||Nothing, because the patient will naturally recover from the anesthesia|
|d.||Assault and battery|
- The nurse has an adequate understanding of a tort when she makes which statement?
|a.||“A tort is a legal wrong committed against another person or their property.”|
|b.||“A tort refers to the nurse’s duty to practice within the boundaries of the nurse’s role.”|
|c.||“A tort is a principle concerned with being fair or just.”|
|d.||“A tort refers to truth telling and not intentionally misleading patients.”|
- A nurse is caring for an elderly patient with terminal cancer. The patient has just told his family that he wants to end treatment and be kept comfortable for the remainder of his life. His family is very upset and does not agree with his decision. Both the patient and his family have confided their wishes to the nurse privately, and the family has asked the nurse to intervene. How would you classify the ethical dilemma that the nurse is experiencing?
|a.||Right to life|
|c.||Right to die|
- A nurse is working the night shift in the ICU. She notices cardiac alarms sounding for one of the patients, and on arriving to the patient’s room, finds him in full cardiac arrest. It is later determined that the patient’s assigned nurse was at the front desk sleeping. The nurse realizes the important of reporting this issue but does not want to face backlash from her co-worker. Which describes what the nurse is experiencing?
- A new nurse has just been hired to work at a local hospital. Which actions by the nurse show her understanding of the Patient’s Bill of Rights? (Select all that apply.)
|a.||Allowing the patient access to health records|
|b.||Responding to patient care requests in a timely manner|
|c.||Explaining to another nurse the patient’s right to refuse treatment|
|d.||Maintaining the patient’s confidentiality|
|e.||Ensuring that the patient is informed about his or her medical condition|
- Which statements by the nursing student describe how ethics help nurses solve dilemmas in health care? (Select all that apply.)
|a.||“Ethics requires us to analyze our actions or potential actions critically.”|
|b.||“Ethics assists us in determining the right course of action to take.”|
|c.||“Ethics allows nurses to let others more qualified make decisions for us.”|
|d.||“Ethics allows nurses to take a break from the situation by waiting for the ethics committee.”|
|e.||“Ethics causes problems in health care rather than helps.”|
- The RN understands the importance of providing culturally competent nursing care when she does which of the following? (Select all that apply.)
|a.||Uses flexibility to accommodate the patient|
|b.||Becomes knowledgeable about other cultures|
|c.||Lets go of negative attitudes about other cultures|
|d.||Believes that her culture is superior|
|e.||Avoids patients of different cultures|
Chapter 09: Care and Safety Standards, Competence, and Nurse Accountability
- A new graduate has been working as an RN for 6 months and is no longer working with a preceptor. However, she still frequently checks with an experienced nurse to validate that she is following the rules and the policies she is still learning. The new graduate in this scenario exhibits the actions of what theoretical level of skill?
- An RN has been working on a cardiac unit for 1 year and has settled comfortably into an efficient, safe, and organized routine for each shift. However, whenever an urgent issue arises, the nurse feels uncomfortable. It is most likely that this nurse is functioning at which skill level?
- Which action would indicate that the RN is practicing at the proficient level?
|a.||Asks another nurse to be present while a Foley catheter is inserted|
|b.||Becomes frazzled when two patients are unexpectedly admitted at the same time|
|c.||Thinks critically about situations and is able to anticipate patient needs|
|d.||Assumes the role of charge nurse while managing a tough patient assignment|
- An RN has been practicing for 12 years in pediatrics. Peers often seek out this nurse to help them with complex problems. This experienced nurse is assigned the patients with the highest acuity, and the nurse accepts these assignments with confidence. This nurse is likely practicing at which skill level?
- The nurse is working on a busy cardiac floor. While preparing medications, the nurse is interrupted by a co-worker, who has a question about another patient. After administering the medication, the nurse realizes that she gave the medication to the wrong patient. Which action by the nurse would indicate accountability?
|a.||Shifting blame to the co-worker who interrupted her|
|b.||Attempting to hide the medication error to avoid getting into trouble|
|c.||Accepting partial responsibility for her own actions|
|d.||Taking responsibility for her own actions and interventions by immediately assessing the patient and reporting the error to a physician|
- An RN realizes that she inadvertently gave a patient who was NPO for surgery his otherwise normally scheduled PO medications. Which action would she take if she were exhibiting professional accountability?
|a.||Report the error to the charge nurse and follow up with the patient’s surgeon.|
|b.||Report the incident to the charge nurse and blame the co-worker who interrupted her medication pass.|
|c.||Keep the incident to herself so that the patient’s surgery will not be canceled.|
|d.||Report the incident the next day that she works.|
- While passing noon meds, an RN notes that one of her patients did not receive his 0600 dose of antibiotic during the prior shift. She calls the prior nurse to try to determine whether the medication was given or not, then fills out an occurrence or care aberrance report, and follows through as institutional policy indicates. What is the best explanation for why the RN who found the error took action?
|a.||Because the prior nurse needed to know she made an error|
|b.||Because she is accountable for not contributing to the error by ignoring it|
|c.||To keep the patient from suing the hospital|
|d.||To keep herself out of trouble|
- In a situation involving a medication error, the hospital policy is to use root-cause analysis to evaluate the situation fully. In the root-cause analysis process, which action would take place?
|a.||A committee is formed to determine the risk of litigation.|
|b.||A committee is formed to determine the punishment for those involved.|
|c.||A committee is formed that can reconstruct the events leading to the error.|
|d.||A committee is formed that can correct the error and avoid damages.|
- There are a number of characteristics that will help a novice nurse find success in a mentoring relationship. Which action represents one of these positive characteristics?
|a.||The novice nurse asks clear, thoughtful questions and seeks clarifications.|
|b.||The novice nurse is patient and waits for the mentor to approach with learning opportunities.|
|c.||The novice nurse is directive rather than open to dialogue.|
|d.||The novice nurse stays busy, and the mentor seeks the opportunities.|
- An operating room nurse has returned from a conference on the impact of never events. Recognition of which of the following would lead her to believe that a never event could occur?
|a.||The patient is losing an anticipated amount of blood during surgery.|
|b.||Toward the end of a surgical procedure, the sponge count does not match up with the beginning count.|
|c.||The procedure is taking longer than planned.|
|d.||The surgeon was late to the procedure.|
- A nurse has just received training on the Quality and Safety Education for Nurses (QSEN) Project. What should the nurse do to show that she understands the importance of the project?
|a.||After assessing the patient, determine a list of priorities for care and begin implementing them.|
|b.||Collaborate with medical personnel involved in the patient’s care to develop a treatment plan for the patient.|
|c.||Develop a treatment plan with the patient and medical personnel that best fits the patient’s needs and lifestyle.|
|d.||Develop a treatment plan based on what the patient’s wife says he needs.|
- A nurse has just realized that her license is due to expire in 5 months. The nurse knows that she is responsible for maintenance of her license in order to continue practicing as a nurse. What would be the best action for her to take?
|a.||Put off obtaining the continuing education credits until 1 month before the expiration date.|
|b.||Immediately begin working on obtaining the continuing education credits.|
|c.||Email the nursing board to inquire about why she was not notified earlier.|
|d.||Forgo obtaining the continuing education credits and hope that she does is not audited.|
- On administering a medication, the RN realizes that she gave the incorrect amount. After assessing the patient, which action would not be appropriate for the nurse to take?
|a.||Report the incident to the patient’s physician.|
|b.||Immediately report the incident to her manager.|
|c.||Keep the incident to herself and continue to monitor the patient.|
|d.||Continue to reassess the patient.|
- A nurse manager is reviewing an incident report submitted by the previous day’s charge nurse. The incident report indicates that the wrong IV antibiotic was given to a patient. What is the best way for the nurse manager to address this incident with the nurse involved so that it may be prevented in the future?
|a.||Provide education to the nurse on how to assess the five rights before medication administration.|
|b.||Punish the nurse for the error by sending her home for the day.|
|c.||Allow the nurse one error, and educate her if the same mistake happens again.|
|d.||Ask the charge nurse to educate the nurse because she caught the error.|
- The medical team determines that a patient needs to be transferred to another facility to continue receiving the most appropriate and beneficial care. The transfer process has been slow and difficult, and the nurse is struggling to care for the transferring patient along with her other assigned patients. What is the best action the nurse can take to improve her situation?
|a.||Continue to do the best that she can do for all of her patients.|
|b.||Inform the medical team that the transfer will have to wait for the next shift.|
|c.||Involve management so that the nurse can focus on patient care.|
|d.||Ask her co-workers to manage her patient assignment.|
- A patient on a medical-surgical floor is unhappy with the care he is receiving from his physician and wants to speak to someone about it. Who should his nurse consult first?
|a.||The director of medical-surgical nursing|
|b.||The patient’s physician|
|c.||The nurse’s immediate supervisor|
|d.||Another nurse on the floor|
- A nurse manager wants to assess quality of care over the last 6 months for her unit. How could the nurse manager best accomplish this?
|a.||Interview each nurse about the patients on the unit for the last 6 months.|
|b.||Review the results of patient satisfaction surveys.|
|c.||Obtain charts from medical records for all of the patients.|
|d.||Ask the nurses to perform discharge phone calls on previous patients.|
- Often, when patients are unhappy or behaving negatively, it is the result of which of the following? (Select all that apply.)
Chapter 10: Using Nursing Theory to Guide Professional Practice
- Which of the following are the concepts common among most nursing philosophies, models, and theories?
|a.||Person, nurse, health, and environment|
|b.||Person, physician, health, and environment|
|c.||Person, nurse, health, and culture|
|d.||Person, nurse, environment, and culture|
- What skills would a nurse demonstrate if the nurse reached the “competent stage” of Patricia Benner’s theory of skill acquisition?
|a.||Relies on more experienced nurses for guidance|
|b.||Can multitask, set goals, and think analytically|
|c.||Can see the whole picture and recognizes subtle changes in condition|
|d.||Recognizes patterns and responds automatically|
- A group of nursing students was discussing the functions of nursing theories. Which statement below would give the impression a student requires more review of the material?
|a.||“Nursing theories help guide professional practice by interpreting evidence.”|
|b.||“Nursing theories have little effect on decision-making in practice.”|
|c.||“Nursing theories are influenced by personal values and beliefs.”|
|d.||“Nursing theories influence professional behaviors.”|
- What criterion would the nurse use to support Hildegard Peplau’s Theory of Interpersonal Relations?
|a.||The relationship between nurse and doctor|
|b.||The mutual caring relationship|
|c.||Meeting the needs of nurse and patient|
|d.||The relationship between nurse and patient|
- The nurse providing teaching on a weight loss program to the obese patient is applying which nursing model developed by Nola Pender?
- What changes in nursing practice did Florence Nightingale make to improve the personal care of patients?
- Betty Neuman’s Systems Model for nursing emphasizes the holistic aspects of nursing from a systems-based perspective. Which of the following is not an example of the clinical application of this theory?
|a.||Caring for the patient at the primary, secondary, and tertiary levels of care|
|b.||Evaluating patient stability|
|c.||Focusing on the nurse-patient relationship|
|d.||Evaluating the effect of stressors on the patient|
- Which statement by a nurse reflects an accurate understanding of systems theory?
|a.||“My patient has anemia reflected by low RBC, Hgb, and Hct values, so I have to monitor for fatigue, dyspnea, and tachycardia.”|
|b.||“It is my responsibility to provide my patients with basic human needs including food, water, and sleep.”|
|c.||“Would you like me to call the chaplain for you to discuss your feelings about your upcoming surgery?”|
|d.||“My patient’s daughter makes all decisions and living arrangements for my patient such as reserving a home health aide and Meals on Wheels during the week.”|
- Which statement about nursing conceptual models is true?
|a.||Nursing conceptual models provide a broad explanation of the world.|
|b.||Nursing conceptual models are composed of a defined and interrelated set of concepts.|
|c.||Nursing conceptual models are abstract concepts that propose outcomes.|
|d.||Nursing conceptual models are related constructs that broadly explain a phenomenon of interest.|
- Which of the following is an example of the application of Levine’s Conservation Model to the clinical setting?
|a.||Teaching the patient to self-administer insulin|
|b.||Encouraging the patient to ambulate|
|c.||Obtaining a wheelchair for the patient|
|d.||Arranging for the patient’s family to visit|
- Select the scientific theory used in several nursing theories to explain the following scenario: One nurse, whose adult son died in the ER 11 years ago, contends that she can never walk into a hospital again and quits her job. A second nurse, whose husband died in the hospital, continues to work her shifts responsibly and compassionately without incident.
- Identify the catalyst of Jean Watson’s Theory of Care.
|a.||Personal values and beliefs|
|b.||Belief that nursing practice should be autonomous|
|c.||Changes in health care delivery and patient satisfaction survey responses|
|d.||Theories promoting the capacity of self-care|
- Which of the following is an example of the application of Madeleine Leininger’s Cultural Care Theory of Diversity and Universality?
|a.||Preparing a patient for a medical procedure by using medical terminology|
|b.||Learning about diverse ethnic patient populations|
|c.||Planning nursing care in a standardized manner ensuring that everyone is treated the same way|
|d.||Asking a non–English-speaking patient to provide an English-speaking person to translate details of care|
- Which is an example of Dorothea Orem’s Theory of Self-Care Deficit?
|a.||A nurse asks a patient how much she can do for herself following a stroke.|
|b.||A nurse performs total care on a stroke patient to conserve the patient’s energy.|
|c.||A nurse leaves a stroke patient to walk to the bathroom and shower by herself.|
|d.||A nurse enables a stroke patient to wash up in bed by providing bath wipes.|
- The goal of Ida Jean Orlando’s theory of effective nursing practice is to:
|a.||focus on relationships among the environment, nurse, and patient.|
|b.||reduce the duration of hospital stays.|
|c.||meet the immediate needs of the patient and relieve distress or discomfort.|
|d.||integrate holism into nursing.|
- Which theory focuses on patterns, life processes, and wholeness and describes seeing the life process as a progression believing that health and the evolving pattern of consciousness are the same?
|a.||Theory of Goal Attainment|
|b.||Theory of Health as Expanding Consciousness: Margaret Newman|
|c.||Theory of Interpersonal Relations|
|d.||Roy Adaptation Model|
- What example illustrates the conclusion that can be drawn from deductive reasoning?
|a.||All men are mortal and the Dalai Lama is a man; therefore, the Dalai Lama is mortal.|
|b.||The planet Earth orbits the Sun; therefore, all planets orbit the Sun.|
|c.||Five marbles taken from the bag are blue; therefore, all marbles from the bag are blue.|
|d.||The first five people you met at a work interview were nice; therefore, everyone at this office is nice.|
- What example illustrates the conclusion that can be drawn from inductive reasoning?
|a.||Bachelors are unmarried men and Danny is unmarried; therefore, Danny is a bachelor.|
|b.||Every eagle seen this week has dark feathers; therefore, all eagles have dark feathers.|
|c.||Most Ford vehicles are reliable, so the Ford you just bought will be reliable, too.|
|d.||All dogs have fleas; therefore, my dog has fleas.|
- What parts make up and work together in Imogene King’s Theory of Goal Attainment? (Select all that apply.)
|a.||Creating a method to evaluate outcomes|
|b.||Defining quality nursing care|
|d.||Focusing on self-care|
|e.||Maintaining a clean environment|
- How would you justify that a nursing theory is, in fact, a middle-range nursing theory? (Select all that apply.)
|a.||It is simple, clear, generalizable, and accessible.|
|b.||It focuses on answering specific nursing practice questions.|
|c.||It predicts the effects of one phenomenon on another.|
|d.||It explains relationships.|
|e.||It is built on several important adapted scientific theories.|
Chapter 11: Providing Patient-Centered Care Through the Nursing Process
- Which statement by the nurse illustrates how a nursing patient assessment differs from a medical patient assessment?
|a.||“The patient is able to stand for 30 seconds before walking 10 feet toward the bathroom without an assistive device.”|
|b.||“The patient is fearful that he will not be discharged home after his hospitalization.”|
|c.||“The patient stated he felt pain in his lower back after slipping on his icy driveway.”|
|d.||“The patient experienced a persistent cough, and azithromycin was prescribed 6 weeks ago. Today, she presents with a recurrent cough, green sputum, and worsening shortness of breath.”|
- The nurse is using Gordon’s 11 categories for data collection in performing a health assessment. Which of the following represents assessment of cognition?
|a.||How educated is the patient?|
|b.||How does the patient describe his or her health?|
|c.||Is the patient well nourished?|
|d.||Has the patient had treatment for emotional problems?|
- The nurse is charting on the patient who is status post surgery for an abdominal abscess and notes: “Pt’s temperature has not exceeded 37°C this shift.” This is an example of a(n):
|d.||diagnosis or analysis.|
- Which outcome statement is a properly written goal?
|a.||“The patient will be free of pain.”|
|b.||“The patient will verbalize the importance of lifestyle changes.”|
|c.||“The patient will get up into the chair one time daily for 1 hour.”|
|d.||“The patient will demonstrate breathing techniques by the end of shift.”|
- The nurse is planning care for a patient with hypertension and obesity. Which of the following is a reasonable and measurable outcome for the nursing diagnosis of noncompliance with treatment regimen related to side effects of medications?
|a.||The patient will state two lifestyle modifications for weight management by (date certain).|
|b.||The patient will be compliant with the treatment regimen by (date certain).|
|c.||The patient will understand the disease process by (date certain).|
|d.||The patient’s blood pressure will never increase.|
- A patient admitted with a diagnosis of Alzheimer’s disease is anxious and dehydrated, has reportedly not been eating, and has had a weight loss of 5 lb in 1 week. Which nursing diagnosis is a priority?
|a.||Fluid volume deficit related to fluid loss|
|b.||Altered nutrition: Less than body requirements related to anorexia|
|c.||Fluid volume excess related to reduced urine output|
|d.||Risk for impaired skin integrity|
- An RN team leader has one LPN and one medical assistant assigned to the unit. Which patient would be most appropriate to assign to the LPN?
|a.||Right lower lobectomy, one day postoperatively, whose temperature went from 37.1°C to 38.3°C during the last shift|
|b.||72-year-old right hip replacement, 2 days postoperatively, complaining of leg and chest pain|
|c.||48-year-old female patient who had a laparoscopic appendectomy 8 hours ago: urine output 165 mL, Hgb 7 g/dL, and Hct 21%|
|d.||Post cerebral vascular accident 1 week ago who had a Dobhoff feeding tube inserted and is now on continuous feedings at 45 mL/hr|
- Which of these strategies should be a priority when the nurse is planning care for a patient with hypertension?
|a.||Obtain less expensive antihypertensive medications.|
|b.||Assist with dietary changes as the first action.|
|c.||Follow evidence-based guidelines for appropriate interventions.|
|d.||Teach about the impact of exercise on hypertension.|
- The nurse reviews assessment findings for assigned patients. Based on this information, which patient demands the nurse’s immediate attention? The patient with:
|a.||renal failure on dialysis whose WBC is 10,000 mm3 (normal)|
|b.||abdominal aneurysm whose blood pressure is 170/90|
|c.||atrial fibrillation whose lab results show and INR of 2.5 (normal)|
|d.||endocarditis who has a loud heart murmur|
- While the nurse is taking the health history, the patient states, “My father and grandfather both had heart attacks and were unable to be very active afterward.” This statement is related to the functional health pattern of:
|c.||health perception–health management.|
- Which of the following is an example of a measurable outcome for the patient who has undergone a surgical procedure with a pain rating of 7 on a scale of 0 to 10?
|a.||The patient’s pain will be under control by Sunday.|
|b.||The patient will have no pain by the end of this shift.|
|c.||The patient’s pain will decrease by the end of shift on (date).|
|d.||The patient’s pain will decrease to 2 or lower by the end of shift on (date).|
- Which of the following would be a priority nursing diagnosis for a 73-year-old male patient with heart failure?
|a.||Constipation related to immobility|
|b.||Risk for infection related to IV lines|
|c.||Activity intolerance related to an imbalance of oxygen and demand|
- Which of the following would be an expected outcome for a patient who is 12 hours status post hip replacement?
|a.||Increase mobility and decrease pain.|
|b.||Care for the catheter independently.|
|c.||Walk without assistance.|
|d.||Bathe daily in a tub.|
- An RN is making assignments on a medical-surgical unit. Which patient could the RN assign to a float RN from the maternity unit?
|a.||A 68-year-old female patient with COPD and viral pneumonia|
|b.||A 60-year-old female patient with atrial fibrillation and a heart rate of 150|
|c.||A 50–year-old male patient post open heart surgery whose blood pressure is 90/50|
|d.||A 36-year-old male patient who is severely neutropenic awaiting chemotherapy|
- A patient with pneumonia has been using the incentive spirometer four times daily while awake during his 3-day hospitalization. How would the nurse explore the effectiveness of this intervention?
|a.||The nurse would ask whether the patient was breathing better.|
|b.||The nurse would add turn, cough, and deep breathing exercises.|
|c.||The nurse would watch the patient use the incentive spirometer.|
|d.||The nurse would auscultate the lungs for adventitious breath sounds.|
- Which nursing diagnosis would be a priority for a patient in acute respiratory distress?
|b.||Impaired gas exchange|
- Determine which example is true of measurability within the context of the nursing diagnosis.
|a.||The patient will list signs of infection such as redness, pain, swelling, and warmth by the end of the shift.|
|b.||The patient will be pain-free and then walk to the bathroom.|
|c.||The patient reported abdominal pain for 2 days but denies nausea, vomiting, and diarrhea.|
|d.||The patient received Dilaudid 1 mg IV and 2 hours later received Lortab 500/5.|
- The nurse is admitting a 64-year-old Hispanic male patient to the rehabilitation facility following surgical intervention for a broken hip. The nurse should first assess which of the following?
- The nurse is attempting to take the history of a newly admitted 92-year-old patient but is unable to obtain the information because of the patient’s cognitive status. The nurse should:
|a.||refuse to complete the admission without more information.|
|b.||contact the family for information on the patient’s history.|
|c.||call the doctor in the emergency room for a history.|
|d.||ask another nurse to try to obtain the information from the patient.|
- The nurse is planning care for an 82-year-old obese female patient with Alzheimer’s dementia. The patient wanders, is unsteady on her feet, and is visually impaired. What should the nurse give priority to when developing the plan of care?
- Which of the following is true about collaborative problems?
|a.||Collaborative problems fall within the definition of nursing diagnoses.|
|b.||Collaborative problems are managed using two physicians.|
|c.||Collaborative problems require the nurse to monitor for changes in status.|
|d.||Collaborative problems emphasize prevention, treatment, or health promotion.|
- Errors may occur with the use of data in formulating an appropriate nursing diagnosis. Based on what you know, which of the following represents the main source of errors in the nursing diagnosis process?
|a.||Making assumptions without supporting data|
|b.||Placing data in incorrect categories|
|c.||Not validating data with the patient|
|d.||Relying on team members for data|
- An example of an intervention independently initiated by the nurse is:
|a.||starting a teaching plan for the patient who will go home tomorrow.|
|b.||instituting diet restrictions with subsequent progression of diet as tolerated.|
|c.||sending an abnormal appearing urine sample to the lab for routine urinalysis.|
|d.||writing an order for aspirin for a headache.|
- A nursing intervention directs the patient to be turned every 2 hours to prevent skin breakdown from immobility. Assessment findings on new reddened areas on the lateral aspects of the right knee and ankle are obtained. What is the most appropriate way for these findings to be used when the care plan is evaluated?
|a.||The information will be added to the relevant area of the electronic medical record.|
|b.||The nursing diagnosis will be changed from an actual problem to a potential problem.|
|c.||The new intervention of calling the physician will be added to the care plan.|
|d.||The intervention will change to have the patient turned every hour.|
- In the assessment phase of the nursing process, there are several ways to collect data. Which statements reflect the need for more training? (Select all that apply.)
|a.||“The patient is talking in full sentences with visitors and appears to be breathing without distress.”|
|b.||“Bowel sounds are hypoactive in all four quadrants; no pain with palpation.”|
|c.||“Mrs. Collins, are you experiencing any pain right now?”|
|d.||“According to the chart, the patient slept well last night as a result of the pain medicine administered at 2100.”|
|e.||“The abdominal wound is slightly red at the approximated edges, no edema noted.”|
Chapter 12: Critical and Diagnostic Thinking for Better Clinical Judgment
- Critical thinking is a purposeful, goal-directed process of inquiry that uses available facts, principles, theories, and abstractions. Which statement best describes the processes that are accomplished through critical thinking?
|a.||Make inferences, solve problems, arrive at decisions.|
|b.||Persuade others, induce debate, use intuition.|
|c.||Make inferences, reduce fractions, make decisions.|
|d.||Solve problems, elevate issues, reflect actions.|
- Reasoned thought is characterized by the lack of:
- Using clinical judgment, the nurse makes decisions on whether to proceed with or revise a course of action. The inquiry (investigational or exploratory) subprocess necessary for sound clinical judgment is _____ thinking.
- Critical thought is a(n):
|a.||disciplined, rational, and self-directed activity that uses standards and criteria.|
|b.||intuitive process that relies only on the nurse’s experience.|
|c.||persuasive process leading to sound decisions.|
|d.||reactive process after an intervention is completed.|
- A patient has a problem that prevents him from shaving himself, tying his shoes, or fixing his meals. He is not physically able to compensate for the problem, so he is in need of assistance. Data support the nursing diagnosis “impaired physical mobility” by what mode of reasoning?
- An RN has been working with a patient on the nursing unit for a 12-hour shift. The nurse recognizes that each time the patient is turned to the left, the blood pressure drops 15 mm Hg. The same RN has seen this phenomenon in several other patients and makes the connection that patients with right-sided heart failure (the medical diagnosis) will experience a blood pressure drop if they are turned to their left side. This type of reasoning is called:
- Each element of the nursing process involves critical thinking. Which definition of assessment reflects critical thinking?
|a.||Correctly and completely documenting the assessment data on a form|
|b.||A process of discovery and decision-making about the nature of the patient’s needs|
|c.||Using a systematic approach to ensure comprehensive collection of assessment data|
|d.||Selecting the most accurate NANDA-I nursing diagnosis for the patient|
- A novice RN is caring for a patient who is saying that something is wrong. Vital signs are normal and there are no new specific findings. The novice RN calls another, more experienced RN who briefly talks with the patient, calls the health care provider, and initiates a transfer to the ICU. Which statement is most likely true of the more experienced RN?
|a.||The experienced RN is an advanced beginner with better assessment skills than the novice nurse.|
|b.||The experienced RN is proficient in assessment and the use of hospital protocol.|
|c.||The experienced RN is an expert nurse with intuitive judgment that the experienced nurse cannot quite explain.|
|d.||The experienced RN is arrogant, foolish, and likely to get in trouble for her assertive behavior.|
- An RN has collected extensive data on a patient with attention deficit disorder. When weighing potential actions to help the patient and considering alternative solutions, which of the attributes of the critical thinker is the RN demonstrating?
- A nurse manager is designing orientation processes for new graduate nurses by using the work of Hansten and Washburn as a model. All of the new graduates are instructed in the model during orientation. The manager knows that a graduate nurse needs more instruction if which comment is made during the evaluation interview?
|a.||“I think I need more mentoring to continue to build my thinking skill.”|
|b.||“Improving my critical thinking will assist in decreasing the risk of sentinel events for my patients.”|
|c.||“Using my improving thinking skills will help improve patient care.”|
|d.||“If my thinking skills are what they should be, fewer errors will happen in patient care.”|
- The nurse has received a shift report. Which patient should the nurse assess first?
|a.||The patient diagnosed with type 2 diabetes mellitus who is complaining of dizziness with a glucose level of 120|
|b.||The patient diagnosed with sleep apnea who is complaining of a morning headache|
|c.||The patient diagnosed with diverticulitis who has a hard, rigid, abdomen and a temperature of 101.3°F|
|d.||The patient diagnosed with a stomach virus who vomited three times during the previous shift|
- The nurse has received a change-of-shift report about these four patients. Which one should the nurse plan to assess first?
|a.||A 23-year-old patient with cystic fibrosis who has pulmonary function testing scheduled in 30 minutes|
|b.||A 35-year-old patient who was admitted the previous day with bacterial pneumonia and has a temperature of 100.2°F|
|c.||A 46-year-old patient who is complaining of dyspnea after having a thoracentesis 1 hour previously|
|d.||A 77-year-old patient with TB who has four antitubercular medications due in 15 minutes|
- As elements of reasoning and critical thought, why are implications or consequences of outcomes important to consider?
|a.||They can help the nurse make confident clinical decisions.|
|b.||They help the nurse understand complex ideas and events.|
|c.||They help the nurse understand how the patient is responding to the demands of the treatment.|
|d.||They can be expected or unexpected and affect the completion of a nursing intervention.|
- Which patient would the nurse see first at the start of the shift?
|a.||A patient admitted yesterday with osteomyelitis of the right arm with a T of 101.0°F|
|b.||A patient with hepatic encephalopathy who is being rude to the nursing assistant|
|c.||A patient with lupus who has been on long-term corticosteroids and whose blood sugar is 180|
|d.||A patient with circumferential burns of the right leg who is complaining of numbness in the right foot|
- Which statement best assists the nurse in planning care for the patient who is not adhering to the treatment regimen?
|a.||Patients’ health attitudes directly affect behavior and therefore influence adherence.|
|b.||Patients usually go to the hospital without preconceived ideas about what is wrong with them.|
|c.||Most patients adhere to the advice of health care providers even if they do not believe that the treatment will work.|
|d.||Noncompliance with prescribed treatment is irrational behavior.|
- Select the hospital patient who has the best chance of avoiding a nosocomial infection.
|a.||A 42-year-old patient who had abdominal surgery|
|b.||A 35-year-old patient with a closed leg fracture|
|c.||A 5-month-old non-breastfed infant|
|d.||A 75-year-old patient receiving chemotherapy|
- The nurse is caring for a 19-year-old trauma patient paralyzed from the neck down. He is alert and oriented, requires assistance with ADLs, and keeps his spirits up with frequent visitors. A priority for the nurse is:
|a.||rounding hourly to assess the patient’s support system and acceptance of his condition.|
|b.||feeding the patient to maintain his nutritional status.|
|c.||ensuring the patient has constant stimuli through his friends because teenagers are peer-focused.|
|d.||watching and preventing skin breakdown as a result of immobility.|
- Which of the following is the best example of an open-ended question regarding a patient’s pain?
|a.||“For how many weeks have you been having this pain?”|
|b.||“Does it feel like a burning pain?”|
|c.||“Where on your body does the pain begin and end?”|
|d.||“Can you describe your pain for me?”|
- The nurse who can think critically will make more effective clinical decisions, meet more of the patient’s needs, and affect positive patient outcomes. How this is accomplished? (Select all that apply.)
|a.||Committing to test one’s own thought process for clarity, accuracy, and logic|
|b.||Accepting an individual responsibility to develop critical thinking skills|
|c.||Joining nursing organizations to keep current on nursing policies affecting patient care|
|d.||Constantly seeking out others for answers to difficult clinical questions and problems|
|e.||Requesting that health care organizations adopt and foster a culture of critical thinking|
|f.||Maintaining the required amount of continued education units for license renewal|
- The complexity of the current health care environment requires nursing to (select all that apply):
|a.||be guided by theory and practice standards.|
|b.||have a more scientific, research-based approach.|
|c.||be more collaborative with other health care disciplines.|
|d.||be open to new policies and procedures.|
|e.||be a multicultural representative of the global demographics.|
Chapter 13: Practicing Evidence-Based Decision Making
- The American Nurses Credentialing Center (ANCC) developed the Magnet Recognition Program for hospitals to address quality patient care. What is the significance of achieving magnet status?
|a.||Excellence in quality patient care and recruitment and retention of nurses|
|b.||Excellence in research, patient care, and retention of physicians|
|c.||Excellence in recruiting nurses, early discharge, and effective billing|
|d.||Excellence in recruitment and retention of ancillary caregivers|
- The chief purpose of evidence-based practice is to:
|a.||offer a problem-solving approach to systematically research clinical evidence directed toward a specific patient problem.|
|b.||prepare the nurse to conduct specific research in patient care practices.|
|c.||prepare the nurse for employment in an evidence-based research center.|
|d.||research clinical evidence that covers the entire aspect of a specific problem.|
- Which statement reflects an important principle to be applied by the nurse who is developing a relevant clinical question regarding a specific patient concern?
|a.||The type of question will determine which resources to access.|
|b.||A systematic approach determines which questions will be asked.|
|c.||The clinical question is formulated at the conclusion of the literature search.|
|d.||Background questions are identified at the conclusion of the literature search.|
- The nurse is interested in whether antibiotic therapy or observation only is most effective in the treatment of sinusitis in young adults. Which of the following best describes the type of question being considered?
|c.||General knowledge questions|
|d.||Both a and b|
- Can you explain how the nurse’s use of PICO helps to formulate an effective clinical question?
|a.||PICO organizes the elements that guide the clinical question.|
|b.||PICO formulates an answer to the clinical question.|
|c.||PICO explains the hierarchy of evidence.|
|d.||PICO identifies the strength of the evidence.|
- The nurse questions whether treatment with antibiotic therapy is as effective as observation in a 3-year-old boy with otitis media. What combination of information supports the proper order of information needed to compose a PICO statement?
|a.||Effective treatment for otitis media; antibiotic therapy; observation; 3-year-old with otitis media|
|b.||Three-year-old with otitis media; antibiotic therapy; observation; effective treatment for otitis media|
|c.||Antibiotic therapy; 3-year-old with otitis media; effective treatment for otitis media; observation|
|d.||Observation; 3-year-old with otitis media; effective treatment for otitis media; antibiotic therapy|
MSC: NCLEX: Safe, Effective Care Environment
- The nurse wants to know how similar the 7-minute screen (7MS) is to the Mini-Mental State Examination (MMSE) in accurately screening for dementia. Can you distinguish the correct clinical question category for this type of question?
- If you had access to the following databases for your research, which would you choose to review clinical trials on effective smoking cessation therapies?
|a.||The Cochrane Library|
- The process of understanding and applying researched clinical evidence to nursing practice requires the nurse to become information literate. Which action by the nurse best describes the use of information literacy?
|a.||Identifies a specific clinical problem, accesses appropriate resources, and assesses the relevancy of use of information for that particular patient’s problem|
|b.||Identifies a particular patient problem and immediately notifies the physician and family for treatment|
|c.||Identifies the lack of research skills and consults a librarian for a workshop on conducting research studies|
|d.||Identifies the lack of research skills and consults a scientific researcher to teach basic computer information|
- Assess the given levels of evidence and choose the one most important when evaluating the strength of a research study.
|a.||Level 3 evidence indicates that specific-quality criteria were met.|
|b.||Level 1 evidence implies an association with specific criteria.|
|c.||Level 1 evidence indicates that specific-quality criteria were met.|
|d.||Level 2 evidence implies a reliable association with specific criteria.|
- What is the relationship between the design and layout when creating a critical appraisal tool?
|a.||Design and layout differ but measure the same areas.|
|b.||Design and layout differ, and reliability measures differ.|
|c.||Design, layout, and reliability are similar but relevancy differs.|
|d.||Design, layout, and reliability differ but trustworthiness is the same.|
- Nursing practice is guided by Carper’s four fundamental patterns of knowing. Which of the four patterns of knowing supports the nurse’s use of the evidence-based practice process?
TOP: Carper’s “Patterns of Knowing” MSC: NCLEX: Safe, Effective Care Environment
- Several sections are included in a research article. For example, the methods section describes the research study and what assessment quality and criteria were used. What information does the abstract or introduction section include?
|a.||An evidence summary from the results of several other studies|
|b.||An outline of the number of studies retrieved and excluded and respective reasons for their inclusions or exclusions|
|c.||A discussion about whether the results are heterogeneous with possible reasons|
|d.||A clearly stated review question|
- A nurse manager attempts to explain why the greatest number of medication errors occurs during the evening shift. The nurse manager chooses a quasi-experimental design to study this relationship. Why did the nurse manager choose this type of research design?
|a.||It does not allow for complete control over the variance.|
|b.||It allows for randomization.|
|c.||It allows for control over the independent variable.|
|d.||It requires manipulation of the variable.|
- The nurse manager wants to determine the cause of an increase in medication errors over the past 6 months. This is an example of which type of research?
|b.||Trial and error|
- A nurse evaluates the results of two different studies examining the relationship between time of day and sundowning in the geriatric setting. After 1 month, the nurse realizes that there is a difference of 1 hour in the instruments used for measurement. What conclusion can be drawn about the type of threat this causes the study?
- Which question should the nurse ask in order to judge the validity of a research study?
|a.||What reliability information has been provided?|
|b.||Are the instrument measures applied consistently?|
|c.||Does the instrument measure what it is supposed to measure?|
|d.||How much random error exists?|
- Which step does a researcher first use when starting a new study?
|b.||Refining an abstract idea|
- Which of the following is an example of direct research utilization?
|a.||Advocating for a change in policy|
|b.||Basing practice on current research available|
|c.||Implementing new techniques for practice|
|d.||Critiquing a research study|
- Characteristics of a quantitative study include all of the following except:
|a.||clarifies underlying assumptions.|
|b.||asks who, what, why, where, when, or how.|
|c.||describes the relationship between variables.|
|d.||is highly structured and controlled.|
- Which of the following are most responsible for the emerging use of evidence-based practice (EBP) in health care? (Select all that apply.)
|a.||Accountability by consumers of governmental and health care agencies|
|b.||Introduction of national health care guidelines|
|c.||Shorter implementation time of new research|
|d.||Variability of care among health care practitioners and facilities|
|e.||Similarity with other science disciplines and their amounts of research|
|f.||Eligibility to receive government grants for research excellence|
- What characteristics support evidence-based practice (EBP)? (Select all that apply.)
|a.||The nurse’s clinical experience is fundamental to the evidence-based practice process.|
|b.||Evidence-based practice provides a theoretical framework for accuracy and safety in patient care.|
|c.||Evidence-based practice involves the use of a holistic approach to patient care in health care.|
|d.||Evidence-based practice is designed to create a generic plan of patient care in clinical settings.|
|e.||Evidence-based practice allows the nurse autonomy in patient care because research proves success.|
- Research studies must be scrutinized to be deemed credible and trustworthy. Choose all the strategies that may be used to critically appraise a research study. (Select all that apply.)
|a.||Examine the validity of the research.|
|b.||Look at the reference list of the study.|
|c.||Look for criteria of inclusion.|
|d.||Look for use of PICO format.|
|e.||Examine the credentials of the authors.|
|f.||Look for a proper sample size.|
- Which goals best justify the need for evidence-based practice (EBP) in nursing? (Select all that apply.)
|a.||Redesign the health care system and recruit more nurses.|
|b.||Improve patient outcomes with evaluations that track outcomes.|
|c.||Introduce national health care guidelines and standards.|
|d.||Restructure health care delivery and improve quality of health care.|
|e.||Apply clinical experience to improve patient care.|
- What are the problems with variables? (Select all that apply.)
|a.||Vary from subject to subject|
|b.||Determined through statistics|
|c.||Difficult to account for them|
|d.||Challenging to explain in relation to the study topic|
|e.||Testing whether a correlation exists between results|
Chapter 14: Communicating With Patients and Co-Workers
- The instructor asks the nursing student to define therapeutic communication. The student’s most appropriate response is that therapeutic communication refers to:
|c.||developing a trusting relationship.|
|d.||emotional commitment to another.|
- An example of a communication blocker is:
- The nurse is caring for a patient 2 hours after a left above-the-knee amputation. The patient states, “My left leg is really hurting, and that medicine you gave me earlier didn’t help.” Which response is the most therapeutic, if made by the nurse?
|b.||“You’ll have to talk to your doctor.”|
|c.||“Keep your chin up.”|
|d.||“I will call your physician.”|
- The RN is documenting the patient’s complaint of pain rated 6 on a scale of 0 to 10. Which chart entry would be the most appropriate, if made by the nurse?
|a.||Pt. complaining of pain. MD notified.|
|b.||Pt complaining of pain rated at 6 on a scale of 0-10, states “My left leg is really hurting.” Pt. grimacing, voice elevated. MD notified.|
|c.||Pt. complaining of pain rated at 6 on a scale of 0-10. Appears to be in pain. MD notified.|
|d.||Pt. complaining of pain rated 6. Wants more pain medication; appears to be drug-seeking. MD notified.|
- The RN has assigned the nursing assistant (NA) a task. The NA becomes angry and begins yelling at the RN. What is the best approach for the RN to take?
|a.||Tell the NA that you will let her leave early if she will do this for you.|
|b.||Ignore her and reassign the task.|
|c.||Meet with the NA to explore his or her feelings and the reason for resistance.|
|d.||Call the nursing supervisor and report the NA for insubordination.|
- The nurse is caring for a 64-year-old woman 4 hours after knee replacement. Although she rates her pain at 6 out of 10, she refuses pain medication and tells the nurse, “I can deal with it.” Which of the following is the nurse’s best response?
|a.||“OK, that’s your decision.”|
|b.||“You’re just being stubborn.”|
|c.||“OK, I’ll come back later.”|
|d.||“What is your concern?”|
- Which statement, if made by the nurse, is an example of a communication technique that can facilitate communication?
|a.||“Yes, I agree with you.”|
|b.||“You need to talk to your doctor.”|
|c.||“I know just how you feel.”|
|d.||“What are you thinking about?”|
- The nurse is working in the outpatient clinic when a patient who has been waiting to be seen for an hour yells, “What are you people doing? I’m sick and tired of waiting!” Which response is the most therapeutic, if made by the nurse?
|a.||“The doctor can only do so much.”|
|b.||“Would you like a magazine?”|
|c.||“I can see that you are frustrated.”|
|d.||“You need to be quiet!”|
- The physician orders a dose of morphine that the nurse considers excessive. The nurse should:
|a.||administer the medication.|
|b.||ask another nurse to administer the medication.|
|c.||call the supervisor.|
|d.||contact the physician.|
- The nurse is caring for a patient following painful radiation treatment for newly diagnosed cancer. Which question, if asked by the nurse in the orientation phase of the nurse-patient relationship, is most likely to elicit a meaningful response?
|a.||“Don’t you love this weather?”|
|b.||“How have things been going for you?”|
|c.||“Tell me why you didn’t stop smoking.”|
|d.||“Are you having any pain?”|
- During the therapeutic relationship with a patient, which of the following is the primary focus of care?
|a.||Meeting the needs of the nurse|
|c.||The patient’s needs and problems|
- A patient scheduled for surgery has a severe level of anxiety. Which action, if taken by the nurse, would be most appropriate at this time?
|a.||Providing teaching about the upcoming surgery and what to expect|
|b.||Telling the patient that there is nothing to worry about|
|c.||Calling the patient’s family and demanding that they help out|
|d.||Asking the patient about her concerns, feelings, and perceptions about the surgery|
- Which of the following would be most appropriate to assess first for the newly admitted Chinese patient?
- The nurse and patient are discussing the patient’s perceptions and feelings related to the patient’s illness. The patient is emotional and tearful and expresses feelings of hopelessness. During which phase of the nurse-patient relationship does this typically occur?
- A nurse has a plan for teaching the patient about a newly diagnosed disease. On entering the room the nurse realizes that the patient is blind. What considerations for communication should the nurse be aware of?
|a.||Tone, pitch, inflection, and intensity affect how messages are communicated.|
|b.||Messages are clearer when verbal communication and nonverbal cues are opposite.|
|c.||Verbal communication must be understood within the context of a patient’s culture, gender, and age.|
|d.||Facial expressions and eye contact are characteristics of verbal communication.|
- The nursing student addresses an 86-year-old patient by his first name at their initial meeting. To the patient, this behavior:
|a.||is a sign of the nursing student’s empathy for the patient.|
|b.||could be interpreted as a lack of respect on the part of the student.|
|c.||clearly indicates that the student feels comfortable working with the patient.|
|d.||indicates that the student is establishing firm boundaries for the relationship.|
- When considering the creation of an environment for emotional support in a therapeutic relationship, the primary focus of the nurse should be:
|a.||removing stressors that cause anxiety and fear.|
|b.||developing a trusting relationship.|
|c.||encouraging the patient to become independent.|
|d.||allowing the patient to be in control of medical decision-making.|
- A patient has just been informed by the physician that he will not be discharged today. The nurse brings in the patient’s lunch tray and puts it on the overbed tray. The patient pushes it off onto the floor and shouts, “Get out of my room and leave me alone.” The nurse’s most therapeutic response would be:
|a.||“Is there something wrong with your lunch tray?”|
|b.||“You seem angry. Can you tell me about it?”|
|c.||“Why are you angry? You seemed so much happier earlier today.”|
|d.||“I’ll order you another lunch, and I’ll be back when you’re in a better mood.”|
- When preparing for patient teaching what should the nurse do first?
|a.||Assess the learner’s needs.|
|b.||List key points to be presented.|
|c.||Collect the teaching materials.|
|d.||Think about how the skill can be done at home.|
- Laura, a nurse manager, is meeting with the staff, which consists of nurses from the Veteran, Baby Boomer, Generation X, and Millennial generations. Which of the following is the best approach to encouraging collaboration and feedback from everyone?
|a.||Ask for volunteers to form a committee to explore the issue.|
|b.||Form a committee made up of at least one representative from each generation.|
|c.||Form a committee primarily composed of experienced, older nurses.|
|d.||Meet with each nurse individually to solicit feedback.|
- Before signing the verbal orders given earlier, the physician notifies the nurse of incorrectly wording the order. The physician requests the nurse to go back and insert the missing information. Which actions illustrate a lack of knowledge by the nurse? (Select all that apply.)
|a.||Use a black pen and insert the missing information.|
|b.||Insist that the physician write a new order.|
|c.||Write an addendum clarifying the order.|
|d.||Toss the old order and write a new one.|
Chapter 15: Teaching Patients and Their Families
- Which fact would you select to describe the mandate by The Joint Commission (TJC) regarding educating patients? The training and education must be:
|a.||specific to the assessed needs, interdisciplinary, and evaluated for effectiveness.|
|b.||specific to the assessed needs, cost-effective, and focused.|
|c.||based on the patient’s ability to learn, cost-effective, and timely.|
|d.||specific to assessed needs, timely, and delivered by only one person for continuity.|
- A nurse discusses home arrangements and safety factors related to emptying and changing the patient’s new colostomy bag. The patient has strong concerns about visibility of any stored colostomy supplies. Which teaching-learning principle does this example demonstrate?
|a.||Using multiple teaching strategies to accommodate a variety of learning styles|
|b.||Increased effectiveness of teaching by involving the patient in the setting of objectives|
|c.||Paying attention to the timing during the hospitalization and planned discharge date when providing needed information|
|d.||Developing a strong nurse-patient relationship from the beginning of the contract with the patient|
- The nurse recognizes that new parents may be ready to learn about their newborn after the birth. What understanding leads the nurse to this conclusion?
|a.||The baby will not be discharged until the parents have the training.|
|b.||The nurses on the mother-baby division do a better job of teaching baby care.|
|c.||The parents now have the motivation to learn because the baby has been born.|
|d.||The parents have no choice at this point.|
- A patient has been newly diagnosed with type 2 diabetes. The teaching begins in the hospital with an interdisciplinary approach and continues with outpatient classes. However, the patient continues to state, “I know I do not need to spend my time doing all this because I will be fine once I get out from under all this stress.” The barrier to learning that the nurse recognizes and must deal with is the:
|a.||patient already knows all she needs to know, so more education is not necessary.|
|b.||patient doesn’t know what she doesn’t know, so the circle will continue.|
|c.||patient’s blood sugar is keeping her from thinking clearly, so it is too soon to try to teach her.|
|d.||patient is in denial and that will need to be dealt with before she will accept the diagnosis and thus the education related to it.|
- The nurse recognizes that, for learning to be effective, the patient must first have his or her basic and most immediate needs met. Which statement best indicates that the nurse clearly understands this principle?
|a.||The nurse administers pain medication to the new diabetic patient before she starts her teaching just in case the patient is in pain.|
|b.||Thirty minutes before the planned teaching, the nurse assesses the patient for comfort and ensures that the patient has eaten and had the opportunity to complete his bath routine.|
|c.||The nurse decides that conversation works best during a meal, so she plans to teach while the patient eats.|
|d.||The nurse asks the patient’s spouse to leave before beginning the teaching.|
- Adult patients are adult learners. Knowing this, the nurse understands the assumptions about adult learners that will help the nurse plan and provide the appropriate education. Which statement provides proof that more instruction about adult learners is needed?
|a.||“Adults will learn as the need develops and the learning will fulfill that need.”|
|b.||“Adults use their lives as the point of reference for all learning.”|
|c.||“Adults are visual learners and learn best by taking notes.”|
|d.||“Adults prefer to have a say in their learning.”|
- A 78-year-old patient has shortness of breath on very slight exertion. The physician has written an order for her to be taught about a 2-gram sodium diet. Based on these data, which factor would be likely to interfere with diet teaching?
|a.||The patient’s age|
|b.||The patient’s shortness of breath|
|c.||The patient’s reluctance to change|
|d.||The chronic nature of the patient’s illness|
- Assessment of patient learning is a required element of patient education. Shorter hospital stays make this step challenging, and we tend to evaluate learning immediately after teaching. What conclusion can be drawn from this?
|a.||It takes time to truly incorporate what is learned, so immediate evaluation is not as accurate.|
|b.||The nurse will not have time to evaluate immediately after teaching.|
|c.||The patient will be too tired to participate in the evaluation.|
|d.||That would be too much information at one time.|
- A 63-year-old patient is uncertain whether she can self-inject her medication. Which would be most likely to be an effective strategy at this time?
|a.||Start with the details about her condition, why she has it, and the importance of her medication.|
|b.||In the first session, teach the patient how and why to rotate her abdominal injection sites.|
|c.||Start with information about avoiding rubbing or putting pressure on the site after an injection.|
|d.||In the first session let the patient handle a syringe while the nurse prepares and administers the next injection with another syringe.|
- A home health nurse is teaching a patient about a new medication he will be starting in the morning. The patient lives with his son’s family, including two spirited children less than 6 years old. The patient replies, “I just can’t learn new information like I used to.” The nurse will plan to:
|a.||schedule the patient for daily visits for medication administration.|
|b.||provide privacy and minimize distractions and noise and try again.|
|c.||teach the patient’s family members to give the medications.|
|d.||tell the patient it is not safe to take the medication independently.|
- Which item would most likely be a barrier to learning for a patient who must begin to care for a large open wound at home?
|a.||Curiosity about the new experience and equipment|
|b.||Tendency for uneasiness about making mistakes|
|c.||Ability to prioritize tasks|
|d.||Understanding that he can promote his own healing|
- The nurse has just taught an adult patient with a new diagnosis of diabetes mellitus how to check blood glucose. The nurse should document:
|a.||“Demonstrated understanding of checking blood glucose.”|
|b.||that the patient demonstrated the procedure properly and the time it took to complete the educational session.|
|c.||the steps of the procedure the patient was taught.|
|d.||that the nurse taught the patient how to check blood glucose.|
- Persons seeking health care have increased autonomy and insist on taking an active role in their medical treatment decisions. What aspect of a nurse’s role does this fact affect?
|a.||Use of professional communication when doing patient teaching and admitting patients to the unit|
|b.||Coordination of human and material resources that are directly used in the delivery of care at the bedside|
|c.||Evaluation of performance and skills of nursing staff members involved in direct patient care|
|d.||Patient collaboration with health care team members involved with the development of focused, quality care|
- Which item would most likely be a barrier to learning for a patient who must begin to wear an insulin pump?
|a.||Curiosity about new experiences and equipment|
|b.||Tendency toward embarrassment about making mistakes and being seen with the pump|
|c.||Ability to prioritize diabetes management|
|d.||Understanding that the patient can promote his or her own well-being|
- Which patient characteristic must a nurse consider when planning teaching?
- The nurse is assessing a patient who needs teaching about how to care for her wound at home. The nurse knows to be sensitive about asking questions that cause embarrassment. Which question is stated in the best manner?
|a.||“Would you like for me to write down how to change this dressing or is it better for you to see a demonstration?”|
|b.||“What is the highest grade you completed when you were in school?”|
|c.||“Do you read and write?”|
|d.||“I am going to give you a handout on how to perform your dressing change. Now don’t worry if you do not read, I’ll read it to you.”|
- An 85-year-old patient with chronic health problems is being considered for placement in a long-term care facility after discharge from the hospital. What purpose does the cost-effective nursing strategy of patient teaching help to achieve?
|a.||Providing reasonable expectations from health care|
|b.||Giving the patient a sense of control over illness|
|c.||Preventing complications of chronic illness|
|d.||Increasing patient satisfaction with care|
- An 18-year-old patient is scheduled for heart surgery tomorrow. To assess this patient’s level of knowledge, the nurse would say:
|a.||“Tell me the name of the surgery you are going to have.”|
|b.||“Do you understand what the doctor is going to do to you?”|
|c.||“Would you be willing to take a test for me?”|
|d.||“Tell me what you know about what is going to happen tomorrow.”|
- Which example demonstrates the principle that all adults learn best from and in relation to their experiences?
|a.||Teaching the attitude of personal responsibility for health care|
|b.||Showing a patient newly diagnosed with diabetes the similarities between an insulin syringe and a 3-cc syringe|
|c.||Refraining from teaching two skills at one time|
|d.||Showing the patient how the current hand washing procedure he is now learning is like the hand washing he has always done|
- The nurse recognizes that, to be an effective teacher, communication must be clear. In an educational session for a patient newly diagnosed with congestive heart failure, which statements by the nurse would demonstrate barriers to teaching? (Select all that apply.)
|a.||“Furosemide will increase urination, so you take it every morning.”|
|b.||“To help reduce the risk of pulmonary edema, your sodium intake must be monitored.”|
|c.||“Just remember, no sodium!”|
|d.||“Pulmonary edema can form if you have too much sodium.”|
|e.||“You will need to make sure you eat less salt to help prevent fluid from collecting in your lungs.”|
Chapter 16: Leading, Delegating, and Collaborating
- Which of these tasks is appropriate for the RN to delegate to a LPN/LVN?
|a.||Documenting patient teaching about a routine surgical procedure|
|b.||Teaching a patient how to self-administer insulin|
|c.||Administering an oral medication to a patient|
|d.||Completing the initial assessment and plan of care|
- All of these nursing actions are included in the plan of care for a patient who is malnourished. Which action is appropriate for the RN to delegate to a nursing assistant?
|a.||Assist the patient in choosing high-nutrition items from the menu.|
|b.||Monitor the patient for skin breakdown over the bony prominences.|
|c.||Assess the patient’s strength while ambulating the patient in the room.|
|d.||Offer the patient the ordered nutritional supplement between meals.|
- A nurse manager must confront an employee about excessive absenteeism. During the confrontation with this employee, which introductory statement is most appropriate?
|a.||“Is there something occurring in your life that is interfering with your attendance at work?”|
|b.||“What is your understanding of our absenteeism policy and being placed on probation?”|
|c.||“You are always calling in sick and leaving the staff in a real mess.”|
|d.||“Let’s pull the policy manual out and read the absenteeism policy together.”|
- A nurse is assigned to care for a patient who has been admitted with an opiate overdose and tells the nursing supervisor, “This is a waste of my time. The patient will be back on the needle right after being discharged.” The most appropriate response by the nursing supervisor is:
|a.||“Your lack of professionalism will make it difficult for you to provide adequate care.”|
|b.||“You know we are obligated to provide appropriate care no matter how we feel.”|
|c.||“It is important to recognize these feelings and then figure out how to deal with them.”|
|d.||“Since you feel so strongly, perhaps you should be assigned to care for a different patient.”|
- A charge nurse and staff nurse are in disagreement over the team assignment for the shift that is about to begin. What is the charge nurse’s best first step to resolving the conflict collaboratively?
|a.||Determine the shared goal.|
|b.||Open a respectful dialogue to bring forth each point of view.|
|c.||Design a plan to meet the shared goal.|
|d.||Determine the roles of those involved in the plan.|
- Nurse A is in conflict with Nurse B regarding holiday scheduling. Because Nurse A really wants to avoid being in this conflict, and because Nurse A just wants to fill the holiday schedule, Nurse A agrees to give up one favored holiday. This is an example of which type of conflict resolution?
- Holiday scheduling is always a sensitive issue on the nursing unit, and the manager is trying something different this year. The manager says that whoever works the most extra shifts when asked to do so will get first pick for the holiday schedule. Which type of conflict resolution does this represent?
- Which of these nursing interventions for the patient who has had right-sided breast-conservation surgery and axillary lymph node dissection is appropriate to assign to an LPN/LVN?
|a.||Teaching the patient how to avoid injury to the right arm|
|b.||Administering an analgesic 30 minutes before the scheduled arm exercises|
|c.||Assessing the patient’s range of motion for the right arm|
|d.||Evaluating the patient’s understanding of discharge instructions about drain care|
- The nurse is a very busy charge nurse with responsibilities for a unit with 24 acute care patients. An experienced nursing assistant is assigned to the unit. The nursing assistant notes that the IV pump is beeping because the tubing appears kinked. The assistant unkinks the tubing, and this resets the pump. The assistant reports the action to the nurse. It is most important that the nurse:
|a.||thank the nursing assistant for taking the initiative to correct the problem and to “keep up the good work.”|
|b.||provide the assistant with additional instructions on safety in IV management.|
|c.||warn the other staff to watch out for the nursing assistant because she works beyond her scope.|
|d.||explain that help is appreciated; however, legally the nursing assistant cannot perform the action.|
- A newly admitted patient has several orders the physician has written. As manager of care, a graduate RN knows that three of the following tasks can be routinely delegated to a nursing assistant, but one of them must be reserved for the RN to complete. Which task must the RN complete?
|a.||Reminding to use the incentive spirometer|
|b.||Irrigating of a urinary catheter|
|c.||Conducting fingerstick glucose tests|
|d.||Collecting data for intake and output|
- The best way for a nurse to determine that a newly hired certified nursing assistant (CNA) is competent to transfer a patient safely from the bed to the commode would be to:
|a.||look in the CNA’s personnel file to determine previous experience.|
|b.||observe the CNA perform the procedure the first time and discuss the outcome.|
|c.||have the CNA explain the procedure before doing it.|
|d.||establish that the CNA is comfortable performing the transfer.|
- Which statement by the RN best represents the “right communication” when delegating a task to an unlicensed individual?
|a.||“Feed the patient and watch for cheeking and choking.”|
|b.||“I want you to help the patient to eat his lunch. You should elevate the head and feed him slowly enough so he does not choke.”|
|c.||“Feed the patient his pureed diet at lunchtime. Elevate the head of the bed to 90 degrees and make certain he swallows each bite.”|
|d.||“Assist the patient with lunch, and make sure he sits up and doesn’t store food in his cheek in between bites.”|
- In a patient care conference one of the nurses makes a controversial statement about the patient’s behavior. The other health care providers raise their eyebrows, and silence follows the original comment. A democratic leader would:
|a.||agree with the comment about the patient, and direct the group to the next topic on the agenda.|
|b.||ignore the statement about the patient’s behavior and the nurse’s judgmental attitude.|
|c.||gather input from the group about the patient’s behavior, and elicit suggestions about how to best work with the patient.|
|d.||respond to the nurse that the comment is judgmental and inappropriate, and ask the nurse to stay after the meeting.|
- A family member of an elderly Hispanic patient admitted to the hospital tells the nurse that the patient has traditional beliefs about health and illness. Being a patient advocate, the best action by the nurse is to:
|a.||avoid asking any questions unless the patient initiates conversation.|
|b.||obtain further information about the patient’s cultural beliefs from the family member.|
|c.||ask the patient whether it is important that cultural healers are contacted.|
|d.||explain the usual hospital routines for meal times, care, and family visits.|
- While talking with the nursing supervisor, a graduate RN expresses frustration that a Mexican American client always has several family members at the bedside. The most appropriate action by the nursing supervisor to help the graduate RN become a patient advocate is to:
|a.||ask about the graduate RN’s personal beliefs about family support during hospitalization.|
|b.||remind the graduate RN that this cultural practice is important to the family and the patient.|
|c.||suggest that the graduate RN ask family members to leave the room during patient care.|
|d.||have the graduate RN explain to the family that too many visitors will tire the patient.|
- Which patient described below most needs an advocate?
|a.||A 68-year-old female patient who tells you that she always relies on her husband to decide what is best|
|b.||An 80-year-old patient who states, “Why do people talk over my head as if I was a child?”|
|c.||A 4-year-old patient whose mother visits each evening but goes home to care for her other two children each night|
|d.||A 36-year-old patient who states, “I really wish this surgery wasn’t necessary. I want to look at my other choices, again.”|
- Which question or statement by the nurse is most helpful in ensuring that a nursing assistant new to the unit understands what is expected of the assistant?
|a.||“Are you ready to begin work now?”|
|b.||“Now, repeat for me what I have just asked you to do.”|
|c.||“Do you know what I expect from you?”|
|d.||“Let me know if you need any help.”|
- The RN is planning care for the day. Which would be the most appropriate task to assign to the nursing assistant?
|a.||Collecting a 24-hour urine specimen|
|b.||Feeding the patient who has difficulty swallowing|
|c.||Changing the dressing on an abdominal wound|
|d.||Monitoring a tube feeding|
- Which statement best reflects that the nurse manager has taken the first action in the decision-making process?
|a.||“We could hire four additional nursing assistants.”|
|b.||“We need to decrease patient falls.”|
|c.||“Patient falls have decreased by 20%.”|
|d.||“Here is the revised staffing schedule.”|
- Which patient should be assigned to an experienced LPN/LVN?
|a.||One day post-op coronary artery bypass graft (CABG) who is on telemetry with T 37.1° C, BP 95/50, P 92, R 18|
|b.||Two day post-op appendectomy with T 36.8° C, BP 118/78, P 78, R 18|
|c.||Snake bite 2 days prior with hematuria, melena, and blood seepage at the IV site with stable vital signs|
|d.||One day post cerebral vascular accident (CVA) on a heparin drip experiencing increasing hemiplegia, with stable vital signs|
- According to the ANA, which elements of nursing cannot be delegated? (Select all that apply.)
|a.||Initial and subsequent nursing assessments requiring professional judgment|
|b.||The determination of nursing diagnoses, goals, plans of care, and progress|
|c.||Interventions that require the application of professional knowledge and skills|
|d.||Interventions that require additional knowledge and skills|
|e.||Routine daily care elements including recording vital signs|
Chapter 17: Promoting Healthful Living in the Primary Care Setting
- A patient admitted with chest pain who is a one pack-a-day smoker tells the nurse, “I am just not ready to quit smoking yet.” The most appropriate response by the nurse is:
|a.||“This would be a really good time to quit.”|
|b.||“Are you familiar with the nicotine patch?”|
|c.||“Your smoking is the cause of your chest pain.”|
|d.||“What do you think keeps you from quitting?”|
- A nurse is caring for a non–English-speaking Asian patient whose cultural practices are not familiar to the nurse. The nurse is curious about practices regarding communication and eye contact. The nurse should:
|a.||tell the patient that it is cultural practice in the United States to maintain good eye contact when communicating with someone.|
|b.||observe the behaviors and interactions between the patient and other members of the culture.|
|c.||avoid all eye contact unless the patient establishes eye contact.|
|d.||use eye contact and communication techniques that are most comfortable for the nurse.|
- After the nurse implements diet instruction with a patient with heart disease, the patient can explain the information but fails to make the recommended dietary changes. The nurse’s evaluation is that:
|a.||learning did not occur because the patient’s behavior did not change.|
|b.||the nursing responsibility for helping the patient make dietary changes has been fulfilled.|
|c.||choosing not to follow the diet is the behavior that resulted from the learning.|
|d.||the teaching methods were ineffective in helping the patient learn the dietary information.|
- A patient is admitted to the hospital with a new diagnosis of diabetes mellitus type 1 and is scheduled for discharge on the second day after admission. In view of the patient’s 2-day inpatient stay, the nurse should set realistic goals by planning to:
|a.||teach the patient how to monitor glucose and self-administer insulin.|
|b.||include detailed information about diet and medication use in patient teaching.|
|c.||use every interaction to teach the patient about the details of glucose control.|
|d.||focus on teaching the family instead of the patient about diabetic management.|
- A nurse recognizes that a homeless patient must walk great distances to obtain food. What kind of need does this patient demonstrate?
|d.||Health continuum need|
- A patient has had no visitors for the 2 weeks he has been on your unit. The patient seems dejected and insists on having his few belongings in sight at all times. The nurse realizes that he may be experiencing what kind of need?
|d.||Health continuum need|
- The priority health promotion nursing diagnoses for an overweight, but not yet obese, patient who is learning about weight reduction may include:
|a.||the potential for obesity.|
|b.||the potential for impaired mobility.|
|c.||alteration in nutrition.|
|d.||health-seeking behaviors or knowledge deficit.|
- Negative dietary influences on the health of Asian immigrants to the United States are most likely considered to be which type of environmental factor affecting health promotion?
- A nurse is developing a health promotion care plan for an otherwise healthy man who is married with four children and has a career as a public school teacher. Which of the following environmental factors could have a major effect on the patient’s health promotion activities?
|c.||None of the above|
|d.||Both a and b|
- While obtaining a health history of a patient who has a large infected wound on the foot, the nurse learns that the patient has taken goldenseal to boost immune function rather than taking antibiotics for the infection. Which action by the nurse is initially most appropriate?
|a.||Instruct the patient about the reasons for antibiotic use with infection.|
|b.||Ask the patient, “How do you feel about using both antibiotics and natural remedies?”|
|c.||Tell the patient that the doctor is likely to prescribe antibiotics.|
|d.||Tell the patient that studies of goldenseal show that it is not effective in treating infection.|
- Several family members of a patient who has just been admitted to the intensive care unit (ICU) with multiple traumatic injuries have just arrived in the ICU waiting room. Which action should the nurse take first?
|a.||Take the family members to the patient’s room.|
|b.||Discuss ICU visitation policies and encourage family visits.|
|c.||With the patient’s approval, describe the patient’s injuries and the care that is being provided.|
|d.||Invite the family to participate in a multidisciplinary care conference.|
- A homeless patient with severe anorexia, fatigue, jaundice, and hepatomegaly is diagnosed with viral hepatitis and has just been admitted to the hospital. In planning care of the patient, the nurse assigns the highest priority to the patient outcome of:
|a.||establishing a stable home environment.|
|b.||maintaining adequate nutrition.|
|c.||increasing activity level.|
|d.||identifying the source of exposure to hepatitis.|
- When developing strategies to decrease health care disparities, the nurse working in a hospital located in a neighborhood with many Vietnamese individuals will include:
|a.||educating the staff about Vietnamese health beliefs.|
|b.||improving public transportation.|
|c.||obtaining low-cost medications.|
|d.||updating equipment and supplies for the clinic.|
- Which family would the nurse consider healthy?
|a.||A family in which the parents do not allow their 10-year-old child to make basic decisions.|
|b.||A family that encourages independence while supporting each other.|
|c.||A family that does not require a specific curfew for their 16-year-old son.|
|d.||A family that does not allow their 15-year-old child to be an individual.|
- A home health nurse is going to visit a new patient for admission to the nurse’s care. At the first meeting the nurse is able to meet the entire family. The nurse recognizes some unhealthy characteristics. Which statement made by the patient would lead the nurse to this conclusion?
|a.||“We all have specific chores that we are responsible for on a daily basis.”|
|b.||“We allow our 14-year-old to make all of her own decisions.”|
|c.||“We like to go camping together as a family in the summertime.”|
|d.||“Our children are actively involved in school-sponsored sports.”|
- A patient has chosen to see a Family Nurse Practitioner (FNP) to assist with health promoting activities. Which of the following services provided by the FNP is the best example of a health promotion activity?
|a.||Teaching about a low-fat diet for a patient with a blood pressure of 136/82|
|b.||Prescribing a cholesterol-lowering medication|
|c.||Scheduling a cardiac stress test|
|d.||Prescribing an anticoagulant for a patient with atrial fibrillation|
- A program designed to increase exercise, reduce fat in a diet, and teach low-fat cooking methods to improve the health of a large population could be best described as:
|c.||diagnosis and treatment.|
|d.||health promotion and health protective.|
- Healthy People 2020 is a:
|a.||new global action plan to prevent and treat disease.|
|b.||prevention agenda for the nation.|
|c.||national effort to improve lives of U.S. citizens.|
|d.||set of national health mandates.|
- To help prevent drug-drug interactions in an older adult patient taking many medications, the most appropriate instruction by the nurse is:
|a.||“Do not take any over-the-counter (OTC) drugs with your prescription drugs.”|
|b.||“Bring a list or all of your medications, supplements, and herbs that you use to every health care appointment and/or the hospital.”|
|c.||“Be sure to have all your prescriptions filled at the same pharmacy.”|
|d.||“Use a medication reminder system so that you won’t forget to take your medications as scheduled.”|
- Before discharging a patient with osteoarthritis (OA) of the left hip and lower lumbar vertebrae, the nurse teaches her about management of the condition. Which replies by the patient demonstrate proper understanding of how to manage her condition? (Select all that apply.)
|a.||“I should try and stay active all the day to keep my joints from becoming stiff.”|
|b.||“I can use a cane if I find it helpful in relieving the pressure on my back and hips.”|
|c.||“A warm shower in the morning will help relieve the stiffness I have when I get up.”|
|d.||“I should take no more than 1 gram of acetaminophen four times a day to control the pain.”|
|e.||“Exercising daily on a stationary recumbent bicycle will lessen joint stress.”|
Chapter 18: Managing Care in Secondary and Tertiary Health Care
- According to Orem, people enter the acute health care setting when they are experiencing either a self-care or a:
- In the acute care environment, what is(are) the primary role(s) of the RN?
|a.||Ensure more independence in self-care ability.|
|b.||Avoid complications as the patient progresses through the illness state.|
|c.||Change the medical plan of care according to the RN’s assessments.|
|d.||Both a and b are correct.|
- A nurse writes the diagnosis of “potential for infection” for a postoperative patient. The charge nurse makes certain not to place a patient with a diagnosed infection in the same room with the fresh postoperative patient. The nurse does this to manage which of the following?
|a.||The potential for noise in the room|
|b.||The potential for patient complaints related to odors|
|c.||The physical environment of the secondary health setting|
|d.||The social environment within the secondary health setting|
- After being diagnosed with cancer, the patient appears angry. At this point it would be appropriate for the nurse to assess for which kind of distress?
- Some cultures see personal touching as an insult unless you are intimately related. In the acute care setting, the need for touching to administer care may produce what within the patient?
|d.||Increased self-care deficit|
- By allowing the ICU patient’s family to visit as often as the patient’s condition will allow, the nurse is considering which type of need within the patient and his family?
- Discharge planning requires all of the following except:
|a.||assessing the patient’s plan of care to determine whether the outcome criteria are met.|
|b.||evaluation of whether the patient and family can continue with the necessary interventions or whether they need assistance.|
|c.||obtaining specific orders from the physician to begin the process of discharge planning.|
|d.||assessing the level of the patient’s understanding with regard to his or her illness state and treatment regimen.|
- The extended care meant to provide health restoration after discharge from an acute care facility is also known as _____ care.
- The health maintenance focus for the patient in tertiary care is to:
|a.||regain or attain as much independence as possible.|
|b.||extend the time in tertiary care as long as possible.|
|c.||ensure total independence with self-care.|
|d.||avoid acquired infections while in the tertiary facility.|
- A stroke patient has been discharged from the hospital and requires care at home. Family support includes the patient’s husband and one adult child who lives 90 minutes away with her family, who helps as often as possible. The husband has had to miss work often and has stopped playing golf weekly to care for his wife. What tertiary care service may be a benefit not only to the family members but to also the patient?
|a.||Home health care|
- A patient has endured 3 years of treatment for colon cancer but recently learned that the cancer has spread to her liver and bone. The patient and her family have learned she may have less than 6 months to live and there is nothing medically to consider. What tertiary service can the RN suggest to the patient and family?
|c.||Home health care|
- A patient has been discharged home after being hospitalized for a fractured foot following a motor vehicle accident. The doctor has ordered physical therapy for the patient to help gain strength and flexibility after the cast can be removed. This patient will likely receive a referral for what tertiary service?
|b.||Home health care|
- Which of the following is an example of a responsible resource manager in an acute care facility?
|a.||Listens to staff input about implementing a new procedure|
|b.||Consumes foods and drinks kept on the unit for patients|
|c.||Considers the unit’s patient census when determining staffing|
|d.||Uses supplies that are not accounted for|
- Spiritual assessment is not usually a part of a formal assessment tool, with the exception of asking about religious practices that may be important to continue in the hospital. Which question addresses religious practices?
|a.||“Would you like a chaplain to come pray with you?”|
|b.||“Do you turn to spiritual guidance as a source of strength in illness?”|
|c.||“What helps you most when you feel afraid?”|
|d.||“What is most frightening about your situation?”|
- In what way(s) do clinical pathways help nurses to manage patient care? (Select all that apply.)
|a.||Evaluate long-term care facilities.|
|b.||Enable consistently safe care.|
|c.||Manage the resources of the health care facility.|
|d.||Define standard assessment data and frequency for data collection.|
|e.||Review patient charts for quality improvement opportunities.|
Chapter 19: Reflecting on Your Transition
- A toddler is brought to the well-child community clinic by her grandmother. The health history reveals recurrent nausea, vomiting, and diarrhea. Her physical exam reveals a negligible gain in height and weight, lethargy, and a delay in achieving milestones. As a result of the child’s delays, multiple disciplines would likely be involved in caring for the child. Which of the following represents the most effective role the nurse would play in caring for the child?
- A 43-year-old patient is scheduled for a laparoscopic cholecystectomy. A nurse has a plan to teach the preoperative patient how to splint his abdomen with a pillow and cough and deep breathe, so the patient can avoid fluid accumulation in the lungs postoperatively. When the nurse enters the room, it becomes evident that the patient is blind. What critical thinking skill would you recommend a scenario like this requires?
- It is 0800 and the nurse just received report. Which patient situation demands the nurse’s immediate attention? The patient:
|a.||with a blood glucose of 200.|
|b.||who needs a 0800 vancomycin level drawn.|
|c.||receiving a blood transfusion who reports slight itching and chills.|
|d.||with a serum potassium level of 4.3 mEq/dL who is receiving digoxin.|
- A patient who had recent abdominal surgery is becoming increasingly agitated and confused. He has pulled out his IV and his nasogastric tube. His skin is pale and clammy, heart rate 120 bpm, BP 130/60. The physician has been called. What nursing action is most important at this time?
|a.||Gather needed supplies and assign the aide to remain with the patient.|
|b.||Stay with the patient and have another nurse obtain needed supplies.|
|c.||Administer pain medication and then recheck vital signs.|
|d.||Assign the aide to retake vital signs every 15 minutes.|
- Which patient is at greatest risk for injury and requires the nurse’s immediate attention? The patient who had a(n):
|a.||paracentesis 20 minutes ago and is sitting in bed with the arms resting on the overbed tray.|
|b.||surgical repair of an incarcerated hernia yesterday and now has slight bruising at the incision site.|
|c.||echocardiogram that showed an ejection fraction of 40% and has a resting heart rate of 110 occasional PVCs.|
|d.||needle liver biopsy 1 hour ago and is now thrashing about in bed and complaining of severe abdominal pain.|
- What could a nurse say who believed that a nursing student has a duty to understand pertinent clinical information to make sound clinical judgments?
|a.||“Sometimes work does get in the way of studying.”|
|b.||“Nursing school is difficult, and striving for average is understandable.”|
|c.||“You should be honest when critically reflecting on your strengths and weaknesses.”|
|d.||“Experience after nursing school will provide real nursing knowledge.”|
- As a graduate nurse, which statement strongly suggests future success in the current nursing practice environment?
|a.||“I am really good at performing nursing skills.”|
|b.||“I always get my work done on time.”|
|c.||“When possible I attend all staff meetings.”|
|d.||“I am actively involved in decision-making on the unit.”|
- Which of the following is an example of an anxiety-causing situation below that is potentially caused by a role transition from LPN/LVN to RN?
|a.||A shift assignment of four patients|
|b.||Managing care based on your knowledge and skills|
|c.||Changing work shifts from days to nights|
|d.||Delegating tasks to LPNs/LVNs and medical assistants|
- The patient reports intense pain and rates it 10/10. He is talking and laughing on the telephone but interrupts his conversion to request pain medication. The nurse would make a decision about the administration of medication based on which indicator of pain?
|a.||The patient’s body language and emotional state|
|b.||The patient’s level of activity and interaction with others|
|c.||The patient’s subjective statements about the pain|
|d.||The nurse’s objective data regarding the physical characteristics of the pain|
- The nurse asks a hospitalized patient to sign the operative consent. The patient tells the nurse, “I do not really understand what is involved in the surgery.” The nurse should:
|a.||postpone the consent form signing and notify the operating room that the anesthesiologist needs to discuss the surgery with the patient.|
|b.||explain what the planned surgical procedure entails before having the patient the sign the consent form.|
|c.||have the patient sign the form and ask the health care provider to visit the patient before surgery to explain the procedure further.|
|d.||delay the patient’s signature on the consent form and notify the surgeon that the informed consent process is not complete.|
- If a patient refuses a medication or is undergoing a diagnostic test that results in a missed dose of medication, the nurse will document the omission on the medication administration record and:
|a.||discontinue the physician’s order.|
|b.||document why the dose was not given.|
|c.||write an incident report.|
|d.||double the dose at the next scheduled administration time.|
- A patient weighed 200 lb 6 months ago. He now weighs 160 lb. He has not been trying to lose weight. Based on the defining characteristics of nutrition, less than body requirements, the nurse’s best response would be:
|a.||“You need to modify your diet so you don’t lose more weight.”|
|b.||“That is a significant weight loss. How would you account for it?”|
|c.||“Congratulations. That is a major achievement.”|
|d.||“How tall are you? I am wondering if that is a good weight for your height.”|
- The nurse enters the room of a sleeping patient to administer the 0200 dose of antibiotic that has been ordered every 6 hours. Which action would most effectively maintain a therapeutic blood level of this medication?
|a.||Administer the medication whenever the client awakens.|
|b.||Omit this dose and chart the reason for doing so.|
|c.||Awaken the patient and administer the medication.|
|d.||Let the patient sleep and double the next dose.|
- The nurse is to take a meal tray to a patient the nurse knows nothing about. Before leaving the tray with the patient, which is the most critical safety factor the nurse should determine?
|a.||The room is neat and orderly without offending odors.|
|b.||The tray has condiments placed within easy reach.|
|c.||The patient is seated securely and in a comfortable position.|
|d.||The patient’s ability to swallow is intact.|
- A nurse notices that the respiratory therapist assigned to his unit frequently forgets to raise the bed rails after completing treatments. The nurse’s best action is to:
|a.||ask other nurses whether they have noticed the same problem.|
|b.||discuss the problem with the therapist.|
|c.||report the problem to the nurse in charge.|
|d.||report the problem to the director of respiratory therapy.|
- A nurse is assigned to care for an elderly, confused patient. The patient’s son is sitting at the bedside and is watching a loud television program. The nurse needs to complete the respiratory and cardiac assessment and vital signs. What would be the best approach to this situation?
|a.||Do not say anything. Just do the best you can with the TV on loud.|
|b.||Say: “That TV is too loud for me to do my work. You have to shut it off.”|
|c.||Say: “I’ll come back after you’ve finished watching this TV show. Can you use the call bell to let me know when it’s over?”|
|d.||Say: “I need a quiet environment while I listen to your mother’s chest. I will need to turn the TV down until I’m finished.”|
- A graduate RN on the telemetry unit is on the way to the nurse’s station to chart and suddenly hears from a patient’s room, “Help! Nurse!” This is not the nurse’s assigned patient. Others also hear this cry for help and quickly run in with the crash cart while the graduate RN looks on. In planning care for this patient, the beginning RN must realize the importance of identifying and (select all that apply):
- Which comments by the graduate RN are examples of interventions that will lead to a successful transition into professional nursing? (Select all that apply.)
|a.||“May I care for patients with COPD? I feel I need more experience with that pulmonary condition.”|
|b.||“How should I prioritize my five patients in order of importance?”|
|c.||“Thanks for your insights about knowing when to appropriately call the physician.”|
|d.||“Now that my new role is as an RN, I would like to be treated as any new graduate RN although I’ve worked here as a LVN for 3 years.”|
|e.||“I’m so nervous every day I come to work, hoping nothing happens to my patients.”|