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284 Cards in this Set
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1. A patient is 89 years old and has just been diagnosed with a malignant brain tumor. The patient’s family wants her to have surgery to remove the tumor, but the patient seems unsure. The patient asks the nurse, “What would you do?” What is the nurse’s best response 2. “I would have the surgery. It could prolong your life for at least a few years.” 3. “I’m not in your shoes, but I will walk with you towards your best decision.” 4. “You shouldn’t do it because surgery can be very dangerous and you could die.” 5. “I can’t answer that. You need to make your own decision with your family.” |
Correct answer: 2 Rational: The presentation on “Ethics in a Changing Society” states that the nurse should not tell a patient his/her opinion (answer choice A). The nurse should not “think they know best” (answer choice C). Answer D is the distractor because although this is better than the other two choices, it isn’t the best response, because it doesn’t seek the patient’s view and rational. Answer choice B is best because when a patient asks the nurse for his/her opinion, it is the nurses responsibility to listen lead the patient down the path of making their own decision. |
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A nurse tells his/her 6 year old, male patient that s/he will find a movie for the patient to watch while the child receives his chemotherapy treatment. The nurse loses track of time and accidentally forgets to find a movie. What moral principle did the nurse break? 1. Veracity 2. Autonomy 3. Justice 4. Fidelity |
Answer: 4 Rational: Fidelity is the correct answer. The definition of fidelity is to “be faithful to agreements and promises.” The nurse made a promise to the patient to find him a movie, but forgot to do so. |
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A patient with AIDS is admitted to the hospital for angina. The nurse assigned to care for the patient doesn’t want to for fear of acquiring AIDS from the patient. What should the nurse do? 1. The nurse has the right to refuse to treat a patient with AIDS if the nurse is uncomfortable. 2. The nurse should approach the charge nurse and ask to get assigned to a healthier patient. 3. The nurse can’t refuse to treat the patient unless the risk exceeds the responsibility. 4. The nurse should calmly tell the patient that she is scared of patients with AIDS. |
Answer: 3 Rational: “According to an ANA position statement, the moral obligation to care for an HIV-infected client cannot be set aside unless the risk exceeds the responsibility.” The question doesn’t state that the patient imposes any risk to the nurse. |
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Which scenario would a Nurse’s performance be protected under the Good Samaritan Act? A. Performing a tracheotomy at the scene of an automobile accident B. Leaving the scene of an automobile accident after initiating EMS C. Administering CPR at an automobile accident which causes the victim’s rib to break D. Ignoring a conscience victim’s refusal for help even when it’s obvious they need it |
Correct Answer: C Rationale: The Nurse would be performing an action that is in their scope of practice and in an emergency situation outside of their place of work and would not be liable for injury to the rib. A – This is not an action that is performed by a Nurse so would be considered gross negligence B – Cannot leave the scene unless injured person leaves and EMS notified or another qualified person takes over D – If a person refuses assistance the Nurse cannot physically assist them, however, they can ask assessment questions in order to assist emergency personnel |
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According to the California Nursing Practice Act what kinds of duties can a Registered Nurse (RN) perform independently? A. Change a client’s post surgical diet to include healthy food B. Change the amount of oxygen client is receiving to help them breathe better C. Turning an immobile client to prevent pressure ulcers D. Perform emergency surgery if no doctor is available |
Correct Answer: C Rationale: This is considered physical care of the client and does not require a physician’s orders. A & B – Requires a physician’s orders so both are not considered independent D- Is considered an unauthorized act by the Nursing Practice Act |
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Which of the following actions would violate The Health Insurance Portability and Accountability Act (HIPPA) ? A. Encrypting personal health information when transmitting electronically B. Leaving an original copy of a client’s health information on the copier C. Placing a clipboard with client information on a nursing station face down D. Discussing a client’s condition over the phone in a soft voice |
Correct Answer: B Rationale: Printed copies of protected health information should not be left unattended at a printer or fax machine A,B & C – All are examples of compliance to HIPPA |
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1. A registered nurse who performs which of the following is not following the California Nursing Practice Act? 1. a nurse who checks the vials for a friend who is feeling feverish 2. a nurse who has a CNA assist him/her in moving the position of a patient 3. an off-duty nurse who drives by an accident and does not stop 4. a nurse who has an LVN assess the condition of his/her patient |
Correct Answer: 4 Rationale: According to the act, a nurse shall not assign unlicensed personnel to perform nursing functions in lieu of a registered nurse and may not allow unlicensed personnel to perform functions under the direct clinical supervision of a registered nurse that require a substantial amount of scientific knowledge and technical skills |
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2. A surgeon asks a nurse to have his/her patient sign a consent form. The patient is scheduled for an appendectomy and asks the nurse, "Is there any possibility that this surgery could kill me?" How should the nurse respond? 1. "You will be fine. People have this surgery done all the time with no complications." 2. "I can't answer any questions but I will ask the surgeon to speak with you." 3. "I will go over the details of the procedure with you if that will make you more comfortable." 4. "With any surgical procedure there is a risk of complications." |
Correct Answer: 2 Rationale: If the client has questions of if the nurses has doubts about the client's understanding the nurse must notify the health care provider. The nurse is not responsible for explaining procedures and could be liable if incorrect or incomplete information is given. |
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. According to the ANA code of Ethics, Nurses are often put in situations of conflict arising from competing loyalties in the workplace including situations of conflicting expectations from patients, families, physicians, colleagues, and health care organizations. Nurses strive to resolve such conflicts in which ways? Select all that apply 1. ensure patient safety 2. guard the patient's best interests 3. preserve the professional integrity of the nurse 4. ensure all involved parties are content with the resolution |
Correct answer: 1,2,3 Rationale: 1,2,3 are all things the nurse should strive for according to provision 2.2. Number 4 is not. |
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An elderly Spanish speaking patient requires stitches after falling.The nurse needs to obtain consent from the patient but realizes the patient does not fully understand what he/she is saying. The nurse uses what knowledge of Spanish he/she has to obtain a signature on the consent form. Once the patient is prepped, the translator finally arrives and briefly speaks to the patient and informs the nurse that the patient no longer consents and prefers to heal on their own. What should the nurse do? Select all that apply. 1. Ask the translator to inform the patient of the pro's and con's of refusing treatment. 2. Inform the patient that the consent form is a legal binding contract and they cannot change their mind. 3. Notify the health provider that the patient has changed their mind and remove the consent form from their chart. 4. Document the patient's refusal of treatment in their chart and notify the health provider. |
Correct Answer: 1 & 4 Rationale: According to the Berman text, A patient "must be aware of the pro's and con's of refusal" and a nurse must, "notify the health provider of the client's refusal and document the refusal in the chart". |
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A nurse notices that one of their patients who was recently diagnosed with Type II Diabetes is displaying frustration and anger while trying to use their blood glucose monitor. The nurse also has another patient awaiting discharge who is eager to leave and waiting for him/her to complete their discharge paperwork. The nurse decides to spend a few extra minutes to make sure their patient understands and is comfortable checking their blood glucose levels. The nurse is acting on which moral principle? 1. Veracity 2. Kindness 3. Justice 4. Beneficence |
Correct Answer: 3, Justice Rationale: According to Berman & Snyder, Justice involves a nurse weighing facts carefully to make sure time is divided equally among patients. |
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A nurse is overseeing an elderly patient who is recovering from hip surgery. While assessing the patient for pressure sores the nurse lowers the rails on both sides of the bed. The nurse hears a code blue called on one of his/her other patients and quickly leaves the room to see what is happening. Upon returning to the room he/she realizes that the patient has fallen out of bed and is unconscious. According to the California Nursing Practice Act, what could the nurse be accused of? 1. Gross Neglegence 2. Incompetence 3. Failure to Rescue 4. Malpractice |
Correct Answer: 1 Gross Neglegence Rationale: According to the California Nursing Practice Act, "'Gross negligence includes an extreme departure from the standard of care which, under similar circumstances, would have ordinarily been exercised by a competent registered nurse. Such an extreme departure means the repeated failure to provide nursing care as required or failure to provide care or to exercise ordinary precaution in a single situation which the nurse knew, or should have known, could have jeopardized the client's health or life." |
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What is the American Nurses Association’s policy on Nurse-Assisted Passive Euthanasia? A: participation is acceptable if it is well documented in the patient's living will. B: nurses should follow the patient's wishes if the patient is competent. C: participation is a violation of the Code for Nurses and professional ethics. D: participation is acceptable after approval from the hospital’s ethics committee. |
Correct Answer: C Rationale. The American Nurses Association issued a position statement stating that assisting in suicide and participating in euthanasia are in violation of the Code for Nurses, the ethical traditions and goals of profession, and its covenant with society. |
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Which of the following scenarios is an example of nonmaleficence? A. Administering analgesics to a patient after childbirth. B. Helping a patient take a bath. C. Intervening when a physician is not following proper aseptic technique D. Educating a patient with diabetes about a glucose monitor. |
Correct Answer: C Rationale: Non-maleficence means to “do no harm.” The nurse’s primary commitment is to the health, well-being, and safety of the patient, this includes questioning practices by other staff that could cause harm to patient. |
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The nurse calls the physician regarding a new medication prescription because the dose prescribed is lower than the recommended dosage. The nurse is unable to contact the physician and the medication to be administered is due. What is the appropriate action? 1. Contact the nursing supervisor. 2. Administer the dose prescribed. 3. Hold the medication until the physician responds. 4. Administer the recommended dose. |
Correct Answer: 1 Rationale: If the physician writes a prescription that requires clarification, the nurse’s responsibility is to contact the physician. If there is no resolution regarding the prescription the nurse should contact the nursing supervisor. Under no circumstances should the nurse proceed to carry out the prescription until obtaining clarification. |
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According to ANA code of ethics, a patient participating in research should be aware of which of the following? Select all that apply. 1. Receive and comprehend information for research 2. Receive information on potential harms and benefits 3. Receive monetary information for participating 4. Receive information on results for the research |
Correct Answer: 1 and 2 Rationale: According to provision 3.3, it is imperative that the patient receive and comprehend the necessary information and information on potential harms and benefits. |
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An experienced nurse provides indirect care for a patient by allowing which of the following? Select all that apply. 1. The patient’s son, a certified EMT, to administer medication 2. The patient’s UAP, a female LVN, to administer medication 3. The patient’s close family friend to administer medication 4. The patient’s UAP, a male CNA, to administer medication |
Correct Answer: 2 and 4 Rationale: Indirect care is when a nurse delegates a nursing responsibility to either an LVN. CNA, UAP or another RN but not family or friends |
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An 85-year-old patient diagnosed with early onset Alzheimer’s and Pneumonia is requesting their physician to let them be and stop their life support. The physician is facing which end-of-life issue? 1. Assisted Suicide 2. Passive euthanasia 3. Withdrawing or Withholding Food and Fluids 4. Termination of Life-Sustaining Treatment |
Correct Answer: 2 Rationale: Assisted suicide is giving clients the means to kill themselves if they request it. Passive euthanasia is withdrawing or withholding life-sustaining therapy. Termination of Life-Sustaining Treatment consists of antibiotics, organ transplants, and technological advances to help prolong life. |
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1. An example of voluntary euthanasia, as is allowed in Oregon, is: A. Dr. Kevorkian injecting his terminally ill patients with a lethal dose of drugs. B. A terminally ill patient deciding the time and manner of their own death by self-administration of physician prescribed drugs. C. A nurse administering a lethal dose of drugs to a patient upon the request of either them or their family. D. A mentally incapacitated individual deciding to end their own life by overdosing on prescription medications. |
Correct Answer: B Rationale: As described by Berman and Snyder, “Voluntary euthanasia refers to situations in which the dying individual desires some control over the time and manner of death.” In states where euthanasia is legal, physicians are allowed to prescribe lethal doses of medications, but cannot administer them, the dying individual needs to be able to take the medication on their own. |
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Of the following choices, please select the guidelines that apply to nurses who choose to stop and be Good Samaritans (Select all that apply): A. Limit actions to those normally considered first aid, if possible. B. If someone refuses help, assume they are disoriented and help anyway. C. Do not perform actions that you do not know how to do. D. Always make sure to bill the person for your emergency assistance. |
Correct Answers: A and C. Rationale: Berman and Snyder describe the Good Samaritan guidelines for nurses as: 1. Limit actions to those normally considered first aid, if possible; 2. Do not perform actions that you do not know how to do; 3. Offer assistance, but do not insist; 4. Have someone call or go for additional help; 5. Do not leave the scene until the injured person leaves or another qualified person takes over; 6. Do not accept any compensation. |
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Nursing students are held to the same standards of liability as registered nurses. If a nursing student is approached by a staff nurse and asked to perform a task that they are not familiar with, the student should: A. Immediately perform the task, the student assumes they should’ve known how to do it. B. Pretend like they did not hear the staff nurse ask and continue on with their assignment. C. Ask the charge nurse if it is ok if they perform the task, after all, they should know. D. Ask the clinical instructor about the task and ask for help if they are given permission. |
Correct Answer: D Rationale: Nursing students on clinical rotation should be given assignments by their clinical instructor based on their level of skill and knowledge at the time of the rotation. It is the responsibility of the nursing student to check in with their clinical instructor and ask for help if they encounter a situation in which they feel inadequately prepared. |
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A nurse is working on a busy intensive care unit and walks into a patient’s room to check their vitals. He/she finishes the task and abruptly leaves the room. One minute later the patient’s call light turns on, and the nurse decides to wait to respond because this patient is in less critical condition than others on the unit. As a result of this delay, the patient suffers nerve damage because the blood pressure cuff was never deflated. Why might other nurses on the unit share responsibility for potential legal action? 1. A malpractice suit can result from breach of duty, among other elements, an example of which includes failure to respond to call lights from patients assigned to other nurses. 2. A malpractice suit often involves all nurses working on a unit at the time of the incident. 3. According to the malpractice element foreseeability, all nurses are responsible on a unit when foreseeable events are ignored. 4. All nurses on the unit would be subject to negligence: practices that are below the expected standards of prudent and reasonable nurses. |
Rationale: A malpractice suit is proven when all six of the following elements are present: Duty, Breach of Duty, Foreseeability, Causation, Harm or Injury, and Damages. The most pertinent element in this situation is the nursing unit’s failure to respond to this patient’s call light. “It is a nurse's duty to respond to all clients' call lights, not just those of assigned clients.” |
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) A client with extensive drug resistant tuberculosis comes into an underfunded clinic for treatment. Working from a deontological moral framework, what is the nurse’s first priority? a) community wide education on prevention b) putting the client’s treatment first at any cost c) assuring the client that s/he will be helped d) isolating the client to reduce further infection |
Answer: B Rational: Deontological ethics focuses on principles and emphasizes individual rights. The cost of treatment would be difficult for an underfunded clinic but a nurse working from a deontological framework would put the treatment of the individual first. In this case “a” represents utilitarianism, “c” is caring, and “d” is utilitarianism again. |
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A nurse receives orders to administer a medication to a client. What statement by the nurse demonstrates a conflict between the principles of autonomy and beneficence? a) “Your doctor is inexperienced. I will explain the risks.” b) “There are newer medications you should ask about.” c) “This medication is effective but can have side effects.” d) “Taking this medication is your choice not the doctor’s.” |
Answer: C Rational: C) Informed consent is an element of autonomy, the nurse must respect the client’s autonomy even if doing so will frighten the client from taking an important medication. In this case saying the medication is effective represents beneficence because the medication will treat the patient’s condition. A, B and D represent beneficence because the nurse intends to do good. However, they ignore autonomy because the nurse fails to explain both the risks and benefits of the medication (informed consent). |
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3) The Board of Registered Nurses places a nurse’s license on suspension. To get the license reinstated what should the nurse do? a) work at least 20 hours per week for the duration of the suspension b) cease practicing for no less than one year while the license is suspended c) cease practicing for no more than one year while the license is suspended d) continue to work and petition the board for reinstatement of the license |
Answer: C Rational: According the California Nursing Practice Act, suspensions may last up to one year. If the nurse practices during this time, the nurse’s license is revoked. The nurse can petition the board for early reinstatement. |
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A nurse accidently gives her patient double the dose of medication. The medication is not harmful even at double dose. What should the nurse do? 1. Record that the patient was given the correct dose since no harm was done. 2. Record that the patient was given a double dose. 3. Quit her job because should we be fired anyways. 4. Record that the patient was given the correct dose and skip the next scheduled dose. |
Correct answer: 2 Rationale: Nurses should always record the truth of what happened |
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Question 2: A nurse with two patients spends most of her time with one of them because she likes that patient more than the other patient. Which of these moral principles is she failing? 1. Veracity 2. Benevolence 3. Justice 4. Fidelity |
Correct answer: 3 Rationale: The nurse is not being fair to the other patient and could be putting her health in jeopardy. |
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Question 3: A 92 year old female with many chronic conditions has a DNR order. A DNR order goes against the nurses personal beliefs and thinks s/he should do anything in her power to keep her/his patients alive. What should she do? 1. Abide by the DNR order. 2. Provide life-sustaining care no matter what. 3. Request a different assignment. 4. Convince the patient to remove the DNR order. |
Correct answer: 3 Rationale: It goes along with the patient’s wishes and doesn’t compromise the nurse’s beliefs. |
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A plastic surgeon explained risks of a plastic surgery. The client signed the consent form in front of the doctor and a nurse. The client died during the surgery. The client’s family wants to sue the plastic surgery clinic. The nurse knows: 1. The family has a case against the clinic since the client died. 2. The nurse’s note should document that informed consent was signed voluntarily. 3. The family does not have a case since the consent form was signed and witnessed. 4. The family does not have a case since it was a plastic surgery. |
Correct Answer: 2 Rationale: Informed consent is an agreement by a client to accept a treatment or a procedure after being provided complete information regarding benefits and risks of treatment, alternatives to the treatment, prognosis and possible outcomes. |
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A nurse needs to obtain an informed consent from a client before a surgery. Which client is legally allowed to give inform consent? 1. A client who cannot read with appendicitis. 2. A 15-year-old with broken nose. 3. An unconscious client with blood loss. 4. A 70 years old in delirium tremens and lacerations. |
Correct Answer: 1. Rationale: If a client cannot read, the consent must to be read to the client, followed by documentation of a client’s understanding. A client who is unconscious or in delirium tremens is not considered functionally competent, and cannot give consent. A 15-y.o. is a minor, and parental consent must be obtained for not life threatening injury. |
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What would be considered as passive euthanasia by a nurse? 1. Administering a lethal dose of Morphine to a client with terminal cancer. 2. Removing a brain-dead client from a ventilator. 3. Refusing to assist a client who wants to commit suicide. 4. Providing pills to a client wishing to commit suicide. |
Correct Answer: 2 Rationale: Passive euthanasia involves withdrawal of live support such as a ventilator. |
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A nurse sees a car accident, and stops to help. The nurse performs an emergency tracheostomy on the hurt car passenger. Which of the following are correct (select any or all that apply) a) The nurse can not be sued regardless of the outcome because of the Good Samaritan Act b) The nurse can not be sued regardless of outcome because they tried to save the person's life c) The nurse can only be sued if the surgery was not successful d) The nurse can be sued if the surgery was successful |
Correct Answer: D Rationale: Good Samaritan Act only protects a nurse for tasks for which they have experience, which will not include a tracheostomy. Trying to save a person's life is not protection under the law. The nurse in this situation can be sued whether or not the nurse was successful, so the correct answer is only D. |
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Which of the following actions performed by the nurse opens them up to malpractice suit? Choose all that apply a) Forgets to wash hands upon leaving a client's room b) Forgets to do a complete assessment on a client c) Forgets to ask how long patient has consumed alcohol d) Forgets to follow up on client's chief complaint e) Forgets to percuss the anterior chest of a client |
Correct Answers: B, D Rationale: Although forgetting to wash hands, and not asking about extent of alcohol use are not good practices, they are not life threatening to the client, and is not malpractice or “professional negligence”. Not percussing the anterior chest is no big deal because it doesn't show much. Forgetting to do a complete assessment (when required of the nurse), and forgetting to follow up on a client's chief complaint are professional negligence and can open you up to a malpractice suit. |
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A nurse is engaged in a follow up interview with a client a month after surgery. The client didn't follow the post-op care instructions, and developed some complications. Which of the following statements would be most helpful in assisting the client in clarifying their values. a) “I told you that you should have asked me what what you should have done...” b) “The doctor clearly told you what you should have done, why didn't you follow their instructions?” c) “Some people feel good or bad after a decision is made, how do you feel?” d) “I bet you now see how bad that decision was that you made.” |
Correct Answer: C Rationale: In values clarification, the nurse shoudl assist the client to think about why they made their decisions. You shouldn't be judgemental or accusatory, so C is correct |
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A nursing student notices a nurse documenting the wrong dosage of medicine given to a patient. How should the nursing student respond to what he/she witnessed? a. Report the documentation error to the clinical instructor. b. Ask the nurse to change the documentation to reflect the actual amount given. c. Change the documentation after the nurse leaves. d. Don't say anything because errors happen all the time. |
Correct Answer: a Rationale: According to the lecture notes from Dr. Lewis this is an ethical issue facing nursing students that needs to be reported to authorities to advocate safety. By asking the nurse to change the documentation one is not solving much because the nurse may deny what the student said, and he/she may do it again if not taken to higher authorities. C and d are not ethically correct |
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The nurse if very adamant about making sure the patient quits smoking. He/she puts a plan together that he/she finds to be reasonable for the patient. The nurse asks the patient to follow through with every recommendation written down. The patient states that the plan is unrealistic and cannot follow through. How should the nurse respond? a. "I see. Well, I care about your health and would be devastated if you ended up with emphysema." b. "Why don't we contact some of your family members who may be able to offer some support." c. "Let's go over all the pros and cons of each recommendation." d. "What are some realistic goals for you at this time with regards to smoking cessation?" |
Correct Answer: d Rationale: According to provision 2.1 in the ANA Code of Ethics "the nurse strives to provide patients with opportunities to participate in planning care, assures the patients find the plans acceptable and supports the implementation of the plan. All the other three responses fail to do what the provision says. |
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A client has refused to have a nurse insert a catheter, because he/she knows it is very painful. The nurse inserts it anyway, because he/she knows the procedure is a priority. In the pending lawsuit, the nurse’s lawyer settles because he/she will be found guilty of which of the following? 1) Causing pain against the client’s will 2) Battery against the client 3) Gross negligence of client will 4) Assault on the client |
Answer. 2 Rationale: The answer is 2) Battery and NOT 4) Assault, because Battery involves touching the client, while 4) Assault could be verbal and doesn’t necessarily mean physical contact occurred. |
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A nurse sees a car pulled off the road in a rural area. Upon stopping, the nurse discovers that a woman is in labor and needs to deliver. The nurse performs an emergency cesarean section to assist the woman in labor. Why is the nurse not protected under the Good Samaritan Law? 1) The woman contracted a bacterial infection due to non-sterile instruments used in the procedure 2) The newborn infant died shortly after delivery due to a heart condition 3) The nurse is not a physician and therefore not qualified to perform the procedure 4) The nurse failed to call 911 in lieu of performing the procedure |
Answer: 3. Rationale: Nurses are not trained to perform surgery, and therefore should never perform any type of surgical procedure, even if the situation is emergent. |
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A child has been hit by a vehicle and is in critical condition. As the child’s condition worsens and brain activity stops, the nurse informs the parents that life support is a false hope of recovery. The parents cannot accept this, so the nurse respects their decision against his/her better judgment. Which moral principle is the nurse following? 1) Courtesy in that the nurse is acquiescing to the distraught parents 2) Veracity in that the nurse informs parents of the child’s true condition 3) Fidelity in that the nurse promised to do all he/she could for the child 4) Autonomy in that the parents have a right to keep the child alive |
Answer: 4 Rationale: The nurse has to respect the wishes of either the client or the client’s surrogate decision makers. In this case, the surrogates are the parents, because the child is not old enough to make such a decision. |
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A newly hired nurse working in a gynecology and obstetrics office looks over her schedule for the day and sees an abortion scheduled. The nurse refuses to participate in the procedure because it violates her moral principles. What clause supports the nurse's refusal to participate? a. The conscience clause b. The nurses autonomy clause c. Beneficence clause d. Nonmaleficence clause |
Correct Answer: a Rationale: "Most state laws have provisions known as conscience clauses that permit individual primary care providers and nurses, as well as institutions, to refuse to assist with an abortion if doing so violates their religious or moral principles." |
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A client with stage IV lung cancer is given by the oncologist a detailed description of the benefits and risks of radiation treatment. The client asks the nurse for help in making the decision of treatment. Which of the following responses by the nurse would be most appropriate? 1) "Do you think the oncologist is not telling you the truth?" 2) "You should consult with your family before deciding." 3) "You sound unsure. What are your concerns at this time?" 4) "There is only one option so you do not have a choice." |
Correct Answer: 3 Rational: Answer 3 helps the client clarify values by opening discussion geared to what the client is concerned with. Answer 1 wrongly invites negative discussion of a colleague (the oncologist). Answer 2 is the close distractor because discussing a health decision with close family may be helpful to the client, but may not be as well if family forces or pushes their values on the client. Answer 4 shuts down the possibilities of alternatives, which at least there are 2... one to do the treatment and one to refuse. |
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Which of these clients would legally be able to sign an informed consent? 1. A client recently diagnosed with dementia 2. A client asking questions about the proposed procedure 3. A client celebrating their eighteenth birthday 4. A client who has received 0.5 mg midazolam (Versed) intravenously |
Correct Answer: C Rationale: A competent adult is a person over 18 years of age who is conscious and oriented. A client with dementia would be legally deemed unable to provide consent, as would a client who had received medication affecting mental status. A client asking questions about the procedure would require further clarification prior to signing an informed consent |
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A nursing student who speaks a second language is asked by a nurse to act as interpreter for a patient. What should the nursing student do first? A. Check the institution’s policy before agreeing to interpret B. Indicate that a family member has agreed to interpret C. Check the nursing school policy before agreeing to interpret D. Indicate the nurse should ask another nursing student to interpret |
Correct Answer: C. Rationale: It is important to verify first whether the nursing school prohibits a nursing student from acting as an interpreter whether or not the institution allows it. Family members are not considered the first choice for interpreters. Asking another nursing student to interpret does not resolve the issue. |
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A patient states that they have an advanced directive on file. This allows the patient to determine which of the following? Select all that apply: A. The patient may state desires about healthcare in any situation in which the patient is unable to make their own decisions B. The patient may state wishes about refusing or accepting life-sustaining treatment in any situation C. The patient may choose someone to speak for the patient when the patient is incapacitated. D. The patient may choose someone to act as power of attorney when the patient is incapacitated. |
Correct Answer: A, B, C Rationale: A, B, and C are all options for a patient to determine in an advanced directive. Power of attorney is a separate legal matter and not covered by an advanced directive. |
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To choose a path of right action in situations, the nurse should: (select all that apply) 1) suspend judgment 2) presume everything is urgent 3) listen and be fully present 4) avoid hasty responses |
Correct answers: 1, 3, 4 . Rationale: In choosing a path of right action, the nurse needs suspend judgment to allow time of unbias to seek and allow all facts and opinions to come forth. Also the nurse needs to listen and be fully present in order to understand the patient's view and rationale, get all pertinent facts, and have clear, clarification of the situation. The last answer is also part of right action in that avoiding hasty or "knee jerk" responses allows the situation to more fully present accurately. The 2nd answer is wrong because first, nurses should NOT presume and second, urgency will NOT allow time to accurately clarify the issues in the situation. |
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A client is noticeably upset after a surgical complication occurs. The complication was noted as a high risk on the informed consent which the client signed beforehand although the client repeatably denies having that knowledge. What will assist the nurse in understanding the client's lack of knowledge? 1) Many clients do not read consent forms before signing them. 2) Clients' memories are affected in most medical procedures. 3) Clients deny understanding risks to increase claims of malpractice. 4) Clients without medical backgrounds cannot understand health risks. |
Correct answer: 1 Rationale: The nurse should have clinical awareness that many clients do not read consent forms before signing them. Although informed consent is a physician responsibility, the nurse can play a support role with this information in mind. Answer 4 is the close distractor which is false because "If given sufficient information, a competent adult can make decisions regarding health" from page 60. |
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Which of the following is a reason that a nurse can question a physician’s order? Select all that apply. a) The nurse believes that the physician’s diagnosis is wrong based on what he/she has learned in nursing school. b) The nurse receives an order from the physician but is unable to read his/her handwriting. c) The nurse’s client questions the order, stating that the physician has changed their medication. d)The nurse notices that his/her client’s condition has changed from the time when the order was written. |
Correct answers: B,C and D. Rationale: The nurse can question the physician’s order when the client questions it, the client’s condition has changed, the order is verbal, or the order is illegible, unclear, or incomplete. A nurse cannot question a physician’s order based on what he/she “thinks”. |
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1. Which of the following scenarios is an example of a what a nurse should NOT do when helping out in an emergency situation outside of his/her workplace? Select all that apply. a) Once Emergency Medical Personal arrive at the scene of the car accident the nurse leaves the scene. b) The nurse stops at a scene of a car accident and insists that he/she helps the injured victim even though he/she says no. c) After saving someone’s life at the scene of a car accident, the nurse declines the reward offered to them. d) The nurse decides to perform a procedure he/she is not trained for but believes it could possibly save the victim. |
Correct answers: B, D Rationale: According to the Good Samaritan Acts, when nurses choose to render emergency care they should NOT perform actions they do not know how to do and should only offer assistance, not insist. A and C are both okay for nurses to do. Nurses should not accept compensation and once another qualified person arrives at the scene the nurse can leave. |
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. Which of the following scenarios is an example of assault? a) The nurse threatens his/her client with an injection after the client refuses the oral medication. b) The nurse forcefully turns his/her client to the side causing a bruise to develop on their back. c) The nurse insists that the client stays in their hospital bed and does not allow them to get up to use the restroom. d) The nurse shares information about his/her client with their friend who is a nurse on a different floor. |
Correct answer: A Rationale: Assault is described as an attempt or threat to touch another person unjustifiably. It is the act that causes the person to believe a battery is about to occur. B is an example of battery- the willful touching of a person C is an example of false imprisonment-“unjustifiable detention of person without legal warrant to confine the person.” D is an example of invasion of privacy- the direct wrong of a personal nature. |
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A patient has just been admitted to the emergency department after a car accident. He/she is unconscious, and has sustained significant brain damage. The patient’s family arrives all together, and wishes to use every life saving measure. Following protocol, the hospital takes the patient off of life support, and the patient dies the next day. Which describes the best reason for the hospital’s actions? 1. The patient does not have an advanced care directive. 2. The patient has a designated health care proxy. 3. The patient has a living will on file stating that he/she does not want to sustain life after significant brain damage. 4. None of the patient’s family members are designated as a health care proxy. |
Correct Answer 3 Rationale: The living will is the most direct way for a patient to detail their wishes for life-sustaining measures. It is written by the patient, and can in some cases be carried out by a health care proxy. In this case, the patient has not designated a health care proxy, and the living will is to be followed despite the family’s wishes. |
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A Registered Nurse is caring for a client that has a suspected infection of methicillin-resistant S.aureus. The R.N. can delegate what responsibilities to an unlicensed assistive personnel? 1)Teaching the client about how adequate nutrition will help the healing process. 2)Assessing the risk of infection to those around the client. 3) Teaching the client good hygiene techniques to prevent re-infection. 4) Obtaining a culture from the client to assess the infection. |
Rationale: 4 is the correct answer. The other answers require education, assessment, or planning which are always an R.N.’s responsibilities. 4 is the one that can be delegated to L.V.N.s or U.A.P.s as it is a specimen collection. The inclusion of “assess” in 4 was purposeful, to be a distractor, but it is the correct answer. |
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When is it ethical to administer a placebo? (Check all that apply) 1) When the nurse’s personal ethics agree with the decision. 2) When a physician orders it, and the charge nurse approves it. 3) When a hospital/clinic administrator approves it. 4) When the health care team believes it will help the client. 5) Emergency situations with hope that the “placebo effect” could help. |
Rationale: 1 and 4. However, it is with the caveat that it is unforeseeable how a nurse’s ethics could agree with that decision to give a placebo to a client who believed that the drug or treatment was real. It is another way of saying that it would not happen, because a nurse and the health care team could not give a client a treatment knowing that it would not be effective while telling the client that it was. |
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What are factors contributing to race/ethnicity-based health disparities in the United States? (check all that apply) 1) Access to quality care. 2) Provider stereotypes and biases. 3) Educational lag of those groups. 4) Income level in those groups. 5) Lack of diverse staff in healthcare settings. |
Rationale: 1, 2, and 5 are all factors that contribute to the health disparities in the United States. 3 places the blame on the lack of education of the clients and so is blaming the clients for the healthcare system’s (and educational system’s) racial disparities. 4 is not true as the healthcare gap between whites and minority groups exists even at similar socio-economic statuses. |
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A patient has recently been diagnosed with cancer and is unclear about how he/she should proceed with treatment. How should the nurse respond to help clarify the client’s values? 1. “I think your best option is to proceed with chemotherapy.” 2. “In what ways might declining chemotherapy be beneficial?” 3. “What does your family think about all of this?” 4. “What can I do to help you make this decision?” |
Correct Answer 2 Rational: #1 is not clarifying because it illustrates the nurse’s value. #2 helps the patient examine possible consequences of his/her choice which may help to determine where his/her values lie. In regard to #3, if the patient values his/her family’s opinion as his/her own then this may be a way to examine the possible consequences of his/her decision; however, if this is untrue then the question would negate the patient’s own values. #4 is an open ended question which does not help to clarify the patient’s values. |
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Licensure to become a Registered Nurse is mostly implemented to protect which of the following? a. The law b. The nurse c. The patient d. The hospital |
Correct Answer: c. The patient Rationale: A licensure is a legal permit that a government agency grants to individuals to engage in the practice of a profession and to use a particular title. It generally must meet three criteria: 1.) There is a need to protect the public’s safety or welfare 2.) The occupation is clearly delineated as a separate, distinct area of work and 3.) A proper authority has been establishedto assume the obligations of the licensing process, for example in nursing, state boards of nursing. |
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The physician asks the nurse to witness an informed consent. Which of the following do not meet criteria to be able to sign an informed consent? a. 75 year old patient who received a narcotic for pain b. A 16 year old patient who is 6 months pregnant c. A 50 year old patient who suffers from depression d. A 30 year old patient who doesn’t speak English |
Correct Answer: a. 75 year old patient who received a narcotic for pain Rationale: A competent adult can make decisions regarding their health. This is any person whois 18 years or older, and can be younger as long as they are married, pregnant, members of themilitary, parents, or emancipated, and who is conscious and oriented. Since the 75 year old justreceived a narcotic, he or she is not considered “functionally competent” (pg 60). The person who does not speak English will need an interpreter present, but still can make decisions regarding his/her health. The 50 year old patient suffering from depression is still deemedcompetent and no restrictions to signing an informed consent apply. |
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A patient on the medical-surgical floor continues to get out of bed at night and wander into neighboring rooms. In order to keep the client in bed, the nurse puts up all four bedrails. Which of the following intentional torts has the nurse committed? a. Invasion of Privacy b. Unlawful Detention c. False Imprisonment d. Defamation of Self |
Correct Answer: C. False Imprisonment Rationale: False Imprisonment is defined as the “unjustifiable detention of a person without legal warrant to confine the person.” By placing 4 bedrails up, the nurse has restrained the patient without an order and therefore has committed an act of false imprisonment. The nurse has not revealed any of the client’s information and therefore, has not invaded the client’s privacy nor has he/she communicated any false information about the client which would be classified as defamation. Lastly, Unlawful detention is not the name of an intentional tort. |
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Which of the following types of law fall under Statutory (legislative) law? (Select all that apply) 1. Nurse Practice Act 2. Living Wills 3. Nurse and client 4. Good Samaritan Acts |
Answer: 1, 2, 4 Rationale: Nurse and Client is a type of Contract, which can be private or civil. The Nurse Practice act, Good Samaritan Act and Living Wills are overseen on the state level. Each Legislature has different (and sometimes the same) legal take on what the role, scope and expectation of nursing practice includes. ( Table 4-1, Chapter 4) |
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Which code section within the California Nurse Practice Act discusses what is direct and indirect patient care? 1. 2527 2. 2759 3. 2761 4. 2790 |
Correct Answer: 2725 states "(b) The practice of nursing within the meaning of this chapter means those functions, including basic health care, that help people cope with difficulties in daily living that are associated with their actual or potential health or illness problems or the treatment thereof, and that require a substantial amount of scientific knowledge or technical skill, including all of the following: (1) Direct and indirect patient care services that ensure the safety, comfort, personal hygiene, and protection of patients; and the performance of disease prevention and restorative measures. (2) Direct and indirect patient care services, including, but not limited to, the administration of medications and therapeutic agents, necessary to implement a treatment, disease prevention, or rehabilitative regimen ordered by and within the scope of licensure of a physician, dentist, podiatrist, or clinical psychologist, as defined by Section 1316.5 of the Health and Safety Code." |
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A nurse is caught stealing drugs from patients. After a discussion with the Head Nurse, the assigned nurse chooses to report him/herself to the Board of Registered Nurses and enter a voluntary Impaired Nurses Substance Abuse program. Because of these factors the Board of Registered Nurses may choose to: 1. Suspend the assigned nurses license 2. Revoke the assigned nurses license 3. place them on probation, and give oversight 4. do nothing, they self-reported |
Correct Answer: 3 Rationale: Due to the high number of nurses who are considered impaired nurses, "...professional organizations such as the ANA (2009), the American Association of Nurse Anesthetists (2009), the International Nurses Society on Additions (n.d), and the National Student Nurses Association (n.d.) have passed resolutions to ensure that nurses and student nurses with chemical dependencies receive treatment and support, not discipline and derision," (Berman, page 63). In addition, Professor Berman stated, during lecture, that impaired nurses would most likely be placed on probation with oversight and re-evaluated after a prescribed time-frame had elapsed. |
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A recent graduate nurse is contemplating a blood draw that has been ordered by the attending physician. The nurse knows there is no law, standard, or policy prohibiting a nurse from performing the procedure. Which sequence best reflects the correct course of action? A) Collect materials, wash hands, assess ability, perform procedure using sterile technique B) Wash hands, collect materials, assess ability, perform procedure using sterile technique C) Assess ability, collect materials, wash hands, perform procedure using sterile technique D) Collect materials, assess ability, wash hands, perform procedure using sterile technique |
Correct Answer: C Rationale: Before performing a procedure the nurse should first determine if it is legal. After assessing external standards (law, standards, policies) the nurse must then assess internal standards (nurse’s job description, education, and experience). Only after a nurse determines a procedure falls within their scope and ability, should they then perform the procedure. |
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Which of the following is the broadest legal boundary surrounding a nurse’s scope of practice? A) Standards B) Law C) Ability D) Policy |
Correct Answer: B Rationale: The Nursing Practice Act is the broadest interpretation of the nursing profession and its scope. Any standard exceeding the scope of the NPA is by definition illegal and subject to prosecution under it’s guidelines. |
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A new nurse is performing an integument assessment on a patient concerned about a new mole. During the assessment the nurse discovers ecchymoses of different colors on the abdomen. The patient explains they do not hurt and would prefer no mention of them be made. Recognizing potential signs of physical abuse the nurse should take which of the following actions? (select all that apply): A) Annotate physical signs in chart with source as given by patient B) Immediately check vitals and airway C) Report potential abuse to charge nurse and inquire about hospital policy D) Maintain confidentiality and respect the patient’s wishes in accordance with HIPAA |
Correct Answer: A, C Rationale: A nurse is often in a position to recognize the signs of abuse in a patient who would otherwise not report it. “As a result, [nurses] are often considered mandated reporters, meaning that they are required, by law, to report suspected abuse, neglect, or exploitation.” In addition, it is the nurses responsibility to chart accurately. It is not the nurse’s place to alter subjective data during an assessment, but to record patient statements and signs. Regarding HIPAA, specific mention is made regarding mandatory breaches in patient privacy in the event of abuse (crime). |
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A nurse is engaged in a conversation with a patient's mother who opposes vaccination for her child. The nurse does not agree with the mother's perspective. According to Mileva Saulo Lewis, which response by the nurse would reflect that he/she chose a path of right action? 1. “Do you not realize how harmful your decision is to other children in the community?” 2. “I’ve been an nurse for many years and I can tell you that declining vaccines is a horrible idea.” 3. “Can you tell me a little bit about why you oppose vaccinations for your child? 4. “Why don’t you share the reasoning behind your opinion and then I'd like to share mine.” |
Correct Answer: 3 Rationale: #1 is a “knee jerk” reaction which should be avoided. #2 is an action illustrating that the nurse thinks he/she knows best. #3 shows the nurse seeking the patient’s view and rationale which is a “do” according to Dr Lewis. #4 is a distractor because the nurses is seeking the patient view which is a “do” but also leading the conversation to his/her own opinion which is a “do not”. |
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A nurse is monitoring a patient suffering from partial thickness burns who is receiving intravenous morphine for pain. The nurse notices that the patient’s respirations have become shallow and irregular. Legally, the nurse is require to immediately 1. Continue monitoring the patient 2. Administer oxygen 3. Withhold the medication 4. Inform the primary care provider |
Correct answer: 3 Rationale: The nurse is required to question any order if the condition of the patient changes. If a medication is compromising a patient’s airway, breathing or circulation (ABCs), the medication should be withheld before the primary care provider is notified. |
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A nurse may be considered negligent if (select all that apply): 1. The nurse leaves the hospital to go for a walk during their lunch break. 2. The nurse fails to obtain an autopsy consent from a decedent before their untimely death 3. The nurse doesn’t report a colleague who repeatedly fails to wash their hands 4. The nurse’s patient falls on the way to the bathroom because the nurse forgot to instruct the patient how to use the call light |
Correct answer: 3, 4 Rationale: Failing to institute a fall protocol and failure to provide a safe environment and adhere to institutional procedures are examples of negligent acts (p.69 Box 4-5). Autopsies are only performed in certain cases and consent may be given by next of kin in the event of death (p.65). Choice 1 is an example of self-care and would not be considered negligent. |
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A patient has a family history of breast cancer and tested positive for an abnormal BRCA 1 gene. The patient contemplates having a complete mastectomy to reduce his or her risk of developing the cancer and asks the nurse his or her opinion. How should the nurse respond? 1. “Breast cancer is an aggressive disease, I think it would be better to be safe than sorry” 2. “How about we look into other treatment options when the time comes, that seems drastic” 3. “I know you'd like my opinion, I can help you along the way to a decision that’s best for you” 4. “I think this is a conversation to have with your doctor, he or she can give his or her opinion” |
Correct answer: 3 Rationale: A patient has the right to autonomy. Although the patient seeks an opinion from a health professional, the best way to respond to the patient’s request is to offer help along the way to a decision the patient made themselves. Nurses are there to advocate for the patient and act as a guide or coach. He or she should refrain from pushing his or her opinion on to the patient. |
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A nurse politely, and non-judgmentally accepts a patient's decision not to have chemotherapy, even though the nurse has strong feelings that the treatment would increase the patient's chances of survival. This nurse is demonstrating which of the following values? Select all that apply. a) Integrity b) Autonomy c) Altruism d) Human dignity e) Social justice |
Correct Answer: (b) and (c) Rationale: "Altruism is a concern for the welfare and well-being of others. In professional practice, altruism is reflected by the nurse's concern for the welfare of patients, other nurses, and other health care providers." This nurse is clearly concerned for the welfare of the patient. "Autonomy is the right to self-determination. Professional practice reflects autonomy when the nurse respects patients' rights to make decisions about their health care." |
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A nurse is on his or her way into the hospital when an elderly person has a serious fall in the parking lot. How should the nurse handle the situation as a good samaritan? 1. Pretend he or she didn't see the person fall and continue into the hospital, he or she doesn’t want to be tardy. 2. Offer assistance, call into the hospital for a response team, and wait until the response team has taken over. 3. Call into the hospital for a response team, alert the person that help is on the way, then leave for his or her shift. 4. Insist on helping the woman, it is the duty of the nurse to not accept no for an answer and to complete first aid immediately. |
Correct answer: 2 Rationale: According to the California Nursing Act, a nurse that witnesses an accident on the hospital property while on the clock is responsible for attending to the person and recruiting a response team to stabilize the situation. The nurse must stay with the person, even if they don't want the assistance until a response team gets there and once the team has the person stabilized the nurse can leave the scene. |
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According to the Nursing Practice Act, what are examples of interdependent functions in nursing practice? (Select all that Apply). 1. The physician certifying the nurse to perform advanced health-care actions 2. Sharing health care responsibilities with other colleagues to explore options 3. Filling a blood serum test order for a physician that requested it for a patient 4. Teaching a 15 year-old patient about safe-sex education to prevent pregnancy |
Correct Answer(s): 1, 2 Rationale: 1 and 2 show the nurse performing interdependent functions because they require multi-disciplinary collaborating or consulting. The other answers display independent nursing functions such as autonomous actions of a nurse that are based of nursing diagnosis and patient-centered care. The other option is regarding dependent nursing functions that involve an order from a physician most often. |
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Nurse practice acts 1. Describe the scope of nursing practice 2. Are the same in every state 3. Are internal standards of care 4. Are contracts between nurses and the state |
Correct answer: 1 Rationale: Nurse practice acts differ from state to state but are similar in that they describe or define the scope of nursing practice (p.54). Nurse practice acts are examples of external standards of care (p. 57), whereas internal standards of care would include job description, education, expertise, and individual institutional policies (p. 57). Finally, a contract is an agreement between two or more competent persons, whereas nurse practice acts are legislative statues. |
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1. In the case of a patient that is found to be in a consistent vegetative state, what guides the continuing treatment of the patient? Select all that apply. A. Follow the desires of family members who are able to speak for the patient B. Follow the advance directive of the patient if one exists C. Follow state laws regarding continuation of care D. Follow the verbally stated wishes of the patient if known |
Answer: B,C,D Rationale: Nearly every state has adopted laws regarding advance directives for patients, and these are legally binding documents that clearly define the wishes of the patient in such a situation. If an advance directive is not available, spouses or family members might be able to provide guidance regarding the wishes of the patient if they were ever expressed. If that is unknown, most states have laws regarding the “best wishes” of the patient which might conflict with those of the family members. |
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A new graduate nurse on a medical/surgical floor suspects the charge nurse is removing narcotics from the pyxis machine that are not for patients. What should the new graduate nurse do? A. Continue to observe the situation to gather more evidence B. Ask other nurses if they have noticed the same thing to figure out if it’s a normal thing C. Follow the organization’s procedure for reporting such events in a way that protects the reporting nurse from retaliation D. Report the nurse to a law enforcement agency because it involves illegal use of drugs |
Answer: C Rationale: According to the ANA code of ethics provision 3.5, nurses are responsible for reporting inappropriate or illegal behavior to the proper channels. Removing drugs not for patient use from the dispensing machine is illegal and must be reported appropriately. Calling the police might be the correct move in some instances. |
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3. A nurse in the emergency department is very busy and asks a technician to help with the nurse’s assigned patients. The technician can do all of these except? A. Run an EKG, put the patient on the monitor, start an IV and draw blood for a chest pain patient B. Remove an IV and prepare a patient for discharge C. Begin the assessment of a new patient that has been brought in for a sore throat D. Collect vitals and enter them in the EMR |
Answer: C Rationale: Nurses can delegate only tasks that can appropriately be delegated. Nurses cannot delegate assessment. What tasks a nurse can delegate is directly related to the scope of practice and skill level of supporting personnel, which can vary from facility. |
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A nurse realizes that a patient has not eaten the meal provided for the second time since the patient arrived. Of the following, which is the most important consideration the nurse may have overlooked?
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Correct Answer: (c)
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1. A Samuel Merritt University student nurse is asked to perform a procedure that he/she has never done before. The staff nurse tells the student that it is an easy procedure and not to be nervous. The student nurse should, A. perform the procedure because the staff nurse knows the hospital's policies. B. check Samuel Merritt's policies and follow what is stated. C. tell the staff nurse no if the procedure has not been covered in class. D. ask their clinical instructor even though they are busy teaching multiple students. |
Answer - D Rationale - A student nurse should always ask their clinical instructor if it is okay to do a procedure they haven't done before. While consulting the SMU's policies is a good choice, asking the clinical instructor is a better choice. |
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2. After completion of a voluntary diversion program for narcotics abuse, an ICU nurse asks their superior when they can start working again. The superior tells the nurse, A. he/she will not have to do any drug screening, but can work under the supervision of another nurse. B. he/she will not be allowed to work until the state board reinstates their full license. C. he/she can work under supervision in a general care unit and will have to partake in drug screening. D. he/she can work in the ICU, but can only give narcotic medications under the supervision of another nurse. |
Answer - C Rationale - If a nurse complete a voluntary diversion program, they will not have their license revoked if they are "closely supervised within specific guidelines (e.g., working on a general nursing unit versus critical care area, no overtime, work only day shift, not allowed to administer or have access to narcotics). The programs require counseling and ongoing participation in support groups with periodic progress reports that may include random drug screening." |
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3. A nurse has an order to put restraints on a patient that keeps trying to remove their IV. According to the Nurse Practice Act this is considered an... A. Independent Action B. Dependent Action C. Interdependent Action D. Direct Action |
Answer - B Rationale - A dependent action requires an order. "Direct and indirect patient care services, including, but not limited to, the administration of medications and therapeutic agents, necessary to implement a treatment, disease prevention, or rehabilitative regimen ordered by and within the scope of licensure of a physician, dentist, podiatrist, or clinical psychologist, as defined by Section 1316.5 of the Health and Safety Code." |
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1. An off-duty nurse drives by the scene of a hit-and-run and stops to help. Other than the victim, the nurse is the only person at the scene. Which of the following can the nurse legally do under the Good Samaritan Act? Leave the scene when the injured insists the nurse not touch her/him. Accept money afterward for saving the injured person’s life. Perform an emergency tracheotomy on the victim. Leave the scene when the EMT arrives. |
Correct Answer(s): 4 Rationale: Under the Good Samaritan Act, nurses who choose to render emergency care are to follow the specific guidelines including the following: do not perform actions that you do not know how to do; have someone call or go for additional help; do not leave the scene until the injured person leaves or another qualified person takes over; do not accept any compensation; and offer assistance but do not insist. Leaving the scene before another qualified person takes over is not legal, even if the victim does not want to be touched. Accepting money would go against taking compensation. Performing an emergency tracheotomy would most likely fall under not performing actions that you do not know how to do. The only correct answer would be Leave the scene when another qualified person (EMT) takes over. |
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2. Which of the following circumstances are nurses mandated to report? An anxious child whose bruised upper thighs and buttocks are at different stages of healing. A six year-old left alone for the weekend with no food in the house. A sedated elderly person in a nursing home who soiled themselves 8 hours ago and has yet to be cleaned. An elderly person in a hospital whose meal was served an hour late. |
Correct Answers: 1, 2, 3 Rationale: As mandated reporters, nurses are required to report instances of: (1) violent behavior; (2) absence of care necessary to maintain the health and safely of a vulnerable individual such as a child or an elder (neglect); and (3) child, elder, domestic, and sexual abuse. |
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3. A nurse posts a disparaging remark about a coworker on Facebook that is untrue. The posting is seen by many staff at a hospital. What kind of lawsuit can the coworker bring against the nurse? Libel Unintentional tort Malpractice Defamation |
Correct Answer: 4 Rationale: Defamation is a communication that is false, or made with a careless disregard for the truth, and results in injury to the reputation of a person. Only the person the defamatory statement is about can sue. |
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Which of the following provisions are included in the ANA Code of Ethics for Nurses? Select all that apply.
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Correct Answer: (a), (b), (c), (d), and (e)
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A group of nurses in the oncology department are unsure of any law changes pertaining to their profession. According to Dr. Berman, what ways can these nurses remain informed, with regard to changes made to the law as they pertain to registered nurses (RN’s)? Select all that apply. 1. RN’s can register with the Board of Registered Nursing to receive updates. 2. RN’s can go view nursing organization websites to read current laws. 3. RN’s can refer to literature as old as 20 years because laws do not change often. 4. RN’s can default to ignorance since unfamiliarity of the law will dismiss liability. 5. RN’s can refer to their employer since they have a vested interest in upholding the law. |
Correct Answer: 1,2,5 Rationale: According to Dr.Berman 1,2 and 5 are ways to keep abreast of changing laws that pertain to RN’s. #3 is false and current literature such as a current journal would have this information. #4 is absolutely untrue, nurses are liable and can be fined, imprisoned or have their license revoked. |
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Implied consent exists when: The client has provided written consent. The client’s family member confirms their agreement The client’s nonverbal behavior indicates agreement The client orally expresses their consent |
Answer: C Rationale: “Implied consent exists when the individual’s nonverbal behavior indicates agreement” |
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A nurse receives an order from a physician to administer an abnormally large dose of a medication. The nurse senses this may be a mistake and could potentially harm the patient. What is an example of an appropriate response? (select all that apply) Check in with the physician before administering to see if he or she made a mistake. Administer a smaller dose of the medication initially to see how the patient responds. Refuse to carry out the order and notify the nurse’s supervisor. Follow the doctor’s order and carry out the administration of the medication. |
Answer: A and C Rationale: A nurse is legally responsible, or in other words liable, for maintaining standards of care and to cause no harm or injury to the client. Responsibility still falls under the nurse when they are performing an act ordered by a physician. “When a nurse is asked to carry out an activity that the nurse believes will be injurious to the client, the nurse’s responsibility is to refuse to carry out the order and report this to the nurse’s supervisor.” |
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Two call lights simultaneously are pushed, one that the nurse is assigned to and one that they are not assigned to. The nurse answers her assigned client's call light and upon leaving, observes that the other client's light is still lit. What should the nurse do? Continue to their next client and assume the assigned nurse will answer the call light. Answer the call light even though it is not coming from one of their client. Notify the charge nurse that their colleague is being negligent of his or her client. Track down the assigned nurse to notify them that their client needs some assistance. |
Answer: B Rationale: “It is a nurse’s duty to respond to all clients’ call lights, not just those of assigned clients” |
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After a brief problem focused assessment, a nurse determines that a patient requires urgent administration of albuterol due to acute asthma. There is no order for this medication in the chart, and the nurse has failed to reach the on-call physician after multiple attempts. What is the next best course of action? 1. Continue contacting the on-call physician, this is the only authorized person to give a medication order. 2. Ask another nurse to find a physician from another unit to write the order. 3. Ask your colleague on the same unit, a certified nurse midwife, to give the order. 4. Ask your colleague on another unit, a physician assistant, to give the order. |
Answer: 3 Rationale: Although a physician, or a physician assistant would both provide viable options for obtaining an order, the best option is the nurse midwife. He/she is also authorized to give orders for medication according to 2725.1 of The Nursing Practice Act. Except for 2, all of the other options are correct, but will likely take longer during this urgent situation. |
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Question 1.) A nurse working in the Emergency Department is asked to care for a client suffering from complications after an abortion. The nurse tells her supervisor that caring for the client is against her religious beliefs. Does the nurse have a moral obligation to care for the client? 1.) No, because the client terminated a life and its against the nurse's personal views. 2.) Yes, because the nurse's personal views should not prevent the ability to provide care. 3.) No, the nurse should not have to violate religious beliefs to care for the client. 4.) Yes, but before caring for the client the nurse can explain the initial reluctance. |
Correct Answer: 2 Rationale: The moral obligation to care for a client cannot be set aside based on the nurse's personal or religious beliefs. The nurse was not being asked to assist in the abortion only the aftercare that was needed for the emergency. |
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Question 2.) A nurse in California rendered emergency care at the scene of an accident. The patient was pronounced dead on arrival at the hospital. Is the nurse liable for any civil damages ? 1.) Yes, the nurse should not have rendered care outside the course of employment. 2.) No, the nurse rendered care in good faith and was not responsible for the outcome. 3.) Yes, in California only a doctor can render care at the scene of an accident. 4.) No, the nurse can only be held liable under the California Nursing Practice Act. |
Answer: 2 Rationale: A licensed nurse who in good faith renders emergency care at the scene of an accident which occurs outside both the place and the course of that person's employment shall not be liable for any civil damages as the result of acts or omissions by that person in rendering care unless there was gross negligence. |
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Question 3.) A nurse was caught stealing drugs from patients. The nurse was subsequently convicted of theft. Which data base must the hospital report the nurse's conviction to ? 1.) Registered Nurses Conviction Data Bank 2.) Food and Drug Litigation Data Bank 3.) Healthcare Integrity and Protection Data Bank 4.) National Practitioner Data Bank |
Correct Answer: 3 Rationale: Healthcare Integrity and Protection Data Bank (HIPDB) was created for reporting civil judgments or criminal convictions related to health care and licensure or certification actions. |
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1) Within the scope of practice, what may a registered nurse in California perform that an licensed vocational nurse performing under the direction of a registered nurse or physician cannot? A) Perform data collection through observation, palpation or auscultation. B) Perform assessments, through analysis, synthesis and evaluation of data. C) Perform immunization techniques, skin tests, and withdraw human blood. D) Perform bedside care, measure vital signs, and administer medications. |
Answer: B Rationale: Only a registered nurse can perform assessments, according to the California Board of Registered Nursing. |
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1. The law serves which of the following functions for the nursing profession? (select all that apply) A. It differentiates the nurse's responsibilities from those of other health professionals. B. It prevents the maintenance of a standard of nursing practice by preventing accountability. C. It allows employers that are unhappy with their employees to have reason to fire them. D. It provides a framework for establishing which nursing actions in the care of clients are legal. |
Correct answer(s): A & D Rationale: This is a knowledge based question. The answers are listed in the Berman book. See reference below. |
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2. A client has been diagnosed and is discussing treatment options with their nurse. The nurse describes the procedure that would be most effective and relays the pros and cons of it to the client. The client seems to want to have the procedure done. The nurse must do what before proceeding? A. Wash their hands and set up a sterile field. B. Have the physician explain the procedure to the client. C. Speak to the family members of the client. D. Obtain either express or implied informed consent |
Correct Answer: D Rationale: Before a nurse can move forward with a procedure, the client must let them know that they want to have the procedure done and do not have any further questions before consenting. This can be done through express (oral or written) or implied informed consent. By the way, a written consent form is only a record of the informed consent, not the consent itself. “A” would be done once the consent has been given, depending on the procedure. “B” is incorrect because the nurse should have covered all of the information regarding the procedure and been available for further questions. “C” could occur if the client requests it, but is not necessary before proceeding. |
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3. A nurse is driving home and sees a two car crash on the side of the road. One person is lying in the road and no emergency vehicles are on the scene. A person from the other vehicle is flagging down the nurse’s car. What can the nurse do? (Select all that apply) A. The nurse is late for dinner so keeps driving and hopes an ambulance shows up soon. B. Call 911, thus activating the emergency response, and stay until the situation is resolved. C. Stop to check on the victim and hand off to the EMTs when they show up. D. Stop to check the victim, but leave when he gets up and walks away. |
Correct Answer(s): A, B, and C Rationale: A: the nurse is not required to stop at an emergency if off employment grounds and not on duty, B: this is the best response C: The EMTs are perfectly capable of handling an emergency situation such as this, so the nurse can feel confident in handing off to them, D: once you stop at an accident, you cannot leave until the Emergency Response has been closed, even if the victim leaves the scene. |
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Question #1. A nursing student administered an IV medication to a patient but he/she forgot to chart it and consequently the patient is given again the medication. Who has the legal responsibility of this error? 1. The nurse is not accountable of the mistake 2. The nurse is fully responsible of the action 3. His/her supervisor is the one responsible 4. The hospital takes the full responsibility |
Correct answer: 2 Rationale: “Nursing students are responsible for their own actions and liable for their own acts of negligence committed during the course of clinical experiences.” |
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Question #2. A nurse is assigned a patient suffering from terminal cancer. The medication that the patient is taking is causing him/her more harm than good; therefore, the nurse: 1. Lowers the dosage of drug 2. Withholds the medication 3. Forces patient to take drug 4. Gives the drug at bedtime |
Correct answer: 2 Rationale: “A nurse is morally obligated to withhold food and fluids (or any treatment) if it is determined to be more harmful to administer them than to withhold them.” |
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Question #3. A nurse is working long hours and he/she takes some medication from the automated medication dispenser to alleviate his/her fatigue. His/her act is considered: 1. Apprehensive conduct 2. Unprofessional conduct 3. Reasonable conduct 4. Maleficent conduct |
Correct answer: 2 Rationale: “Unprofessional conduct includes incompetence or gross negligence, conviction for practicing without a license, falsification of client records, and illegally obtaining, using, or possessing controlled substances.” |
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#1 What are the four ways to decrease liability? 1. Know the law 2. Practice within boundaries 3. Positive nurse/client relationship 4. Positive nurse/family relationship 5. Documentation |
Correct answer: 1,2,3,5 |
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#3 A young woman falls at the mall and is yelling for help. A Registered Nurse happens to see the woman in distress so he/she calls 9-1-1 and provides basic support until the paramedics arrive. Which of the following statements are true? (Select all that apply) 1. The Registered nurse acted in good faith and is covered by the Good Samaritan Act 2. The Registered nurse acted in good faith but is not covered by the Good Samaritan Act 3. The Good Samaritan Act states that a Registered Nurse is required to provide emergency care 4. The Good Samaritan Act states that a Registered Nurse is not required to provide emergency care |
Correct answer: 1,4 |
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#2 A patient with Alzheimer’s is recovering in the hospital after recent back surgery. The patient is told to remain in bed because he/she is still unstable and at risk of falling. Because of the severity of the Alzheimer’s Disease, the patient’s family is concerned he/she might forget about being told to stay in bed and try to get out of bed alone, so they ask the nurse to order a bed alarm. Requesting an order for a bed alarm is what type of nursing function? 1. Independent nursing function 2. Dependent nursing function 3. Direct nursing function 4. Indirect nursing function |
Correct answer: 2 |
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# 1 A nurse enters a room intending to give a patient their prescribed tetanus shot. The nurse is distracted by the many things that must be done after this task, and forgets to properly identify that the shot is being administered to the correct patient. As the nurse turns to leave room, they catch a glimpse of the patients medical ID bracelet and realize that they have given the medication to the wrong patient. Which of the following actions by the nurse demonstrates accountability?
a. the nurse notifies the charge nurse of the error and asks for advice on next steps to take b. the nurse verifies patient allergies, and checks on the patient for adverse reactions c.the nurse administers the shot to the patient that was originally supposed to get the tetanus shot. d. the nurse makes a formal complaint with hospital union about hospital understaffing. |
Answer: A. Accountability means being not only responsible for something but also ultimately answerable for your actions. The nurse is showing accountability for their actions by taking ownership for her mistake. |
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A nurse is asked out on a date by a patient they see regularly. According to the ANA Code of Ethics, which of these would be an appropriate response? 1. “I would love to” 2. “I can’t answer right now, but ask me after my shift is over” 3. “I have to check my hospital policy.” 4. “I’m sorry, I don’t think that would be appropriate” |
Correct Answer: 4
Rationale: The question asks about the ANA Code of Ethics (institutional policy does not apply here). According to the code, while a nurse-patient relationship is inherently intimate, it is also purposeful and structured for alleviating suffering and restoring the health of the patient. In all cases nurses are “responsible for retaining their professional boundaries.” If the nurse ever feels uncomfortable with maintaining these boundaries, they should speak with their peers or a nursing supervisor to remove themselves from the case. |
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Health care facilities receiving what type of reimbursement are required to implement the Patient Self-Determination Act regarding advance health care directives? Medicaid Preferred Provider Organization (PPO) Health Maintenance Organization (HMO) Children’s Health Insurance Program (CHIP |
Correct answer: 1 Rationale: Health care facilities receiving payment from Medicaid and Medicare must follow the Patient Self-Determination Act of 1991 which includes: recognizing advance directives, asking clients if they have advance directives, and providing educational materials to clients on their rights regarding treatment. |
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The nurse must inform a client that he or she is diabetic. According to the standards of competent performance, which action should the nurse take? Collaborate with the client’s family members to create a care plan Educate both the client and family of how to take care of the client’s new health needs Ask a physician to speak with the client about lifestyle changes he or she must make Tell the client the diagnosis and direct him or her to search the internet for information about diabetes |
Rationale: While it is important to involve the family in the client’s care, the nurse must involve the patient in the planning as well. Correct – It is important to involve both the client and the family in caring for his or her health needs. Formulating a plan for client care is a nurse’s responsibility. Also, the nurse is to delegate to his or her subordinates, a physician does not fall into this category. Although researching on the internet may be useful, it is the nurse’s duty to guide the patient in creating an all encompassing plan that includes, “client’s safety, comfort, hygiene, and protection, and for disease prevention and restorative measures.” |
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During clinicals, the nursing student uses her phone to take a picture of a nurse administering fluids to a patient intravenously while the patient is unconscious. The nurse wants to use the picture for the slideshow at their graduation ceremony. What type of privacy is the student violating? Unreasonable intrusion Putting a person in a false light Use of the client’s name or likeness for profit, without consent Public disclosure of private facts |
Correct Answer: 1 Rationale: Correct - Unreasonable intrusion is observation of client care without his or her consent. Putting a person in false light is publishing false and offensive information. Use of the client’s name or likeness for profit - an example of this would be using a client’s identifiable photo in a healthcare ad without asking permission. Public disclosure of private facts is sharing client information with those who do not have a legitimate reason to know. |
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A family member of a Chinese patient with stomach cancer asks a nurse for hot water to prepare herbal remedies that avoid drug interactions. The nurse shows cultural competence by which of the following ways?
1. Kindly explain that the doctor has already given a prescription 2. Assisting the family member with their needs |
Correct Answer: 2. Assisting the family member with their needs. Rationale: Cultural competence is being culturally aware, culturally knowledgeable, culturally skillful, and seeking cultural encounters. The best way to become culturally |
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According to ANA Code of Ethics, as the scope of nursing practice changes, the nurse must exercise judgment to others who carry out nursing care in which of the following? Select all that apply.
1. accepting up to 4 patients in a med-surg unit. 2. delegating the CNA all their tasks the don’t want. 3. seeking the help of other nurses. |
Correct Answer: 1, 3, and 4. Rationale: Provision 4.1 states that as the scope of nursing practice changes, the nurse must exercise judgment in accepting responsibilities, seeking consultation, and assigning activities to others who carry out nursing care. |
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A 45 year old civilian collapses on the floor in the middle of the street. You come onto the scene of the emergency and you discover that they need CPR. You perform CPR, but you break a few ribs in the process. Which of the following may you be liable for?
1. the fractured ribs while you were giving compressions 2. the bacteria transferred while performing mouth to mouth breathing |
Correct Answer: 3. Rationale: According to Nursing Practice Act, Section 2727.5 A person licensed under this chapter who in good faith renders emergency care at the scene of an emergency which occurs outside both the place and the course of that person's employment shall not be liable for any civil damages as the result of acts or omissions by that person in rendering the emergency care. |
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While out to dinner, a 75-year-old man started to choke and collapsed. A nurse notices he is not breathing and performs CPR. After few weeks, the person sues the nurse for a broken rib that may have resulted from CPR. Which of the following law protects the nurse from the lawsuit? |
Correct answer: B. Good Samaritan Act |
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A client asks a nurse information on medications. The nurse clearly explains about medicaions, side effects, and other treatments and the clinet decides to refuse treatment. This is an example of which moral principles? |
Correct answer: A. Autonomy |
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Which of the following is in correct order from broadest to narrowest legal boundaries of scope of nursing practice? |
Correct answer: C. Law-Standard-Policy-Ability |
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1. A 96 year-old patient whose esophagus has collapsed is expected to die within 48 hours given he has chosen not toaccept a feeding tube. He has implemented with his wife's help a DNR order, as well as an order to withhold any lifesaving measures, including feeding tube, specifying only palliative measures are to be taken. His level of consciousness shifts with increasing frequency between alert and aware and comatose. His wife has gone for a short walk around the unit with other family members. The nurse is alone with the patient, who awakes and clearly asks the nurse for a drink of water. The nurse should:
a) Honor the patient's request and allow him a small cup of water b) Follow the written order and tell him he cannot have any c) Insert a feeding tube and give the patient some water d) Sit with and explain to the patient why the nurse cannot honor his request |
Correct answer: d) Rationale: d) The nurse cannot honor the patient's request, so sitting with the patient to attend to any other needs is the best choice. It is ethical for a nurse to withhold food or drink from a patient when food or drink may harm the patient. a) Given that the patient's esophagus has collapsed, water per os would put the patient at risk of aspiration. b) Though it is true the patient cannot have any water due to risk of aspiration, if the patient requested in lucidity a drink that countered their written advance directive, the nurse could grant the patient's request for water if it posed no risk to the patient. In this circumstance, this choice, though correct, is not caring. c) This is an invasive procedure that could not be performedimmediately. |
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2. A nurse is assessing a client with whom the nurse is having difficulty communicating due to a language barrier. The nurse acquires the aid of an interpreter. The nurse should:
a) Use metaphors and similes such as “Is the pain stabbing like a knife?” to increase clarity b) Address questions and comments to the interpreter, not the client, to assure understanding c) Ask the interpreter to translate the nurse's words as closely as possible d) Ask the interpreter to refrain from sharing anecdotes and colloquialisms related to the client's culture and language |
Correct answer: c) Rationale: c) This is the best choice, and it places on the nurse's shoulders the responsibility of knowing what they are talking about and being clear. a) Metaphors and similes do not always translate well. Common metaphors and similes in English may not be used at all in the client's language, and may confuse the client. b) To respect the client, questions and comments should be addressed directly to the client, whether the client understands or not. Watching the client for nonverbal communication will greatly enhance the nurse's understanding. d) Colloquial words and the like can be learned by the nurse and incorporated into conversations when future interpretive services are utilized. This will enhance the cultural sensitivity of the care the nurse if providing the client. 3. A nurse working at a family planning clinic is discussing hormonal contraception with a client lacking health insurancewho has been acquiring her hormonal contraceptives directly from this nurse for just under three years. The client requests a refill on her Ortho-Tricyclin Lo. The nurse's next step/s should be: |
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3. A nurse working at a family planning clinic is discussing hormonal contraception with a client lacking health insurancewho has been acquiring her hormonal contraceptives directly from this nurse for just under three years. The client requests a refill on her Ortho-Tricyclin Lo. The nurse's next step/s should be:
a) Fulfill the client's request, as defined and allowed by California State Law b) Educate the client about the possible side-effects of hormonal contraceptives c) Refer the client to a physician, nurse-practictioner, nurse-midwife or physician assistant for an evaluation d) All of the above |
Correct Answer: d) Rationale: d) All of the above is the best choice. a) Is appropriate to the nurse's role as a caregiver. b) is appropriate to the nurse's role as teacher and communicator. c) “If a patient has been seen exclusively by a registered nurse for three consecutive years, the patient shall be evaluated by a physician and surgeon, nurse practitioner, certified nurse-midwife, or physician assistant prior to continuing the dispensation or administration of hormonal contraceptives.” The client will have to, as required by law, be evaluated by one of the health care providers listed above before her next visit to the family planning clinic for a hormonal contraceptive refill. |
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An ABSN nursing student passes by the scene of a drive-by shooting. They watch as one of their classmates responds, introduces themselves as a registered nurse and proceeds to administer CPR to a child shot in the abdomen. According to the California Nursing Practice Act, what action is appropriate for the student to take? Select all that apply. 1. The student, trained in first aid, can assist the other in removing the bullet with a pocketknife. 2. The student should tell their classmate to introduce themselves as a trained nurse 3. The student should tell their classmate they should not call themselves a nurse 4. The student can take over chest compressions for the injured child. |
Correct Answer(s): 3,4 Rationale: According to the California Nursing Practice Act, it is unlawful to call oneself a “registered nurse”, “graduate nurse” or “trained nurse” until licensed or certified. It is also unlawful for a nurse to perform surgeries (as in removing a bullet from the abdomen). The student is, however, allowed to perform CPR, as that is within their scope of practice. As they are at the same level, the classmate may pass off care to the student and vice versa. |
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# 2 Before administering a medication, a nurse should take which of the following items into consideration? Select all that apply.
A. Question any order that is incomplete or illegible. B. Inform the prescribing physician if patients condition has changed. C. Verify with physician, dosage, delivery, documentation. D. Recheck a physicians order that a client questions. |
Answer: A, B, D.
Rationale: The nurse will want to question any unintelligible physicians order to ensure that they are giving the proper medication at the correct dose. Additionally the physician must be made aware if a patients condition has changed as this may affect what and how much of our medication is prescribed. Lastly, if a patient questions the physicians order this should be taken into consideration. |
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Question 1: A person with a “do not resuscitate” (DNR) advance health care directive in place which includes a directive for no CPR / DNR in pre-hospitalization and/or emergency care situations, should do which of the following to help emergency health care providers honor this directive (select all that apply): Nothing is needed because the advance health care directive has been executed Carry an Advance Health Care Directive Wallet Identification card on your person Have the emergency health care personnel contact the primary health care provider Obtain a “do not resuscitate-EMS” medallion to help make the emergency personnel aware |
Correct answers: 2,4 Rationale: An Advance Health Care Directive Wallet Identification card and DNR-EMS medallion on your person would help make EMS personnel aware, prior to starting CPR/treatment, that a patient has a DNR order in place. (1 EMS personnel will not have an advance directive with them. 3 this assumes the patient is conscious, in which case they could just refuse treatment) |
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Question 2: A patient goes to the local health clinic to receive an annual flu shot. They have received a pamphlet/reading on the benefits and risks of the flu vaccination as well as a brief consultation with the nurse. The patient has not given the nurse who is giving the injections any written consent to complete the injection. When it is their turn, the patient sits in the designated chair and rolls up their sleeve to receive the flu shot. The nurse would most likely do what next: Proceed with the injection as the patient has provided an implied consent for the injection Refuse to proceed with the injection as the patient has not handed the nurse written consent Inform the patient of the nurses’ standard of care to make them aware of their responsibilities Send the patient to the back of the line to allow them more time to complete written consent forms |
Correct answer: 1 Rationale: The patient has received complete information on the flu vaccination. As part of informed consent, an “implied consent” for treatment(s) exists when a patient’s non-verbal behaviors indicate agreement for the treatment. (2 There may not be any written consent form required or the nurse may not be the one collecting the form if there was. 3 not applicable. 4 not applicable.) |
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Question 3: Good Samaritan Acts legislation provides protection to nurses (and non-nurses) who stop to render aid to people in an emergency. Which of the following are guidelines of the Good Samaritan Acts for nurses who choose to render emergency care (select all that apply): They should offer assistance, but not insist on providing help Should normally leave the scene with EMS to complete diagnosis and provide assistance Perform an action that you have not been officially trained on, but have seen done before Limit your actions to those normally considered first aid if possible |
Correct answers: 1, 4 Rationale: If stopping to render aid it is important to offer assistance, but not to insist and pressure the injured into unwanted treatment. Actions should be kept to standard first aid actions whenever possible. (2 EMS is trained to stabilize and transport injured people, it is not the norm to leave the scene with them. 3 Do not perform actions that you do not know how to do.) |
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A nursing student is on clinical and assigned to give bed baths. The student forgets to change the sheets for a client that soiled themselves. The client contracts pink eye and the client’s family seeks legal action. According to the Berman text who is liable? Select all that apply 1. The student’s clinical instructor 2. The student’s school 3. The student’s buddy nurse 4. The student’s assigned hospital 5. The student |
Correct Answer: 2, 4, 5 Rationale: This is a case of gross negligence. It is also a skill under a nursing student’s scope of practice. In clinicals, students are not practicing under their clinical instructor or their buddy nurse’s license. The hospital and the school created a contract to provide education to the students and as such are held accountable for their actions. The student, like a registered nurse, is responsible for providing safe client care and a clean living environment. |
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#1. Which of the following situations is an example of an unintentional tort? Documenting in a client’s chart that the patient is uncooperative Using a tranquillizer on a disruptive patient before a procedure Telling another nurse that the client is gay Administering a medication that causes the patient harm |
Correct Answer: 4. Rationale: An unintentional tort (e.g. negligence, malpractice) is a civil wrong committed against a person that does not require intent but does require the element of harm. |
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#2 A nurse while walking through Temescal on his day off encounters a cyclist who has been hit by a car and left on the side of the road with life threatening injuries. What guidelines are included under Good Samaritan Acts for actions he can take? (Check all that apply) Have someone call or go for additional help Decide to keep walking and leave this for a response team trained for these situations Perform lifesaving actions despite forgetting some of the steps Limit actions to those normally considered first aid, if possible |
Correct Answer: 1,2,4 Rationale: If you decide to render emergency care, it’s advised to call or go for additional help. It’s also not required by law to stay and provide care, except in some states (Vermont). No actions should be performed that you don’t know how to do and actions should be limited to first aid if possible. |
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#3 A nursing student is working on a nursing unit for clinicals. Which of the following is true in regards to the legal responsibility of the student? The hospital is not held potentially liable for the negligence of the student because they are not considered employees. The nursing student can do clinicals without the clinical faculty on site as long as they are under the supervision of an on-duty nurse. In cases of negligence the hospital and their educational institution will be help potentially liable. The nursing student is held to a lower standard of skill and competence than a registered professional nurse. |
Correct answer: 3 Rationale: Nursing students are held to the same standard as RNs and are held equally accountable for their actions under both the hospital’s and the educational institution’s legislation. Clinical faculty must be on site during clinicals. |
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1. A nurse is caring for a 10-year old obese client whom the nurse suspects may be malnourished. Which of the following actions demonstrate the nurse’s competence according to the California Nursing Practice Act? Select all that apply. 1. The nurse assesses for signs of micronutrient deficiencies and diabetes. 2. The nurse uses intuition to investigate the client’s dietary habits. 3. The nurse creates a plan in collaboration with the client and her mother. 4. The nurse forms a diagnosis based on the symptoms and physical exam. |
Answer: 1, 3, 4
Rationale: The California Nursing Practice Act defines competence in terms of a nurse’s ability to transfer scientific knowledge from social, biological and physical sciences in applying nursing process. #1, #3 & #4 demonstrate applications of the nursing process. #2 is a practice but is not necessarily delineated as a standard of competent performance in the CNPA. |
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2. A graduate entering into the profession of nursing is advised to take her/his reduce legal liability. What steps should the graduate take upon starting her/his first job? Read the Board of Registered Nurse’s proceedings regularly. Consult the department of hire for policies on client care. Ask other nurses on the floor how they perform procedures. Consult the ANA’s “Code of Ethics” on how to perform procedures. |
Answer: 2
Rationale: The best way for a nurse to reduce liability is to know the law and to practice within the guidelines of the law. #1 is correct as staying informed is important in reducing liability. However #2 is best because departmental policies further restrict the policies set by the BRN and ANA. #4 is a distractor because the Code of Ethics does not have guidelines for how to perform procedures, but about the ethical guidelines for the role of nurses. |
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3. A client with gallbladder infection is in need of a cholecystectomy. The surgeon assigned to the procedure has asked the nurse to help obtain informed consent. Which step should the nurse take to ensure that the consent is informed and given freely? Select all that apply. Discuss the benefits and risks with the client thoroughly. Witness the consent to ensure that the client is competent. Place the form by the client’s bed and step out of the room. Let the client know that he can change his mind any time. |
Answer: 2, 4
Rationale: #2 is correct because the nurse’s role in obtaining informed consent is to witness that the client gives the consent voluntarily , that the signature is authentic, and that the client appears competent enough to give consent #4 is also correct because the client may always refuse treatment, even after signing a consent.. #1 is incorrect because the provider who is performing the procedure should discuss the benefits and risks with the client. #4 is incorrect because the client should have enough information to make an informed decision. |
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2) A nurse calls a physician to clarify a drug order that will put a client at risk. The physician responds by demanding the nurse be drug tested or be fired, because he/she is not competent to care for a rock. The nurse should do which of the following? A) File a lawsuit against the physician for defamation by libel and slander. B) Inform the physician that the call is being recorded for training purposes. C) Ask the physician some questions to determine his/her level of consciousness. D) Restate his/her concern for the client’s well being and ask for medication clarification. |
Answer: D Rationale: “Question and record verbal orders to avoid miscommunications. In addition to recording the time, the date, the primary care provider's name, and the orders, the nurse documents the circumstances that occasioned the call to the primary care provider, reads the orders back to the primary care provider, and documents that the primary care provider confirmed the orders as the nurse read them back.” |
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A patient asks their nurse how to access their records, request changes and if access can be restricted to others. Which of the four areas HIPPA allows for patient access and protects others from accessing their records?
A. Electronic transfer of information B. the security rule C.the privacy rule D. self determination rule
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Answer: The privacy rule
Rationale: The privacy rule establishes the standards of appropriate disclosure of public health information. This rule also allows for the patient to access their records, restrict access to others, and request changes. |
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3) A family member of a client asks a nurse, “What did the doctor mean Grandma will receive palliative care? What is that?” Select all that apply: A) Palliative care is reserved for clients with an “Advance Health Care Directive” on file. B) Palliative care treats the physiological, spiritual, needs of someone with a life threatening illness. C) Palliative care is a team approach towards the support and care for client and family. D) Palliative care is focused on pain management and keeping Grandma comfortable. |
Answer: B, C, D, Rationale: “as described by the World Health Organization, is an approach that improves the quality of life of clients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.” |
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A patient comes in seeking information regarding abortion. The nurse is against abortion. How should the nurse proceed? The nurse has a moral obligation to care for the patient and assist with the abortion if the patient so chooses because there is no apparent risk in doing so. The nurse has a moral obligation to care for the patient but may refuse to assist with the abortion procedure if it violates the nurse’s moral or religious principles. The nurse has a moral obligation to care for the patient but may refuse to assist with the abortion if the risk of infection from the patient outweighs the nurse’s moral responsibility. The nurse has no moral obligation to care for the patient or assist with the abortion because the patient’s values violate the nurse’s moral or religious principles. |
Correct Answer: 2 Rationale: Most state laws have provisions known as conscience clauses that allow care providers and nurses to refuse to assist with an abortion if doing so violates their religious or moral principles. However, nursing codes of ethics support patients’ rights to information and counseling in making decisions without the nurse imposing their values on the patient. |
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When a nurse decides to render emergency care under the Good Samaritan Act, the nurse may: Insist on offering assistance to the individual if the individual’s condition is fatal. Perform procedures beyond their ability if nobody more qualified is available. Accept compensation if the duties performed exceed normal first aid care. Have a non-medical professional help by calling or going for additional help. |
Correct Answer: 4 Rationale: When an emergency situation happens outside of the hospital or another care facility, it is always important for the nurse or someone else to call or go for additional help. |
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A nurse shares information about a client’s medical condition with other medical professionals at the hospital. Is this an invasion of the client’s privacy? It is always considered appropriate to share client information with other medical professionals within the hospital, but is not appropriate to share information with non-medical persons. It is considered appropriate to share client information with other medical professionals only if the discussion is necessary to treatment of the client’s medical condition. It is considered appropriate to share client information with other medical professionals and it is commonly understood that medical personnel often discuss and gossip about client’s medical conditions amongst themselves. It is an invasion of privacy and a violation of the client’s right to confidentiality to reveal information about a patient under any circumstance. |
Correct Answer: 2 Rationale: There is a fine balance between the need for other medical professionals to contribute to the diagnosis and treatment of a client and the client’s right to confidentiality. In most situations necessary discussion about a client’s medical condition is considered appropriate. Those engaged in discussion should only be those involved in the client’s care. Unnecessary discussions and gossip are considered breaches of confidentiality. |
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1. During the assessment, a client tells the nurse, “I got sick because of the natural balance and harmony is all disturbed.” The nurse realizes this client is demonstrating: 1) Magico-religious belief 2) Holistic health belief 3) Biomedical health belief 4) Scientific health belief |
Correct Answer: 2) Holistic health belief Rationale: “The holistic health belief holds that the forces of nature must be maintained in balance or harmony. Human life is one aspect of nature that must be in harmony with the rest of nature. When the natural balance or harmony is disturbed, illness results. “ |
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2. The nurse is communicating with a client who has limited knowledge of English. Which of the following the nurse should do: 1) Avoid slang words but use the same medical terminology that is written on the patient’s chart. 2) Use congruent gestures and show pictures to increase the client’s understanding. 3) Speak loudly to help the client understand. 4) Interpret a client’s smiling and nodding to mean that the client understands. |
Correct Answer: 2.) Use congruent gestures and show pictures to increase the clients understanding. Rational: 1) A nurse should avoid medical terminology and abbreviations. 2) Correct. 3) Speaking loudly does not help a client understand and may be offensive. 4) The client may be trying to please the nurse by smiling and nodding but not understand what is being said. Source:Berman & Snyder Ch.18 Culturally Responsive Nursing Care |
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3. A patient asks for additional towel and a new graduate nurse orientee tells him that she will get back to him shortly. The nurse orientee soon returns and gives him the towels as promised. The nurse’s action is an example of which principle? 1) Justice 2) Beneficence 3) Fidelity 4) Veracity |
Correct Answer: 3) Fidelity Rational: “Fidelity means to be faithful to agreements and promises.” |
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#1. When a Tagalog speaking nurse begins talking with a client and his daughter from the Philippines in Tagalog, the client responds in English. The client also stops his daughter when she responds to the nurse in Tagalog and asks her to speak English. What attitude toward cultural identity is the client most displaying? A. Cultural awareness B. Cultural rejection C. Acculturation D. Assimilation |
The correct answer is D Rationale: Cultural assimilation is a process in which a foreign person actively gives up their previous cultural identity and assimilates the identity of the dominant culture. The client displays assimilation by actively refusing to communicate in the language of their previous cultural identity. |
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#2. Which of these tasks could a registered nurse delegate to an unlicensed assistive personnel? Select all that apply. A. Documenting the results of a PPD tuberculin skin test B. A physician ordered blood draw C. Re-positioning a patient at risk for bed ulcers D. Assessing a patient for signs of heart failure E. Teaching a client how to use a spirometer |
The correct answers are B and C Rationale: Drawing blood and helping position a client comfortably are within the scope of care of certain UAP's. D involves assessment which a nurse can never delegate. Teaching (choice E) or documenting test results(Choice A) is usually the role of a registered nurse, but it may be performed by an LPN or LVN. |
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#3. Utilitarianism, which views a good act as the action that is most useful, is an example of a: A. Relationship based theory B. Principles based theory C. Consequence based theory D. Autonomy based theory |
The correct answer is C. Rationale: Utilitarianism is an example of a Consequence (teleological) based theory and focuses on the principle of utility and issues of fairness. |
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1. A woman with a family history of breast cancer recently discovered she tested positive for the cancer-causing gene, and is contemplating a mastectomy and asks for the nurse’s advice. How should the nurse respond? a. “Whatever you think is best, do it.” b. “Are you considering other courses of action?” “Tell me about them.” c. “Personally, I would get the surgery done.” d. “That’s a big decision, but I think it is the right one.” |
Correct answer: B Rationale: The nurse needs to ensure that the client is aware of all the options available before making a major decision. The nurse should not give their own personal opinion but attempt to clarify the client’s own values. |
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2. Certain confidential client information must be reported due to the jurisdiction of the country. Which of the following confidential client credentials must be reported? a. Infections and communicable diseases b. Family history of chronic diseases c. Child or elder abuse d. History of any surgeries e. Both A and C |
Correct: E Rationale: The four major categories of client information that must be reported are: vital statistics (births and deaths), infections and communicable diseases, child or elder abuse, and violent incidents. |
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3. A Native American, middle-aged and obese woman with hypertension is at a high risk for diabetes. The nurse understands culturally that this woman may value her larger body size; how should the nurse discuss treatment with the client? a. “I know that in your culture you value a larger body size, but you need to make some changes.” b. “What do you suggest to lower your weight?” c. “You are at a high risk for diabetes, if you don’t lose weight your condition will get worse.” d. “Please let me know if I do anything that is unacceptable in your culture, but it is important for you to implement some healthier lifestyle changes because your higher weight puts you at risk for diabetes.” |
Correct: D Rationale: The nurse needs to address the cultural needs and/or differences of the client to make them feel valued, but also needs to provide the right care for the client. |
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During an initial assessment, a nurse identifies that his/her patient has a strong family history of breast cancer. According to Healthy People 2020, which foundational health measure might the nurse discuss with the patient as a teaching opportunity regarding her risk for breast cancer?
1. Disparities 2. Determinants of Health 3. Health-related quality of life and well-being 4. General health status |
Correct answer: 2 |
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An 18 year old patient has endured a long chemotherapy treatment that has failed to work, and is thinking about his/her option to discontinue therapy. The patient’s family wants the patient to continue treatment. As an advocate, how will the nurse help the patient navigate this decision?
1. The nurse respects the patient’s decision, and discontinues the chemotherapy immediately. 2. The nurse facilitates an open conversation between the patient and his/her family, and helps them to communicate their opposing views. 3. The nurse speaks to the family separately, and reminds them that the patient has the right to autonomy. 4. Anticipating a legal battle, the nurse suggests that the patient hire a lawyer. |
Correct answer: 2 |
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During an initial assessment, a nurse identifies that his/her patient has a strong family history of breast cancer. According to Healthy People 2020, which foundational health measure might the nurse discuss with the patient as a teaching opportunity regarding her risk for breast cancer?
1. Disparities 2. Determinants of Health 3. Health-related quality of life and well-being 4. General health status
Rationale: Determinants of health include genetic and biologic factors. Since this patient has a strong family history of breast cancer, she also has a strong genetic pre-disposition for getting breast cancer in the future. The nurse should provide the patient with information to prevent deadly cancer, such as regular screening. The nurse should also provide resources such as nutrition and lifestyle; two ways that have proven to reduce one’s risk for cancer. |
2 Rationale: Determinants of health include genetic and biologic factors. Since this patient has a strong family history of breast cancer, she also has a strong genetic pre-disposition for getting breast cancer in the future. The nurse should provide the patient with information to prevent deadly cancer, such as regular screening. The nurse should also provide resources such as nutrition and lifestyle; two ways that have proven to reduce one’s risk for cancer. |
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An 18 year old patient has endured a long chemotherapy treatment that has failed to work, and is thinking about his/her option to discontinue therapy. The patient’s family wants the patient to continue treatment. As an advocate, how will the nurse help the patient navigate this decision?
1. The nurse respects the patient’s decision, and discontinues the chemotherapy immediately. 2. The nurse facilitates an open conversation between the patient and his/her family, and helps them to communicate their opposing views. 3. The nurse speaks to the family separately, and reminds them that the patient has the right to autonomy. 4. Anticipating a legal battle, the nurse suggests that the patient hire a lawyer. |
2 Rationale: The client advocate works to protect patient’s right to decide, and helps them navigate health care decisions. A nurse advocate should not express his or her “…approval or disapproval of the client’s choices” While option (1) respects the patient’s choice, it doesn’t give the patient the opportunity to synthesize their decision, and discuss it with their family. |
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After reading the recent article describing the top health concerns for Americans and their relationship to lowered life expectancy, the community health nurse stresses primary prevention in which major health area?
1. Tuberculosis 2. Smoking 3. Infant mortality and low birth weight 4. Cancer |
3 Rationale: Infant mortality and low birth weight are among the top 9 health areas Americans struggle with, causing lowered life expectancies compared with several other nations. |
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During an initial assessment, a nurse identifies that his/her patient has a strong family history of breast cancer. According to Healthy People 2020, which foundational health measure might the nurse discuss with the patient as a teaching opportunity regarding her risk for breast cancer?
1. Disparities 2. Determinants of Health 3. Health-related quality of life and well-being 4. General health status |
Correct answer: 2 Rationale: Determinants of health include genetic and biologic factors. Since this patient has a strong family history of breast cancer, she also has a strong genetic pre-disposition for getting breast cancer in the future. The nurse should provide the patient with information to prevent deadly cancer, such as regular screening. The nurse should also provide resources such as nutrition and lifestyle; two ways that have proven to reduce one’s risk for cancer. |
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An 18 year old patient has endured a long chemotherapy treatment that has failed to work, and is thinking about his/her option to discontinue therapy. The patient’s family wants the patient to continue treatment. As an advocate, how will the nurse help the patient navigate this decision?
1. The nurse respects the patient’s decision, and discontinues the chemotherapy immediately. 2. The nurse facilitates an open conversation between the patient and his/her family, and helps them to communicate their opposing views. 3. The nurse speaks to the family separately, and reminds them that the patient has the right to autonomy. 4. Anticipating a legal battle, the nurse suggests that the patient hire a lawyer. |
Rationale: The client advocate works to protect patient’s right to decide, and helps them navigate health care decisions. A nurse advocate should not express his or her “…approval or disapproval of the client’s choices” While option (1) respects the patient’s choice, it doesn’t give the patient the opportunity to synthesize their decision, and discuss it with their family.
Correct answer: 2 |
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After reading the recent article describing the top health concerns for Americans and their relationship to lowered life expectancy, the community health nurse stresses primary prevention in which major health area?
1. Tuberculosis 2. Smoking 3. Infant mortality and low birth weight 4. Cancer |
Rationale: Infant mortality and low birth weight are among the top 9 health areas Americans struggle with, causing lowered life expectancies compared with several other nations.
Answer: 3 |
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The nurse received an order to administer amoxicillin by mouth to a patient that contracted an urinary tract infection after a foley catheter was placed during surgery. Prior to administering the medicine to the patient what should the nurse do? Select all that apply. |
Correct Answer: a, b, c |
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MA came in for her first prenatal check since finding out she is pregnant. The pregnancy was unplanned. Which are negative outcomes that the nurse should be aware of associated with the patient's unintended pregnancy? Select all that apply. |
Correct Answer: a, b, c |
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An eighteen year-old patient is admitted to the Emergency Department for an allergic reaction. The doctor orders an injection of 25mg of Benadryl. The nurse approaches the patient and states that s/he is going to give the patient an injection of Benadryl in the deltoid. How can the patient demonstrate implied consent? The patient states, “I am agreeing to receive an injection of 25mg of Benadryl.” The patient removes their sweatshirt and rolls up their sleeve exposing the deltoid. The patient zips up their jacket and stares at the nurse with his/her arms crossed. The patient asks the nurse, “Can you please give me some pain medication first?” |
Correct answer: B Rational: “Implied consent exists when the individual’s nonverbal behavior indicates agreement. For example, clients who position their bodies for an injection or cooperate with the taking of vital signs infer implied consent” (59). |
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A new nurse is working in the Intensive Care Unit and has been assigned to a patient that has a Do Not Resuscitate Order (DNR). The nurse does not personally believe that a patient should be able to have such an order and is uncomfortable caring for the patient. What is her best course of action? Refuse to take care of any patient with a DNR order, regardless of the reason. Approach the nursing manager and request a new patient without a DNR order. Approach the patient’s family and attempt to get them to change their mind. Converse with the patient directly and persuade them to reverse the DNR order. |
Answer: B Rational: “If it is contrary to the nurse’s personal beliefs to carry out a DNR order, the nurse should consult the nurse manager for a change in assignment” (67). |
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A nurse walks into the room of his/her nineteen year-old male patient admitted for an infection related to genital herpes. The nurse puts on gloves and immediately walks over to the patient and pulls up his robe to inspect and palpate the lesions. The patient becomes very embarrassed. What tort can the nurse be held liable for? Defamation Embarrassment Invasion of Privacy Battery |
Answer: D Rational: “Battery is the willful act of a person that may or may not cause harm…the touching must be wrong in some way; for example, touching done without permission, that is embarrassing, or that causes injury” (71). |
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A nurse is showing signs of irritability, increased isolation from others and occasional blackouts. The nurse is displaying what type of impairment? 1. Alcoholic Nurse 2. Drug-Addicted Nurse 3. Mentally Ill Nurse 4. Drug-Abused Nurse |
Correct Answer: 1 Rationale: Alcoholic Nurse displays signs of irritability, increased isolation from others and occasional blackouts. Drug-addicted nurse displays signs of rapid mood and/or performance changes and frequent absence from unit; frequent use of restroom. Mentally Ill nurse displays signs of depression, lethargic, unable to focus or concentrate, apathetic. There is no nurse considered as drug-abused nurse. |
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An experienced nurse is managing care for 12 patients and realizes she only documented for 11 patients, the nurse shrugs off the mistake. Which liability is the nurse potentially facing? Select all that apply. 1. Breach of duty 2. Negligence 3. Foreseeability 4. Misdemeanor |
Correct Answer: 1 and 2. Rationale: Breach of duty is something was done that should not have been done or nothing was done when it should have been done. Negligence is misconduct or practice that is below the standard expected of an ordinary, reasonable, and prudent person. |
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According to Institute of Medicine, what are the health behaviors of Americans compared to their peer countries? Select all that apply. 1. More likely to smoke 2. Consume more calories 3. More likely to drink 4. Less likely to use seat belts |
Correct Answer: 1 and 4 Rationale: Americans are currently less likely to smoke and may drink alcohol less heavily than people in peer countries, they consume the most calories per person, have higher rates of drug abuse, are less likely to use seat belts, are involved in more traffic accidents that involve alcohol, and are more likely to use firearms in acts of violence. |
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A nurse suspects a domestic violence by observing multiple bruises in her female patient. What should the nurse do according to Nursing code of Ethics? Select all that apply. 1. Keep this information private, if the patient wishes. 2. Follow up in so far as the patient will permit. 3. Provide referrals to counseling regarding domestic violence. 4. Mandated to report even a suspicion of domestic violence. |
Correct Answer: 1, 2, and 3.
Rationale: According Privacy and Confidentiality Interpretive Statements 3.1 and 3.2, Nursing Code of Ethics, in some states laws covering domestic violence mandate healthcare professionals to report even a suspicion of domestic violence. This laws differ from state to state. Nurses need to be aware of this laws. |
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According to Healthy People 20-20, examples of effective programs that address adolescent health issues include:
1. State graduated driver licensing program. 2. Teen pregnancy prevention program. 3. HIV prevention programs. 4. Violence prevention programs. 5. 1, 2, and 4. 6. All of the above |
Correct answer: 6. Rationale: All of the above answers are examples of effective programs that address adolescent health issues.
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According to Healthy People 20-20, efforts to address health disparities among lesbian, gay, bisexual, and transgender (LGBT) individuals include all, except: |
Correct Answer: 3. |
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An older gentleman goes to the doctor for his yearly physical. While at the clinic, the nurse notices in his chart that he has not had his annual flu vaccination. The nurse gives it to him even though he had concerns about getting the vaccination. What can the nurse be sued for? Select all that apply. 1. False Imprisonment 2. Invasion of Privacy 3. Battery 4. Assault |
Rationale: In this case, the person can be sued for battery, because the man did not give the nurse permission to touch him. Willful touching without permission is considered battery and is grounds for a lawsuit. The nurse can also potentially be sued for assault, because assault is the intention to touch somebody without their permission. Correct Answer: 3, 4 |
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A nursing student accidentally leaves the guard rails down for an elderly patient. During the night, the patient falls out of bed and breaks her/his hip. The patient decides to sue the hospital. Who can the patient potentially sue for negligence? Select all that apply. 1. The nursing student 2. The hospital 3. The school the nursing student attends 4. The health insurance company of the patient |
Rationale: In cases of negligence, the nursing student, the hospital, and the educational institution are held potentially liable for negligent actions by the nursing student. Correct Answer(s): 1, 2, 3 |
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According to Healthy People 2020, which populations have been identified as having health disparities? Select all that apply. 1. Corn farmers in rural Iowa 2. The lesbian population in Santa Fe 3. Flight attendants 4. Tech workers in the Silicon Valley |
Rationale: Healthy People 2020 has identified those with health disparities by the following categories: race and ethnicity, gender, sexual identity, Disability status or special healthcare needs and geographic location (rural and urban). Correct Answer: 1, 2 |
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A nursing student assisting with the placement of a foley catheter fails to follow hospital protocol for sterile technique. When corrected by the nurse, the nursing student states “I know, but I always accidentally contaminate something and none of my clients have had urinary tract infections.” How should the nurse respond first? A. Report the incident to the nursing school in writing B. Report the incident to the nursing student’s clinical instructor C. Report the incident to the charge nurse D. Report the incident to the nursing manager |
Correct Answer: B Rationale: While other options would be appropriate if the nursing student’s performance does not improve, it is first important to alert the clinical instructor to the nursing student’s lack of understanding. |
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Quality of nursing surveillance is affected by which of the following? (Select all that apply). A. A low patient-nurse ratio B.The nursing skill mix C.The patient’s condition D.Rapid mobility of hospital resources |
Correct Answer: A, B, D Rationale: Low patient-nurse ratio, the nursing skill mix and rapid mobility of hospital resources all contribute to the quality of nursing surveillance, reducing the risk of failure to rescue. While important, the patient’s condition is not necessarily an indicator of whether nursing surveillance is adequate to detect changes. |
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A nurse has a difficult time hearing a physician’s orders over the telephone. When preparing a client’s medication the nurse realizes that the order did not include dose. What action should the nurse have taken to seek clarification? A.Question the order for medication and delivery route B.Read the orders back the physician prior to ending the call C.Require the physician provide orders in person D. Require the physician provide orders in writing |
Correct Answer: B Rationale: Reading back the orders to the physician would alert both healthcare providers to the missing dose information |
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The client asks the nurse to call a clergy member to visit with the client. The nurse asks another nurse if it is acceptable first, and then follows the client’s request. The nurse is acting: (select all that apply) 1)Collegially 2)Dependently 3)Independently 4)Interdependently 5)Cautiously
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Rationale: 1 and 5 are the correct answers. The nurse is asking collegially by asking another nurse on the unit if it is an acceptable practice for a nurse. But the nurse is also acting very cautiously because it is within the standards of independent practice for R.N.s to ensure the comfort and promote restorative actions for the patient. It can be assumed if the patient asks the nurse to contact the clergy that the client sees a benefit to that and the nurse would be helping the client by doing so. |
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A nurse wants to work with the most under-served community in the U.S. The nurse should seek out: 1) A community health center 2) A school based community health center 3) An elder care center 4) An alcohol abuse rehabilitation center |
Rationale: The nurse should seek out a school based community health center (2). Community based health centers are designed to reach the under-served communities in the U.S. Also, the children in these communities are the most under-served as they are victims of health disparities because of race/ethnicity, income, and age. In addition, they are not able to advocate for themselves. |
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A nurse is assisting a client with many complications from bowel surgery The client states that she/he is angry at all the nurses for not taking better care of him/her. The nurse should explain: 1) “You underwent a procedure that had potential for many complications.” 2) “I did tell you that this surgery could be dangerous.” 3) “What issues are giving you the most pain right now?” 4) “You signed the consent form that explained the risks.” 5) “Who do you think is to blame for this?” |
Rationale: The correct answer is 3 because it is open ended and encourages the client to discuss more. The other answers do not truly address the client’s concerns and anger over the complications; they are statements rather than discussion beginners. Option 4 addresses the misconception that because a client has signed a form she/he understands everything stated in that form. Option 5 does not help anyone, it simply passes blame and will not help the client. |
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Which of the following situations involves a patient giving implied consent?
1. A patient who signs a document agreeing to have an appendectomy 2. A patient who holds out his/her arm for a nurse to draw blood 3. A patient who verbally agrees to a bath that will be performed by a nurse 4. An 3 year-old patient whose parent agrees to have ear tubes inserted in the eardrums |
Correct Answer: 2 Rationale: Implied consent exists when an individual's non-verbal behavior indicates agreement, such as positioning the body for an injection. |
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A patient has been receiving intravenous pain medication following a spinal surgery. The patient tells the nurse her surgeon changed the order to an oral form of pain medication and would like to have it as soon as possible. How should the nurse respond?
1. "Yes, it will take me a few minutes to get prepared but I will be happy to switch if that is what you prefer." 2. "Your surgeon did not inform me of the change so I will need to continue giving you the intravenous medication." 3. "I'll have to check the order before I can give you the medication orally." 4. "I'm sorry but I can not change medications once an order has been placed." |
Correct answer: 3 Rationale: Nurses must question any order a patient questions. The nurse must seek clarification of ambiguous orders from the prescriber. Clarification from any other source is unacceptabl |
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In over 50% of seriously-ill patient deaths, miscommunication occurred between patients, families, and physicians regarding end-of-life decisions and patients ended up dying in pain. Which is NOT a factor as to why these situations occur? 1. Medical interventions and biotechnology have increased patient longevity. 2. 80% of Americans die in healthcare institutions, often of chronic illnesses. 3. Medicine has the ability to prolong life and prolong death. 4. Patients inability to make end-of-life decisions on their own. |
Correct Answer: 4 Rationale: Answer 1,2, and 3 are all discussed in the article as factors to situations where end-of-life decisions where misunderstood. According Saulo, "It is no surprise that a great deal of apprehension attends any discussion of death. When a physician announces "There's nothing more I can do," there always is something more." With medicine advancing continually, there is an ability to keep patients alive when otherwise they would have died, but the quality of life is what is the issue and whether or not the patient wants that kind of life. According to the author, "...we need to continue working to capture the voice of the patient and to incorporate their values and beliefs in the decision making process." |
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A nurse from Arizona is working for a few weeks in New Mexico under an interstate compact. A complaint is filed on their behalf after a medication error. According to the Berman textbook, which state(s) is/are responsible for addressing the complaint? 1. Arizona, the nurse’s home state 2. New Mexico, the nurse’s practice state 3. Arizona and New Mexico 4. Neither, the nurse will be charged at the federal level |
Correct Answer: 3 Rationale: According to Berman, complaints and/or violations in states following the mutual recognition model are addressed by the home state and the remote state. It should be noted that the nurse would be held accountable for the nursing practice laws in the state they are visiting (New Mexico) when the error was committed. |
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Healthy People 2020 defines health disparities as:
1. The difference in insurance rates for people in two adjacent communities |
Answer: 2 Rationale: Disparities in health exist between many different sectors of the population. Race or ethnicity, sex, sexual identity, age, disability, socioeconomic status, and geographic location all contribute to an individual’s ability to achieve good health. It is important to recognize the impact that social determinants have on health outcomes of specific populations. Healthy People 2020 strives to improve the health of all groups. |
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You are attending a little league baseball game when a player gets spiked on the top of the hand. You think to yourself that the injury likely requires sutures, and when the child’s parents ask you, you say: Call 911, the medics will know better what to do I can’t really tell you what to do, but I can help you make your own decision. Here are some ideas to think about Wash it off with some water and peroxide and look at it again tomorrow That cut is probably deep enough to warrant stitches, you had better take him/her to the clinic |
Answer: 2 Rationale: Outside of the workplace, a nurse should never give medical advice because they can be held liable for the outcomes. It is better to help an individual make their own decision, but do not tell someone specifically what to do in order to avoid liability and a potential lawsuit. |
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According to the concept of Respondeat Superior, if the facility you work at gets new equipment, who is responsible for making sure staff members know how to properly use the new equipment? Select all that apply: The manufacturer of the equipment is responsible and must provide sufficient training materials The facility is responsible for making sure the staff have an opportunity to learn how to use the new equipment The charge nurse must make sure all staff are trained up on any new equipment The staff must make sure they attend scheduled trainings or make other arrangements in order to be prepared to use the new equipment |
Answer: 2, 4 Rationale: Your employer can be found negligent if they provide new equipment and do not provide proper training opportunities and someone gets hurt due to incomplete employee teaching. Employees can also be negligent if they do not attend required training sessions which lead to injury. |
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A 42 year old patient is newly diagnosed with arthritis. Which of these Healthy People 2020 objectives would lead to improved outcomes for them? Select all that apply. 1. Increase in genetic testing for Lynch syndrome 2. Reduction in the number of hip fractures 3. Reduction in the unemployment rate 4. Increase in counseling for weight reduction |
Correct Answer: 3, 4 Rationale: Working-age adults with arthritis often experience difficulties maintaining employment. Among the objectives for individuals with doctor-diagnosed arthritis is a reduction in the unemployment rate. Additionally, there is a goal for an increase in the proportion of overweight and obese adults who receive health care provider counseling for weight reduction. A reduction in the number of hip fractures is an objective for older adults with osteoporosis, and the increase in genetic testing for Lynch syndrome applies to individuals with a family history of colorectal cancer. |
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Compared to peer countries, Americans have a higher incident rate in which of the following categories? (Select all that apply.) A) Heart disease B) Chronic lung disease C) Adolescent pregnancy D) Disability |
Answer: A,B,C,D Rationale: "The U.S. health disadvantage spans many types of illness and injury. When compared with the average of peer countries, Americans as a group fare worse in at least nine health areas: 1. infant mortality and low birth weight 2. injuries and homicides 3. adolescent pregnancy and sexually transmitted infections 4. HIV and AIDS 5. drug-related deaths 6. obesity and diabetes 7. heart disease 8. chronic lung disease 9. disability" |
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Americans on average have a higher income than in other countries, but have lower rates in which of the following? Select all that apply.
A. poverty B. safety net program benefits C. education of youth D. social mobility
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Answer A.
Rationale: "Although the income of Americans is higher on average than in other countries, the United States also has higher levels of poverty (especially child poverty) and income inequality and lower rates of social mobility. Other countries are outpacing the United States in the education of young people, which also affects health. And Americans benefit less from safety net programs that can buffer the negative health effects of poverty and other social disadvantages." |
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Which of the following is a principle pertinent to mediation?
A. setting an agenda for the case B. the nurse leaders final verdict C. the neutrality of all parties involved. D. data evaluation and definitive conclusions |
Answer A. Rationale: Setting an agenda is a necessity for mediation as time is precious, and planning is helpful in maintaining the participants commitment and focus. |
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A nurse is waiting for a patient file to be faxed from a clinic. When the expected file arrives the nurse receives a sexually explicit photograph with an obscene joke instead of the requested lab results. Which is the first action the nurse must take? Shred the inappropriate photograph. Call the clinic and ask who sent the photograph. Call the nursing supervisor. Post the photograph in the break room. |
Correct Answer: 3. Rationale: Ensuring a safe workplace is a responsibility of an employing institution. Sexual harassment in the workplace is prohibited by state and federal laws. Sexually suggestive jokes, and open displays of or transmitting sexually oriented photographs are examples of unprofessional conduct. These concerns should be reported to the nursing supervisor immediately. |
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The nurse is giving hand-off report to the night shift nurse and notices the night shift nurse is slurring words and has breath that smells of alcohol. Which is the most appropriate action by the nurse? 1. Call the police. 2. Threaten to report the nurse. 3. Call the nursing supervisor. 4. Tell the night shift nurse to go home. |
Correct answer: 3 Rationale: Nurse practice acts require reporting impaired nurses. This incident needs to be reported to the nursing supervisor, who will then report to the board of nursing and other authorities, such as the police, as required. |
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A six year old patient has been in foster care for the last 6 months. He arrives to the Emergency Department after a car accident and requires emergency surgery. Who is authorized to consent for the procedure? The foster father the child lives with. The social worker who placed the child in the home. The registered nurse caring for the child. No consent is needed. |
Correct Answer: 4 Rationale: Consent is implied in a medical emergency when an individual cannot provide express consent because of physical condition. |
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A nurse receives orders to insert a nasogastric tube. Before doing so what should the nurse say to the client? (Select all that apply)
a) “This tube will allow you to safely get the food and medicine you need.” b) “Inserting this tube may be uncomfortable but it should not hurt.” c) “Because of your condition, having this tube inserted is necessary.” d) “In some cases the tube can cause tissue damage during insertion.” |
Answer: a,b,d
Rational: The nurse must gain informed consent. In this case “a” represents explaining the purpose of the procedure, “b” is letting the client know what to expect, and “d” is sharing the possible risks of the procedure. C is wrong because the client must decide what is necessary; it is the nurse’s role to offer the advantages and disadvantages of alternative treatments. |
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A nurse manager is educating the nursing staff on the objectives of Health People 2020. Under what circumstances does the manger recommend educating clients about the benefits of genetic testing? (Select all that apply)
a) The client has a high-risk family history of breast cancer. b) The client has a high-risk family history thyroid cancer. c) The client has a high-risk family history colorectal cancer. d) The client has a high-risk family history of osteosarcoma. |
Answer: a and c
Rational: Healthy people 2020 recommends genetic testing for clients with high-risk family histories of breast, ovarian, and colorectal cancer. |
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A nurse observes that a post-operative client’s temperature has spiked to 102. Before addressing the change in vitals, the nurse is pulled into an urgent matter in another room and forgets about the temperature change. The client suffers a severe infection requiring an extensive hospital stay. Which of the categories of negligence describes the nurse’s actions? (Select all that apply)
a) Failure to use equipment in a responsible manner b) Failure to communicate c) Failure to document d) Failure to asses and monitor |
Answer: b,c,d
Rational: The nurse fails to document and communicate with the client’s provider which are examples of failure to communicate, document, and asses and monitor.
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In the “U.S. Health in International Perspective” article, what American health behavior contributes to “Why Are Americans So Unhealthy?” A) Alcohol consumption rate B) Calorie consumption rate C) Domestic violence rate D) Tobacco consumption rate |
Answer: B Rationale: “Although Americans are currently less likely to smoke and may drink alcohol less heavily than people in peer countries, they consume the most calories per person, have higher rates of drug abuse, are less likely to use seat belts, are involved in more traffic accidents that involve alcohol, and are more likely to use firearms in acts of violence.” |
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A nursing student is being questioned after administering the incorrect dose of medication. Their response is, “It was only Ibuprofen, the patient is fine.” How might the clinical coordinator interpret this statement? Select all that apply.
A. conclude that the nursing student had good intentions B. conclude that the nursing student was exhibiting self serving behaviors. C. decide that since there was no harm to the patient, no action will be taken. D. determine that the nursing student demonstrated a lack of knowledge of basic nursing care. |
Answer: B, C. Rationale: The nursing student appears to be justifying their actions, and not taking responsibility. This sets a tone of distrust. Additionally, their statement suggests a lack in basic knowledge of care. |
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During surgery, a nurse fails to remove a surgical sponge. As a result of the nurse's action, the patient suffers from severe abdominal pain. The nurse can be charged with which of the following? A. Defamation |
Correct answer: C Rationale: Malpractice requires six elements-duty, breach of duty, foreseeability, causation, harm or injury, and damages. In this scenario, the nurses's professional misconduct resulted in injury to the client. |
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According to Healthy People 2020, which of the following factors are identified as the social determinants of health? Select all that apply. A. Public safety |
Correct answer: A, D Rationale: Social determinants of health includes conditions in whcih people are born, live, learn, play, work and age. Examples of social determinants include public safety, quality schools, social support and interactions, socioeconomic conditions, transportation options, and residential segregation. Tobacco, alcohol, and other drug use(B) and hand washing(C) are examples of individual behavior determinants. |
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Prior to abdominal surgery, a client is asked to sign a consent form. Which of the following tasks are the nurse's responsibilities as a witness that attest to the client's signature on the consent form? Select all that apply. A. Explaining the risks and benefits of surgical procedure. |
Correct answer: B, D Rationale: The nurse should confirm whether the client gave consent voluntarily, the signature is authentic, and the client appears competent to give consent. The nurse is not responsible for explaining the risks and benefits of medical or surgical procedure(A). Obtaining informed consent is the responsibility of the person performing the procedure(C). |
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Falling for an older adult can cause severe disability such as breaking a hip or an arm. For an older adult an injury from a fall can lead to: A. Risk taking behavior B. Sedentary behavior C. Higher Quality of Life D. Improved mental functioning |
Correct answer: B Rationale: After a fall where there is injury older people become more fearful that they will fall again so they tend not to walk, exercise or take any risks that may involve the possibility of falling again. A, B & D are the opposite of what can happen. |
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The primary care provider has asked a nurse to witness a client’s signature on a consent form. What does the nurses’ signature on the consent form confirm? Mark all that apply: A. The client appears competent to give consent B. The client is giving consent and it is involuntary C. The nurse has explained the procedure so the client understands D. The family members have been informed of the procedure |
Correct answer: A Rationale: The nurse’s signature as a witness only confirms the competency of the client, the client’s signature is authentic and voluntary. B- is the opposite of voluntary, C&D – the nurse is not responsible for explaining the medical/surgical procedure and can be liable for interfering in the client–provider relationship if they do. |
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A client is refusing to have a feeding tube inserted, because it is ordered by the primary care provider the nurse insists and inserts the tube anyway. What is the nurse legally guilty of in this scenario? A. An unintentional tort B. Gross negligence C. Assault D. Battery |
Correct answer: D Rationale: Because the nurse willfully touched the client without permission it is battery. A & B - are acts that are unintentional. C – is an attempt or threat to touch another person without permission |
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During a health history, a client relates having trouble sleeping more than 20 nights a month.The client feels this chronic sleep deprivation may be contributing to poor health and asks the nurse if there could be a correlation. Which of the following is the nurse's best response? 1) "Adequate sleep is necessary to fight off infection, support the metabolism of sugar to prevent diabetes, and work effectively and safely." 2) "The amount of sleep does not affect an individual's health regarding disease or disease prevention, but does affect mental alertness." 3) "The amount of sleep does not affect any endocrine, metabolic, and neurological functions that are critical to individual health." 4) "Sleep health is only a particular concern for individuals with chronic disabilities and disorders such as arthritis, kidney disease, and pain." |
Correct answer: 1 Rationale: Answer 1 is correct as noted from Healthy people 2020 in sleep health "Adequate sleep is necessary to: Fight off infection. Support the metabolism of sugar to prevent diabetes, Perform well in school, Work effectively and safely". Answer 2 is wrong because amount of sleep does affect disease and disease prevention. Answer 3 is wrong because "sleep timing and duration affect a number of endocrine, metabolic, and neurological functions that are critical to the maintenance of individual health." Answer 4 is the close distractor but is incorrect because of the word "only" as sleep health is a concern for everyone not only those with chronic disabilities and disorders. "Sleep health is a particular concern for individuals with chronic disabilities and disorders such as arthritis, kidney disease, pain, human immunodeficiency virus (HIV), epilepsy, Parkinson’s disease, and depression." Read the answer choices CAREFULLY as the words NOT and ONLY make the choices 2,3,4 wrong although the content is correct if those words are overlooked! |
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Which of the following would a registered nurse collect as comprehensive data pertinent to a client's health? Select all that apply. 1) Physical, functional, sexual, and cognitive assessments of the client 2) Cultural, spiritual, psychosocial, and emotional assessments of the client 3) The client's values, preferences, expressed needs, and health knowledge 4) Financial, literacy, communication, and environmental assessments of the client |
Correct answer: All of the above! Rationale: All of the answers are comprehensive data which are pertinent to the client's health that a registered nurse should collect as listed on page 32 of the Standards of Professional nursing practice. |
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A student nurse just completed the National Council Licensure Examination test for the first time, but has not yet received the results. A client at the clinic expresses concern about the student nurse's lack of registered nursing license. Which of the following is the student nurse's best response? 1) "I have an interim permit which allows me to practice nursing while waiting for the results." 2) "I can practice nursing for up to one year after taking the test and finishing nursing school." 3) "A physician checks all of my nursing work to make sure it is done correctly and completely." 4) " I received straight A's in all my nursing courses and will never make a mistake." |
Correct answer: 1 Rationale: According to the Nursing Practice Act, "the board issues interim permits authorizing the applicant to practice nursing pending the results of the first licensing examination following completion of his or her nursing courses or for a maximum period of six months, whatever occurs first." Answer 2 is the close distractor as the interim permit allows the student to practice after completing nursing school requirements and taking the national licensing test for up to 6 months, NOT one year because the interim permits are not renewable for any additional length of time. |
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A preceptor requests a university review the clinical performance of a nursing student due to questionable moral conduct. According to the “Ethics in Practice” article, what obligation/s does the university have to protect the public? (Select all that apply) A) The university must advocate for the best interests of society and the vulnerable patient. B) The university acts as teacher and advocate for the student while determining his/her intent. C) The university must clarify the student’s demonstration of critical thinking and ethical behavior. D) The university must distinguish the student’s early mistakes from a lack of moral character. |
Answer: A, C, D. Rationale: A) “the best interests of society (the needs of the vulnerable patient) must come first.” p.17. C) “What is critical in these decisions is the clarity that faculty have about how students demonstrate critical thinking and ethical behavior. p.18. D) “There is a need to separate early student mistakes from a lack of moral character.” p.17. |
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A competent adult patient had a pre-op consult for a deviated septum. The patient was offered the opportunity to also straighten the lower part of his nose that was the result of an old injury. The patient declined the additional procedure. However, shortly after patient was given medication for sedation, he changed his mind and requested the additional procedure. What action should be taken?
b) Since the patient previously declined the additional procedure, he is no longer eligible to have the procedure done. c) Since the patient is not considered competent at the time he requested the procedure, the doctor should refuse to do the additional procedure. d) Since the patient is a competent adult who is conscious and oriented, the doctor should perform the procedure as requested. |
Correct Answer: (c)
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A student nurse is asked to perform an unfamiliar procedure. Upon hesitation the buddy nurse advises that it is o.k. because the hospital policy allows it. Why should the student nurse refuse to do the procedure? a) A student nurse should never do something they aren't sure about. |
Correct Answer: (a)
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Which of the following are likely to result in a malpractice lawsuit? Select all that apply.
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Correct Answer: (a), (b), (c), (d), and (e)
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A student nurse is assigned to Lily, an experienced registered nurse, for their clinical rotation in the medical-surgical unit. Lily, refused to talk to the student nurse, or address the student by name, until they came upon a client who had soiled himself, and she said, “You! Clean him up.” Lily then rolled her eyes, walked over to the nurses’ station and laughed with her friends about “breaking in the newbie and showing the student their place.” This behavior falls under: (select all that apply) Nonverbal cues Verbal remarks Humiliation Withholding information
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Answer: 1,2,3 Rationale: Nonverbal cues (1) can be overt and covert, in this case Lily “rolls her eyes” which is a manifestation of a nonverbal cue of bullying. She made verbal remarks (2) an overt action of bullying, whereby she seemed too important or busy to take care of the task and finally, humiliation (3) Lily never addressed the student by name and made fun of her status as a novice with her friends at the nurse station. |
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Name calling, bickering and gossiping are three examples of: Overt Covert Illegal Severe
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Answer: 1 Rationale: this is specifically a type of overt verbal remarks, these can be “Sine, rude, and demeaning comments” or “abrupt responses to honest questions. |
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While at a swimming pool with friends, a nurse watches as a little boy jumps off of a table top and lands on the side of his ankle. The ankle swells immediately and the child’s mother asks the off-duty nurse what she should do. How should the nurse respond? Take the boy immediately to the emergency room Call Emergency Medical Services Ask the mother what she thinks she should do Apply her knowledge of RICE: rest, ice, compression, elevation
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Answer: 3 Rationale: Outside of the workplace, the nurse is not covered by liability insurance (unless they carry their own personal liability insurance). Any advice or assistance given could lead to being held liable and being sued. It is always better to ask questions and help the person arrive at their own decision. |
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An off duty nurse stops at the scene of an accident. The person involved in the accident is unconscious and in need of emergency services. The nurse is free to leave the scene if... A. emergency services have been contacted. B. the injured person becomes stable. C. an off duty doctor arrives on the scene and offers to take over. D. an off duty EMT arrives on the scene and offers to take over. |
Answer - D Rationale - The nurse must remain on the scene until someone of equal or higher level arrive. In this situation an EMT or paramedic is of higher level because they have been trained to deal with emergency situations. While a doctor has a higher level of training than nurses on most accounts, they may not be trained to deal with an emergency situation as well as an EMT. |
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A nurse inadvertently gives a patient three times the dose of their medication. The patient has no complications, but wants to sue the nurse for their mistake. The attorney representing the patient... A. has a case to sue since the nurse made a clear medication error. B. has no case to sue since the patient was not harmed. C. has a case to sue since the patient could have been harmed. D. has no case since the nurse documented the mistake in the patient's chart. |
Answer - B Rationale - In order for a nurse to be sued the patient must actually be harmed. Even though the nurse made a huge error by giving the patient the wrong dose of medication, the patient can not sue since they had no adverse effects. |
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Which of the following is an example of a patient receiving informed consent before a surgery? A. A nurse giving detailed information about the surgery the day before the procedure. B. The patient receiving and signing a consent form. C. A interpreter explaining the consent form to a patient with language barriers. D. The performing physician going over the details of the surgery immediately before the procedure. |
Answer - D Rationale - Informed consent must be given by the person performing the procedure. The information should include benefits, risks, alternatives and prognosis. |
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What is the difference between negligence and malpractice? (Select all that apply) 1. Negligence and malpractice are considered to be the same 2. Malpractice is defined as professional negligence 3. Negligence refers to omission while malpractice refers to commission 4. Malpractice is defined as the intent of being negligent |
Correct answer: 2 |
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There are standards in place for Nursing students and Registered Nurses. Which of the following statements is true? 1. There are different standards in place for Registered Nurses and Nursing students 2. The standards are the same for Registered Nurses and Nursing students 3. Registered Nurses have more responsibility therefore they have higher standards to follow 4. Universities cover the liability of Nursing students therefore there are no standards to follow |
Correct answer: 2 |
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Mary, Elizabeth, and John have been working at the hospital together for the past ten years. They have formed a close group, but consistently and purposely exclude new nurses from interacting with them. Which type of violent behavior are the experienced nurses exhibiting? 1. Purposefully sabotaging 2. Group infighting 3. Scapegoating 4. Passive-aggressive behavio |
Correct answer: 2 |
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The Patient Self-Determination act 1. Requires hospitals to inquire if patients have an advance directive 2. Requires physicians to initiate any course of treatment the patient desires 3. Requires nurses to communicate the patient’s wishes to their families 4. Requires the patient to select a health care proxy |
Correct Answer: 1 Rationale: The Patient Self-Determination Act “requires all hospitals, nursing homes, health maintenance organizations, and home health agencies to inquire whether their patients have executed an advance directive,” (p.55) |
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A nursing student working at a clinical placement is observed taking a patient’s blood pressure incorrectly on more than one occasion. Which of the following are appropriate responses by the hospital administrator? (select all that apply) 1. Report the incident to the student’s nursing school 2. Ask the nursing school to retrain the student 3. Immediately terminate the student for incompetence 4. Ask the nurses working during the student’s shifts to train the student |
Correct answer: 1, 2 |
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According to the Center for American Nurses (2008), horizontal violence jeopardizes which of the following? (select all that apply) 1. nurse retention 2. nurse moral 3. quality of care 4. patient safety |
Correct answer: 1, 3, 4 Rationale: Walrafen, Brewer & Mulvenon (2012) state, “the Center for American Nurses (2008) published a position statement acknowledging the affects [of horizontal violence] on patient safety, quality of care, and how this phenomenon directly affects the organization’s and profession’s ability to attract and retain nurses,” (p. 7) |
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A nurse agrees to bring a glass of hot water to another nurse’s client. The nurse warns the client “this will be hot” but the hard of hearing client does not hear them, spills the glass and suffers a minor burn. According to the lecture on Ethics by Dr. Berman, which of the five elements of negligence is present in this case? Select all that apply.
1. Breach of duty 2. Proximate Cause 3. Duty of care 4. Harm or injury |
Correct Answer: 3, 4 Rationale: Though the nurse is not specifically assigned to this client, they have a general duty of care to them. The nurse was following the standard in warning the client of the heat of the glass (there was no breach of duty), but the client still suffered an injury. There was no proximate cause because the injury was not a direct result of them not following a standard. |
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A nurse was asked to witness a client’s signature on the consent form for a surgery. The nurse’s signature on the consent form confirms which of the following (Select all that apply): 2) The nurse witnessed that the client gave consent voluntarily. 3) The nurse witnessed that the signature was authentic. 4) The nurse witnessed that the client was competent to give consent. |
Correct Answer: 2),3) and 4) Rationale: 1) The nurse is not responsible for explaining the surgical procedure but the person performing the surgery is. The person performing the procedure is responsible for obtaining informed consent form. The nurse may be asked to witness the client’s signature on the consent form and the nurse’s signature on the form confirms 2),3) and 4). |
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A nursing student observed care provided to a client without the client’s permission. This is an example of: 1) Slander 2) Assault 3) Battery 4) Invasion of privacy |
Correct answer: 4) Invasion of privacy. Rationale: Unreasonable intrusion involves observation of client without the client’s permission. Unreasonable intrusion is a type of invasion of privacy of the clients. |
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According to Healthy People 2020, which of the following are included in Respiratory Diseases objectives? (Select all that apply) 1) Reduce asthma deaths among adults. 2) Reduce asthma deaths among children. 3) Reduce deaths from chronic obstructive pulmonary disease (COPD) among adults. 4) Reduce deaths from chronic obstructive pulmonary disease (COPD) among children. |
Correct answer: 1) 2) 3) Rationale: 4) Reducing deaths from chronic obstructive pulmonary disease(COPD) among "children" is not included in Respiratory Diseases objectives in Healthy People 2020. 1)2) and 3) are Respiratory Diseases objectives in Healthy People 2020. |
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A nursing student is assigned to work at an emergency department; he/she feels that every time he/she approaches his/her preceptor for questions the preceptor leaves. The nursing student responds to this situation by: 1. Telling these situations to charge nurse 2. Confronting his/her preceptor privately 3. Keeping these situations as private 4. Complaining to the hospital director |
Correct answer: 2 Rationale: “It appears that a behavioral intervention (e.g., immediate confrontation) positively influenced changes in actions of later- ally violent nurses.” |
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A nurse gives his/her patient, at the patient’s request, an overdose of a medication that kills the patient. The nurse was participant of: 1. Passive euthanasia 2. Assisted suicide 3. Active euthanasia 4. Active suicide |
Correct answer: 2 Rationale: “A variation of active euthanasia is assisted suicide, or giving clients the means to kill themselves if they request it (e.g., providing lethal doses of pills.)” |
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A nursing student fails to wash his/her hands between examining patients. His/her preceptor confronts the nursing student; however he/she continues with this conduct. The preceptor’s response is: 1. Order the student to go home 2. Report to the nurse manager 3. Force the student to wash hands 4. Report incident to hospital director |
Correct answer: 2 Rationale: Any concerns the staff nurse has they have to be first reported to the nurse manager |
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The nurse in charge of the nursing students notices that one of the students fails to wash his or her hands before taking a client’s vital signs. What action should the nurse take? Report the incident to the nursing student’s school Turn in a formal report to the hospital supervisor Report the incident to the charge nurse Approach the student and identify the problem |
Correct Answer: 4 Rationale: Addressing the issue with the nursing student is the first step that needs to be taken, it is important that the nursing student understands what he or she did wrong in order to take actions to correct the behavior. If the nursing student does not correct the behavior, further action would be necessary. |
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What are the controllable risk factors for heart disease and stroke? Select all that apply. Family history Diabetes Age High blood pressure |
Correct Answer: 1 and 4 Rationale: Diabetes and high blood pressure can be modified by making lifestyle changes, i.e.: diet and exercise. Family history and age are uncontrollable risk factors. |
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In order to improve the health of its population, the United States must take serious action to address which of the following behaviors? Using firearms Smoking cigarettes Driving at night Controlling blood pressure |
Correct Answer: 1 Rationale: The United States is more likely to use firearms to perform violent acts than other countries. Smoking cigarettes and controlling blood pressure are important health topics but the United States actually ranks higher than other countries in managing these issues. Driving at night is not a behavior of concern but driving drunk is. |
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A nurse is consistently criticizing and bullying a novice nurse, The new nurse complains to the head nurse and claims horizontal hostility? What is this phenomenon? 1. Nurses being mean to each other at work. 2. Two nurses on the same professional level fighting. 3. A pattern of behavior designed to diminish another. 4. Physical or verbal assault against a co-worker. |
Answer: 3 Rationale: The definition of horizontal hostility is people believing, acting on, or enforcing the dominant system of discrimination and oppression. |
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A student nurse is caught name-calling, gossiping, and bickering. The charge nurse informs the student that she is exhibiting what type of hostility? 1. overt 2. covert 3. severe 4. illegal |
Answer: 1 Rationale: Overt behaviors are those which are directly observable, In this case name-calling, gossiping, and bickering. |
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A nurse instructed a client to remain in bed. The client got up and fell. What information should the nurse not include in the report ? 1. Names of any witnesses. 2. That the nurse left the room. 3. That the client received a sedative. 4. That the client disregarded the nurse's instructions. |
Answer: 4 Rationale: The nurses report should include: client identifying information, date, time, place of incident, facts of incidence, any witnesses, medication taken, and clients statement. Placing blame on the client should not be included. |
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A patient reports an allergy to morphine when asked by their nurse, but their chart states "No Known Allergies". The prescribing physician has asked that the patient receive and injection of morphine. What initial steps should the nurse take? Select all that apply. A. Give the patient Benadryl & administer the Morphine. B. Ask the patient what happens during their allergic reaction. C. Contact the prescribing physician to notify them of the allergy. D. Update the patient's chart and wristband to reflect the allergy. |
Correct Answer: B, C, D. Rationale: Although it is possible that the patient's reaction to the drug is minimal and the prescribing physician may decide to administer the medication, the initial steps would be to ask the patient what their reaction to the drug in question consists of, contact the prescribing physician to notify them of the allergy and figure out the next step and update their chart and bracelet to reflect the allergy so the same mistake is not made in the future. |
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A new graduate speaks with the charge nurse about bullying that occurring in the hospital. Why is it in the charge nurse's best interest to handle the bullying issue immediately? Select all that apply. A. Horizontal violence in the workplace makes it difficult for an organization to improve the care they provide. B. Horizontal violence in the workplace makes it difficult to provide or create a satisfied work force. C. Horizontal violence in the workplace is the leading cause of depression and suicide among new nurses. D. Horizontal violence in the workplace makes it difficult to attract the most desirable employees. |
Correct Answer: A, B, D, Rationale: Horizontal violence in the workplace is not listed as the leading cause of depression or death among new nurses, but all three of the other answers are accurate. |
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According to the article, "Combating Disruptive Behaviors: Strategies to Promote a Healthy Work Environment", what is the best way for employers to combat disruptive behaviors among healthcare workers? A. Do nothing because reporting this behavior could reflect negatively on the hospital. B. Take a zero-tolerance stance toward disruptive behaviors. C. Provide a counseling office where employees can safely discuss their grievances. D. Initiate a three-strikes rule to warn aggressors and protect victims of disruptive behavior. |
Correct Answer: B. Rationale: According to this article, hospitals should take a zero-tolerance stance toward disruptive behaviors to protect their nurses. |
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A nurse knows that while looking at family history, which of the following inflictions are effected by genomics? Select all that apply. a) Heart Disease b) Alzheimer's Disease c) Tuburculosis d) Stroke e) Diabetes |
Answer : A,B,D,E. Rationale: All of the above inflictions with the exception of tuburculosis are effected by genomics. |
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Although the client verbally refused an invasive catheter, the nurse insisted and put in a foley catheter in the client. The client sued, and the hospital decided to settle the lawsuit because they decided that the nurse would most likely be found guilty of which of the following? A)slander b) battery c) gross negligence d) assault |
Answer: b Rationale: Battery is defined as the willful touching of a person that may or may not cause harm, and when done without permission, it can be liable for suit. This action isn't gross negligence, because the nurse didn't exhibit a lack of knowledge or skill, it isn't assault because assault would have been the nurse threatening to put in a foley cath, and it isn't slander, because it isn't defamation by the spoken word |
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A nurse sees that a primary care provider has prescribed two medications to a patient that the nurse believes to be contraindicated. What should the nurse do in this situation?
a) report provider to board of health b) report concern to head nurse c) call the prescribing provider d) give the patient the medication |
Answer: c Rationale: The nurse should contact the person who wrote the order so they can clarify and alleviate their concerns. A is a bit too much as a first reaction, B doesn't deal well with the problem at hand, and D is just silly. |
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According to Dr. Berman, which three steps must be taken before giving a medication to a client? Checking the client’s chart for allergies, checking the client’s wristband for allergies, and asking the client if they are allergic to the medication. Checking the client’s chart for allergies, asking the physician what allergies the client has, and asking the client if they are allergic to the medication. Checking the client’s wristband for allergies, asking the physician what allergies they have, and asking the client if they are allergic to the medication. Asking the client if they are allergic to the medication, asking the other nurses what allergies the client has, and checking the client’s chart for allergies. |
Correct answer: A Rationale: You do not need to ask the physician about the client’s allergies(they may not even know). The other nurses could know but it is currently your client and you are responsible for checking the chart, the wristband, and asking the client. |
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Which of the following needs to be included when getting informed consent for treatment from a client? Select all that apply. Prognosis if not treated Risks and benefits Alternative options Cost of treatment |
Answer: a,b, and c should all be mentioned before getting consent from a client. D could be discussed but is not required. |
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Which of the following scenario(s) gives an example of an impaired nurse? Select all that apply. a. The nurse cannot perform her essential job functions because he/she is distracted by her personal problems at home. b. The nurse cannot perform her essential job functions because he/she is under the influence of alcohol. c. The nurse cannot perform her essential job functions because he/she has a psychiatric disorder. d. The nurse cannot perform her essential job functions because he/she is too emotionally attached to the client. |
Answer: b and c. Rationale: An impaired nurse refers to a nurse's inability to perform essential job functions because of chemical dependency on drugs or alcohol, or mental illness. |
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Malpractice lawsuits may result from one of six Categories of Negligence. Specifically regarding ‘failure to act a client advocate,’ which of the following scenarios falls under that category? a) Listen to a client’s complaints and act on them. b) Observe a client’s ongoing progress c) Question incomplete or illegible medical orders d) Implement a plan of care |
Answer. c Rationale: a) this falls under ‘failure to communicate.’ b) and d) fall under ‘failure to assess and monitor.’ Choice c) exhibits client advocating, since incorrect execution of a physician’s orders can lead to a negative patient outcome. |
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A cardiac nurse practitioner’s brother is undergoing open heart surgery at the hospital where he/she is currently employed. After complications arise, he/she wants to assist. What is the most appropriate practice? a) The nurse can ask the operating room nurse for updates b) The nurse can obtain a signed release form to view the chart c) The nurse may speak with the surgeon with whom he/she routinely works d) The nurse may assist since it could provide a positive patient outcome |
Answer. b Rationale: The only person entitled to information without written consent is the client and those providing direct care. Nurses only have access to information regarding their assigned clients. |
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Nursing students are expected to fulfill responsibilities to clients and minimize his/her chances for liability. Which of these options best helps him/her accomplish this? Select all that apply. a) Comply with the policies of the agency in which they perform clinical work b) Comply with the policies of the school of nursing they represent c) Perform all tasks for which they have received instruction or have experience d) Perform only the tasks in which they feel adequate to carry out |
Answer. a), b), and d) Rationale: Having prior experience does not give the nursing student a right to perform a task they have performed previously. In all cases, school and hospital policy must be observed regardless of the student’s past experience. |
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A nurse is reviewing discharge instructions with the caregiver of an older adult who is being discharged from the hospital after having a broken hip repaired. What concerns should the nurse inform the caregiver to look out for? (Select all that apply):
Sedentary behavior Anger Limiting regular activities due to fear of falling Thrill seeking |
Correct Answer: 1 and 3 Rationale: According to the Healthy People 2020 when an older adult falls and suffers an injury from that fall, they begin to fear falling again, so they limit their regular activities, and as a result begin to live a sedentary lifestyle, which after a period of time decreases their muscle mass and mobility and that puts them at a greater risk to fall again. |
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A nurse is called into a client’s room to be a witness to the signing of a consent form. The client is currently medicated with heavy doses of dilaudid and is drifting in and out of consciousness. The spouse grabs the form and signs it since the client is not able to. What is the nurse's best reaction to this situation? Sign on the witness line; the nurse knows the patient would want the procedure anyway. Sign on the witness line, but write an explanation of what happened next to the signature Not sign on the witness line and go inform the charge nurse of what happened. Not sign on the witness line and go notify the health care provider of what happened. |
Correct Answer: 4 Rationale: According to Berman and Snyder, if a nurse has any doubts about the clients understanding of a procedure or if it is not in fact the client who signs the form, the nurse must not sign on the witness line of the consent form and must inform the health provider of what happened. |
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A newly graduated nursing student is in the middle of their first year as a registered nurse and is working on a medical/surgical floor. The new graduate tells their mom that they are getting ready to quit the new job and apply at another hospital. What would be some common reasons for this decision? (Select all that apply) No challenge Job Conflict Too much work stress |
Correct Answer: 2 and 4 Rationale: According to Martha Griffin, job conflict and stress are the biggest problems that new nursing school graduates face in their first year of nursing. These problems are often a result of nurse/nurse lateral violence in the work place. |
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A hospital client is unhappy with his/her assigned nurse who’s behavior is unprofessional. The client states his/her complaints to another recently employed registered nurse (RN). This nurse is reluctant to report the complaint to the charge nurse. According to Dr. Mileva Lewis, what issues prevent the RN from carrying out their advocacy role? (Check all that apply) A. Fatigue and frustration B. Fear of loss of employment C. Lack of support D. Institutional constraint E. Fear of loss of friends F. Fear of being ignored |
Correct Answer: A, B, C, D. Rationale: Fear of loss of friends and being ignored are not included in the list of issues preventing the RN from carrying out their advocacy role. |
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The client informs the home health nurse the phone isn’t working and that this is a problem in case there is an emergency. Which of the following demonstrates the nurse as a patient advocate? Reporting to the financial advisor immediately Notifying the client’s health care provider Taking the client to the store to buy a new phone Ignoring the client’s requests for a new phone |
Correct Answer: a. Report to the financial advisor immediately Rationale: “In mediating, the advocate directly intervenes on the client’s behalf, often by influencing others”(Berman, 93). In this case, the home health nurse should report to the financial advisor immediately in order for the client to obtain funds for a new phone, regardless if it is the client’s family or a conservator. The client’s health care provider does not need to be notified as this does not pertain directly to the client’s health. Buying the client a new phone is not necessary and ignoring the client’s request for a new phone does not demonstrate advocacy. |
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A client’s blood pressure of 190/98 was recorded by the student nurse. The client’s blood pressure had been within normal limits prior, yet the student nurse failed to report to the preceptor. Which of the following actions should the preceptor take? Select all that apply. Notify the charge nurse Notify the clinical instructor Suspend the student File an incident report |
Correct Answer: a, b Rationale: If a student fails to complete his/her tasks, the preceptor should notify the charge nurse and clinical instructor in order to review the student’s performance because “A documented history or pattern of behavior provides faculty greater confidence in making a decision with grave consequences”. Suspension of the student may only be necessary if, during the practice review process, the violation is deemed serious enough to warrant student suspension. An incident report will only be filed if harm were done to the patient. |
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Which of the following can enhance ethical decisions and practice? Select all that apply. Serve on institutional ethics committees Put others’ values before your own Memorize the nursing codes of ethics Participate or establish ethics rounds Seek continuing education about ethical issues |
Correct Answer: a, d,e Rationale: The nurse can serve on institutional ethics committees in order to become more familiar with the ethical decisions and practices of others. It is important for the nurse to recognize that his or her own values may be different from others’ but this does not necessarily mean they have to be put after the values of others. The nurse should be familiar with the nursing codes of ethics, but does not have to memorize the codes of ethics. Participating or establishing ethics rounds and continuing education will expand the nurses’ knowledge of ethical issues in nursing and in patient care. |
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A hospital client, awaiting a procedure, asks the nurse if he/she will be able to go home in a day. What is the nurse’s best response to this question? A. “Good question. I will find out before you go into pre-op” B. “Yes, If all goes well you will be able to leave tomorrow.” C. “I’m really not allowed to discuss the details of your discharge” D. “Life is unpredictable, we can’t be certain when you will leave” |
Correct Answer: A Rationale: You can’t give an answer to a patient that could possibly interfere with their decision on a procedure, doing so is considered an invasion of client/physician relations. It would be better not to let them know when they will be leaving until they are are about to do their procedure. The nurse wouldn't want them changing their mind about the procedure based on the time of discharge. |
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A client suffering from diabetes and obesity tells the nurse he is trying eat healthier so he can lose weight. When the nurse asks about his typical diet, he explains that he enjoys McDonalds Big Macs because they have a lot of protein. He also reveals that he doesn’t eat many fruits or vegetables because he doesn’t like the taste. The nurse notices that his behavior is inconsistent with his stated value of being healthy. What are some ways the nurse can clarify this client’s values? (select all that apply)
a. Ask the client if he has considered a healthy meal delivery service. |
Answer: A, B, D |
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A nurse wants to delegate a task to an Unlicensed Assistive Personnel (UAP). Which of the followings should be considered before the nurse makes the delegation decisions? (Select all that apply)
1. The task is within the UAP’s range of functions. 2. The UAP has appropriate knowledge, skill and abilities to accept the delegation. 3. The employer’s policies for delegation support the delegation. 4. The nurse can delegate the task to the UAP in an emergency. |
Correct Answer: 1, 2, 3 Rationale: The nurse cannot delegate a task to the UAP if they do not have the proper support of the employer’s policy even in an emergency. |
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A nursing student with previous Unlicensed Assistive Personnel (UAP) experience decides to help the preceptor nurse with a Foley Catheter with the consent of the clinical instructor. Which best describes this action against the patient? 1. Assault 2. Battery 3. Defamation 4. Malpractice |
Correct Answer: 2 Rationale: Consent is required before procedures are performed. Battery exists when there is no consent, even if the plaintiff was not asked for consent. Unless there is implied consent, such as in life-threatening emergencies, a procedure performed on an unconscious client without informed consent is battery. |
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A nurse employee is demanded to float to a different department at the last minute by an assistant manager due to a shortage of nurses. The nurse rightfully denies the assignment and is sternly lectured in front of peer employees. Why would employees feel reluctant to report these types of disruptive behaviors? (Select all that apply.)
1. Lack of information regarding help 2. Lack of managerial follow-through 3. Fear of losing relationships with manager 4. Too busy with patient care |
Correct Answer: 1, 2 Rationale: One of the reasons that disruptive behaviors have been allowed to flourish is that often employees are reluctant to report these behaviors. Reasons for this reluctance include concern for their job, fear, lack of confidentiality around the report, lack of managerial follow-through on complaints of disruptive behaviors, and lack of information regarding where to get help. |
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A nurse neglects to obtain a client’s consent prior to inserting a Foley catheter. This is an example of which intentional tort? a. Assault |
Answer: D |
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A nurse is concerned that a colleague may have developed a substance abuse problem. What would be considered a warning signs the nurse may be observing? (select all that apply) a. The colleague appears to be more social than they were a couple months prior. |
Answer: B, C, D |
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A nurse is experiencing difficulties with his/her co-workers. Subsequently he/she is considering leaving his/her place of employment. According to Joy Longo, what is the most frequently reported type of disruptive behavior among healthcare workers? A. Emotional-verbal abuse B. Sexual abuse C. Physical abuse D. Drug abuse |
Correct Answer: A Rationale: According to Joy Longo, this is the most frequently reported type of disruptive behavior. |
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In which area are evidence-based interventions for addressing disruptive behaviors being developed? |
Correct Answer: a |
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Between which two behavioral stages should interventions be applied to effect change according to investigations in horizontal violence?
A) Behavior consequences & individuals learn new behaviors B) Individuals models behaviors & individuals learn new behaviors C) Individuals reflect on previous actions & individuals learn new behaviors D) Groups model behaviors & individuals learn new behaviors |
Correct Answer: B
Rationale: This is a knowledge question testing comprehension of the horizontal violence intervention model. Correct application of interventions should follow individuals modeling behaviors of those with whom they identify. |
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A nurse has noticed throughout the week a coworker has been becoming increasingly tired. They also have requested to trade two difficult patients because of a headache and GI upset. The nurse notes these symptoms oddly reflect their own condition. These symptoms might be the result of what common workplace dynamic?
A) Bullying B) Sexual Harassment C) Disruptive Behaviors D) Alcoholism |
Correct Answer: C
Rationale: While all of these options may produce these symptoms in an individual, it is unlikely two or more would be experiencing them unless there was a shared experience. Disruptive behaviors have been shown to produce all of these symptoms. |
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While working on a new floor, a nurse notices an odd dynamic among coworkers. In the first week, the nurse sees other nurses raising eyebrows, making faces, and occasionally bickering. What action by the nurse best reflects methods for reducing early stages of lateral violence?
A) Avoid actions associated with lateral violence and lead by example B) Report offenders to charge nurse C) Speak with OMBUDS and request they act as a mediator D) Suggest to charge nurse a facilitator be used. |
Correct Answer: D
Rationale: While OMBUDS might be a good resource for ideas, their role is to provide ideas and anonymous reporting of issues not act as a mediator. A facilitator specific to that issue would be best and the charge nurse is the most appropriate person to whom the request should be made |
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Based on the Horizontal Violence Intervention Model (Walrafen, et. Al., 2012), at what point must intervention take place in order to prevent bullying in the workplace?
A. Individuals model new/learned behaviors B. Individuals learn behaviors by observation |
Correct answer: D |
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The newly hired nurse is working on the cardiology wing and is asked by the charge nurse to take the vitals of a client. The Dynamap is not functioning properly, which the new nurse reports to the charge nurse who replies, “Oh, that one always shuts down, document the vitals anyway.” The vitals were found to be inaccurate but the client was not harmed. This is an example of what? A. Proximate care B. Unprofessional conduct C. Negligence |
Correct answer: B |
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The nurse is asked by the primary physician to perform a routine procedure on a client; the physician has told the nurse the patient has already consented to the physician, so the nurse can go ahead with the procedure. How should the nurse respond? A. Perform a complete assessment prior to the procedure. |
Correct answer: C |
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A student nurse is working at a clinical site and notices that a nurse is not documenting vital signs correctly. The nurse goes into the patient rooms without a pressure cuff or thermometer and comes out with the vitals recorded. The student suspects the nurse is making up the data. What should she do?
A. Assume that the nurse is doing everything correctly and not say anything. B. Go into a patient room with the nurse to observe to be sure of what is happening. C. Go to the nurse manager and explain what they suspect is happening. D. Confirm with another colleague that the nurse is making up the data. |
Correct Answer: B Rationale: It is the nurse manager’s job to make sure the nurse is documenting correctly. “As nurse leaders, administrators have an obligation to investigate practice concerns”. However, the student has only suspected the nurse is falsifying records because they do not enter the room with the correct equipment. It would be good practice to observe them first, before taking a serious complaint to a manager. |
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Horizontal violence is seen in many forms. Examples of this behavior include: (select all that apply)
A. Bickering Among Peers B. Covert Verbal Compliments C. Nonverbal Negative Innuendo D. Undermining Clinical Activities |
Correct Answers: A, C, and D Rationale: This is a knowledge based question. There are 9 behaviors listed in the article, “Sadly Caught Up in the Moment…”. Answer B would be a good thing |
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As a Nurse Manager, you are called into mediation over a patient that is in a coma. The patient does not have an advance directive and the parents are in disagreement with the spouse over how to proceed. During the proceedings, you might hear the Mediator say which of the following:
A. “Mr. Smith is correct. He is making the most valid point.” B. “I think we have heard enough from each side at this point; it is time to settle” C. “Mr. Smith, please do not cry during this conversation” D. “Mr. Smith, please clarify what you meant by, ‘That’s not allowed’” |
Correct Answer: D Rationale: A is not correct because a mediator does not take sides. As it says in the article, “…my task as your mediator is not to tell you who is right or who is wrong”. (p. 5) B is not correct because a mediator never forces a settlement – “Mediators neither order participants to settle…” (p. 9) and C is incorrect because “It is very important to pay attention to emotions” (p. 8) |
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A nurse at a high school clinic is conducting screenings for asthma. The nurse determines risk factors for asthma in this population according to health determinants defined by Healthy People 2020 . Which of the following risk factors would reflect social determinants of health? Select all that apply. 1. Household income at or below the poverty line. 2. Proximity of the school to refineries and freeway corridors. 3. Cigarette smoking habits of the children and/or their parents. 4. Family history of asthma and other respiratory conditions. |
Answer: 1, 2 Rationale: Healthy People 2020 defines social determinants of health as reflective of “social factors and the physical conditions in the environment in which people are born, live, learn, play, work and age.” #1 and #2 are both risk factors that fall in these categories. |
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A hospital administrator notices an increase in complaints from new nurses on the night shift about bickering, gossiping and ranting among some of the nursing staff. The administrator investigates. Why does the administrator decide to institute a zero-tolerance policy towards this behavior in the department? Select all that apply. 1. Because this behavior threatens patient safety. 2. Because this behavior is unprofessional and unpleasant. 3. Because this behavior can increase nurse turnover. 4. Because this behavior is detrimental to nurse morale. |
Answer: 1, 3, 4 Rationale: Bickering, gossiping and ranting are forms of horizontal or lateral violence. Patient safety, nurse retention and nurse morale are all important reasons to address horizontal and lateral violence. #2 is incorrect because being unprofessional & unpleasant, does not necessarily warrant a zero-tolerance policy. |
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A new graduate nurse recently hired in the emergency department of a hospital experiences continual difficulty with the attending physician on duty. When the nurse asks questions, the physician responds with impatient, condescending language. What can the new nurse do to ensure a healthy work environment? 1. Seek support in confronting the physician about the behavior. 2. Complain to other nurses in the break-room about the physician. 3. Try to communicate more clearly, concisely, and directly. 4. Direct these questions to administrators and clerks instead. |
Answer: 1 Rationale: Impatient, condescending language is an example of disruptive behavior that harms the work environment and in doing so, negatively impacts patient safety. Although the best solution would be to report the behavior to administrators, #1 is the best answer of those listed above, as the behavior needs to be addressed directly. #2 is wrong because it does not lead to a change in behavior, and gossip is itself a disruptive behavior. #3 is a distractor – while it may be true that the nurse can work on a clearer communication style, the disruptive behavior is still not addressed. Similarly, #4 may get some of the nurse’s questions answered, but does not address the behavior. |
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According to the article Failure to Rescue, a nurse’s “surveillance” involves which of the following actions: Watching and double checking co-nurses’ work Monitoring other nurses’ actions with patients Recognizing patients’ complications Watching over patients’ visitors |
Correct answer: 3 Rationale: Surveillance includes assessing patients frequently, attending to cues, and recognizing complications. (1,2 experienced nurses may serve as “safety-checks” but are not part of every nurse’s duty of surveillance. 4 not applicable) |
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A newly licensed/hired nurse received snide remarks from a more experienced and efficient nurse while at work. The newly hired nurse should: Use the remarks as constructive criticism Confront their co-worker Tolerate the remarks as they are not personal Ask to be transferred to another unit |
Correct answer: 2 Rationale: Studies have shown that behavioral intervention (i.e. respectful confrontation/clarification) positively changed the behaviors of laterally violent nurses. (1, 3 Respectful confrontation to determine the intentions of snide remarks should be done prior to taking them as “advice,” or dismissing them entirely. 4 confronting the laterally violent co-worker should be done prior to requesting transfers) |
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Inherent stress compounded with uncontrollable circumstances in the health care environment often leads to: disruptive behaviors, lateral and horizontal violence in the workplace. Every health care professional, including nurses, can use what to help combat these issues: Self-awareness Confrontation Code of Ethics Emotions |
Correct answer: 1 Rationale: Self-awareness allows the individual to recognize and indentify their emotions so they can be redirected in a more positive manner as opposed to being disruptive. (2 confrontation may not always required/needed. 3, the individual would need to be self aware of their disruptive behavior(s) before they went seeking their code for guidance. 4 Uncontrolled emotions are often the cause of disruptive behaviors) |
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Healthy People 2020 identifies Health problems that affect the population in the United States. What are some of these problems? Check all that apply
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Correct answer:1,2,3,4 |
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A fellow nurse wants to protect herself. The hospital where she works always settles legal battles out of court and she doesn’t usually agree with those decisions. What should she do?
1. Get a new job. 2. Change the legal policies. 3. Obtain personal liability insurance. 4. Never make a mistake. |
Correct answer: 3 Rationale: She can keep her job and challenge any legal battle the way she wants to without having to go with the hospitals decision |
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You notice another nurse on your floor acting strangely and when you get close you can smell alcohol on her breath. What should you do? Talk to her in private and tell her to never do it again. Report her to the charge nurse. Ignore the incident as a one-time occurrence. Report her to the state nursing board. |
Correct answer: 2 Rationale: You have to report something that endangers patient safety, and you should report up the chain of command. |
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A student nurse makes a significant charting error during their preceptorship, what course of actions should be taken and what, if any, is the effect on their consideration for employment? (Select all that apply) A probationary period should be given to allow the student a chance to improve. If the student succeeds in changing their performance, no negative evaluation should follow their employment interviews. 3. The student should be dropped from the preceptorship and be moved off the unit. 4. The problem is identified and reviewed with the student. |
Correct response: 1,2,4 Rationale: 3 is incorrect because protocol is to give a second chance with charting errors. However if the student was instructed on how he/she should correct the charting and doesn’t do it, then 3 would be correct. |
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A nurse researcher is attempting to set up a study comparing death rates and why they differ among local hospitals. What variables must be accounted for? (Select all that apply) Only patients going through similar procedures can be compared to each other Identifying extraneous cases in which there were particularly difficult complications Patient variables such as age, gender and concurrent diagnoses Level of training of staff on the appropriate response to emergency situations |
Correct Response: 1, 2, 3 Rationale: 4 would be a possible finding of the study that would explain the reasons for increased death rates and failure to respond to emergencies, rather than an extraneous variable. |
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A new nurse wants to work at a hospital with a relatively low death rate of patients, what features should the nurse look for that are associated? (Select all that apply) A high proportion of board-certified anesthesiologists A lower patient to nurse ratio 3. A hospital with a complete range of departments 4. High technology equipment and services |
Correct answer: 1,2,4 Rationale: These are all associated with better patient survival rates, while 3 is a distractor. A hospital should never be without any department that would cause an inability to treatment some patients in its absence. |
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When administering medications the most important tasks to remember are? (Select all that apply) Checking the health record Checking the patient’s arm band Verifying with the patient Verifying with the patient’s family |
Correct Answers: 1,2, & 3
Rationale: When administering medication to patients, especially those who may be allergic to certain medications for fighting viral, fungal, or bacterial infections, it is crucial for the healthcare provider to collect this information and chart it. Before administering the medication the provider should also verify with the health record, any arm bands regarding allergies, as well as the patient’s themselves. |
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A nursing student is completing clinical rotations on the medical-surgical floor, when the patient that he or she is caring for goes in for an appendectomy. The nursing student has been anticipating the opportunity to watch a surgery and is debating whether or not to go in and watch. What should the nursing student do? Observe the surgery and ask the patient for consent while he or she is in recovery Observe the surgery, the patient and nursing student are close, he or she won’t mind Wait to obtain consent from the patient before observing a procedure or surgery Wait to obtain consent from the patient’s spouse, then proceed with observing the surgery |
Correct Answer: 3
Rationale: The underlying principle of patient autonomy pertains to consent. As a nursing student, it is considered an invasion of privacy to go through the patient’s medical history or watch a procedure without the prior consent of the patient. |
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A nurse preceptor in the intensive care unit observes one of his or her nursing students not recording vital signs correctly. The nurse has noticed this particular student taking shortcuts throughout the rotation and fears that this student could be a danger to his or her patients if the student is not reprimanded for their lackadaisical behavior. How should the nurse preceptor first respond to the nursing student’s behavior? Give a probationary stage for the nursing student to improve on his or her clinical performance Use the nursing student as an example for the other clinical group members as a type of warning Send a letter to the dean of the university to let he or she know that the student’s behavior is dangerous Speak with the clinical instructor and nurse manager regarding the student’s behavior and review the incidents |
Correct Answer: 1
Rationale: The nursing student is still in the beginning stages on learning all the fine-tuned skills and techniques of nursing. Speaking with the nursing student one on one, letting he or she know the severity of his or her mistakes, and allowing he or she to improve upon his or her previous mistakes is the first step to becoming a skilled nurse. By going straight to the dean or clinical instructor the nursing student is not given the opportunity to learn from his or her mistakes and is more likely to repeat them. Those measures should be taken after the probationary period to improve is up, and he or she is continuing to demonstrate unsafe or inappropriate behavioral patterns. |
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A nurse contributing research to Healthy People 2020 would best contribute to the initiative's Mission by:
a) Submitting a proposal for a longitudinal study on the effect of small group sex education for young teens at the state level b) Identifying health improvement priorities in her county c) Serving as a traveling nurse in multiple areas around the globe including Syria and Iraq d) Seeking further education to enable his or herself to better serve the community |
Correct Answer: a) Rationale: a) This would contribute to part of Healthy People 2020's Mission: Identify critical research, evaluation, and data collection needs. Teen pregnancies and STI rates are high among teens. b) Part of the Mission of Healthy People 2020 is Identifying health improvement priorities as the national level, not the county. This county information may help inform the national process, but this is not the best answer. c) Healthy People 2020 is focused in our nation. d) Though this would help the nurse's community longer-term, it does not directly aid the mission of Healthy People 2020 – further actions would be needed to do so. |
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A nurse witnesses another nurse verbally lashing at an unlicensed assistive personnel. How should the nurse proceed?
a) Wait until everyone calms down to talk about it b) Address the issue with the offender immediately c) Find a private location in which to discuss the offense with the offender d) Let it go – disruptive behavior escalates when outsiders get involved |
Correct Answer: c) Rationale: a) Disruptive behavior should be addressed as soon after the incident as possible b) Privacy is needed c) Yes d) TJC recommends a “zero tolerance” policy when it comes to disruptive behavior |
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A nurse arrives on shift and finds the floor severely understaffed. The nurse feels overwhelmed. The best course of action would be:
a) Get to work right away because speed will help make up for the lack of staff b) Listen carefully to the charge nurse's instructions before going on rounds c) refuse to work until more help arrives, for the safety of the patients d) Prioritize the patients, communicate effectively with team members and ask for help regularly |
Correct Answer: d) Rationale: d) This is the best choice. Prioritizing the patients would be the next part of listening carefully to the charge nurse's instructions at the shift change a) speed may help but other steps need to be taken as well b) true but other steps also need be taken c) Ethically and legally the nurse cannot refuse to care for patients while on shift – the nurse could be charged with abandonement |
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Nurse A does not like Nurse B. Nurse B requests Nurse A’s assistance on a procedure. Nurse A has time but turns down Nurse B’s request and walks away. What type of bullying behavior did Nurse A exhibit? Scapegoating Undermining Clinical Activities Breaking Commitments None of the Above |
Correct Answer: 2 Rationale: Undermining Clinical activities refers to behaviors such as not being available to help or turning away when being asked for help. |
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A nurse is called into a patient’s room. The nurse is not assigned to this patient. The patient requests another pillow. The nurse should: Take a pillow to the patient because they have a duty to all patients nearby as well, within reason. Take a pillow to the patient and check on that nurse’s other patients because they are clearly very busy. Contact the patient’s doctor and let the doctor know about the patient’s request. Do nothing since the nurse isn’t assigned to the patient; it isn’t the nurse’s responsibility. |
Correct Answer: 1 Rationale: The nurse has a duty to the patients to which they are assigned and others within their general area. A nurse who refuses care to a patient based on assignment could be found negligent for not “taking a pillow to the patient” in this instance. |
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Which of the following is considered to be an unintentional tort? Defamation False imprisonment Malpractice Invasion of privacy |
Correct Answer: 3 Rationale: Negligence and malpractice are examples of unintentional torts that may occur in the health care setting. Negligence is misconduct or practice that is below the standard expected of an ordinary, reasonable, and prudent person. Malpractice is professional negligence. |
