2020 NCLEX-RN TEST PREP: MANAGEMENT AND PRACTICE DIRECTIVES (STUDY MODE) PRACTICE QUESTIONS WITH: ANSWERS & EXPLANATIONS

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MANAGEMENT AND PRACTICE DIRECTIVES (TEST MODE) 1. At the beginning of the shift, a nurse receives report for her daily assignment. Which of the following situations should the nurse give first pri ... ority? a. A diabetic client with a blood glucose level of 195 mg/dL b. A family member of an elderly client who has questions c. A client with COPD with an oxygen saturation of 84% d. A client who requires assistance to use the bathroom 2. Mr. W has orders for a physical therapy consult. The nurse contacts the appropriate department but 12 hours later, no one has come to see the client. Which is the most appropriate action of the nurse? a. Call the supervisor and file a complaint against the physical therapy department b. Contact the physician to notify him that the orders were not carried out c. Assess the client's activity level by assisting with ambulation using a gait belt d. Contact the physical therapy department again and repeat the order 3. The "B" in the SBAR acronym stands for: a. Background b. Basic c. Beginning d. Break 4. Decide which of the following tasks may be delegated to unlicensed assistive personnel. a. Cleansing a wound with peroxide b. Irrigating a colostomy c. Assisting with performing incentive spirometry d. Removing a saline-lock IV 5. According to HIPAA, which of the following is considered an individual right for privacy of a client's protected health information? a. The right to receive medical bills for care received b. A copy of the organization's privacy practices c. A right to change personal health information d. An understanding that protected health information will only be used in regards to client treatments 6. Which of the following clients is most likely ready to be dismissed from an inpatient care setting to home? a. A 65-year old male with urine output of 60cc in the past four hours. b. A 2-month old female with a temperature of 100.6 rectally c. A 38-year old female who transitioned from IV TPN to full liquids six hours ago d. A 4-year old male with an oxygen saturation of 96% on room air 7. The nurse is performing discharge teaching for Mrs. S after cardiac angioplasty. Her husband is present for the teaching. While explaining the prescription for antiplatelet medication to use at home, Mrs. S's husband states, "I don't think I can afford to refill that medication." What is the most appropriate response of the nurse? a. Don't worry, your insurance will cover it." b. I'll ask the physician if he can prescribe a medication that is more affordable." c. You should apply for Medicare to see if they can help you." d. This medication is essential for her care and should be given priority over all others that she is taking." 8. The discharge planning team is discussing plans for the dismissal of a 16- year old admitted for complications associated with asthma. The client's mother has not participated in any of the discharge planning process, but has stated that she wants to be involved. Which of the following reasons might prohibit this mother from participating in discharge planning? a. The client is an emancipated minor b. The mother has to work and is unavailable c. The client has a job and a driver's license d. The mother does not speak English 9. A nurse enters a client's room and finds her lying on the floor near the bathroom door. As the nurse provides assistance, the client states, "I thought I could get up on my own." What information must the nurse document in this situation? a. A statement explaining the condition the client was found in, quoting the client's words about the situation b. An explanation of how the fall happened and when the physician was notified c. An account of the conditions of the room that contributed to the client's fall d. A description of the client's condition and the reasons why she should have had assistance to the bathroom 10. Which of the following may be a cultural barrier that impacts a nurse's ability to provide care or education to the client? a. A nurse offers educational materials to a client that are written at an 8th grade reading level b. A Vietnamese woman wants to use steaming in addition to her prescription antibiotics c. A nurse uses pantomime to explain a procedure to a deaf client d. A Native American client requests a healing ritual before he will consider surgery 11. Which of the following is an example of low health literacy skills? a. A nurse's aide cannot calculate the correct IV rate for Ringer's lactate b. A client cannot read an admission form to sign it c. A nurse is unable to explain the dose, indications, side effects, and structural formula of carbamazepine d. A client does not understand the treatment for his cholecystectomy 12. A 39-year old woman presents for treatment of excessive vaginal bleeding after giving birth to twins one week ago. Which nursing diagnosis is most appropriate in this situation? a. Knowledge Deficit related to post-partum blood loss b. Self-Care Deficit related to post-partum neglect c. Fluid Volume Deficit related to post-partum hemorrhage d. Body Image Disturbance related to body changes after delivery 13. Mr. K is admitted to the orthopedic unit one morning in preparation for a total knee replacement to start in two hours. Which of the following is a priority topic to instruct this client on admission? a. The approximate length of the surgery b. The type of anticoagulants that will be prescribed c. The time of the next meal of solid food d. The length of time until the client can return to work 14. Which of the following is an example of the intervention phase of the individualized nursing care plan for a client who receives a colostomy after a bowel resection? a. Taking a health history and performing a physical exam prior to the procedure b. Instructing the client about how to care for his colostomy stoma c. Developing goals that state the client will ambulate three times a day d. Determining that the client may need more support at home after dismissal 15. Research participants are involved in a trial that incidentally separates them into two groups. One group receives an intervention, while the other group does not. Both groups are compared for outcomes. What type of research method is this? a. Experimental design b. Double-blind experiment c. Randomized controlled trial d. Repeated measures design 16. A nurse is caring for an in-patient client in the hospital who is from another country and who fasts for temporary periods in order to promote his own spiritual growth. The nurse responds by saying, "You need to eat something while you are here. Food and proper nutrition is extremely important for your health." What social philosophy is the nurse demonstrating? a. Ethnocentrism b. Relativism c. Stereotyping d. Xenocentrism 17. A nurse is using active listening as a form of therapeutic communication when: a. She uses humor to put the client at ease in a situation b. She restates what the client said in slightly different words c. She uses eye contact and maintains an open stance while the client is talking d. She provides personal information to show the client she can relate to him 18. A client asks a nurse, "Do you think I should move back home after this procedure?" and the nurse responds by saying, "do you think you should move back home?" What type of therapeutic communication is the nurse representing? a. Observation b. Reflection c. Summarizing d. Validating 19. Which of the following is an example of a living will? a. A client's son has been appointed to make his healthcare decisions if he becomes incapacitated b. A client has designated which of his children will receive his home and property before he dies c. A client has instructions that he does not want to be resuscitated through chest compressions if his heart stops beating d. A client designates what type of burial or cremation services he would want after his death 20. What is involved with obtaining informed consent? a. An explanation of the reasons for the procedure b. A signature on a form that states the client agrees to the procedure c. A statement affirming liability if complications arise during the procedure d. Both a and c 21. Which of the following questions must the nurse ask when formulating a nursing diagnosis? a. What diagnosis did the physician make for this client? b. What is the issue that I can solve for this client? c. What physician orders will resolve this issue? d. What underlying disease does this client have? 22. A nurse walks into a client's room to find the nursing assistant yelling "sit back down or I won't help you eat and then you will starve!" This type of behavior is known as: a. Psychological abuse b. Abandonment c. Material exploitation d. Physical abuse 23. A physician has written an order for "2.0 mg MS q 2-4 hr prn pain." What is the nurse's response to this order? a. Give 2 mg of morphine sulfate to the client b. Give 20 mg of morphine sulfate to the client c. Contact the pharmacy to clarify the order d. Contact the physician to rewrite the order 24. A client is being admitted to the stroke care unit of a rehabilitation center. Which of the following best describes the action of the nurse at admission? a. Collect and arrange documents to be placed in the client's medical record b. Prepare the client's identification bracelet c. Identify pertinent health history data as well as current needs and limitations d. Gather the client's valuables and place them in a locked container 25. A client is refusing to undergo any more treatments in the hospital and wants to leave against medical advice. When the nurse requests the client sign an AMA order, the client refuses and leaves. What is the next action of the nurse? a. Call security to hold the client until he will sign the order b. Notify the physician to convince the client that he needs to stay c. Speak with the client's spouse to persuade him to stay d. Allow the client to leave and document the refusal in his chart 26. Which example best describes a nurse who exhibits moral courage? a. A nurse feels angry when a parent refuses important treatment for his child. b. A nurse considers seeking help for depression when she feels she cannot meet the needs of her clients in the oncology unit. c. A nurse contacts a physician for further orders when he fails to order comfort measures for a client with a terminal illness. d. A nurse is frustrated when the laboratory is slow in responding to an order for a stat blood glucose. 27. Which method is most appropriate for managing moral distress in the workplace? a. Recognizing that life is unfair and nurses cannot meet every need of every client b. Declining to act when clients or visitors make requests that are not justifiable c. Developing a new policy that would address the problematic situation d. Both a and b 28. A nurse is required to float to another unit within the hospital where he is asked to care for a client on a ventilator. The nurse is uncomfortable with this assignment, as he has not had a ventilated client since nursing school. What is the nurse's most appropriate response? a. Explain to the nursing supervisor the level of discomfort and ask for a different assignment b. State that the client's needs are outside the nurse's scope of practice and request a different assignment c. Accept the assignment, asking for help when necessary d. Request to return to the home unit and send another nurse who can perform the job 29. A nurse is asked to perform a task that she believes is outside her scope of practice. What is the appropriate response to this issue? a. Contact the state board of nursing licensure to report the offense b. Review the state scope of practice standards for nurses c. Ask another nurse to perform the task to learn the procedure d. Contact the house supervisor to make the decision as to whether the nurse should perform the task 30. A nursing unit is implementing a new electronic charting program for the nursing staff to use. Which of the following best describes a disadvantage of using electronic charting? a. The information is more likely to be lost or used inappropriately b. Any provider in the unit can have access to the client's medical records c. The system diminishes communication between nurses and providers d. The program may be confusing and difficult to implement 31. A client has volunteered to take part in a research study. After participating for two months, he decides that he can no longer tolerate the study and decides to leave. What are the client's rights in this situation? a. The client has a right to be released from the study but must reimburse the researchers for charges incurred b. The client has a right to be released from the study without any liability c. The client has a right to be released from the study but is prohibited from participating in any future studies d. The client does not have the right to be released from the study; he must finish his participation 32. A client is seen in the emergency room as a victim of suspected domestic violence. The nurse's aide brings the client to a center curtained area, gives her a gown to change into, and asks her to wait for the nurse. What is the most appropriate action of the nurse upon arrival? a. Ask the client to undress to visualize any injuries b. Take the client into a private room c. Notify the police to file an initial report d. Notify the house supervisor to keep security on alert 33. A nurse is examining a woman who has bruises on her face and back in various stages of healing. The client states "sometimes he just gets so angry." Which of the following statements is most appropriate as a response from the nurse? a. Do you mean your boyfriend?" b. You need to leave him as soon as possible." c. No one will ever hurt you again." d. Tell me more about what happens when he gets angry." 34. A nurse is performing an end-of-shift count of narcotics kept in the locked cabinet. The narcotic log states there should be 26 oxycodone pills left, but there are only 24 in the drawer. What is the first action of the nurse? a. Perform the count again b. Contact the pharmacy to determine if the narcotic log is incorrect c. Check with the last nurse to sign out narcotics from the system d. Notify the house supervisor that narcotic medications are missing 35. Which example best describes the concept of beneficence? a. A client has an advanced directive in place stating that he does not want intubation if he needs CPR b. A nurse provides pain medication for a client in the recovery room who is experiencing pain c. At the request of the client, a nurse does not inform his family about his cancer diagnosis d. A nurse withholds narcotic medication for a client in pain, knowing that he is currently disoriented 36. A nurse is caring for a dying client whose family wants to be with him in the operating suite. The surgeon, however, does not allow families to be present during surgery. The nurse recognizes this as an ethical dilemma. What is the initial step of the nurse when managing this situation? a. Contact the physician to amend the order for the client b. Document an account of the situation to ensure adequate coverage of details c. Consult with the medical ethics committee to determine a safe and workable solution d. Speak with the chief nursing officer to change the policy governing this situation 37. A nurse is at the beginning of her shift in a long-term care facility. Which of the following clients should she check on first? a. A 91-year old man who needs help eating breakfast b. An 86-year old man who has been incontinent in his bed c. An 82-year old woman who needs IV antibiotics d. A 75-year old man who is recovering from an injury who needs an ice pack 38. The charge nurse is notified that the unit will be receiving an admission of a client from another bed in the hospital in order to make room for others being admitted through the emergency room. The unit is the Women's Health Center of the hospital. Which of the following people would be most appropriate to be transferred to this unit? a. A 26-year old woman who had a bowel resection b. A 40-year old man who underwent a hernia repair c. A 31-year old woman with septicemia and who is on a ventilator d. A 91-year old man with Alzheimer's disease recovering from a fall 39. A nurse in the emergency room enters a client's care area to start an IV. She finds a man sitting on the table, hunched over, and attempting to take deep breaths. He states, "my chest hurts so much!" His wife is sitting on a chair in the corner, crying. Which of the following is the first action of the nurse? a. Bring the IV kit and quickly start an IV b. Assess his breathing and provide oxygen, if necessary c. Administer medication to control chest pain d. Talk with his wife and find out why she is crying 40. Examples of preservation of self-integrity include all of the following except: a. Using assistive equipment to move bariatric clients b. Participating in wellness programs c. Accepting the challenge of caring for clients with oppositional beliefs or practices d. Using hand hygiene and personal protective equipment 41. Which method best describes the use of evidence-based practice? a. Reading and analyzing research reports to see how they can be implemented into nursing practice b. Collecting data to determine how efficiently nursing practice is contributing to quality care c. Monitoring unit practices to determine compliance with Joint Commission standards d. Using the most effective, current, and applicable information available to guide nursing care for the best of the clients. 42. A public health nurse discovers that many of the children in the neighborhood where she works are developing lead toxicity. She implements a program to screen for lead exposures among clients in the community. This is an example of: a. Social justice b. Policy resources c. Autonomy d. Moral justification 43. Which of the following is an example of whistle blowing? a. A nurse contacts administration about a colleague who takes supplies to use for a mission trip b. A client sues a nurse because she failed to call the physician about his wound infection c. A nursing assistant calls for help when a client falls out of bed d. A client developed a sacral pressure ulcer when he was not turned in bed for over four hours 44. Which situation might require an occupational health nurse consult? a. A nurse is injured from using incorrect body mechanics to lift a client b. A nurse receives a subpoena to testify in court about a client's case c. A client who has been injured in a diving accident needs assistance with planning rehabilitation and surgery d. A nursing unit is implementing a new electronic health record system 45. Which of the following is the most appropriate example of anticipatory guidance for a 16-year old who has been hospitalized for an ankle fracture? a. Changes associated with puberty b. Driving and staying safe c. The health hazards of smoking d. Social media influences 46. Which action represents the evaluation stage of the plan of care? a. The nurse assigns a nursing diagnosis of Impaired Skin Integrity related to diminished skin circulation b. The nurse assesses the client's vital signs and asks about symptoms c. The nurse determines that the client is not meeting his set outcomes and makes revisions d. The nurse discusses the client's health history 47. A nurse is assigned to care for a deaf client. During her lunch hour, she visits the hospital library and reads more about deaf culture in order to better provide appropriate care for her client. This action is an example of: a. Cultural knowledge b. Cultural noise c. Cultural diversity d. Cultural divide 48. A nurse is providing discharge instructions for a client who had back surgery. All of the following exhibit that the client is ready for discharge EXCEPT: a. The client still has sutures at the incision site b. The client is able to take a shower c. The client must still use an ice pack at the wound site d. The client has a temperature of 100.8 F 49. Which of the following is an example of intragroup conflict? a. A nurse writes a grant for a non-profit organization to raise money for advertising b. Members of a multidisciplinary team cannot agree on the best course of action for a client c. A client does not receive his medication on time because the nurse was on break d. A nurse feels frustrated that her employer does not provide on-site child care 50. A nurse is providing dismissal instructions for a child who was admitted for rotavirus. Which of the following statements by the parent indicates the need for further teaching? a. I'll start giving him his antibiotics as soon as we get home." b. I will call the physician if he becomes dizzy or overly fussy." c. He will need to wash his hands a lot to keep this from spreading." d. I'll watch to see when he stops having diarrhea stools." 51. A teacher brings a 5-year old child to the school nurse because of a bruise under her eye. When asked about the bruise, the child responds, "my daddy did it." What is the nurse's initial action in this situation? a. Allow the child to return to class and monitor for future events that are suggestive of abuse b. Call the parent and request an explanation for the bruises c. Call the police and ask for a warrant for the parent's arrest d. Notify the school administrator 52. What does an anti-kickback statute prevent? a. It prevents healthcare workers from providing food or parties to celebrate special occasions at work b. It promotes thorough and complete documentation when a client becomes injured c. It forbids giving or accepting gifts to promote or provide referrals for certain services d. It prevents physicians from ordering treatments that may require nursing care that is over and above the usual amount 53. Which of the following is an example of restorative care? a. A nurse teaches a new mother how to breastfeed her infant b. A nurse helps a client with developing a bladder-retraining program c. A nurse places an allergy wristband on a client's wrist to notify other providers of potential reactions d. A nurse contacts the family of a client to tell them he will be out of surgery soon 54. Which of the following clients have a barrier to accessing healthcare? a. A 36-year old client who must use a wheelchair for mobility b. A 44-year old client who is visiting the United States on a visa from India c. An 81-year old client who is unable to drive d. All of the above 55. A client in a long-term care facility tells the nurse "my daughter never visits me." The nurse responds by telling the client that when her own mother was in a long-term care facility, she found it difficult to visit. This is an example of which communication technique? a. Empathy b. Self-disclosure c. Disapproval d. False reassurance 56. Which of the following is an example of intrapersonal conflict? a. Hospital bills are denied by an insurance company due to policies b. A nurse is called to testify in court about a client she cared for three years ago c. A nurse feels guilty when she administers essential medication that causes a client to have nausea and vomiting d. The spouse of a nurse is upset that she is working overtime 57. A nurse with five years of experience working in a hospital unit is promoted as a mentor and preceptor to a new nursing staff. This is an example of: a. Collegiality b. Competence c. Advocacy d. Integration 58. Which of the following is an example of libel? a. A client overhears a nurse telling her assistant that he is "too high maintenance" b. A client reads disparaging remarks that a nurse has written about him in his chart c. A nurse fails to notify a physician when a client's hemoglobin level is 8.1 gm/dL d. A nurse administers narcotic pain medication to a client in pain but does not have an order 59. All of the following are essential components of supervision EXCEPT: a. All tasks to be delegated or supervised are within the nurse's scope of practice b. The necessary tasks require repeated assessments c. The nurse has adequate time to develop staff assignments d. Policies have been developed that govern nursing practice 60. Which of the following is an example of a breach to a client's right to privacy? a. A nurse who is not caring for the client reads his personal information in his chart b. A client is not allowed to keep a copy of his original medical record c. A nurse filed an incident report about a client that was reviewed with all staff at a meeting d. A client's photograph was used without permission for the hospital newsletter 61. Which of the following abides by the Americans with Disabilities Act of 1990? a. A nurse is allowed to have a leave of absence to recover after a back injury b. A nurse manager cannot cancel an interview with a potential employee because he has left-sided paralysis c. A nurse is mandated to receive 12 weeks' off of work after having a baby d. A nurse manager must hire a nurse who uses a walker for mobility 62. Because of budget cuts in the hospital, the nursing manager informs the staff that they must either float to other units more often or take their turns staying home from work. Which principle is this nurse manager demonstrating? a. Justice b. Paternalism c. Veracity d. Fraternity 63. A new nursing unit is opening in the hospital. In order to meet the staffing needs of the unit, nurses from other areas will be moved and required to work in the new area. When notifying the nurses chosen to staff this area, the nurse manager states "you will either move to work on this unit or you will no longer be employed at this hospital." Which of the following strategies is this nurse manager using? a. Manipulation b. Facilitation c. Co-optation d. Coercion 64. A group of nurses who work on the quality assurance council of a unit have gathered to discuss ideas about how to educate their coworkers about Joint Commission requirements. Each of the nurses gives ideas, which are listed together without initially criticizing any of the suggestions. Eventually, all ideas on the list will be discussed as to their validity. This activity is known as: a. Optimizing b. Satisficing c. Brainstorming d. Centralizing 65. An assisted living facility is an example of which type of healthcare provider? a. Primary care b. Secondary care c. Tertiary care d. None of the above 66. Which of the following statements is true regarding non-profit organizations? a. They are located in poor or rural areas to provide care to the largest number of people. b. They are mandated to care for people, even if clients are unable to pay for services c. The money they receive for services is divided among stockholders that have invested in the organization d. They are also called proprietary organizations 67. Which of the following is a function of risk management? a. To consider the problems that arise if errors happen and their effect on the healthcare environment b. To identify how nursing care responds to specific client problems c. To view clients as customers and decide what actions will provide a satisfying healthcare experience d. To analyze physician-nurse relationships and determine where collaboration efforts can improve 68. A nurse caring for a pediatric client shows little concern when the parents attempt to speak with her about their daughter's illness. When approached by the nurse manager about her behavior, the nurse responds by saying "I don't want to get involved. It doesn't matter what I do anyway; my work does not make much of a difference." This nurse is exhibiting which of the following characteristics? a. Objectivity b. Depersonalization c. Procrastination d. Disruption 69. Which of the following is an example of effective time management? a. Always agreeing to others' requests for help b. Arranging long meetings to discuss important data c. Using multiple forms of technology to communicate or educate others d. Working in a secluded area to minimize interruptions 70. A nurse is asked by a physician to speak to a colleague about her unprofessional behavior in front of a client. The nurse does not want to create conflict with her colleague, so she does not confront her and stays away from the physician when he comes in to work the next day. Which type of conflict resolution is this nurse exhibiting? a. Accommodation b. Competition c. Avoidance d. Negotiation 71. You are caring for a patient with newly diagnosed multiple sclerosis. Discharge instructions will likely include all of the following EXCEPT: a. PT referral for development of a planned exercise program. b. Avoidance of prolonged sun exposure. c. Hot baths to promote muscle relaxation. d. Instructions to evaluate the home environment to ensure safety 72. The BRAT diet is often prescribed for patients with gastroenteritis. This acronym stands for: a. Bananas, Rice, Applesauce, and Toast b. Bread, Rice, Apricots, and Tapioca c. Bananas, Rolls, Apricots, and Toast d. Bananas, Rolls, Applesauce, and Tapioca 73. OSHA has very strict standards for hospital employees who may encounter hazardous materials or patients who have been exposed to them. These regulations include all of the following EXCEPT: a. Respiratory protection must be provided to all employees who might be exposed. b. Training on respiratory protection must be provided. c. Employers must provide personal protective equipment to all employees. d. All ED personnel must be trained in decontamination procedures. 74. Which of the following screening tools have been found to have a high diagnostic accuracy for screening for intimate partner violence? a. Hurt, Insult, Threaten and Scream (HITS) b. Humiliation, Afraid, Rape, and Kick (HARK) c. Slapped, Threatened and Thrown (STaT) d. All the above 75. What is the relationship between HIPPA and technological advances? a. Technology helps to foster HIPPA confidentiality. b. Computers help us to share information with others. c. Computer screens are not visible to others in the area. d. Technology places us at risk for HIPPA violations. 76. Which technological advance is MOST likely to place you at risk for HIPPA violations? a. Social media b. Word processing programs c. Spreadsheets d. Clouds and SOEs 77. A patient is having a colposcopy procedure performed. How should the patient be instructed to prepare for the procedure? a. NPO for 8-12 hours before the procedure. b. D/C all HTN Rx for two days prior to the procedure. c. Take three Dulcolax tablets and two containers of Miralax the day before to clear out the lower GI system. d. None of the above prep is necessary for this type of procedure. 78. A physician is explaining a procedure to a patient that may cure her recurring Staph infection. The doctor explains how the procedure is done, what to expect, the odds of the procedure curing the infection, and possible side effects and risks. The physician is: a. Preparing the patient to give informed consent. b. Protecting HIPAA by listing all of the steps of the procedure with the risks involved. c. Not required to inform the patient of any alternative therapies. d. None of the above. 79. After a lengthy explanation of a medical procedure, the patient asks many questions. The physician answers all of the questions to the best of her ability. The patient then gives consent for treatment. The costly equipment and supplies are put into place and the patient is prepared. Two minutes before the procedure is to start, the patient begins panicking and changes her mind. Which of the following situations would be the best way to avoid litigation? a. Document that the patient originally gave consent and proceed if the benefits of the procedure outweigh the patient's wishes. b. Have the patient sign a form that she is refusing consent. If she refuses to sign, proceed with the procedure. c. Repeat the explanation of the procedure until the patient understands that having the procedure done is the best form of treatment. Proceed with the procedure. d. Do not proceed. Document the patient's refusal, have the patient sign a refusal to consent to treatment. If the patient refuses to sign the form, have a witness available to sign. 80. Who of the following wrote a medical code of ethics? a. Hammurabi b. Tomas Percival c. Hippocrates d. All of the above. 81. In which of the following examples would informed consent be required? a. A patient is apprehensive about an upcoming surgery and chooses not to learn of the risks involved with the procedure. b. A child is rushed to the Emergency Room after falling from a third story window. c. An adult in a coma in a mental health institution with no listed next of kin. d. None of the above require informed consent. 82. A woman has died as a result of a motor vehicle accident. She is listed as an organ donor and her family is considering whether to comply with her wishes. Which of the following is true? a. The woman would have had to list herself as an organ donor and notify her family prior to her death that she has considered donating her organs. b. The Uniform Anatomical Gift Act requires the physician caring for the patient to inform the family who receives the donor organs. c. Physicians can choose to go against the deceased's wishes if the family decides that organ donation is not an acceptable choice. d. Physicians have the legal responsibility to inform patients of the risks involved in donating organs. 83. Which of the following choices would best answer the question, "Who owns a patient's medical record?" a. The patient b. The physician c. The Legal Counsel of the Office d. No one owns a medical record. 84. Which of the following choices would best answer the question, "Who owns a patient's x-rays?"? a. The patient b. The doctor c. The facility that performed the procedure. d. None of the above. 85. Which of the following reasons would be legal when considering a patient's medical record? a. Allowing a patient's brother to view her chart to find out her birthdate and address so that he can mail her a card b. Not allowing a patient to view her own chart because the physician feels this information would be detrimental to her wellbeing. c. Not allowing a patient to view her chart because she is behind on her payments. d. All of the above are legal. 86. Choose the BEST answer. To ensure adequate protection for legal issues, offices should maintain patients' charts for: a. 10 years b. Forever c. until the age of majority d. 2 years after the patient was last seen in the office 87. The purpose of performing quality control is to: a. create a paper trail to show that the laboratory is compliant with OSHA standards for quality control. b. improve the odds that the results that are reported for any given test are as accurate and reliable as possible. c. Are required by law to be part of a quality assurance program. d. All of the above. 88. Richard is a 72-year-old with stage 4 lung cancer who has been admitted to the hospital for pneumonia. He is alert and oriented, and states he would like to sign a do not resuscitate (DNR) order. His wife enters the room after he has signed it and is very upset that he has made this decision without discussing it with her. She wants to know what she can do to get the DNR reversed. What should your first response be? a. Contact the unit manager to talk with her b. Contact the hospital's attorney to discuss with her c. Try to talk Richard out of his decision d. Offer caring support for both parties 89. You are on the unit and overhear another nurse talking on the phone to a patient's friend who wants to see her patient who is comatose and on a ventilator. Since you cared for that patient yesterday, you know that the patient's significant other, who is also the designated health care surrogate (HCS) and has power of attorney (POA), has expressly stated that he wants this person on the list for restricted visitors. The nurse whispers that she'll call him to visit as soon as the significant other has gone home. What should your first response be? a. Inform the significant other b. Report the nurse to the nurse manager c. Speak with the nurse directly in private d. Call the visitor and tell him he can't visit 90. Teresa is an 84-year-old with stage 4 ovarian cancer who has been admitted for a bowel obstruction. She recently stated that she has decided that she doesn't want any further aggressive care and is requesting to be placed under hospice care. Her husband and daughter are supportive of her decision. She spoke with her oncologist about it, and he stated that he did not agree, and wrote orders on her chart for chemotherapy. What would be the best first response to this situation? a. Give the patient a list of other oncologists b. Tell the family to report the doctor to the state quality board c. Notify the doctor that the patient refuses the chemotherapy d. Give the patient hospice information 91. Upon entering an elderly patient's room, you find a research assistant with a clipboard, obtaining consent to participate in a new study. After signing the form, the patient begins to ask questions about the study. The assistant smiles and says, "Don't worry about all that, we'll take good care of you. Now enjoy the chocolate I brought." What should your first response be? a. Ignore the patient's questions b. Stop the assistant and question the consent c. Notify the nurse manager d. Notify the research department 92. Monica is a 28-year-old nurse who had been admitted to the hospital after a near-drowning in which she suffered cardiac arrest and hypoxic encephalopathy. She has been stabilized and has a tracheostomy to room air. She has been on the general floor for several weeks, is in a persistent vegetative state, and has a very poor prognosis for any improvement in her neurological status. Monica had previously signed a living will, which indicated that she did not wish to receive enteral feedings to be kept alive if she had a terminal condition or was in a persistent vegetative state from other causes. Her parents have decided to move her to the hospice unit and have given permission for removal of her feeding tube. The patient care technician who has been caring for Monica is very distressed over this decision and feels that the parents are "killing" her. What would be an appropriate initial response? a. This will relieve the burden for her parents." b. Her parents have a right to make decisions for their child." c. Monica has stated her wishes and they should be honored." d. The ethics committee should be consulted." 93. Jack is a 2-month-old with a diagnosis of spinal muscular atrophy (SMA) type I. He has been admitted to the hospital for progressive respiratory difficulty. His parents have been informed that if he is not placed on ventilatory support, he will continue to decompensate and die of respiratory failure. Jack's physician discusses the poor prognosis of Jack's condition, and tells the parents that he will not be able to be removed from ventilatory support once it is initiated, due to his progressive neurological disease. After much discussion, the parents have decided to decline ventilatory support, agree to a do not resuscitate (DNR) order, and request hospice care for Jack. Another parent heard them discussing Jack's situation in the waiting room and says she could never do that to her baby. What is the most appropriate response to this parent? a. You never know what you'll do until you're in that situation." b. I can't discuss another patient's situation." c. They have been through too much already." d. You can contact administration with your concerns." 94. Albert is a patient in the hospital who is scheduled for surgery the following morning. After the pre-operative visit from the anesthesia staff member who has obtained surgical consent, Albert asks for an explanation of what type of surgery he is going to have. He states that he's not sure what he just signed. What is your best response? a. Don't worry, they'll explain it in the operating room." b. It's standard procedure to get the consent, you don't need to worry." c. Let me ask the nurse anesthetist to come back and explain it further." d. Someone will review it with you prior to surgery." 95. If a nurse prevents intentional harm from occurring to a patient, which ethical principle is she supporting? a. Beneficence b. Nonmaleficence c. Justice d. Fidelity 96. What ethical principle has led to the need for informed consent? a. Autonomy b. Justice c. Fidelity d. Beneficence 97. Victor is a 43-year-old patient who is HIV positive with a diagnosis of pneumocystis carinii pneumonia (PCP) who has been admitted to the hospital. His prognosis is very poor, and his partner, Roger, would like to have a ceremony performed in his room to honor their union in case something happens to Victor, who is in agreement. What is the most appropriate response to their request? a. Inform him that Victor is too ill for a ceremony b. Ask the social worker to intervene c. Tell him it's against unit policy d. Coordinate with other disciplines to support their request 98. A victim of a gunshot wound to the abdomen has been admitted to the hospital, accompanied by a police officer. When questioned, the officer states that the patient is a suspect in a homicide, which occurred as part of the same incident. A small child was killed as the result of a stray bullet. The patient is combative, yells that he's in pain and demands medication. What is your most appropriate response? a. Tell him you'll take care of him after your other patients b. Reinforce restraints c. Perform a pain assessment and administer pain medication d. Ask the officer for more details of the incident 99. You have accompanied the physician into the family waiting room to tell a young husband that his wife has not survived the car accident she was in. The husband is crying and distraught. What is the most appropriate approach to supporting this family member? a. Ask if he would like to donate his wife's organs b. Sit quietly with him c. Ask about funeral arrangements d. Consult social services 100. Rachel is a 48-year-old mother of three who has been admitted after a drug overdose in a failed suicide attempt. When she regains consciousness, she states that she is ashamed and embarrassed that she tried to take her own life. What is the most therapeutic response to Rachel's statement? a. It's a blessing your children weren't left without a mother." b. What were you thinking?" c. We're here to help patients who value life." d. I know life can be difficult. We're here to help you." 101. Family members of an patient ask repeated questions about the monitors and various readings in the patient's room. What is the most supportive response to their questions? a. Inform them that you can't take to the time to answer all their questions b. Provide detailed explanations for each device c. Tell them it's too technical to explain d. Provide an overview and encourage them to spend their time with the patient 102. The mother of a 3-year-old pediatric patient would like to remain at the patient's bedside throughout the night. The patient seems to be calmer when she is present. What is the most caring and appropriate response? a. Reinforce visiting hours b. Allow her to stay for a short period beyond normal hours c. Allow her to stay throughout the night d. Offer to get bedding for a couch in the waiting room 103. You are caring for a Hispanic patient who is scheduled for surgery in the morning. A member of the surgery staff is in a hurry when she visits the patient to obtain surgical consent. You know that the patient speaks limited English, and can see that he does not really understand what's being said. What is the most appropriate next action? a. Call a family member to interpret b. Consult the hospital translator to assist c. Allow the consent to be signed d. Ask the staff member to come back later 104. Becky is a 17-year-old type I diabetic who has been admitted for her third episode of diabetic ketoacidosis (DKA) since being diagnosed last year. She states that she hates feeling different than her friends and refuses to take her insulin as recommended. What would be the most helpful action for Becky? a. Scold her for not taking her insulin b. Recommend that she use an insulin pump c. Contact the local support group for diabetic teens d. Tell her parents they must provide more strict oversight 105. Ruth is a 72-year-old patient who has been upset and crying all morning. When asked why she is upset, she turns toward the wall in silence. What collaborative process may be helpful in caring for this patient? a. Speak with the patient care technician b. Call the chaplain c. Call the social worker d. Call the patient's husband 106. Brandon is a 38-year-old with a history of cocaine addiction who has just been admitted for his second myocardial infarction that was due to cocaine use. What collaborative process should begin as soon as Brandon is stable enough to interact with additional resources? a. Law enforcement for further prevention b. Social services for rehab c. Narcotics anonymous d. Financial counselor to apply for assistance 107. The previous charge nurse fell during her shift and was taken to the emergency room. You have been assigned to take over as charge nurse without any report. At the end of the shift, you have made the assignments for the next shift's nurses and posted them. As the nurses come in, they begin to complain that the assignments make no sense, based on patient acuity. One refuses to take her assignment and threatens to go home. What could you have done to prevent their dissatisfaction? a. Reviewed the notes of the previous charge nurse b. Tried to contact the previous charge nurse in the emergency room c. Collaborated with the nurse manager d. Collaborated with the other nurses on your shift 108. What consideration is important when caring for a female Muslim patient? a. Make eye contact b. Provide long-sleeved gowns or allow her to use her own c. Touch while talking d. Assign male caregivers when possible 109. Of the following, what is an important component of Vietnamese culture to consider when teaching the Vietnamese patient who has been treated for pneumonia, who needs to complete her antibiotic regimen at home? a. Cupping will help to pull toxins from the body b. Coining will help to release the wind or bad energy from the body c. Once symptoms disappear there is no longer an illness d. Most households consist of a least 3 generations 110. If you are caring for a patient of the Hindu culture, what may you anticipate regarding visitors? a. Limited visitors, respectful of privacy b. Family members only c. Large number of visitors/community support d. None of the above 111. You have noticed that the last several patients you have cared for have had questionable blood pressure readings from their arterial lines. When checked against cuff pressures, a discrepancy has been noted, and further investigation has revealed faulty transducers. This is not the first product issue with this company. What positive step could you take to help resolve this situation? a. Use the old stock from a previous company b. Verify the cuff pressures every hour to ensure accuracy c. Notify the risk manager d. Form a peer workgroup to evaluate new products 112. The family of a patient who is receiving therapeutic hypothermia states they do not understand why the patient is being kept so cold. What objective information can you provide to help address their concerns? a. Let them talk to another patient who has had the same therapy b. Provide research-based information about therapeutic hypothermia c. Connect them with the nurse manager d. Call the physician and ask him to talk to the family 113. A family member is complaining that the lights are too dim in the middle of the night when she comes in to visit her husband. What is the most objective response? a. Patients sleep better with the lights dimmed." b. The nightshift nurses prefer to work with less light." c. It's time for him to sleep, and you should, too." d. There's a reason we do that. Let me share a research study with you." 114. You are attempting to teach the wife of a Greek patient how to administer his gastrostomy tube feedings once he returns home. She smiles and nods through your explanations, but when you ask her for a return demonstration, she looks confused and shakes her head. Her daughter enters the room and states that she does not speak English. What would be most helpful in this situation? a. Teach the daughter instead b. Teach both and ask the daughter to translate for you c. Contact a home health agency to provide care d. Provide a pamphlet with detailed instructions 115. What is a key principle of patient teaching that must take place to ensure patient safety? a. Family members should be present b. Teaching must be documented c. Understanding must be confirmed d. Teaching should be provided by multiple staff members [Show More]

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