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212 Cards in this Set
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A nurse is caring for a postpartum patient who underwent a successful cesarean section, and is also a first time parent. During the nursing assessment, what key transition(s) is/are identified. Also, what transition condition should be paid special attention to with regard to her surgery?
1. Organizational and Health-Illness transitions, environment 2. Developmental transition, level of planning 3. Developmental and Health-Illness transitions, expectations 4. Situational transition, environment |
3
Rationale: The patient is experiencing two key transitions: the birth of her first child (Developmental), and recovery from an invasive surgery (Health-Illness). As the nurse explains care post-surgery, the patient will not experience as much stress if expectations are established, and should experience a smoother transition. |
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After administering a medication to a patient in the emergency department, the nurse notices that this routinely administered medication doesn’t elicit the usual response in the patient. What key intuitive process does the nurse use to help this patient?
1. Pattern recognition 2. Similarity recognition 3. Commonsense understanding 4. Intuitive analysis |
2
Rationale: All intuitive processes are at play here, but the main process is similarity recognition. The nurse in this case remembers that most patients have responded differently to the medication. She/He can use this exception as a way to identify a patient who needs further care. |
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A 67-year-old patient is seen in the emergency department after falling and breaking his pelvis. After his recovery, he is sent home with a bag full of medications as well as a referral for physical therapy. He is enrolled in Medicare plan part A and D. Which services and/or items will he have to pay for out of pocket in addition to his monthly premium?
1. Visit to the emergency department 2. Medications 3. Radiologist reading and interpreting the x-ray of his pelvis 4. Physical therapy |
4
Rationale: Patients enrolled in Medicare part A automatically receive coverage for hospitalization, home and hospice care. Patients enrolled in the voluntary part D coverage receive medications as part of their plan. In order for a patient to receive coverage for outpatient services such as physical therapy in the outpatient setting, they must also be enrolled in part B. |
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A hospital administrator mandates that all nurses wear white uniforms while caring for patients in the hospital. According to Burn in an article titled, "An Experiment in White", what is the best rationale for this requirement?
1. To distinguish nurses from other hospital staff 2. To maintain a certain level of professionalism 3. To show respect for the traditional portrayal of nurses 4. To demonstrate prestige and honor for the profession |
1
Correct Answer: (1) Although all answers provide insight into why white uniforms have proven to be beneficial for nurses, the best rationale given was to distinguish nurses from other hospital staff, thus lowering the confusion among patients and visitors as to who is a person who can be expected to have a certain level of skill or knowledge and who is not. |
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Which of the following transitions is considered a Health-Illness transition?
1. The introduction of restraint-free care in a nursing home 2. Hospitals transitioning from paper to electronic patient charting 3. The transition of a patient from the hospital to a rehabilitation center 4. The transition of a woman into parenthood. |
3.
Health-Illness transitions focus on transitions among the health care system over the course of an illness. The patient still requires the need for care and therefore is not recovered from an illness. |
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A nurse caring for a client with recently diagnosed diabetes mellitus instructs the client how to use a device to monitor blood glucose. The nurse is demonstrating which nursing role?
1. The nurse is functioning as a counselor. 2. The nurse is functioning as a teacher. 3. The nurse is functioning as a change agent. 4. The nurse is functioning as a communicator. |
Correct Answer: 2.
Rationale: The nurse is teaching the client a procedure required to restore and maintain health. |
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A charge nurse notices at the beginning of a shift the nurse enters a client’s room, completes necessary tasks, and leaves the client’s room without speaking to either the client or the client’s family. What should the charge nurse recommend the nurse do first upon entering a client’s room for the first time?
1. Encourage the nurse to greet the client and the client’s family. 2. Advise the nurse to practice proper hand hygiene. 3. Advise the nurse to introduce his/herself by name and as a registered nurse. 4. Indicate that the nurse should ask the client if they have any needs or concerns. |
Correct Answer: 3.
Rationale: A nurse should begin a shift by introducing his/herself including name and role as a registered nurse prior to completion of other activities |
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A nursing student tells a classmate “These NCLEX questions we have to write are impossible. I’m just going to write some garbage questions and hope no one notices- I’m not a test author and I don’t have time for this!” How should the classmate respond? Select all that apply.
1. Encourage the nursing student to visit the student counseling office for options in stress management. 2. Offer to assist the nursing student to with the assignment by providing examples from textbooks and online. 3. Recommend that the nursing student speak with the instructor and ask to be excused from the assignment. 4. Recommend that the nursing student speak with the instructor and ask for further assistance. |
Correct Answer: 1, 2, 4
Rationale: The nursing student is likely in the conflict phase of the returning-to-school syndrome model and therefore requires academic as well as psychological support. |
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The authors of Avoiding Socialization Pitfalls in Accelerated Second-Degree Nursing Education: The Returning-to-School Syndrome Model state that there are three stages of the returning-to school syndrome model. At what stage, is there an initial strong rejection of the new culture?
1. Honeymoon 2. Resolution 3. Conflict 4. Reintegration |
Correct answer: 4.) the third stage of reintegration, students will go through multiple phases to achieve integration or positive resolution. At the beginning of this stage, students may reject the new culture and blame faculty, the program, or the institution for perceived unsatisfactory achievement. The reintegration phase culminates when second-degree students are able to integrate their original work culture with the new culture of nursing.
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A nurse is assigned a patient who is recovering very well from a cerebrovascular accident. The patient is recovering speech, movement and strength. However, she notices the patient is a less talkative than the day before. The experienced nurse recognizes that there might be a problem underlying the patient’s new behavior by using:
1. Skilled Know-How 2. Similarity Recognition 3. Sense of Silence 4. Deliberative Rationality |
Correct answer: 2 “Similarity recognition sets up the conditions for recognizing dissimilarities as well. This patient is experienced as dissimilar to past patients who have had similar diagnosis or treatment."
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A patient arrives at the hospital due to a fall down the stairs. Patient assessment reveals contradictory information about the accident and the nurse notices fear in patient’s body language. Final nursing diagnosis points at a case of abuse from her partner. The nurse’s next step is:
1. Advice the patient to seek couple’s therapy 2. Ask the hospital social worker to meet the patient 3. Nurse informs the charge nurse that they should take action 4. Nurse tells the patient to stay at his or her place for a week until patient is fully recovered |
Correct answer: 3 “Clinical judgment, to mean an interpretation or conclusion about a patient’s need, concerns, or health problems, and/or the decision to take action (or not)…”
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Doctor. A. prescribes a new intravenous drug to a patient. His/her nurse administers the prescribed dosage. Minutes later patient shows a toxic reaction to the drug. Charge nurse is not able to locate doctor A. and neither the floor resident. Charge nurse next step is to:
1. Give patient a lot of fluid to decrease the toxic level 2. Keep trying to locate doctor A. 3. Contact doctor at nearby hospital 4. Give patient the antidote to this drug |
Correct answer: 4 “Nurses deal with change in stressful environments. A client's condition may rapidly change and routine protocols may not be adequate to cover every unexpected situation. Critical thinking enables the nurse to recognize important cues, respond quickly, and adapt interventions to meet specific client needs at the right time.”
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It is vital for nurses to be culturally sensitive and to convey this sensitivity to clients, support people, and other health care personnel. Which of the following actions supports this cultural sensitivity? Select all that apply.
a.) Always address clients by their first name, unless otherwise requested b.) Introduce yourself by your full name, and then explain your role c.) Avoid culturally sensitive language, such as “gay”, “lesbian”, or “bisexual” d.) Always ask when you do not understand to avoid making assumptions |
Correct answers: b and d
Rationale: a) The client should initially be addressed by their last name until permission is given to use other names. b.) The nurse should always introduce himself/herself by their full name and explain their role when meeting a person for the first time.c.) The nurse should use language that is culturally sensitive, not avoid it. Terms such as “gay”, “lesbian”, or “bisexual” are all culturally sensitive and should be used |
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What type of knowledge is a pediatric nurse who utilizes toys and puppets to communicate with clients using?
a) Ethical b) Empirical c) Aesthetic d) Personal |
Correct answer: C. Using puppets and toys to facilitate communication is an example of a nurse using their own personal style and creativity to meet the needs of their client, which is encompassed by aesthetic knowledge.
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A nurse sees a client who has lost forty pounds and quit smoking since the nurse last saw them one year ago. Which stage of health behavior change is the client presently in?
a) therapy stage b) contemplation stage c) maintenance stage d) action stage |
Correct answer: c. The client in the past year has lost weight and quit smoking which means that they haven't just begun to implement the changes in their lives, which would be action stage. Therapy stage isn't a stage. Contemplation stage is when the client has acknowledged having a problem and is considering making a change. Due to the other three options being incorrect, and the client clearly having integrated the behavior changes in the past year, they are in maintenance stage.
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What should the nurse do first to help alleviate the stress of a worried patient only just diagnosed with Crohn’s disease?
1. The nurse should provide the patient statistics about the survival rate of other patients with Crohn’s disease. 2. The nurse should give the patient further information about the treatments that the gastroenterologist has just recommended. 3. The nurse should find out what social support the patient has to encourage and support the patient at this time. 4. The nurse should ask the patient what immediate concerns and worries the patient has at the present time. |
CORRECT ANSWER= 4
Crohn’s disease is a chronic illness which is an identifiable health-illness transition for this patient. The nurse should first ask the patient what immediate concerns the patient has to allow the patient to articulate the worry and stress being experienced. “Awareness of the meaning of a transition for clients is essential for understanding their experience of it as well as
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The nurse is caring for a patient with an undiagnosed illness with neuropsychiatric symptoms. The patient asks the nurse, “When do you think I will get better?” What is an appropriate response?
1. “I am sure you will get better soon.” 2. “God only knows.” 3. “I do not know.” 4. “I cannot answer that.” |
ANSWER= 3
Part of developing critical thinking is learning to tolerate and be comfortable with ambiguity for a time. “For a while, the nurse will need to say, ‘I don’t know’ and be comfortable with that answer until more is known.” page 172 Berman and Snyder
Wrong answer rationales: The answer 1 gives false hope and undermines patient trust if the illness does not resolve. Answer 2 is completely inappropriate as mentioning a particular diety might be offensive to the patient. Answer 4 is the close distractor but the word “cannot” may mean to the patient that the nurse is not allowed to answer the patient’s questions, maybe because it is bad news.
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A patient experiencing gastroparesis refuses to take a medication in pill form because it is too large and hard to digest. The nurse demonstrates critical thinking by:
1. Asking how the patient normally swallows a large pill. 2. Accepting the patients legal right to refuse treatment and documenting it. 3. Asking the nurse manager what to do. 4. Checking the pharmacy to see if the medication comes in liquid form. |
correct answer 4. Part of critical thinking is being creative in approaches to difficult situations. Asking how the patient normally swallows a large pill or asking the nurse manager what to do does not involve critical thinking. Although a patient can refuse treatment it would not involve critical thinking if the nurse accepted that decision.
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After explaining that the cause of her injuries was an accidental fall, an older patient now tells the emergency nurse privately that she is afraid of her current caregiver. What should the nurse do? Select all that apply.
1. Assume that the original explanation of the injuries is correct. 2. Privately question the patient further regarding the caregiver. 3. Disregard the comment due to probable senior memory loss. 4. Document this information and relay to the attending physician. |
ANSWER= 2, 4
Using intuition and clinical judgment, the emergency nurse will use pattern and similarity recognition to identify the possibility of elder abuse. The nurse will use commonsense understanding to get more information from all available sources, document information obtained, and relay information to appropriate personnel. The nurse will not make assumptions.
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The head of the emergency department is holding a meeting and is suggesting that all the nurses wear white uniforms to look more professional and to better distinguish themselves from other hospital employees. Which of these statements would be the best argument against wearing white uniforms?
1. Nurses have been wearing scrubs for so long now patients no longer associate white uniforms with nurses. 2. Nurses would have to buy new uniforms all the time because white gets so dirty. 3. All white uniforms could scare children and make a difficult time even more difficult. 4. Scrubs are way more comfortable and allow nurses to express their own personality better, making them more comfortable in a stressful environment. |
Correct answer: 3. Answer three is the only one that affects the patient. “Pediatric nurses, whose patients might be frightened by white uniforms, began to wear colorful tops…”
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A Hispanic woman in labor is surrounded by her family and is told that a cesarean delivery needs to be performed. Labor and delivery is extremely busy and the nurse brings in the standard consent form with a pen and insists that the patient sign it. The nurse notices that the patient and her family are clearly uncomfortable. What could the nurse have done to alleviate the discomfort.
1. Ask the doctor to explain the reason a cesarean delivery is needed and then have the patient sign the form. 2. Find a nurse of Hispanic heritage to explain the reason a cesarean delivery is needed and then have the patient sign the form. 3. Explain to the entire family the reason that a cesarean delivery is needed and after they understand have the patient sign the form. 4. Immediately call in a Spanish speaking interpreter to explain the reason a cesarean delivery is needed and then have the patient sign the form. |
Correct answer: 3.
This question was intended to highlight the importance of cultural sensitivity in clinical practice, especially in obstetrics and gynecology. The traditional approach can fail to gather the most crucial information for providing appropriate medical care. The nurse failed to realize that there were family members in the patients room and that for many women of Hispanic heritage, it is customary to involve family members in medical and personal decisions. |
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A patient recently had hip replacement surgery and is receiving physical therapy care in the hospital. This type of care is an example of:
A. Secondary Prevention B. Health Promotion C. Tertiary Prevention D. Treatment and Prevention |
Answer: C. The patient, by receiving physical therapy, is working towards returning function and independence. This rehabilitative care is a form of tertiary prevention: rehabilitation, health restoration, palliative care.
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There are four areas that fall under the scope of nursing practice, which of these is not one of them.
1. Promoting Health and Wellness 2. Curing Disease 3. Preventing Illness 4. Caring for the Dying |
Correct answer: 2. According to Kozier & Erb’s Fundamental of nursing: Concepts, process, and practice, 2 is not in the scope of practice for nurses. The fourth area is “Resorting Health”.
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A patient suffering from dyspnea is admitted to the Emergency Room. The attending nurse has treated the patient before and remembers that he/she is allergic to cats. The nurse compiles an emergency database and asks the patient if he/she has come in contact with any cats. What part of clinical judgment is this nurse demonstrating?
A) Interpreting B) comparing C) noticing D) reflecting |
Correct answer: C
Rational: Noticing stems from a nurses expectations of a situation. These expectations are based on both the nurse’s knowledge of the patient and his/her clinical experience with similar patients (Tanner, p. 209).
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A patient recovering from triple bypass surgery received a urinary tract infection (UTI) from their catheter. The treatment of the UTI will need to be paid for by:
A Private insurance B Medicaid C Medicare D Hospital |
Correct Answer: D, the hospital. Rationale: Since the UTI is not the primary diagnosis, it means it was contracted while in the hospital. This event has been designated a Hospital Acquired Condition "never event," meaning that if staff numbers were correct, enough attention would have been paid to the patient and they never would have acquired a UTI from their catheter.
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A 7 year old patient was admitted for multiple grand mal seizures, of which they had no previous history. After a having a seizure in the hospital, the nurse notices that the child seems more withdrawn than earlier in their stay. The nurse asks the patient why they seem to be a bit more quiet and the patient responds that they are scared and miss their mommy and daddy. What intuitive process did the nurse utilize to assist this patient?
A Commonsense understanding B Pattern recognition C Intuitive analysis D Similarity recognition |
Correct Answer: A. While all intuitive processes are applicable in this situation, the best answer is commonsense. The nurse realized that the patient is young, and its their first time experiencing grand mal seizures, it would be scary for anyone, but especially a young child.
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A patient is being treated for a panic attack. The nurse contemplates using mindful meditation techniques he/she recently read about in a research article. What should the nurse do first?
A) Consider whether the demographics of the study’s sample population is similar to the patient. B) Ask the patient about his/her spiritual and cultural background. C) Consider the patient’s interpretation of why the panic attack occurred. D) Inform the patient of the benefits of mindful meditation. |
Correct answer: C. The first step is to investigate the significance of the panic attack to the patient. Evidence Based Practice informed by research studies does not take into account the meaningfulness of life events to the individual. Nursing care plans must demonstrate “feasibility, appropriateness, meaningfulness, and effectiveness"
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A novice registered nurse is caring for a patient. The patient's vital signs show elevated heart rate, elevated respiration rate and low oxygen saturation. The novice calls a more experienced nurse for help. What does the competent nurse do?
A) Rechecks vital signs and performs an electrocardiogram test. B) Considers each of the vital signs and determines low oxygen saturation to be most important. C) Asks a mentor for assistance D) Immediately focuses on increasing oxygen saturation |
Correct answer: B. The competent nurse can determine which aspects of a situation are most important but lacks the speed and intuitiveness of a more experienced nurse (Benner & Tanner, p. 28).
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A charge nurse is working in coronary care on a step down telemetry unit. The nurse informs the cardiologist that a patient is not responding to dopamine and nitroglycerin as most patients have in the past and could be experiencing some other condition that doesn't respond to vasodilators. What type of reasoning did the nurse use in this situation ?
1. deductive 2. Intuitive 3. Inductive 4. Adductive |
Correct answer: 2. The nurse in this example drew a conclusion not from facts and evidence, but from feelings and senses. Years of knowledge and experience enabled the nurse to know how most patients usually react to the medication given. Through pattern and similarity recognition, commonsense understanding and skilled know-how the nurse determined what was happening with the patient.
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Tom, the Emergency Department charge nurse, is concerned about a recent increase in readmission of patients for improper wound care. He asks staff to track the number of return patients who are being seen for errors in following discharge instructions and/or prescription labels. After he receives the requested data from staff, what is the next step in the Evidence Based Practice?
1. Tom needs to implement a department wide policy. 2. Tom needs to critically analyze the evidence. 3. Tom should design a change to ensure that proper teaching is completed prior to discharge. 4. Tom should assess the need for change in the Emergency Department. |
Correct answer: #2. Step 3 of the Evidence Based Practice is to critically evaluate the evidence presented. The other answers listed represent other steps in the Evidence Based Practice process.
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A nurse is assessing a 16 year old Latino patient in his/her free clinic. The patient is being evaluated for gestational diabetes with her current pregnancy, has 2 other children, and a Body Mass Index of 35. The patient is having difficulty comprehending the dietary instructions the nurse is giving. The nurse is concerned the patient has not previously received adequate education regarding diet and weight gain during pregnancy. What could be the cause for the patient’s lack of understanding?
1. Previous nurses in the clinic were not knowledgeable about the risk of gestational diabetes in obese patients and did not provide the patient with adequate information. 2. The patient does not know that having 2 children can lead to weight gain. 3. Hispanics were 1.7 times as likely as Whites to report poor provider-client communication. 4. Previous nurses in the clinic gave this patient a substandard quality of care because she is a minority. |
Correct answer: #3.
Rationale: According to the U.S. Department of Health and Human Services, the two major factors contributing to health disparities are Inadequate access to care and Substandard quality of care. |
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A nurse is trying to educate his/her patient’s wife on how to use a glucose monitor at home. The patient’s wife states, “I’m going to wait for the doctor to come in and explain this. I’m sure HE will be able to answer my questions better.” What are some possible reasons for this person’s bias against nurses’ medical/diagnostic knowledge? Select all that apply.
1. The image of nursing has been under scrutiny in the past and it is necessary to redefine nurses as skilled, knowledgeable professionals. 2. Nurses have less medical/diagnostic knowledge than physicians and are unable to educate patients accurately. 3. Nurses have historically been recognized as caregivers and physician’s helpers, not medical professionals. 4. This patient’s wife was treated poorly by a nurse in the past. |
1. Correct answer: #1 and #3.
Rationale: Over time, nurses have had many images, ranging from angel of mercy to sexual stereotype. There have been many misrepresentations of nurses in popular culture and in the media |
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An RN’s advise to a teenager to use condoms on a regular basis correlates with which level of disease prevention?
1. Secondary Prevention 2. Basic Prevention 3. Tertiary Prevention 4. Primary Prevention |
Correct Answer: 4. Primary Prevention involves immunizations, identifying risk factors for illness and preventing this illnesses from occurring
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A returning-to-school accelerated BSN student has depression, has academic difficulties and bursts of anger, feels helpless, insecure, sad and lethargic. This are the signs of which stage of Shane’s returning-to –school model?
1. Reintegration 2. Conflict 3. Shock or Rejection 4. Honeymoon |
Correct Answer: 2. This student is in conflict stage displaying negative emotions. 1. In Reintegration stage students achieve positive resolution. 3. Shock or Rejection is not one of the stages of Shane’s returning-to –school model. 4. Students in Honeymoon stage have positive emotions, sense of satisfaction and positive outlook.
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Participants were asked this question: What single change would have the least impact on the image of emergency nurses?
1. Whether or not we introduce ourselves as nurses. 2. How we act around nursing station. 3. How easily patient and family can read our name tags. 4. Whether or not we belong to the Emergency Nurses Association (ENA) |
Correct Answer: 4. 50% of participants believe membership in ENA has little effect on the image emergency nurses, compare to 1. 19%, 2. 13%, 3. 45%
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A seasoned nurse with 20 years of experience gets frustrated when trying to adapt to the Electronic Medical Records system the hospital has just implemented. The nurse is experiencing difficulty with which type of transition?
1. Situational Transition 2. Developmental Transition 3. Health-Illness Transition 4. Organizational Transition |
Correct Answer: 4. Rationale: 1. Although this could be considered a situational transition because it is a transition in a professional role, 4 is a better answer. 2. Developmental transitions focus on an individual’s changing role from one stage of life to another such as parenthood or adolescence. 3. Health-Illness transitions relate to the health and wellness of the individual. 4. Organizational transition is the correct answer, the nurse’s frustration is due to “the adoption of new policies, procedures, and practices”
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A nurse is attempting to take a patient health history, but the client is having difficulty remembering her medications and is distracted by her two young children. What should the nurse do to take as accurate a health assessment as possible?
1. The nurse should complete as many questions as possible and base his/her assessment off of those answers. 2.The nurse should ask the client to come back later with a list of medications and without her children. 3. The nurse should ask the client to call the clinic back later with a list of medications. 4. The nurse should get toys for the client's children and ask the client more specific questions to finish the health history. |
Rationale: Answer 4 is most correct because it shows that the nurse can be flexible and creative, while also thorough and understanding of real-life distractions. Answer 1 does not display any of this, while also ignoring the danger of missing medical information. Answer 2 is dismissive, and displays ignorance of the client's situation. Answer 3 might work if nothing else was available, but the client might not call with important information. It is important for the nurse to get as much information as possible, even if it means describing pill shape or finding pictures to help patients remember what they are taking.
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An 87-year old woman in the intensive care unit contracts a urinary tract infection from her urinary catheter. The novice nurse assigned to the patient over night observes normal vitals but notes the patient is confused and agitated. The nurse is unable to find an available physician or experienced nurse with whom to relay the patient’s mental status. Over the next few hours the patient develops urosepsis, goes into multi-organ failure and dies. Which unit-wide interventions could have prevented failure to rescue in this case? Select all that apply.
1. Having experienced nurses in this unit serve as “safety checks” in order to consult and observe novice nurses. 2. Monthly team-building trainings in which nurse leaders role model communication techniques for other team members. 3. Avoiding the use of urinary catheters in elderly patients due to the high incidence of urinary tract infection contraction. 4. Hiring more nurses and increasing the number of nurses scheduled for each shift. |
Correct answer: 1, 2, & 4. “The quality of nursing surveillance depends largely on management’s hiring and staffing decisions,” (Clark & Aiken, 2003, p. 42). Less than optimal staffing and too few sufficiently trained clinicians in given unit are risk factors for failure to rescue. Additionally, teamwork, trust and communication among medical staff are inherent to failure to rescue prevention.
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A nurse works with a patient to develop a weight loss plan that is within the patient’s limited financial means and time constraints. The nurse clearly and thoroughly documents the plan in the patient’s electronic health record. The nurse is demonstrating knowledge and skills from which two Institute of Medicine pre-licensure competencies?
1. Quality Improvement and Safety 2. Patient Centered Care and Informatics 3. Teamwork and Collaboration and Quality Improvement 4. Creativity and Organization |
Correct answer: 2
Rationale: Patient-centered care considers “patient values, preferences and expressed needs” in the development and implementation of a care plan (Cronenwett et al, 2007, p. 123). Documenting and planning patient care in the electronic health record is an Informatics skill.
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The nurse is caring for a patient who is showing signs of depression and lethargy while in the hospital recovering from surgery. Which action(s) suggest the nurse follows Florence Nightengale's Environmental Theory Model?
1. The nurse allows the patient to watch television for two hours each day. 2. The nurse opens the blinds to allow bright light into the room. 3. The nurse attempts to tell the patient a joke to lighten his/her mood. 4. The nurse takes the patient outside in a wheelchair for fresh air. |
Correct Answers: 2 & 4. According to Florence Nightengale's Environmental Theory, pure or fresh air, pure water, efficient drainage, cleanliness and light enhance wellness.
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A new graduate nurse working in a community clinic has been reminded by their mentor to refer to the people they see as clients instead of patients. When the nurse asks the mentor why, the mentor states:
1. This is part of the Affordable Care Act of 2010 and the updated language is mandated by federal law. 2. This is a very diverse area and you need to get accustomed to using politically correct and modern medical language. 3. Some of the people we see are from lower economic levels and referring to them as clients gives them a morale boost. 4. In the community health setting, goals include actively participating in health promotion and illness prevention rather than receiving only direct medical treatment or care. |
Correct answer: 4. The term patient usually refers to someone who is undergoing or waiting for medical treatment or care, while the term client is a broader term and can include individuals who want to maintain and/or promote good health, not only receive medical treatment, so client is a more accurate term than patient.
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A critical care nurse who has ten years of experience in the intensive care unit has a different approach to decision making than a new graduate nurse. Much of the decision making of the experienced nurse is influenced by:
1. Texts and manuals that provide a cookbook like approach to medicine. 2. Primarily from gut instinct, doing what they feel is right for the patient which comes from their years of experience. 3. Knowledge gained from education, clinical experience, and from information gained by treating that individual patient and working with their family. 4. The evidence that is being given by the patient, family members, lab results and other datasets. |
Correct answer: 3
Rationale: Experienced nurses are more influenced by what knowledge and experience they bring to a situation than the more obvious, objective data being provided by the patient. Through practice, they have absorbed and synthesized years of experiences and health related data and combine that knowledge with the individual story of each patient to determine the best course of action. |
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A nurse starts their shift on a medical/surgical floor, and an elderly patient describes being confused by the number of staff visiting his room. He doesn’t understand whose role is what. Which of the following could help alleviate this patient’s confusion? Choose all correct answers.
1. Introducing yourself and your position upon entering the room. 2. Check the patients chart to see if they have a diagnosis of dementia or Alzheimer’s disease. This could explain the confusion. 3. Standardized uniforms could be worn, with one color for nurses, one color for support personnel like nursing assistants, and one color for technicians like x-ray techs, etc. 4. Explain to the patient that the staff dress the way they do for the benefit of the patient. A hospital can be a difficult place to spend time and wearing cartoons on uniforms helps lighten the mood for everyone. |
Answer: 1 and 3
Rationale: 1: Patients can have many caregivers and introducing yourself and your role on the health care team helps alleviate questions a patient might have about who is coming into their room. |
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A charge nurse over-seeing several new graduates performs research on the incidence of infection in the daily care of patients at the hospital in which he or she works and realizes there is a very high rate. According to Gawande's article entitled, "The Checklist", what can the nurse do to decrease the incidence of infection among patients?
1. Require all new graduates receive additional monthly training. 2. Fire the new graduates and hire only nurses with five years of experience. 3. Implement a checklist to ensure all nurses are following the same protocol. 4. Show the research to the staff and hope that they perform their tasks correctly in the future. |
Correct Answer: 3. Rationale: According to, "The Checklist" by Atul Gawande, implementing a checklist in an ICU significantly decreases the number of deaths and the rate of infection among patients.
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Nursing’s metaparadigm focuses on which four concepts central to nursing?
A. Person, Knowledge, health, nursing B. Family, environment, health, and nursing C. Person, environment, health, and nursing D. Patient, vital signs, care plan, rehabilitation |
Correct answer: (C)
Rationale: Answer C is the correct answer. It clearly outlines the major nursing practices as stated in our text. Answer D is related to nursing but does not outline the central concepts. Answers A and B are close to being right, but in each there are options that are not central concepts.
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A pediatric nurse has just finished the difficult task of drawing blood from a fearful male child of Asian decent. What is the least appropriate action the nurse can exhibit to the child?
a) Offer a small toy and candy to the child in congratulations of overcoming a scary procedure. b) Offer mild praise to the child for being tough. c) Offer a congratulatory pat on the head rewarding the braveness of the child. d) Progress to taking the child's rectal temperature after the fearful procedure of drawing blood. pecifically Asian, and therefore should be avoided. |
Answer: C. Rationale: All are acceptable practices except for patting the child on the head, because the nurse is expected to be culturally responsible. Different cultures dictate what forms of touching are appropriate. When in question, the nurse is advised to ask for permission before performing procedures that require physical contact. Touching a child on the head is not accepted in most cultures, s
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A 25-year old patient has undergone a spinal column break and has lost the use his legs. During this time in the patient’s life what should the nurse do to prepare the patient to make a healthy transition into his new life?
1. Focus on helping the patient learn how to do everyday tasks in a new way. 2. Focus on the process of transitioning to a new lifestyle. 3. Make sure the patient is a good state of mind.4. Focus on the patient staying positive in the face of tragedy. |
Correct answer: 2. Rationale: In the paper “Transitions: A Central Concept in Nursing” the author states that for a healthy transition relies more on the process of transition rather than focusing on an end result of a positive transition.
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A patient in an urgent care unit complains to a novice nurse that he is still in pain after an initial dose of hydrocodone. An experienced nurse hears this and says "He is always asking for more pain meds. Probably an addict." The novice nurse's first action is to:
1) Ask the physician on call to evaluate the patient because the nurse is inexperienced in recognizing drug users. 2) Trust in the intuition of the experienced nurse and discount the patient's complaint 3) Immediately evaluate the patient for pain and alert physician of possible need for more pain medication. 4) Ask another nurse on the floor to evaluate the patient because the experienced nurse has shown bias. |
Rationale: Answer 3 is correct because the nurse should treat pain as a 5th vital sign, and take a patient's report of pain as true. There is also no indication of addiction other than one other nurse's report. Answers 1 and 4 are incorrect because although she/he is a novice, the nurse should be able to evaluate pain and assess patients first before consulting others. Answer 2 is obviously incorrect because of bias and the disregard of a patient's complaint of pain.
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A client interrupts a nurse introducing himself to ask "Are you my doctor? I don't understand all these tests they are running and what's wrong with me." The nurse should answer:
1) I am not your doctor. Would you like me to get him for you? He can answer your questions. 2) I am your nurse. I will explain why these tests are necessary and explain more about your condition. 3) I am a nurse, not a doctor. I cannot make diagnoses. 4) I will ask the doctor about your condition and why he is running those tests. |
Rationale: Answer 2 is correct. The nurse identifies himself to clear up confusion about his role, and also seeks to inform and educate the client about the health problems the client has. The other answers either leave all responsibility up to the doctor and confuse the client more, or do not help the client understand who the nurse is and why he is there. Also, in the incorrect answers, the nurse is reinforcing the stereotype that doctors are male and that nurses are not knowledgeable health professionals.
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A vasospastic patient in intensive care is prescribed a variety of medications by the attending physician. The nurse notices that the painkiller regimen included in the drug treatment is interfering with their ability to assess whether or not the vasospasm is ameliorating. The patient is in severe pain, has become unruly, and the physician is unavailable for assistance. What is the proper course of action.
a) Discontinue the painkiller treatment prescribed by the attending physician. b) Increase the painkiller medication due to the subjective needs of the patient. c) Explain to the patient the gravity of the situation and that you are doing everything you can for them. d) Modify the Rx of meds without physician assistance to find a suitable balance of pain mediation and vasospastic amelioration. |
Answer: d. Rationale: The lack of precision, while scientifically questionable, would seem to be the least ideal option for all of these choices. However, the inexactitude of medical situations requires the nurse to use their intuition and skilled judgement for each individual patient. Therefore, to "play" around with the medications is the best course of action in finding multiple solutions for a single patient.
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According to a survey in 2006 of 331 registered nurses, what is the quality that they considered to be the most important as far as having the greatest effect on the professional image as a nurse?
a) How skilled they appeared to be at their jobs. b) How nurses presented themselves to the patient and their family. c) Whether or not the patient felt they cared about them. d) How many professional nursing organizations that they presented. |
Answer: b. Rationale: While skill level certainly sets some nurses apart from others and nurses showing their patients that they care is a given, it is how nurses present themselves to the patient and their family that has the greatest effect on their image according to the poll
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A single father of two is ending his first month as a nursing student. He is excited to learn and eager to complete his assignments, often going home and practicing his new skills on his children. What phase of the RN-BSN educational process is he experiencing?
1. Excitement 2. Honeymoon 3. Reintegration 4. Anticipation |
Correct answer: B. Rational: “During the honeymoon stage, there is a positive glow on the experience of having returned to school, accompanied by a sense of satisfaction and an optimistic outlook.”
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A nurse has been working in the acute care setting for three years and notices that one of his/her patients who has congestive heart failure is exhibiting early signs and symptoms that have historically been detrimental to this illness. What aspect of intuitive judgment is the nurse exhibiting?
1. Similarity Recognition 2. Commonsense Understanding 3. Pattern Recognition 4. Sense of Salience |
Answer: C
Rational: “Pattern Recognition is a perception ability to recognize relationships without prespecifying the components of the situation…This patient’s history forms part of the pattern for this nurse.” |
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A female nurse was overheard speaking inappropriately to a male nurse. She has since had to work on redefining her professional image in the hospital in which she works. What is her best course of action to regain the respect of her colleagues?
1. She should go to work and only do her job, refraining for social activities 2. She should wear an all white uniform in an attempt to be taken seriously. 3. She should apply for a nursing job in a different unit within the hospital. 4. She should value nursing as a profession, and project that image daily. |
Answer: D. Rational: “To create a new image for nursing, nurses must: value nursing and project that image daily.” They must also “take themselves seriously and dress the part”, however, this doesn’t necessarily mean dressing in all white.
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A nurse is educating a young female about the dangers of smoking tobacco. Which of the following suggestions, by the nurse, is the best example of Primary prevention?
1. A bone density exam for early detection of osteoporosis may be beneficia 2. An outreach program may help with addiction to cigarettes 3. Training for a marathon may help deter cigarette smoking 4. This pamphlet offers various options to help quit smoking |
Correct Answer: 4. Rational: 4 is the best answer because it offers the client options in which to prevent illness. C may also be a way to prevent illness but is too specific and may not work with this particular patient’s individual needs. B is an example of tertiary prevention and A is an example of secondary prevention.
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A nurse is confronted with a patient who suddenly stops breathing after hip replacement surgery. Which of the following is not an example of a measure used to prevent the measure of hospital performance known as “failure to rescue”?
1. Lowering the patient-to-nurse ratio 2. Recognizing complications 3. Teaching illness-prevention-techniques to patients 4. Anticipating possible complications |
Correct Answer: 3
Rational: Failure to rescue describes the clinicians’ inability to save a hospitalized patient’s life when he/she experiences a complication that was not present upon admission ( Clark & Aiken, p 1). Educating a patient does not affect the clinicians ability to save his/her life should a complication in the hospital occur. |
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A charge nurse witnesses one of the floor nurses rolling her eyes when asked by another nurse asks about his/her first week of employment. The nurse also appears disheveled and unkept. What can the charge nurse do to implement an image of professionalism and value in the nursing profession, within the workplace ? Check all that apply.
1. Define appropriate dress in the workplace 2. Define inappropriate behavior in the workplace 3. Post nursing accomplishments in the workplace 4. Encourage staff to contribute to research and the community 1. Require staff to address all nurses formally with title and last name 2. Have staff contribute to the development of unacceptable behaviors and dress code |
Correct answer: All correct except 5.
Rational: 5 is not listed by Shelly Cohen as a method of instilling a sense of value in the nursing profession or implementing an image of professionalism. |
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A nurse who works at a research hospital has learned that a colleague has been recruiting patients for a research study with out informing them of the risks. This is a clear violation of the patient’s Right Not to Be Harmed, how should the nurse react?
A.) The nurse should report their colleague to the Charge Nurse. B.) The nurse should report their colleague to the head of the hospital. C.) The nurse should report their colleague to the police. D.) The nurse should report their colleague to the Institutional Review Board (IRB) for that study. |
Correct answer:
D. Rationale: The Institutional Review Board is a committee that is responsible for ensuring and protecting the client/patient’s rights.
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A public health nurse is working with a young woman who is pregnant for the first time and has just found out she has HIV. During the clinic intake interview, what types of Transitions does the nurse identify? (Select all that apply.)
A.) Developmental Transition B.) Situational Transition C.) Health-Illness Transition D.) Organizational Transition |
Correct answer: A and C.
Rationale: The type of transition that applies to a person who is entering parenthood, in this case the young woman in the middle of her pregnancy, is Developmental Transition. The young woman’s new diagnosis of HIV is solidly in the Health-Illness Transition category. |
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A patient is admitted to the hospital for a routine surgery and held overnight for observation. In the middle of the night the patient suffers complications from the surgery and ends up dying. This death is determined to be a case of failure to rescue, according to Clarke and Aiken, the authors of the article “Failure to Rescue”, what is the most effective way for hospitals to prevent this type of death?
A.) Always have post-operative patients observed in the intensive care unit. B.) Have a low patient-nurse ratio on all hospital floors. C.) Assign one physician to stay on the patient care floors at all times. D.) Only hire register nurses to work on the patient care floors |
Correct Answer: B
Rationale: According to Sean P. Clarke and Linda H. Aiken, the key to preventing failure to rescue is to increase the rate and quality of patient surveillance; which can only be done if there is a low patient-nurse ratio. This low ratio allows the nurse to spend more time with each patient and to observe, recognize and react to any complications that a patient might experience, thus decreasing the failure to rescue rate. |
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Which best defines nursing practice?
1. Formalized experiences designed to enhance the knowledge or skills of a practicing professional. 2. Process of helping a client to recognize and cope with stressful psychological or social problems. 3. Activity that assist the client physically and psychologically while preserving the client’s dignity. 4. The protection, promotion, and optimization of health and abilities, preventions of illness and injury, alleviation of human response, and the advocacy in the care of individuals, families, and populations. |
Correct Answer: D. Rationale: According to the American Nursing Association, 2003, p.6, they define Nursing as answer D. This definition is broader than previous definitions of Nursing. This definition includes the caregiving, advocacy and critical thinking portions of Nursing.
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Which of these behaviors best describes a nursing student in the conflict phase of the Returning-to-School Syndrome Model?
1. Prepares for classes by doing all the readings and assignments a week before they are due. 2. Becomes depressed after getting a C+ in the Introduction to Nursing class. 3. Rejects the advice of a preceptor because the preceptor is younger than himself/herself. 4. Adapts to skills learned in his or her previous job as a waitress to cope with difficult patients and staff. |
Correct Answer: B
Rationale: During the Conflict stage, more turbulent, negative emotions arise. The conflict stage may be associated with student depression, bursts of anger, feelings of helplessness, academic difficulties, insecurity, sadness, and lethargy. |
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The parents of a young patient newly diagnosed with Type I diabetes would benefit most from which of the following?
1. Instruction on how to read nutrition labels. 2. Instruction on how to test blood sugar and inject insulin. 3. Referrals to schools that have a lower student to teacher ratio. 4. Referrals to therapists to help the parents cope with having a child with diabetes. |
Correct Answer: B
Rationale: Successful nursing outcomes requires successful transitions into the home life of a patient. Two components of a healthy transition are role mastery and well-being of relationships. Family demonstrating the ability to successfully take care of a patient by correctly treating the child with diabetes exemplifies both of these components. |
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A nurse is trying to give pre-operative directions to a 45-year-old female Spanish speaking client awaiting an emergency hysterectomy. The nurse does not speak Spanish and an interpreter is not available. According to our textbook, who would be the best choice of interpreter?
1. The 7-year-old daughter 2. The 44 year-old brother 3. One of the Spanish-speaking male nurses on shift 4. Wait at least an hour for the interpreter |
Correct Answer: One of the Spanish-speaking male nurses on shift. Rationale: An interpreter of the same gender is always preferred, especially when discussing potentially embarrassing sexual matters, however the directions for a hysterectomy may expose the child to concepts they are not developmentally ready for. The male nurse is preferred over the brother who may not have proficiency with the medical language. This is an emergency procedure, time is of the essence and they cannot wait for the interpreter and risk jeopardizing the patient’s well-being.
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A nurse manager is looking to write a letter of recommendation for one of the nurses in their department. The nurse has 3 ½ years of experience and has demonstrated improved decision-making skills relying on theories and rules. When thinking of patient care they take into account the entire health history and anticipate the long-term needs of the patient. Which stage of nursing expertise should the nurse manager rank them in?
1. Proficient 2. Competent 3. Excellent 4. Advanced beginner 5. Expert |
Correct answer: Proficient. Rationale: Nurses with 3-5 years of experience and who focus on long-term goals fit in Brenner’s fourth stage of nursing expertise; “proficient.” They cannot yet intuit what will happen next as an “expert” can but their planning ability is more advanced than a stage 3 “competent” nurse.
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You are with a patient waiting for a central line insertion. When the doctor enters he introduces himself, and begins to prepare the materials without washing his hands. Which option is the best course of action in protecting the patient from healthcare harm:
A) Bring a bottle of alcohol sanitizer to the prep table and hope the doctor notices B) Say nothing to avoid embarrassing the physician C) Make a mental note to request the charge nurse talk to the doctor D) Ask the doctor if he forgot to wash his hands |
Correct Answer (D). Rationale - While the hospital can be an extremely busy place and various procedures can have many steps, it is the responsibility of healthcare providers to ensure avoid causing harm to the patient. Saying nothing may spare the doctors feelings in the moment, but should a complication arise the doctor would experience greater disstress than a warning would bring. In addition, this option, as well as options 1 and 3 fail to protect the patient from potential harm. Option 4 is the only viable option as it calls the doctors attention directly to the potentially unsafe action.
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You notice that a patient in your care has had no visitors during their one week stay. In addition, because of the unusually high volume of patients, the nursing staff have been unable to spend any significant time with individual patients aside from providing treatment. As you enter, the patient does not greet you or meet your eyes as you check their vitals. This patient is most likely failing to meet which of Maslow’s human needs:
A) Physiological needs B) Love and Belonging needs C) Self-actualization needs D) Safety and Security needs |
Correct Answer (B). Rationale: physiological needs include basic biological requirements for survival such as food and water. Self-actualization needs are the highest needs involving the realization of one’s abilities and qualities. Safety and security needs regard safety in an environment. None of these options fit as well as Love and belonging needs, which include the need to give and receive affection and to maintain a feeling of belonging.
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You attempt to begin a general survey with a new patient by saying hello and offering your hand only to find they do not understand your greeting and shy away from your gesture. After calling for a translator how might you begin your interview again to avoid possible cultural offenses:
A) Ask the interpreter to rely your exact words in their language to avoid misunderstandings B) Ask the interpreter if there are any cultural taboos your exam might violate C) Instruct the interpreter to translate only when asked if the patient cannot answer a question D) Instruct the interpreter how to perform tasks that require touching the patient so you don’t offend them |
Correct Answer (B) Rationale: There are far too many cultural, religious, and ethnic groups for one person to be an expert on the practices of them all. When you have the opportunity to take advantage of the cultural expertise of another, do so. When able, ask the interpreter what cultural taboos need to be carefully navigated
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A patient is admitted to the emergency department and is showing signs of confusion, agitation, and combativeness. How should the nurse first respond to this patient’s behavior?
1. Have the patient transferred to another nurse colleague that can better deal with the behavior. 2. Administer a sedative to help alleviate the patient’s confusion and agitation 3. Attempt to soothe the patient and keep them as calm as possible without sedation. 4. Refer the patient to a psychiatric nurse to perform a psychiatric evaluation for the erratic behavior |
Correct Answer: C. The nurse should not administer any sedatives because if there is any neurological conditions the nurse will not know if the quietness is indicative of the sedative or further neurological damage. By keeping the patient as calm as possible without sedation, the nurse can hopefully relieve the patient of distress before having to move to more drastic measures.
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A nursing student has just recently graduated and is entering a new grad program at a nearby hospital. She is nervous about leaving the role of “nursing student” to a professional nurse. What type of transition is this new graduate going to focus specifically on?
1. Organizational transitions 2. Situational transitions 3. Developmental transitions 4. Health-illness Transitions |
Correct Answer: B. Rationale: A recent graduate from nursing school entering a new grad program is experiencing a transition from an educational role to a professional role which is known to be a situational change that he or she must adapt to.
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Members of the health care team share some common goals when it comes to their client’s health. What is the most important goal?
A. To ensure that the clients receive fiscally sound, appropriate care B. To restore the client’s health and promote wellness C. To find and implement the best treatment plan for the client D. To assist clients to gain the skills to perform activities of daily living |
Answer: B. Rationale: Healthcare professionals share all of these goals, but the goal to “ensure that the clients receive fiscally sound, appropriate care” is more specific to a case manager. The goal to assist clients “to gain the skills to perform activities of daily living” is more specific to an occupational therapist. All health care professionals share the goal of restoring the client’s health and promoting wellness.
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A pregnant woman learns that she has gestational diabetes. What type(s) of transitions is she undergoing? Select all that apply.
1. Organizational 2. Health-Illness 3. Developmental 4. Situational |
Answer: B and C. Rationale: The woman is undergoing the transition to parenthood (Developmental) while also dealing with learning how to care for her gestational diabetes (Health-Illness)
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An English-speaking nurse, is assigned to a patient who only speaks and understands French. To get past this communication barrier, the nurse should:
1. Provide a pen and paper to the patient so they can communicate with illustrations. 2. Notify the charge nurse that he or she cannot communicate with the patient and request for a switch to be made. 3. Bring in the hospital’s interpreter to translate between the nurse and the client. 4. Bring in one of the patient’s family members who understands French and English to provide translations. |
Answer: C
Rationale: Hospitals usually have certified interpreters available for non-English speaking clients. Complications can arise by using a family member to provide interpretations, so it is best to avoid this. |
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A patient is 65 years old, healthy, and middle class. He/she is doing research on Medicare. Which of the following Medicare options are available to him/her? (Select all that apply).
A. Medicare Part B B. Medicare Part A C. Medicare Part C D. Medicare Part D |
Correct answer: A, B, D
Rational: “The Medicare plan in divided into parts: Part A is available to people with disabilities and people 65 years and older…Part B is voluntary and provides partial coverage of outpatient and physician services to people eligible for Part A. Part D is the voluntary prescription drug plan…Most clients pay a monthly premium for Parts B and D coverage.” Although the patient doesn’t have to participate in the Medicare Parts, they are available to him/her. |
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A 65 year-old patient gets admitted to the hospital for chronic heart failure (CHF) and declares to the nurse that s/he is an alcoholic and is considering changing his/her behavior. What should the nurse say to the patient?
A. “You shouldn’t wait a year to stop drinking, you should stop immediately.” B.“My dad was an alcoholic for 30 year and he died from CHF at 60.” C.“I will gather some information for you about alcohol addiction programs.” D.“Drinking alcohol is fun, you don’t necessarily need to stop any time soon.” |
Answer: C
Rational: The patient is in the contemplation stage, “the person acknowledges having a problem, seriously considers changing a specific behavior, actively gathers information, and verbalizes plans to change the behavior in the near future.” Because the patient is already in this phase, the nurse should accept his contemplation and help get him to the next stage of preparation by supplying him with useful information. |
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A nurse gives her/his patient the wrong dose of morphine. S/he immediately tells her charge nurse and states that s/he had trouble reading the numbers on the medication. The charge nurse notices that over the past three weeks, many nurses have complained of their inability to read the small numbers on the medication bottles. What should the charge nurse do?
A. Immediately fire the nurses that are having trouble seeing the labels. B. Recommend to the nurses that they get their eyes checked and report back. C. Develop a comprehensive checklist for administering medication. D. Participate in a root cause analysis of the ongoing and dangerous problem. |
Answer: D
Rational: The charge nurse needs to “recognize that nursing and other health professions students are parts of systems of care and care processes that affect outcomes for patients and families…(and) participate in root cause analysis of an event.” The nurse needs to look at the root cause of the problem and with her hospital, work on getting the font on the medication enlarged. Developing a checklist in this situation wouldn’t be beneficial because the root problem is that the font is not easily read on the medication bottles. |
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There are three levels of prevention in health care. Select all that apply:
A. Health promotion B. Initial assessment C. Diagnosis / treatment D. Health restoration |
Correct answer: A, C, D
Rationale: The primary, secondary, and tertiary levels of prevention are health promotion, diagnosis/treatment, and rehabilitation/health restoration/palliative care. Initial assessment is not a part of the levels of prevention and is meant to be the distractor. |
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A local hospital has noticed a drastic increase in deaths associated with nursing errors. What process should the hospital implement first in order to address and further prevent such errors?
A. Design and implement Checklists B. Color coded labels on medications C. Increase pharmaceutical staff D. Only allow doctors to administer medications |
Correct answer: A
Rationale: Checklists are key, and are most important in addressing and preventing hospital errors. They ensure accuracy. Color coding each individual label is impossible due to the vast variety of medications available. Increasing the pharmaceutical staff would neither help nor hurt the situation, as would only allowing doctors to administer medications. These would not help solve the issue or reduce the amount of hospital deaths due to error. |
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Jennie and Jayson are nursing students who have just finished their first day of clinical rotations. They decide to meet up with some friends afterwards to discuss the details of their first day. Jennie notices that Jayson has taken photos of his patients from earlier that day and is showing them to his friends. He is also saying their full names and revealing their conditions. Jennie decides to bring this to the attention of the clinical instructor, as well as reminding Jayson of the HIPAA regulations. In this situation, which of the following “C’s of Caring” is Jennie most appropriately utilizing?
A. Caring B. Competence C. Conscience D. Comportment |
Correct answer: C
Rationale: Jennie is utilizing her conscience, which is defined as “morals, ethics, and an informed sense of right and wrong” (Kozier, p449). She is aware of her personal responsibility as a nursing student and as a professional about to enter the health care setting. |
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What type of unit is a nurse working on, if it has it's own admitting, pharmacy, lab, and radiology departments ?
1. case managed unit 2. patient focused unit 3. hospice unit 4. oncology unit |
Answer 2 patient focused unit
Rationale: A patient focused unit is self contained. Workers are cross trained and perform multiple tasks. |
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A patient comes onto the surgical floor after just going through surgery to correct a hemopneumothorax. A newly hired nurse is put in charge of the patient and notices that the patient’s vital signs are slowly rising, but still within normal range. The charge nurse just went on break and is nowhere to be found. What should he/she do?
A. Call a code blue immediately. B. Wait to see if the patient’s vital signs go outside of normal range. C. Call the attending physician for help. D. Wait for the charge nurse to come back. |
Correct answer: 3
Rational: This is the quickest way to get help with this patient without wasting the hospital’s emergency services for what could not be an emergency. |
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A twenty year old male comes in for a physical assessment for his new job. During the interview he says that he smokes a pack of cigarettes a day. He knows they are bad for him, but says that since he is young he has plenty of time to quit and not suffer any consequences. What is the best way to take him from the precontemplation stage to the contemplation stage about quitting smoking?
A. Mention that he should quit every time he comes in. B. Teach him about the dangers of smoking, focusing on his age. C. Give him pamphlets about the dangers of smoking. D. Show him what a smoker’s lung looks like compared to a health lung. |
Correct Answer: 2
Rational: Teaching is one of the roles nurses have in health promotion. And tailoring the lesson specifically to the individual will better get through to him. |
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When practicing self-care it is important to maintain a healthy lifestyle. What lifestyle practices can help anybody maintain a healthy lifestyle? Choose all that apply.
A. Nutrition B. Meditation C. Recreation D. Rock-climbing |
Correct answer: 1, 3
Rationale: Answers 4 is too specific and won’t apply to everyone. Answer 2 is a mind-body therapy rather than a lifestyle practice. |
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A patient postoperative gallbladder removal was transferred to the surgical floor. The nurse did not properly monitor and review trends in the patients vital signs. The patient went into shock and died. What could the hospital have done to prevent this outcome?
1. Have more doctors on staff to attend to postoperative patients. 2. Have only the charge nurse provide care for postoperative patients. 3. Have nurses prepared and supported to handle possible complications that can occur with postoperative patients. 4. Have a case manager assigned to all postoperative patients. |
Answer: 3
Rationale: Nurses need to recognize and manage complications before catastrophic events occur. If barriers are in place with team support to implement them, lives can be saved. |
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Because of cultural and linguistic differences, a client has failed to follow a health promotion plan developed by a nurse. What should the nurse do ?
1. Speak to the clients physician about noncompliance. 2. Not treat the client due to noncompliance 3. Persuade the client to comply with the plan. 4. Not force the client to comply and give up the plan. |
Answer: 4
Rationale : A nurse must understand that a client may not be ready for change. In this case cultural and linguistic barriers are preventing compliance. Forcing a client by any means will not work. The client and nurse need to reevaluate the plan in light of the client's barriers and decide if change is possible. |
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A nursing student exercised 20 minutes, ate a balanced breakfast, and meditated for 5 minutes before going to clinical. Which one of the following is a consequence of these actions?
1. The nursing student lost 25 minutes of valuable study time. 2. The nursing student increased ability to care for others. 3. The nursing student modeled beneficial healthy behaviors. 4. The nursing student was selfish by performing these actions. |
Correct answer: 2
Rational:Caring for self by attending to the nursing student's needs of exercise, nutrition, and meditation (mind-body therapy) actually gives the student more ability to care for others in the clinical setting. "Caring for self is central to caring for others." (page 455) Answer #3 is the distractor and is incorrect as modeling healthy behavior is a description of the student's actions, not a consequence of the student's actions. |
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Which of the following examples best illustrates the principle of competence?
A. The nurse asks the client several health history questions and listens carefully to learn more about the client’s health. B. The nurse takes time out of her busy day to massage one of his/her client’s that is complaining of neck pain. C. The nurse understands how diabetes affects the body so she is able to provide the proper care to his/her client. D. The nurse spends some time sitting with the mother and father of his/her patient who is critically injured. |
Correct answer: C
Rationale: A: This answer illustrates the principle of knowing the client. By getting to know the client’s health history the nurse will know more about her client and provide them with the proper care. B:This illustrates comfort. Comfort is associated with the principle of compassion. C:This illustrated the principle of competence. The competent nurse employs the necessary knowledge to respond properly to the client’s needs. D:This illustrates the principle of nursing presence. Nursing presence can be both physical and/or emotional. |
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Which of the following scenarios is an example of perceived self-efficacy in a patient?
A. A patient has trouble eating healthy because of the lack of restaurants in her community that offer healthful menu items. B. A patient stays motivated to keep exercising because it makes her feel energized and decreases her stress levels. C. A patient has difficulty following a diet and exercise program because he has little support from family and friends. D. A patient feels confident in his ability to follow a new exercise and diet regimen in order to lose 100 pounds. |
Which of the following scenarios is an example of perceived self-efficacy in a patient?
A. A patient has trouble eating healthy because of the lack of restaurants in her community that offer healthful menu items. B. A patient stays motivated to keep exercising because it makes her feel energized and decreases her stress levels. C. A patient has difficulty following a diet and exercise program because he has little support from family and friends. D. A patient feels confident in his ability to follow a new exercise and diet regimen in order to lose 100 pounds. |
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Which of the key terms do the following principles apply to? Care across the life span, discharge planning, preparing clients to go home, home health care teaching, and referrals.
A. Continuity of care B. Community-based nursing C. Primary health care D. Integrated health care system |
Correct answer: A
Rationale: Answer A: Continuity of care is the coordination of health care services by health care providers for clients moving from one health care setting to another and between/among health care professionals. Continuity of care involves care across the lifespan, discharge planning, preparing clients to go home, home health care teaching, and referrals. Answer B: Community-based nursing is nursing care directed toward specific individuals. Answer C: Primary health care has its own set of five principles including equitable distribution, appropriate technology, a focus on health promotion and disease prevention, community participation, and a multi sectional approach. Answer D: An integrated health care system makes all levels of care available in an integrated form-primary, secondary, and tertiary care. |
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An expert nurse with knowledge on the “Failure to rescue” concept would ask all of the following questions except
1. “How many patients am I caring for this shift?” 2. “How many nurses am I working with this shift?” 3. “How many deaths have occurred in this hospital?” 4. “How quickly am I able to utilize my resources?” |
Correct Answer: 3
Rationale: It is crucial for a nurse to have a low patient-nurse ratio and to be able to mobilize their resources quickly to prevent failure to rescue. Death rate does not reflect the failure to rescue rate if similar patients aren’t compared. |
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According to Maslow’s needs theory, a Self-Actualized person would not possess the following characteristics:
1. Is realistic and objective 2. Is highly dependent 3. Is open to new ideas 4. Is friendly and loving |
Correct Answer: 2
Rationale: A characteristic of a self-actualized person is highly independent. A Self-Actualized person develops one’s abilities and qualities. |
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Family members are seeking an institution, which involves stimulation and socializing, where their grandmother could periodically attend since she can no longer be home alone. The nurse would suggest which of the following health care agency?
1. Retirement center 2. Assisted living center 3. Skilled nursing facility 4. Day care center |
Correct Answer: 4
Rationale: Day care center provide care and nutrition for adults cannot be left at home alone but do not need to be in an institution. Elder day care center provides socializing, exercise programs, and stimulation. |
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A mother is concerned that her child is not exhibiting appropriate behavior for his/her age. Using developmental stage theories, how should the nurse respond? Check all that apply.
A. “You should speak with a child psychologist” B. “Choose your battles; safety should be a priority” C. “You can expect your child to begin speaking in sentences” D. “You should not worry, no two children are exactly alike” E. “Having imaginary friends is typical for a 3 year old” |
Correct Answer: B, C, E.
Rational: “The nurse’s knowledge of developmental stage theories can be used in parental and client education, counseling, and anticipatory guidance.”(Berman & Snyder p. 280, 9th ed.) Answer B is an example of counseling which may be helpful to a parent who feels overwhelmed by the responsibilities of parenting. Answer C is an example of anticipatory guidance that allows the mother to know what sorts of developmental milestones she can expect to observe in her child. Answer E is an example of parental/client education that allows the mother to understand what is typical behavior for a specific age group. Answer A is not an example of the nurse utilizing knowledge of developmental stage theories. Answer D may have some truth that no two children are exactly alike, however it does not address knowledge of developmental stage theories. |
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A public health nurse wants to provide better access to health care in a neighborhood community that is severely poverty stricken. What type of care would be most appropriate for this area?
A.Primary Care (PC) B. Community-Based Health Care (CBHC) C. Community-Centered Health Care (CCHC) D. Primary Health Care (PHC) |
Correct Answer: D
Rationale: Primary health care is focused on not only the traditional aspects of health promotion, prevention and treatment of illness, but it also focuses on socio-economic development of people. PHC involves issues of housing, transportation, employment, poverty, and environment and how these factors affect overall health and health promotion and prevention. Community-based health care does much of the same thing, but it tends to be focused on a “specific group within a geographic neighborhood,” where as, PHC is focused on the whole neighborhood. |
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. What is the best example of Tertiary Prevention?
A. A nurse refers a client with Chronic Obstructive Pulmonary Disease to a support group. B. A health care provider performs a risk assessment for any genetic or acquired diseases. C. A nurse teaches a client how to perform regular breast and skin self-examinations. D. A nurse implements a care plan in response to a nursing diagnosis of acute pain. |
Correct Answer: A
Rationale: Tertiary Prevention occurs after a person has been diagnosed and treated for a disease. It is designed to help the client function as normally as is possible with their specific medical condition. |
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Two nurses work on the same floor, but on different shifts and they each cover the same patients. One of the patients notices that each nurse responds to complaints and requests in different, but effective ways. This is due to:
Ethical Knowing: The Moral Component B. Personal Knowing: The Therapeutic Use of Self C. Aesthetic Knowing: The Art of Nursing D. Empirical Knowing: The Science of Nursing |
Correct Answer: C
Rationale: Aesthetic Knowing is how each individual nurse responds to and meets the needs of their clients. This type of knowing allows each nurse to be creative in their problem solving skills and makes the care they provide unique to themselves and their clients. |
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A patient has been in the hospital for one week and will need to be transferred to a skilled nursing facility. What would be the nurse's best next step to ensure continuity of care?
A. Initiate discharge planning for the patient. B. Involve the patient’s family in the planning process C. Mail patient’s health records to the new facility. D. Arrange for appropriate mode of transportation. |
Correct Answer: B
Rational: Answers A and B are both necessary steps to accomplish continuity of care; however, when initiating discharge planning for the patient, it should occur upon admission rather than discharge. Answer C is incorrect because mailing health records would not be considered a vigilant method of protecting the patient’s privacy according to HIPAA. Answer D is not considered one of the necessary steps to accomplish continuity of care. |
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A 70 year-old woman who has been a life-long smoker is in the hospital with severe COPD. If in the precontemplation stage, how would she respond when her nurse explains to her the importance of quitting smoking?
1. "I have tried before. It is hopeless." 2. "I am going to buy Nicorette gum on my way home." 3. "I haven't smoked in 2 weeks and my husband promised to not buy them for me." 4. "I stopped a awhile ago. I'm not touching another cigarette." |
Correct Answer: 1
Rationale: In the precontemplation stage, the person does not think about changing his or her behavior in the next six months. He/She may have tried changing the behavior in the past, and was unsuccessful and may see the behavior as his or her "fate" or believe the change is hopeless. |
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A 35 year-old male has been diagnosed, and is being treated for Diabetes mellitus type 2. He knows the importance of changing his lifestyle and now exercises daily and eats healthy nutritious meals. This demonstrates which kind of prevention(s)?
1. primary prevention and secondary prevention 2. secondary prevention and tertiary prevention 3. tertiary prevention 4. secondary prevention |
Correct Answer: 2
Rationale: Secondary prevention consists of diagnosis and treatment and tertiary prevention consists of rehabilitation, health restoration, and palliative care that helps people move to the highest level of health given their current health status.. It would be both since he is currently being treated and also taking steps to restore his health to its highest level considering his health status. |
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A nurse is approached by the daughter of an elderly man who is being treated for pneumonia. The daughter states that her mother recently passed away and the father is lonely and would be comforted if the nurse would sit with him for a few minutes during his meals. How would the nurse respond?
1. "I am sorry but I am so busy and don't have time to sit with him." 2. "I will arrange for someone to sit with your father." 3. "I would be happy to sit with him as much as I am able to." 4."I'm sorry but that is not part of my duties as a nurse." |
Correct Answer: 3
Rationale: The nurse is portraying caring when he/she offers to sit with him as much as she can. Caring attends to the totality of the client's experience. The nurse should ask: Who is this patient? What are his/her needs? What is the patient's history? The knowledge is gained by observing and talking with the client and family while using effective listening and communicating skills. Knowing the patent increases the possibilities for therapeutic interventions. |
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A novice nurse is assigned a Native-American patient. The patient does not look at the nurses’ eyes; thus the nurse determines:
1. Patient is simply being disrespectful 2. Needs to report his/her patient behavior 3. It is a cultural behavior in native-Americans 4. Ask the patient to look at his/her eyes |
Correct answer: 3
Rationale: “…the nurse must first develop self-awareness of his or her own culture, attitudes, and beliefs, and examine the biases and assumptions he or she holds about different cultures.” |
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A nurse in a community clinic is informing pregnant women that breastfeeding is more beneficial for their newborns' health than formula feeding. The nurse is applying:
1. Secondary prevention 2. Primary prevention 3. Tertiary prevention 4. Experience prevention |
Correct answer: 2
Rationale: "Primary prevention focuses on (a) health promotion and (b) protection against specific health problems (e.g., immunization against hepatitis B). The purpose of primary prevention is to decrease the risk or exposure of the individual or community to disease.” |
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A patient is diagnosed with cancer, and after he/she received all the required information he/she decides not to follow any treatment. The nurse reaction is to:
1. Call the specialist to talk to the patient 2. Respect the patient’s decision to choose 3. Advise patient is best to have a treatment 4. Organize a meeting with patient’s family |
Correct answer: 2
Rationale: “Advocacy requires accepting and respecting the client's right to decide, even if the nurse believes the decision to be wrong.” |
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A nurse overhears a colleague complaining that there is a revolving door for their clients struggling with addiction. What should the nurse say?
a) “Relapse is preventable, the problem is insufficient social support and treatment." b) “Relapse can be fatal, the severity of an addiction is often worse after a relapse.” c) “Relapse is common and periods of sobriety predict better success in the future” d) “Relapse is hard on everyone your feelings are understandable, but your client is suffering more.” |
Answer: C
Rational: According to the Transtheoretical Model the stages of behavioral change are cyclical. The person that takes action and relapses is more likely to succeed in a second attempt at change than a person that never takes action. |
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A hospital is instituting mandatory checklists. Several nurses complain, “We already know what we are doing.” What reasons should the charge nurse give for implementing the change? Select all that apply.
a) “Due to the complexities of our work, experience is not enough to prevent error.” b) “Checklists will empower you to correct doctors when they fail to follow procedure.” c) “Health care is trending toward outpatient care, check list’s are a teaching tool for patients.” d) “Checklists clarify the minimum necessary steps in caring out complex processes.” |
Answer: A, B, and D
Rational: A: medicine is becoming more and more specialized; healthcare providers cannot depend on memory to prevent error. B: Nurses often feel uncomfortable correcting doctors but the checklist provides clear guidelines from which all healthcare workers can hold each other accountable. C: Checklist would be helpful in home health but this scenario takes place in a hospital. D: Making the minimum steps explicit prevents the error of skipping steps. |
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A client is receiving a full knee replacement. Before surgery the client shares with the attending nurse that s/he dreams of climbing Half Dome with his/her son after rehabilitation. Which of Kalish's hierarchy of needs does the nurse recognize in the client? Rank each answer in order of importance.
A) Self-actualization B) Stimulation C) Love and belonging D) Physiologic |
Answer) D, B, C, A
Rational: Each of the needs are met by the client's plans. The client is getting exercise (physiologic), exploring a new environment (stimulation), bonding with his son (love and belonging), and developing his maximum potential/realizing abilities (self-actualization). The needs are ranked in the order Kalish suggests are most essential to survival. |
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An elderly patient has been admitted to a facility that offers nursing care (limited), transportation and social activities. She will have a private room, and will likely stay here long-term because she is unable to live alone. What type of health-care facility will she live in?
1. Extended (long-term) care facility 2. Assisted living center 3. Rehabilitation center 4. Home health care agency |
Correct answer: 2
Rationale: Assisted living centers provide limited nursing care to patients, while providing an independent lifestyle. Residents can enjoy social activities, transportation to off-site locations, and in-house meals. They differ from extended care in that they have a lower level of nursing care, and clients tend to be more independent. Patients in rehabilitative centers are not always elderly, and do not always have the option of residence. Home health care agencies provide care in the home of the patient. Patients with this type of care may require more consistent, or around-the-clock nursing care than someone who can live in an assisted living center. |
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A patient has just received a diagnosis of cancer that requires immediate chemotherapy. The nurse caring for this patient wishes to go over their medication options, including an opportunity to participate in a new drug trial. Although the nurse believes the latter option is the best choice, what should the nurse say to the patient in order to clarify their values?
1. “I have looked into it, and you should consider the drug trial. It may be the best option for you. What do you think?” 2. “If I were you, I would weigh both options before making my final decision.” 3. “Have you had time to consider both options? Have you thought about any other course of action that you would like to discuss?” 4. “I’m sorry, but we are running out of time and you need to pick one option now.” |
Correct answer: 3
Rationale: When clarifying values with patients, nurses must engage the patient in a discussion about their care every step of the way. In this situation, the nurse needs to clarify the patient’s values regarding the options for drug therapy. He/she should not assume the patient would have identical values and beliefs about this drug trial. |
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Nurse Michael notices a sharp rise in the number of catheter associated urinary tract infections. Upon further investigation, he identifies the problem and brings it to his nurse manager. He says, “I have noticed that some nurses are putting newly unwrapped catheters onto the abdomens of patients before insertion, I think I have identified the reason we have seen a spike in catheter associated urinary tract infections.” According to Quality and Safety Education for Nurses (QSEN), Michael is utilizing which area of skill?
1.Evidence-based Practice 2. Patient-centered Care 3. Teamwork and Collaboration 4. Quality Improvement |
Correct answer: 1
Rationale: Although Michael aims to improve quality of care; he first uses his scientific reasoning and evidence-based practice to question the rationale for the method of catheterization in his unit. He is able to identify problems, and bring them to the attention of a colleague with the intention of decreasing “less-than-desired outcomes or adverse events”. |
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A patient comes to the emergency department with an apparent broken leg. Although they appear to be in great pain, they refuse any pain medications citing religious beliefs. The nurse believes that they should administer drugs anyway due to the clear pain the patient is in, but still obeys the patient's request. Which moral principle provides the basis for the nurse's actions?
a) Nonmaleficience b) Autonomy c) Fidelity d) Veracity |
Correct answer: b
Rationale: Although not causing harm (nonmaleficience), being faithful to promises made (fidelity), and always telling the truth (veracity) are all important nursing moral principles, the act of respecting a patients decision is the moral principle of autonomy. |
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The nurse that is currently caring for a patient with an UTI due to complication of care gets the blame for providing low-quality care to that patient. What impact can this have on the nurse? Select all that apply:
a. Divert resources and attention away from issues of quality b. Damages morale and satisfaction c. Provides constructive criticism d. Contributes to aggressive behavior |
Correct choices: a, b
Rationale: According to the reference article, 'blaming workers has been found to divert resources and attention away from issues of quality and damages morale and satisfaction". It does not provide constructive criticism nor does it contribute to aggressive behavior. |
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A nurse is receiving training on becoming more culturally competent in their practice. Which of the following things said to clients demonstrates this practice the best?
a) “Your people use sweat huts, so I can get you access to a sauna.” b) “Which type of Asian are you?” c) “Let me know if I do anything that is not acceptable in your culture.” d) “Have you considered having your children not just speak Spanish?” |
Correct answer: C
Rationale: Although option A is a nice gesture, this comment has the nurse explaining the client's possible beliefs to the client. B asks the question that will be covered during the health history, and D is pretty offensive. C is a culturally competent statement since it allows the nurse to attend and accommodate the client's situation, whatever it may be. |
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The nurse is teaching a client who is set to receive dialysis for the first time about arteriovenous fistula development and maintenance after discharge. This teaching most clearly reflects which caring activity?
a) Nursing Presence b) Compassion for the client c) Empowering the client d) Influencing the client |
Correct answer: C
Rationale: In this situation, the nurse is empowering the client by facilitating the client's passage through a life transition such as beginning the dialysis process. A and B are both important caring activities for a nurse to practice, but not the most accurate for this example, and D is a distractor. |
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A 78 year old pt is transferred to the ICU from an assisted living facility for a respiratory infection. He has end stage pancreatic cancer and a Do Not Resuscitate order. The night of his admission, he becomes bradycardic and apneic. His family demand he be resuscitated and life saving measures be implemented.
What is the appropriate response of his nurse? The nurse administers IV antibiotics to treat the infection. The nurse informs the family that resuscitation is against the patient’s wishes. The nurse contacts the attending physician and case manager to explain the DNR. The nurse calls a code team to stabilize the patient. |
Correct answer: #2
Rationale: Patients have the right to self-determination and autonomy when it comes to medical decisions about their treatment. The nurse may provide interventions to relieve pain, but must respect patient autonomy. #1 is the detractor, as a student may confuse giving antibiotics as a viable solution to the infection. However, administering IV medication is an invasive procedure and violates the Do Not Resuscitate order. |
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A nurse arrives at work and is told to float to the critical care unit (CCU) for the shift because it is short staffed. The nurse has never worked in the CCU. What is the appropriate action?
1. Call the hospital lawyer. 2. Refuse to float to the ICU. 3. Call the nursing supervisor. 4. Identify tasks that can be performed safely in the CCU. |
Correct Answer: #4
Rationale: Legally, nurses cannot refuse to float unless a contract guarantees that they work only in a specified area. When encountering this situation, the nurse should set priorities and identify potential areas of harm to the client. The nursing supervisor is called if the nurse is expected to perform tasks that he or she cannot safely perform. Reference: Berman Text Chapter 10: Critical Thinking and Nursing Practices |
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A nurse checks vitals on a patient and notes his blood pressure was 140/95 and heart rate 77 beats per minute an hour ago. Upon recheck, the heart rate has decreased to 64 beats per minute and blood pressure is 124/81. This is an example of:
Homeostasis Equilibrium Positive Feedback Negative Feedback |
Correct Answer #4
Rationale: Most biologic systems are controlled by negative feedback to bring the system back to stability. The baroreflex provides a rapid negative feedback loop in which an elevated blood pressure reflexively causes the heart rate to decrease and also causing blood pressure to decrease. |
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A 65-year-old patient is having cataracts surgery in an outpatient surgery center and is sent home the same day. Years ago, the patient’s older sibling had cataracts surgery in a hospital and remained in the hospital under observation for ten days. The difference in experience between the two patients can be attributed to which factor affecting health care delivery?
Specialization Increasing number of elderly Advances in technology Patient preference Uneven distribution of services |
Correct answer: 2
Rationale: The goal of secondary prevention is to identify individuals in an early stage of a disease process and prevent future disability through prompt intervention. |
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The nurse notices an extensive amount of blood loss from a caesarean incision site on the patient. The nurse documents the findings and walks out. An hour later, the patient is found dead due to blood loss. What should the nurse have done to help prevent the patient's death?
a. Recognized possible complications and acted accordingly b. Contacted the charge nurse to respond to the situation c. Called the nurse assistant to take her vitals d. Given her medications to stop the bleeding |
Correct choice: a
Rationale: According to the reference article, the nurse should have been able to pick up on "attending cues" and recognize complications. After doing "a" the nurse could have contacted the charge nurse for assistance. The nurse should have taken her vitals right away, not have the nursing assistant do it. The nurse should not give her any medicine without a doctor's order. |
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A 25 year-old woman with a family history of breast cancer in her mother, maternal aunt, maternal grandmother and older sister reports to her nurse that although she knows how to complete a breast exam she does not perform self-breast exams because her fear of finding a lump causes her to suffer anxiety attacks. The woman does not experience anxiety when being examined by a physician. How should the nurse intervene?
Schedule the patient once a month to ensure she is getting frequent breast examinations. Do nothing. The patient is too young to get breast cancer. Tell the patient she has to get over her anxiety because it is a matter of “life or death.” Suggest the patient teach her partner how to perform a breast exam on her. |
Correct answer: 4
Rationale: The patient has a perceived barrier to action as a result of the negative emotions she has when attempting to perform a self-exam. The importance of the self-breast exam is not who is performing it, but rather the fact that it is being performed effectively. The nurse can therefore suggest having someone else who is close to the patient perform the exam since the patient does not exhibit distress when another person examines her breasts. “Nursing interventions usually focus on factors that can be modified,” (Berman & Snyder, p. 284) Choice 1 is the distractor and is not the answer because it isn’t cost-effective and likely would create other barriers to action such as inconvenience and available time. |
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A nurse observes an anesthesia resident placing an arterial line in a client. During the procedure, the nurse notices that the anesthesia resident is not adhering to sterile technique as outlined by hospital policy. What action should the nurse take?
1. The nurse contacts the attending anesthesia provider to inform the provider of break in sterile technique. 2. The nurse refrains from interfering, recognizing the anesthesia resident’s level of professional expertise. 3. The nurse informs the anesthesia resident that the nurse will complete the procedure in order to maintain adherence to hospital policy. 4. The nurse reminds the anesthesia resident that sterile technique is important to prevent hospital acquired infections and offers assistance. |
Correct Answer: 4.
Rationale: The nurse is demonstrating teamwork and collaboration skills by offering support functioning within scope of care, as well as demonstrating teamwork and collaboration attitudes by acknowledging the expertise required to place an arterial line requires practice and giving the anesthesia resident a chance to correct technique before contacting the attending anesthesia provider. |
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A nurse is speaking with a seventeen year old woman who is pregnant. In their assessment, the patient discusses her failed relationship with the baby's father who was verbally abusive.The patient then states that she is excited to have a baby so she can experience "real love". According to Maslow's Hierarchy of Needs, which basic need is the patient seeking to fulfill?
1. Safety & Security 2. Success & Self-Esteem 3. Love & Belonging 4. Nurturing & Dependence |
Correct Answer: 3: Love & Belonging
Rationale: According to Maslow, the basic needs of every human include: self-actualization, self-esteem, love & belonging, safety & security and physiologic. |
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Checklists can be a valuable tool for reducing illness and mortality in a hospital. Which of the following is the most important factor in implementing checklist procedures in a hospital?
1. That doctors have full respect for supporting staff, like nurses 2. That the checklist is appropriate for the procedure 3. That there is a laminated copy of the checklist at the bedside during the procedure 4. The support of hospital administration who oversee the processes and enforce compliance |
Answer: 4
Rationale: According to Gawande, the most compelling reason that doctors were willing to follow the checklist procedures was because administration was adamantly supporting nurses who reported non-compliant doctors. |
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A nurse is caring for the driver from an alleged drunk driving accident that involved two fatalities. What should guide the decision making for this patient?
1. Follow the facility protocol for treatment of etoh positive patients 2. Follow local laws regarding treatment of an alleged criminal 3. The decisions made must be in the best interests of the patient 4. As an advocate for the family members of the deceased |
Answer: 3
Rationale: Under all circumstances, the decisions made by a nurse are always made for the best interests of the patient |
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Select from these options, those that would be considered Health Insurance Portability and Accountability Act (HIPPAA) violations
1. A nurse not minimizing the charting software before leaving the computer station, leaving the screen visible to others 2. Having a friend in the lab look up old lab results for a family member 3. Discussing an interesting case with another nurse without identifying the individual patient 4. A hospitalist calling an oncologist to discuss a cancer patient who has just been admitted to the hospital |
Answer: 1,2
Rationale: HIPAA protects patient privacy and confidentiality on many levels, including the protection of patient records, the disclosure of health records and patient privacy. |
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During lecture the nursing students learn the importance of Maslow’s hierarchy of needs. What type of knowledge are they learning?
1. Ethical Knowing: The Moral Component 2. Personal Knowing: The Therapeutic Use of Self 3. Aesthetic Knowing: The Art of Nursing 4. Empirical Knowing: The Science of Nursing |
Correct Answer: 4
Rationale: 1. Ethical Knowing is based on moral judgment and what a nurse feels “ought to be done” in the best interest of the patient 2. Personal Knowing focuses on engagement, wholeness, and integrity in the personal encounter 3. Aesthetic Knowing refers to a nurse’s creativity and style he or she expresses when caring for a patient 4. Empirical Knowing is knowledge based on the scientific discipline of nursing and “ranges from factual, observable phenomena…to theoretical analysis…”, Abraham Maslow's hierarchy of needs is a theory in psychology |
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In preparation for discharge of a homeless patient, which of the following parameters should the nurse consider? Select all that apply.
a) The patient’s cultural beliefs. b) The patient’s ability to prepare meals. c) The patient’s mental stability. d) The patient’s financial ability to obtain prescribed medications. e) The patient's mental health. |
Correct answer: a, b, c, d, and e.
Rationale: Discharge planning begins upon patient admission. Discharge planning prepares the client for transition from one level of care to the next. Upon discharge, a patient may require resource referrals to help meet their needs in the next environment, and within their community. A nurse should assess ability of the patient to meet self-care needs, disabilities, available caregivers and their role, financial resource needs, community support, potential home/environmental hazards, and need for assistance. |
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A charge nurse is attempting to integrate better teamwork and collaboration within her staff of nurses. According to Cronenwett et al in an article entitled, "Quality and Safety Education for Nurses", which action demonstrates that she understands the teamwork and collaboration principles in QSEN and making sure patients receive the best possible care? Select all that apply.
1. She requests that nurses treat the patient and their family as the center of the healthcare team. 2. She requests that nurses treat the patient only as the center of the healthcare team. 3. She requests that nurses analyze and consider differences in communication styles within the team. 4. She requests that nurses urge the family to communicate in a way that is sensitive to the patient's emotions. |
Correct Answer: 1 & 3.
Rationale: Two of the attitudes associated with the Teamwork & Collaboration portion of QSEN are the ability to, "respect the centrality of the patient/family as core members of any health care team" and to, "value different styles of communication used by patients, families and health care providers". |
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The nurse notices that the client is crying because she just lost her mother. By sitting with the client, the nurse is exhibiting which of the following caring encounters:
1.) Empowering the Client 2.) Nursing Presence 3.) Compassion 4.) Availability |
Correct Answer: 2. Nursing presence
Rationale: By being emotionally available to the client and family, the nurse conveys that they and their experience matters. This may be as simple as responding to the call bell promptly or as complex as sitting with a parent who just lost their child in a neonatal intensive care unit. Although, the nurse is available to the client, this is not a component of caring encounters. Empowering the Client and compassion are not shown here as the nurse is simply sitting with the client. |
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A client recently diagnosed as prehypertensive with a Body Mass Index of 40 states to the nurse “I am worried about my health. I’m thinking about trying to lose some weight.” This client is demonstrating which stage of change?
The client is in the action stage. The client is in the preparation stage. The client is in the contemplation stage. The client is in the precontemplation stage. |
Correct Answer: 3.
Rationale: The client is acknowledging having a weight problem as well as a potential health problem; however the client is not yet ready to commit to action. |
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An elderly client informs a nurse of an inability to fill a prescription due to cost, stating “I just don’t understand, I have Medicare but they told me I don’t have prescription coverage”. How should the nurse respond?
“That’s too bad. Perhaps you can pay out of pocket or get by without the medication.” “Medicare Plan D covers prescription medication, perhaps you should enroll.” “Medicare Plan B covers prescription medication, perhaps you should enroll.” “Medicare does not cover prescription medication; you will have to enroll in coinsurance to have medication coverage.” |
Correct Answer: 2.
Rationale: Medicare Plan D is a voluntary prescription drug plan that began in 2006. |
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A client with COPD returns to the clinic for a follow up appointment and tells the nurse, “I’ve been doing everything the doctor has recommended. I have learned to chew gum instead of smoking and it seems to really be helping.” Based on the stages of health behavior change, the nurse understands that this is an example of:
1.) Action 2.) Termination 3.) Maintenance 4.) Change |
Correct answer: 3. Maintenance
Rationale: The action of the health behavior change has already been implemented and at this point in time, the person is striving to prevent relapse by integrating a newly adopted behavior into his or her lifestyle, defined as the maintenance phase. Here, the client has learned to chew gum to prevent his/her relapse of smoking. Change is not considered a stage of health behavior change. The client is not yet in the termination stage because there is not indication that the problem is no longer a threat or temptation. |
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Health promotion plans need to be developed according to the needs, desires, and priorities of the client. What is the first step in developing a joint promotion/prevention plan?
1. Reinforce strengths and competencies of client 2. Review and summarize data from assessment 3. Determine a time frame for implementation 4. Identify behavioral or health outcomes |
Correct Answer: 2. Review and summarize data from assessment.
Rationale: The first step in establishing a promotion/prevention plan is to review and summarize data from assessment. This allows the nurse to share with the client data that has been collected from various assessments. Next, the nurse and client can come to consensus about which areas are doing well and which need further development. The nurse will then identify health goals and related behavioral change options and then identify these outcomes. The nurse will then develop a plan for these outcomes and reiterate benefits of change, address environmental and interpersonal facilitators and barriers to change, determine a time frame for implementation and lastly, formalize commitment to behavior-change plan. |
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A patient gives the nurse a long list of barriers to losing excess weight. The nurse perceives which one of the following?
1) The patient does not want to lose the excess weight. 2) The patient may have decreased commitment to lose weight. 3) The patient cannot be convinced to lose excess weight. 4) The patient will have extreme difficulties in losing excess weight. |
Correct answer: 2
Rational: "A person's perceptions about available time, inconvenience, expense, and difficulty performing the activity may act as barriers" and "affect health-promoting behaviors by decreasing the individual's commitment". Giving the list of barriers does not show that the patient does not want the needed change or cannot be convinced the change is needful. The close distractor is answer 4 because it may be true that the patient will have extreme difficulties in losing weight, however if the perceived barriers can be overcome the patient may not have extreme difficulties. Also the word "extreme" is a clue that it is not the right answer (like "always" and "never" in N-CLEX questions). page 284 |
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The nurse should do which of the following in providing patient-centered care? Select all that apply.
1) Recognize the patient as the source of control 2) View the patient as a full partner in care 3) Respect patient's preferences, values, and needs 4) Implement all necessary physician care orders |
Correct answer: 1,2,3
Rationale: The very definition of patient-centered care includes answers 1, 2, and 3. However, implementing necessary physician orders may or may not be part of patient-centered care depending on what the patient's desires, values, and preferences are. So answer 4 is the close distractor that seems like a correct action to take but may not be what the patient wants. The nurse should communicate the patient's values, preferences and expressed needs to other members of the health care team, including the physicians involved in care. |
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A client tells the nurse that he is aware that his chemotherapy is no longer effective, he will most likely live two more months, and that he wants to die at home. The nurse should respond:
1) "Would you like to learn about in-home hospice services?" 2) "Would you like to discuss this with your family first?" 3) "Would you like to reconsider? Nothing is certain in medicine." 4) "Would you like to fill out an advance care directive?" |
Rationale: The best answer is 1 because it is respecting the client's choice, independence, and autonomy. It is also showing the nurse’s role as educator and counsel. 2 and 3 do not respect the client’s choice, and might undermine the client’s acceptance of his death. 4 is better, but it does not address the whole of the client’s concern, and the client might already have one.
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Which behavior would demonstrate that a person is self-actualized, according to Maslow?
1) The person desires to change the world, is optimistic. 2) The person desires to see the best in people, is trusting. 3) The person desires privacy, is remote and detached. 4) The person desires the good opinion of others, is hopeful. |
Rationale: Privacy, remoteness, and objective detachment (answer 3) are signs that a person is self-actualized, it displays that he/she is able to see things clearly and for what they are. While the other options are usually seen in a somewhat more positive light, they do not display self-actualization, according to Maslow.
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A caring nurse:
1) Approaches each patient equally 2) Lobbies for more time with each patient 3) Continues learning through online classes 4) Reflects on events to learn from experiences |
Rationale: 4 is the best answer; caring nurses need to reflect to learn from the many events and to process experiences to continue to provide compassionate caring. Online learning is good, but not ideal, as it could be an isolating experience. Lobbying for more time with patients is also good, but could lead to frustration and might not lead to higher patient:nurse ratios. Approaching every client equally negates the reality that every client is different and might need a different approach.
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A female patient who uses intravenous drugs is being screened for sexually transmitted diseases. The patient expresses remorse for use of drugs and states being ready to change. What stage of the Transtheoretical model proposed by Prochaska, Redding, and Evers is the patient in?
A) Preparation stage B) Precontemplation stage C) Contemplation stage D) Action stage |
Answer: C
Rationale: In the contemplation stage, the patient acknowledges the problem, verbalizes it, and begins to search for material in order to help her make the change. |
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Which example of best illustrates the principle of empowering the client?
A) Listening to the life story of the client. B) Displaying vast amount of knowledge about the diagnosis of the client. C) Maintaining a warm and friendly demeanor. D) Educating the client and his/her family about health promotion. |
Answer: D
Rationale: Nurses empower clients through promotion of well-being, understanding, and self-care. All are example of health promotion. A, B, and C deal with the requisite compassion and competence that a nurse must display but do not empower the client. |
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A nurse who is relatively new to the Critical Care Unit at Clooney General has noticed that the repeated actions of a renowned physician have put his/her patient at risk for further injury. The physician has threatened to have the nurse fired if he/she discloses information on the questionable practice. Knowing this to be a fact, what should the nurse do?
A) Discuss the questionable practice with the charge nurse in hopes of support. B) Report the questionable practice to the regulatory agency which evaluates standards of practice. C) Discuss the questionable practice with a lawyer in lieu of the upcoming legal battle. D) Report the questionable practice to the Chief Physician of Clooney General. |
Answer: B
Rationale: In this case, B is appropriate course of action due the fact that the actions have been repeated and not corrected. This denotes a problem at Clooney General, so the only option for the nurse is to report to the higher governing bodies, which include the practice commissions of pertinent professional organization or any regulatory bodies applicable. |
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A nurse is dissatisfied in their relationship with the nurse manager on shift. The nurse says “I think that if we talk through our problems, we can have a much stronger working relationship.” According to the Thomas-Kilmann Conflict Mode Instrument, what is likely the nurse’s dominant conflict management style?
1. Accommodating 2. Collaborating 3. Competing 4. Avoiding |
Correct Answer: 2
Rationale: The nurse that adopts the collaborating conflict style believe that differences may be resolved by talking through problems. They believe there is a creative solution to every issue and conflict should not be avoided. Those who adopt the competing conflict style also approve of conflict but see it as competition for status and an opportunity to persuade those whose opinions are in doubt. Those who adopt the accommodating conflict style believe it is more important to preserve the relationship than to argue one’s own viewpoints. Those who adopt the avoiding conflict management style see argument and persuasion as hopeless endeavors and will withdraw from situations involving them. |
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A nurse living and working at a hospital in North Carolina is looking to pick up shifts at a hospital across state lines in Virginia. A colleague tells her...
A. "In order to work there, you will have to get an additional state license in Virginia." B. "You can only work in one state at a time." C. "You can work there under your North Carolina license if they have an interstate arrangement in place." D. "You can work in any state under the same license." |
Answer - C
Rationale - Under the "mutual recognition model," a nurse can work in a bordering state under their original license. "With mutual recognition, a nurse who is not under any disciplinary action can practice in person or electronically across state lines under one license. For example, a nurse who lives on the border of a state can practice in both states under one license if the adjoining states have an interstate compact." |
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A school nurse is looking to implement health prevention measures on campus. Which of the following is an example of a secondary prevention?
A. Coordinating influenza vaccinations during flu season. B. Installing alcohol based sanitizers in public areas. C. Bringing in a group of student nurses for lice removal during an outbreak. D. Referring a student diagnosed with dyslexia to campus tutoring services. |
Answer - C
Rationale - Secondary preventions are "prompt interventions to alleviate health problems." By having extra staff on hand to check hair will prevent more students from getting lice. |
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An expert nurse is assisting a novice nurse on how to access patient information via electronic health records. This is an example of which Quality and Safety in Education (QSEN) competency?
A. Informatics B. Safety C. Patient-Center Care D. Evidence Based-Practice |
Answer A
Rationale - Informatics is "use information and technology to communicate, manage knowledge, mitigate error, and support decision-making. Applying technology and information management tools to support safe processes of care." |
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A nurse and his/her patient identify well with each other. The nurse maintains professional objectivity and simultaneously engages in an interpersonal relationship that generates a self-healing process. Which of the nursing theories on caring does this scenario depict?
A. Ray’s theory of bureaucratic caring B. Boykin and Schoenhofer’s theory of nursing as caring C. Watson’s theory of human care D. Swanson’s theory of caring |
Answer: C
Rational: This is a knowledge based question. Ray’s theory focuses on caring in organizations as cultures. Boykin and Schoenhofer’s theory focus on the nurse’s approach to viewing him/herself as caring and also viewing the patient as a caring person. Watson’s theory emphasizes that the practice of nursing is both transpersonal and metaphysical. According to Watson, transpersonal contact has the power to generate the self-healing process. According to Berman & Snyder, “An assumption of Swanson’s theory is that a client’s well-being should be enhanced through the caring of a nurse who understands human responses to a specific health problem. |
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The physician has ordered an MRI for a patient exhibiting confusing and disorientation following a car accident. The nurse explains to the patient the procedure, its benefits, possible complications, alternatives, and the risks of doing nothing. The patient makes no coherent response to this explanation. Which statement best describes ethical treatment by the nurse?
A) The nurse notes a failure to agree to the procedure in the chart and does not wheel the patient to imaging. B) The nurse notes patient is not mentally competent and does not wheel the patient to imaging. C) The nurse recognizes symptoms which justify implied consent to the procedure and takes patient to imaging. D) The nurse brings a friend of the patient to the room, explains the procedure again, and uses consent of the friend to justify taking the patient to imaging. |
Correct Answer: C
Rationale: This patient is demonstrating symptoms incompatible with giving informed consent. As a result, the nurse must use judgement to both evaluate the patients ability to give consent, and the beneficence of the procedure. In this case, an MRI stands to provide useful information regarding injury and potentially life-threatening conditions without high risk of harm. |
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A nurse is interviewing a male patient of Asian descent who averts his gaze. The patient is accompanied by his child, but the child has no trouble looking at the nurse during the interview and translating as needed. This shedding of cultural characteristics in favor of those in a new country demonstrates the principle of:
A) Indoctrination B) Acculturation C) Adaptation D) Assimilation |
Correct Answer: B
Rationale: Indoctrination refers to the imprinting of cultural norms on a child in early development, Adaptation refers to biological changes over time to meet the demands of an organism’s environment, assimilation is the process by which an individual develops a new cultural identity. |
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A patient undergoing life-saving surgery suffers a ischemic attack in the brain and is rendered vegetative. The family has decided to allow natural death. The nurse monitoring the patient has become increasingly uncomfortable and brings the situation to the charge nurse. Which response is most likely to reduce or alleviate the discomfort of the nurse?
A) “Have you discussed your concerns with a therapist?” B) “Have you taken advantage of hospital resources to reduce stress?” C) “Have you followed Thompson and Thompson’s decision making models?” D) “Have you used the 4A process?” |
Correct Answer: D
Rationale: While all of the options may help to alleviate some stress the method specifically designed for combatting moral distress is the 4As. Ask, Affirm, Assess, Act |
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What could help to improve learning strategy in order to improve the quality and safety of healthcare system? Check all that apply.
1. Increase number of years students spend in a Nursing school. 2. Require all nurses to be CNA. 3. Require nursing students to practice all nursing skills on each other. 4. Promote critical thinking in majority of nursing classes. |
Correct Answer: 2, 4.
Rationale: Increase the years of nursing school without specifying the strategy or classes included will not improve the quality and safety of health system, 1. Nursing students can’t practice all nursing skills on each other because of the legal liability a nursing school might encounter. |
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According to Prochaska, Norcross, and DiClemente, which stage in health behavior change would include when the client no longer experiences temptation to return to previous unhealthy behaviors:
1. Termination Stage 2. Action Stage 3. Maintenance Stage 4. Contemplation Stage |
orrect Answer: 1
Rationale: 1. Client copes with a new lifestyle without fear to relapse; 2. Client makes observable modifications in a lifestyle; 3. Strives to prevent relapse; 4. Acnowledges having a problem, but not ready to commit a change. |
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An elderly client, alert and oriented, with a terminal cancer and multiple comorbid conditions refuses to receive anti-cancer treatment. His family insists on continuing the treatment. What should the role of the nurse be in family disagreement?
1. Help the client to understand the concerns of the family 2. Continue the anti-cancer therapy in client’s best interest. 3. Say, “I can’t be involve in the family disagreement”. 4. Be an advocate for the client. |
Correct answer: 4
Rationale: Nurses act as advocates of their clients. A client in clear state of mind has a right to refuse any treatment, including life-saving. Nurses empower clients through activities that enhance well-being, understanding and self-care. |
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A nurse is discussing a discharge plan with a patient in order to promote healthy choices and prevent further illness after the patient’s procedure. The patient appears nervous about the upcoming changes. What advice could the nurse offer this patient to establish healthy self-care techniques?
1. “Try having a glass of wine at dinner to help unwind and relax from a stressful day” 2. “Go to a quiet place to concentrate on breathing and meditation to reduce stress” 3. “Check the internet when any symptoms arise to be sure of any possible illnesses” 4. “Try various activities or mind-body therapies to find a self-care system that works” |
Correct Answer: 4
Rationale: Although the nurse is giving the patient advice, the best thing to do in this situation is leave the advice open-ended. By allowing the patient to try different self-care tactics, this doesn't force the patient into thinking one is better than the other. Giving the patient the chance to develop their own self-care system helps he or she to feel it is personalized to their lifestyle, not the nurse imposing his or views onto the patient. |
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Some examples of nursing surveillance can include: (Select all that apply)
1. Identifying patient complications 2. Screening patient rooms with cameras 3. Evaluating patients on a frequent basis 4. Assessing for patient distress signals |
Correct Answer: 1, 3, 4
Rationale: The nursing surveillance system is there help nurses and other hospital staff act on any patient complications before there is a pressing need to save the patient. There is most often something that could have been prevented if the early signs of distress were observed and acted upon. Identifying patient complications, evaluating patients frequently, and attending to cues allows the nurses to assess the severity of the patients condition before it is too late. Screening a patients room with unknown security cameras could be a breech in privacy laws for patients and therefore is not a component of nursing surveillance. |
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A nurse is discussing health promotion with a seven year-old patient’s mother. Which of the following topics is most appropriate for this patient based on lifespan considerations?
a) Dental checkups b) Play group influences c) Exercise d) Vision screening e) Weight Control |
Correct answer: (a)
Rationale: In the scope of lifespan considerations, dental hygiene and checkups are age-appropriate promotions for this patient. Weight control may be a prominent concern for SOME patients in this age group. Regardless of health status, promotion of healthy habits and preventative care is appropriate. |
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Which of the following exemplifies a nurse empowering a client who just found out she is HIV positive?
1. Providing the client with tools, resources, and support on managing her condition 2. Showing empathy and genuine concern 3. Assessing the client’s condition, creating a plan, and implementing it 4. Trying to share the client’s joys, sorrows, pain, and accomplishments |
Correct Answer – 1
Rationale: 1. Empowering the client is “facilitating the other’s passage through life transitions and unfamiliar events” which includes informing, explaining, and supporting 2. Empathy and concern are examples of compassion 3. The ability to assess, plan, and implement are components of competence 4. Trying to relate to a client’s joys, sorrows, pain, and accomplishments is an example of compassion |
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A 3 year old boy is brought into the community clinic for a check up by his overweight parents. He weighs 26 lbs. and is considered obese. It is important for the health care provider to discuss with the parent: (select all that apply)
A) Healthy eating habits B) Eating the same diet as adult C) Encourage family exercise D) Call CPS for child endangerment |
Rationale: A and C. It is important for the HCP to encourage healthy eating habit and exercise for illness prevention and health promotion. Although, you usually would like for the child to eat what adults eat (aka no special meals like mac n’ cheese or corn dogs instead of a green salad and grilled chicken) it would be wise to determine what the parents ate on a typical day and assess their diet as well. It would be easier if they made the change as a family. And although the child is very overweight for his age group, his parents did bring him to the clinic for a health check up, leading me to believe that intervention by CPS is not needed at this time.
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A patient is receiving dialysis 5 times a week for end-stage renal failure and was recently diagnosed with prostate cancer. They determine that they would like to stop receiving treatment, and return home to die. Which principal supports the patients right to choose death?
A) Justice B) Autonomy C) Nonmaleficence D) Beneficence |
Rationale: B, autonomy, allows the client to make choices about their health care even if it mean death or goes against medical advice.
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nurse notices that her patient hasn’t touched any of the food on their dinner tray. After politely questioning the patient, the nurse learns the patient is Jewish and will only eat Kosher food. The nurse should then:
A) call the patients family and ask them to provide the kosher meals B) ask the patient to eat now, a kosher meal can be arranged for tomorrow C) scold the patient for not mentioning it sooner D) call the dietary department to request a kosher meal |
Rationale: The best answer is to first call the dietary department to see if they can accommodate the request. IF they can’t then you could ask the family or a Jewish leader within the Jewish community to provide kosher meals.
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A nurse is assessing a 20 year old patient who has anxiety about the recent passing of her mother to breast cancer and a history of cancer on her maternal side. Which level of prevention would be most appropriate for the nurse to implement with this patient?
1. Primary Prevention: The nurse should refer the patient to a breast-cancer specialist for further assessment. 2. Primary Prevention: The nurse should refer the patient to a support group for loved ones lost to cancer. 3. Secondary Prevention: The nurse should teach the patient how to perform regular breast exams. 4. Tertiary Prevention: The nurse should urge the patient not to worry but recommend a mammogram at 22. |
Correct Answer: 3: Secondary Prevention: Teach patient how to perform regular breast exams.
Rationale: The only level of prevention properly matched with its scenario is secondary prevention and instructing the patient how to perform self-examinations. |
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A local hospital recently found out their incidence of deaths from nosocomial infections and medication errors was high. Based on the article “Failure to Rescue”, which of the following is the best plan of action for hospital administrators to lower these rates if the hospital keeps the same number of patients?
1. Isolating patients who have been diagnosed with a nosocomial infections. 2. Hiring more Registered Nurses. 3. Hiring more Family Medicine doctors. 4. Changing the shifts for nurses from eight to twelve hours. |
Answer: 2
Rationale: Lower patient – nurse ratios is one of the most consistent findings for decreasing failure to rescue cases. Nosocomial infections and medication errors are both examples of possible Failure to Rescue cases. If more Registered Nurses are hired while the number of patients remains the same, lower patient-nurse ratios will result. |
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Which of the following activities is an example of tertiary prevention?
1. Teaching middle aged adults about the importance of weight control and exercise to prevent illness and maintain health. 2. Doing a home hazard appraisal in the home of an aging client whose family has a history of neurological disorders. 3. Referring a new amputee to a rehabilitation center to receive training on how to do daily activities. 4. Referring a new mother to a breast feeding consultant for the best way for a baby to latch on. |
Answer: 3
Rationale: Tertiary care begins after an illness, when a defect of disability is fixed, stabilized, or determined to be irreversible. Its focus is to help rehabilitate individuals and restore them to an optimum level of function. |
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A nurse turning and moving an immobile patient at risk for pressure ulcers is an example of what kind of caring?
1. Competence 2. Compassion 3. Comportment 4. Conscience |
Answer: 1
Rationale: The act of moving an immobile patient requires competence which means having the knowledge, judgment, skills, energy, experience, and motivation to respond adequately to others within the demands of professional responsibilities |
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A nurse is responsible for ten patients and doing their best with managing the patient’s needs. Patient A asks for more pain medication and the nurse replies, “I will go get your pain medication and bring it to you within the next couple minutes”. While the nurse is getting the pain medication, they get wrapped up in attending to Patient B for 20 minutes and forgets about bringing the medicine to Patient A. Which moral principle has the nurse violated?
1. Justice 2. Veracity 3. Nonmaleficience 4. Fidelity |
Answer: D. Fidelity
Rationale: The nurse did not violate veracity, which refers to telling the truth, because she had intended to bring the medication right away. Justice is referred to as fairness and nonmaleficience is referred to as the duty to “do no harm”. While the other three moral principles may seem plausible, fidelity makes the most sense because it means being faithful to agreements and promises. |
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A teen discovers that she is pregnant and after a long thought out and difficult decision process, she has decided she is going to abort her baby. She goes to the school nurse to discuss her options. This particular nurse is very against abortions for personal reasons. As a client advocate, the nurse should:
1. Advise the teen that she should consult with her parents before proceeding with her decision. 2. Inform the teen of resources where she can safely and privately follow through with the procedure. 3. Explain why he or she does not believe an abortion is appropriate for the teen. 4. Explain other alternatives, for example putting the baby up for adoption. |
Answer: B. Inform the teen of resources where she can safely and privately follow through with the procedure.
Rationale: An advocate must remain objective and protect the clients’ rights. The other responses would mean the nurse was trying to impose his or her opinion on the client and not respecting her decisions. |
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A patient with asthmatic symptoms has expressed to their nurse that they are considering quitting smoking. The nurse recognizes that this patient is in the contemplation stage of health behavior change. What is the nurse’s best response to help move the patient to the next stage?
1. “I’ve been waiting for the day when you when you would say that.” 2. “Great. I will help you create a plan you can follow to accomplish this change.” 3. “Wonderful. I will prescribe you a nicotine patch so you won’t be tempted with cravings.” 4. “Good for you. I hope you’re ready for this difficult challenge ahead of you.” |
Answer: B
Rationale: The contemplation stage of health behavior change is followed by the preparation stage, which involves making small behavioral changes and making specific plans to accomplish the change. |
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After promising a young patient a cold drink right away, the nurse is distracted by a personal phone call from his/her own child. The nurse chooses to follow-through with delivery of the drink before taking the call. This is an example of which of the Six Cs of Caring:
a) Comportment b) Conscience c) Compassion d) Commitment e) Competence |
Correct Answer: (d)
Rationale: Commitment is evidenced when one acts to follow-through with an obligation, despite a conflicting desire. |
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Which of the following is an example of the provisions within the ANA Code of Ethics?
A. The nurse must think of others before themselves in all cases. B. The nurse’s primary commitment is to the patient, whether an individual, family, group or community. C. The nurse participates in the advancement of the profession before all else. D. The doctor promotes, advocates for, and strives to protect the health, safety, and rights of the patient. |
Correct answer: B
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An RN is on shift with 12 patients; 4 critically ill. He has one other RN on shift with him and one CNA due to illness among staff. One of the critically ill patients has a 102° temp and another started to vomit blood. What should the RN do?
A. Call the charge nurse for help. B. Keep doing his job. Two RNs are perfectly adequate for this situation. C. Have the CNA take charge of the patients that are not critically ill. D. Discuss the situation with his RN colleague so that the patients are appropriately divided among them. |
Correct answer: A
Rationale: The nurse:patient ratio is too high and something is likely to slip by under these conditions. Though it is good that both nurses are bachelor’s trained, the ratio is still too high for them to manage appropriately. The charge nurse is responsible for finding more staff for this ward. |
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A patient with pancreatic cancer is in the hospital. The lucid patient claims that they are “ready to go” and refuses to eat or drink any longer. The spouse of the partner gets angry and tells the nurse that they must provide nutrition and liquids to the patient to keep them alive. What does the nurse do?
A. Attempts to convince the patient to eat but, when that fails, obtains orders for a feeding tube. B. Spoon feeds the patient applesauce against their will. C. Advise the spouse to respect the patient’s wishes and direct them to a counseling support group. D. Respects the patients wishes but checks with them regularly to see if they have changed their mind. |
Correct Answer: D
Rationale: “The nurse must also honor competent and informed clients' refusal of food and fluids. The ANA Code of Ethics for Nurses (2005) supports this position through the nurse's role as a client advocate and through the moral principle of autonomy. However, the debate on ethical, legal, personal, and religious grounds continues |
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A hospital has just had a large hiring of nurses, they all have their Bachelor of Science in Nursing. Which part of the American Nurses Association’s Health System Reform Agenda does this change address?
1. Quality 2. Workforce 3. Access 4. Cost |
Correct Answer – 2
Rationale: Quality addresses measures focusing on “safe, effective, patient-centered, timely, efficient, and equitable health care” Workforce is correct because it is a strategy for “ensuring an adequate supply of well-educated nurses” Access concerns the ideas of affordability, availability, and acceptability Cost addresses the idea of a single-payer system that focuses on primary and secondary prevention in the community |
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When considering a patient’s preferences regarding their medical indications, a healthcare provider should not do which of the following?
1. Discuss in detail the burdens of each treatment with the patient. 2. Explain all pathophysiologic considerations before posing treatment options with the patient. 3. Communicate to a patient, what treatment goals are realistic and the likelihood of achieving them. 4. Ask noncontextual open-ended questions like, ‘‘What do you want us to do?’’ |
Correct answer: D
Rationale: “Open-ended, noncontextual questions, such as ‘‘What do you want us to do?’’ are rarely helpful and often engender a sense of confusion in patient and family. Before posing any questions, before considering any options, it is important that the patient understands the disease, injuries, or other pathophysiologic considerations.” |
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Upon entering the patient's room, the nurse notices that his/her terminally-ill patient has been crying, the urine stains on the linens, and the unkept appearance of the patient. How should the nurse first respond to this situation?
a. Comb the patient's hair b. Get the patient out of bed and change the linens c. Direct the patient to go take a shower d. Ask if there is anything he/she can do to make the patient feel more comfortable |
Correct choice: d
Rationale: Choices a-c would all be something the nurse might do to physically care for the patient. However, of most importance is d before a-c. According to the reference, "knowing means understanding the other's needs and how to respond to these needs." |
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A nurse on a Medical-Surgical nursing unit is preparing to discharge his patient who has been recovering from surgery for several days and is very frail and without a good support system. Discharge planning should include all of the following EXCEPT:
1. Preparing for the patient’s discharge as soon as they are admitted. 2. Gather as much information as possible to give to a home health agency about the patient and the hospitalization. 3. Be familiar with the resources available in the community to make a referral. 4. Provide instruction on all necessary further treatment and insure the home health agency implements them safely. |
Correct answer: 4 The nurse must also ensure that the patient demonstrates safe performance of the treatments.
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Which of the following patient problems is considered of the highest priority on Maslow’s hierarchy of human needs?
1. Spiritual distress 2. Homelessness 3. Decreased skin turgor indicating dehydration 4. Impaired interpersonal relations |
Correct answer: 3. Physiological needs are considered of the highest priority.
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A patient would like to know why a diagnostic test is being run and the nurse responds with “I’m not aware of the reason but will go and find out for you”. When the nurse returns to the patient with the answer the nurse is acting under which principle?
1. Beneficence 2. Nonmaleficence 3. Fidelity 4. Justice |
Correct answer: 3 The nurse is being faithful to the agreement they made with the patient.
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An expert nurse is expanding their sex-education program to teens in a Latino community center. The center director has advertised the program and brought condoms to give out. According to Berman, which of the following variables represent barriers to the success of the program? Select all that apply
1. The nurse’s perceived self-efficacy 2. The teens’ perceived benefits of action 3. Interpersonal influences 4. The director’s perceived benefits of action |
Correct Answer: 2, 3
Rationale: An expert nurse who has successfully instituted other sex-education programs is unlikely to doubt their ability to present the program. The director has shown strong support of the program and is likely to perceive the program to be successful. The barriers to success lie with the teens who may not see sex-education as beneficial. Additionally, interpersonal influences including cultural beliefs surrounding sex education (i.e. Catholicism in the Latino community) also may hinder the program’s success. |
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Which of the following best describe a nurse who employs the principal of Autonomy?
1. Expresses and defends the cause of another. 2. Respects patient’s choice when not in the patient’s best interest. 3. Is faithful to promises and agreements made to the patient 4. Spends extra time with the patient during a home visit. |
Correct answer: B
Rationale: “Honoring the principle of autonomy means that the nurse respects a client’s right to make decisions even when those choices seem to the nurse not to be in the clients best interest.” |
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A teenager comes in the ER with a broken bone injury. In the interview, the patient states that they just wanted to prove that they could do the same tricks as their older brothers. Which would best describe this teenager’s highest priority of human needs?
a) Self esteem b) Safety and security needs c) Physiological needs d) Love and belonging needs |
Correct Answer: A
Rationale: A teenager are at an age where they are still finding themselves and wanting to earn recognition and respect from others so they’ll do whatever it takes if it is at a high priority. |
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Which of the following attitudes best describe teamwork and collaboration?
a) Only acknowledging one’s own potential within team b) Appreciate the risks associated with handoffs among providers and across transitions in care c) Seek learning opportunities with patients who represent all aspects of human diversity d) Value the need for continuous improvement in clinical practice based on new knowledge |
Correct Answer: B
Rationale: Appreciating the risks associated with handoffs require a positive and patient attitude which is essential to teamwork and collaboration. |
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There’s a patient who is has had a stroke and smells profusely but also refuses a bath every time asked. Which one of the following would be the best example of Aesthetic Knowing?
a) The nurse states that the patient has bad odor so she gives a bed bath to the patient by force. b) The nurse gives options to patient to figure out a way to work it in with the morning schedule. c) The nurse secretly gives the patient a bath at night while he/she is sleeping. d) The nurse gently explains why baths are important and how they promote health, promising to make the bath quick yet thorough. |
Correct Answer: D
Rationale: Aesthetic knowing is the art of nursing and is expressed by the individual nurse through his or her creativity and style in meeting the needs of clients. The nurse uses aesthetic knowing to provide care that is both effective and satisfying. Empathy, compassion, holism, and sensitivity are important modes in the aesthetic pattern of knowing. The nurse shows compassion by gently explaining the importance of baths while meeting the needs of the clients of needing a bath. |
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Richard is an 85 year old patient that has come to the hospital with a kidney infection. Richard lives with his son’s family and is in the beginning stages of dementia. His son has accompanied Richard to the emergency department. The nurse is concerned because this is the third time in the last 6 months that Richard has had problems with his kidney. Richard’s son wants to discuss alternative treatments for his father. What is the correct action for the nurse to take?
1. Discuss the medical condition with Richard’s son since it’s obvious that Richard would not understand? 2. Discuss the medical condition with Richard only and ask his son leave to give them privacy. 3. Just send Richard home with another round of antibiotics 4. Ask Richard to give permission for his son to discuss the medical condition with both Richard and his son explaining the risks and benefits of the different available options for treatment |
4 is the correct answer
Rationale: Getting Richard’s permission would be the most appropriate answer, it is obvious that he needs help but unless his son has power of attorney which is unknown from the information given the nurse would need to follow the ANA standards of professional performance and also HIPPA laws regarding patient information. |
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Which assessment tool would the nurse be using when asking the patient the following questions:
What do you think is wrong? What do you think caused your problem? What have you done to make your condition better? What are your concerns regarding the condition and treatment? A. The LEARN model B. The 4 C’s of culture model C. Assement and diagnose model D. The ABCE model |
B is the correct answer
Rationale: The questions asked follow the model of what the patient’s condition is “called”, how it was “caused”, how they “cope”, and what are their “concerns” A - Gives a model that is specific to how the nurse conducts the interview for assessment B - No such model C - No such model |
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Culturally responsive care is characterized by?
1. Care that is centered on the client’s cultural perspectives and beliefs 2. Care that integrates the client’s values and beliefs into the plan of care 3. The nurse develops self-awareness of her own culture 4. All of the above |
4 - is the correct answer
Rationale: culturally responsive care includes all of those characteristics in order to help the nurse create an environment where trust can be developed with the client |
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A nurse comes on to a PM home health care shift with orders to make sure that the patient with dementia “eats today.” The nurse becomes frustrated after checking on the patient and finding their plate of food untouched. What would be the best first course of action?
A. The nurse should report her findings to her colleague who wrote the initial request. B. The nurse should ask the patient if there is a reason they are not eating. C. The nurse should inform the patients family that if the patient doesn't eat, their condition may worsen. D.The nurse should bring out more food, hoping that the patient will eat it. |
Correct Answer : B
Rationale: A nurse should encourage and consider patient input when making goals. Asking a patient about their behavior, such as not eating allows for potential solutions towards a care plan that will best serve their needs. |
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A patient is admitted to the emergency room at the hospital with alcohol poisoning. He has been seen at the hospital many times and is often referred to a rehabilitation house upon discharge. Many of the nurses feel that he should not be treated as their prior efforts to care for him have “ been in vain”. Which of the following describes this ethical conflict?
A. Fidelity versus autonomy B. Justice vs. benefience/nonmalefience C. Veracity vs. benefience D. Autonomy vs. benefience |
Correct Answer: B. Justice versus beneficence/nonmaleficence
Rationale: Justice in this case, “doing what is right” might mean giving a bed and treatment to critically ill patients vs. one that is uncooperative. This is in conflict with the doing good and no harm to this same uncooperative patient. |
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A nurse is consulting with a patient that has just been diagnosed with liver disease due to alcoholism. The patient asks for resources and support to help him “cut back” on his drinking. Which stage of health behavior change is this patient in?
A. Precontemplation Stage B. Preparation Stage C. Contemplation Stage D. Planning Stage |
Correct Answer: Contemplation Stage
Rationale: A patient that is in the contemplation stage “acknowledges they have a problem, and actively gathers information, verbalizing plans to change their behavior in the near future.” However, they may or may not be ready to take the actual steps required to put the plan in motion. |
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A nurse who is attempting to clarify health values of a patient should do the following (select all that apply):
1. Assist the patient by offering an opinion when asked for one 2. Assist the patent by imposing their personal values 3. Assist the patient by listing alternatives actions 4. Assist the patient by examining possible consequences |
Correct Answer(s): 3-4
Rationale: Listing alternatives and examining possible consequences of a patient’s actions with them, allows the nurse to help the patient think each question through and helps the patient clarify their health values. (1 the nurse will rarely, if ever, offer an opinion when asked for one as this may influence a patient’s decisions. 2 a nurse should not impose their own values on a patient) |
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A nurse has been assigned their first patient from Afghanistan. The patient is not eating the pork chop that was provided for their dinner on the second night’s hospital stay. The night before however, the nurse observed the patient eating the salad that was served. The nurse would best address the uneaten pork chop dinner by:
Bringing other types of food to the patient as they are most likely Muslim 1. Call a dietician to consult with the patient in case they cannot eat pork 2. Consult with the patient and ask if they are not able to eat pork due to their religion 3. Consult with the patient to discover the meaning of their non-eating 4. Bringing the patient a salad for dinner, as they ate that the night before |
Correct Answer: 4
Rationale: Consulting with the patient directly will allow the nurse to get information from the patient without making assumptions or cultural stereotypes. (1 This is a stereotype, race/ethnicity are not religion. 2 unnecessary first step without consulting the patient first. 3 This questions assumes much and may be offensive to the patient. The nurse should allow the patient to explain why they are not eating. i.e. Perhaps they were simply not hungry at the moment. 5 no need to bring more food prior to knowing why the patient did not eat before) |
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Of the following list; which 2 of the 4 are types of knowledge, as identified by Carper, that are integrated to guide the nursing practice?
1. Embedded 2 Personal 3. Ethical 4. Caring |
Correct answers: 2-3
Rationale: The 4 types of knowledge are indentified as empirical, personal, ethical, and aesthetic. (1 this is not applicable, 4 caring is a practice with theories, of which, the nurse will need the 4 different “knowledges” to practice) |
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A hospital volunteer asks a nurse on shift what jobs they recommend in healthcare. The volunteer is interested in direct interaction with patients and a lot of autonomy, but believes their hands are not steady enough for surgery. Which of the following members of the health care team are appropriate? Select all that apply.
1. Unlicensed assistive personnel 2. Case manager 3. Podiatrist 4. Social worker 5. Massage therapist |
Correct Answer: 4, 5
Rationale: 1. Unlicensed assistive personnel (e.g. medical assistants) have a lot of patient interaction, but their duties are often delineated by nurses (not autonomous). Case managers could be any member of the team who is most involved. Thus there is not guarantee the volunteer is not performing surgery. Podiatrists are also licensed to perform surgeries. Social workers and massage therapists represent appropriate choices here. Massage therapists are alternative/complementary care providers, a significant branch of the health care team. They are often in private practice and used in combination with Western therapies. Social workers are commonplace in hospitals and work mostly in client counseling. |
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A nursing school graduate is interested in working in primary health care and asks her/his mentor for advice. To what type of setting should the mentor direct the graduate?
1. A health clinic on a college campus 2. An urgent care clinic in a hospital 3. A skilled nursing facility in a suburban area. 4. A family practice in an urban area. |
Answer: 1
Rationale: Primary health care is community-driven and is available in a place where people live and work. #3 and #4 are examples of primary care, in which care is driven by experts rather than community. #2 is not necessarily in a location where people live and work. |
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A nurse is performing a health assessment of a 25 year old patient who has been smoking for five years. The patient states that she has tried to quit smoking for the past year, but finds it difficult to do so in the midst of her demanding graduate program. What should the nurse say?
1. “Health is wealth. You should prioritize your quitting over your schooling.” 2. “ Have you tried exercising to alleviate your stress instead of smoking?” 3. “What would be the pros and cons of quitting smoking right now?” 4. “Here is a flyer for a support group that could help you quit smoking.” |
Answer: 3
Rationale: Health promotion involves helping a patient make behavioral changes that can benefit his/her health and avoid potential health problems. Promotion for behavioral change should be based on the stage of readiness of the patient. Since the patient has been thinking about quitting smoking, the nurse can help the patient become more aware of the behavior by asking her to weigh the pros and cons of smoking.” |
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A patient checks into a wellness center to follow up on lab results. The nurse sees from the patient’s chart that the patient has a diagnosis of Diabetes Type I. Which of the following is an example of nursing advocacy for the protection of the patient’s rights?
1. The nurse teaches the patient how to safely administer insulin. 2. The nurse considers the socioeconomic status of the patient in planning care. 3. The nurse presents the patient with medication information in language that is easily understood. 4. The nurse requests a private room to discuss the patient’s test results. |
Answer: 4
Rationale: Patients have a right to confidentiality, and the role of the nurse as an advocate is to inform and support the request for privacy to discuss health matters is an example of advocacy for that right. #3 is also an example of advocacy, but is aimed to protect a patient’s safety and health more than the patient’s rights. |
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A nurse feels an economically constrained healthcare environment is compromising his/her ethical integrity. What should she/he do?
A. Understand that in an economically constrained healthcare environment conditions will never be ideal. B. Tell the charge nurse she/he refuses to work that shift with out more support. C. Email the hospital President and file an official complaint. D. Seek an integrity-preserving compromise not jeopardizing dignity or well being of self or others. |
Correct answer: D
“Integrity is an aspect of wholeness of character and is primarily a self-concern of the individual nurse. Nurses have a duty to remain consistent with both their personal and professional values and to accept compromise only to the degree that it remains an integrity-preserving compromise.” |
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The nurse has requested the presence of a physician in an intensive care patient's room where contact precautions requiring gown and gloves upon entry are in place. As the physician enters the room in her lab coat, she requests an alcohol prep pad to clean her stethoscope and begins washing her hands. The nurse should first:
a. Support the physician by retrieving a prep pad as requested b. Remind the physician that she is not following contact precaution procedure c. Inform the charge nurse that there is a problem after the physician leaves d. Ask the physician to leave the room |
Correct Answer: (b)
Rationale: It is a nurse's responsibility as part of the healthcare team to help protect coworkers and other patients by speaking up when unsafe practices are being performed. Whether checklists are used or not, precaution procedures help minimize risk to patients and healthcare workers. (a) is an appropriate support to the physician but another choice needs to occur first. (c) This option will not help prevent the spread of infection in the hospital setting and (d) is not effective communication and may give rise to unnecessary tensions between the nurse and physician. |
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Early detection of disease by screening individuals at increased risk of developing certain conditions is an example of what?
a. Primary Illness Prevention b. Secondary Illness Prevention c. Tertiary Illness Prevention d. Quaternary Illness Prevention |
Correct Answer: (b)
Rationale: (a) Primary illness prevention includes health promotion and illness prevention, not diagnosis/detection. (b) Secondary illness prevention includes diagnosis and treatment (c) Tertiary illness prevention includes rehabilitation, health restoration and palliative care (d) Quaternary illness prevention isn't a type of health care service listed in the text |
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When planning for a client's discharge, a nurse should be careful to:
a. Include the client's entire chart/file when being transferred to another level of care or facility b. Include the client and the client's family or support persons in the planning process c. Prioritize the client's physical needs above psychosocial, cultural and spiritual needs d. Not start planning for discharge until necessary, because conditions and medical orders change |
answer: b
(RATIONALE WAS TOO LONG!!! ) |
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A nurse is caring for 85-year-old man who lives alone and is taking multiple medications for chronic illnesses. During the assessment, the patient reports that he does not have a good understanding of medications and sometimes he even forgets to take medications. The nurse explains about his medications and gives him a pillbox to enhance medication adherence. This is an example of which Quality and Safety in the Education of Nurses (QSEN) competency?
A. Patient-centered care B. Evidence-based Practice C. Safety D. Informatics |
Correct answer: C. Safety
Rationale: Safety: “minimize risk of harm to patients and provides through both system effectiveness and individual performance.” Medication use in older-adult can be associated with safety concerns. There is the risk for drug interactions and side effects. The nurse tries to minimize the risk by helping him understand how to take medications properly and organize and track medications. |
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Which of the following is an example of secondary prevention?
A. Referring a patient who had coronary artery bypass surgery to a cardiac rehabilitation program. B. The local hospital offering cholesterol screenings to the public. C. Providing an annual influenza immunization. D. Teaching high school students the dangers of Tobacco use. |
Correct answer: B. The local hospital offering cholesterol screenings to the public.
Rationale: The secondary prevention focuses on early detection and treatment of illness. Referring a patient who had coronary artery bypass surgery to a cardiac rehabilitation program.(Tertiary) Providing an annual influenza immunization.(primary) Teaching high school students the danger of Tobacco use.(primary) |
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An obese patient decides to lose weight. He purchases a gym membership to start exercising. According to the Transtheoretical model, which stage of health behavior change is the patient in?
A. Contemplation Stage B. Maintenance Stage C. Action Stage D. Preparation Stage |
Correct answer: D. Preparation Stage
Rationale: During the preparation stage, the patient prepare to make small behavioral changes.(purchasing a gym membership) |
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A patient tells the nurse that she is a smoker and thinks that smoking is a major reason for her reoccurring respiratory illness. She tells the nurse she has cut back to 8-10 cigarettes per day and asks the nurse for a prescription for a nicotine patch to aid her in quitting completely. What stage of health behavior change is the patient in?
1. Termination Stage 2. Contemplation Stage 3. Maintenance Stage 4. Preparation Stage |
Correct Answer: 4. Preparation Stage
Rationale: The patient has already begun making small behavioral changes by cutting back the number of cigarettes that she smokes daily and has a specific plan to accomplish quitting completely. It is clear that she intends to take action in the immediate future. |
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As a physician prepares to insert a central line, a nurse observes that the patient's legs are not fully draped as specified on the procedure checklist. The nurse should:
A. Remain quiet because draping the patient's legs is irrelevant to central line insertion. B. Remain quiet because you do not want to second guess the physician or alarm the patient. C. Ensure the doctor is safe when inserting the line, but remind the doctor after of the standard procedure D. Immediately inform the physician of your concern for patient safety regardless of the consequences |
Correct answer is D
Rationale: Because draping the patient's legs is part of the facility's standard procedure in the form of a checklist, following procedure exactly to ensure patient safety is the best answer. Choices A, B and C all allow for the line to be inserted without following the proper safety procedures. |
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A patient is admitted to a cardiac rehabilitation center following an acute myocardial infarction. The care plan consists of physical therapy, psychological rehabilitation and regular exercising. These are examples of:
1) Illness prevention 2) Primary prevention 3) Secondary prevention 4) Tertiary prevention |
Correct answer: 4) Tertiary prevention
Rationale: “Tertiary prevention focuses on restoration and rehabilitation and its goal is to return individual to optimal level of functioning. “ |
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According to “Failure to Rescue” by Clarke and Aiken, which of the following is least associated with failure-to-rescue rates?
1) Patient’s clinical characteristics 2) Patient-nurse ratio 3) Portion of RNs relative to other nursing personnel 4) Technology and services available |
Correct answer: 1) Patient’s clinical characteristics
Rational: “Failure to rescue has been closely linked to certain hospital characteristics (e.g. a low patient-nurse ratio, a greater portion of RNs relative to other nursing and/or more high-technology equipment and services) and somewhat less so to patient characteristics.” |
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The nurse is educating a patient who uses indoor tanning regularly about the risk of skin cancers associated to indoor tanning. The patient refuses to quit using indoor tanning saying that “No worries, I know indoor tanning is much safer than direct sun tanning. Let’s not talk about this.” The nurse recognizes that the patient is in which stage of the health behavior change process?
1) Precontemplation stage 2) Contemplation stage 3) Preparation stage 4) Action stage |
Correct answer: 1) Precontemplation stage
Rationale: The person in precontemplation stage is not thinking about changing her behavior in the next 6 months and does not want to talk about her high-risk behavior. |
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Which of the following activities would be considered healthy lifestyle self care behavior by the nursing student?
1. The nursing student practices yoga three times per week for 30 minutes to increase balance, flexibility and mental alertness. 2. The nursing student practices yoga five times per week for 30 minutes to increase balance, flexibility and mental alertness. 3. The nursing student bikes to school five days per week, for 40 minutes per day round-trip to incorporate vigorous-intensity aerobic physical activity into his/her schedule. 4. The nursing student walks to school five days per week, for 10 minutes per day round-trip to incorporate moderate-intensity aerobic physical activity into his/her schedule. |
Correct Answer: 3
Rationale: Healthy lifestyle self care behavior includes moderate-intensity aerobic physical activity for a minimum of 30 minutes on five days each week, vigorous-intensity aerobic activity for a minimum of 20 minutes on three days each week or a combination of activity that meets those requirements. While yoga is also part of self care, it is classified as a mind-body therapy. |
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Which of these are stages in Maslow's hierarchy of needs. Select all that apply:
A. Love and belonging needs B, Stimulation needs C. Physiological needs D. Safety and security needs E. All of these are levels in Maslow's hierarchy of needs |
The correct answer is A, C, and D.
Rationale: Stimulation needs is defined in Kalish's adapted model. He notes that people often attend stimulation needs such as sex, activity, manipulation, exploration and novelty before their safety and security needs. |
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Which of the following is NOT ethical practice regarding end-of-life issues? Select all that apply:
1. A nurse withholds food because it is more harmful to administer it to the patient than to withhold it. 2. A nurse withholds life-sustaining treatment at the request of the patient, although the family has requested life-sustaining treatment be continued. 3. A nurse administers life-sustaining treatment to the patient at the request of the family, although the patient requested withdraw of life-sustaining treatment. 4. A nurse administers a lethal dose of medication to the patient at the patient’s request. |
Correct Answer: 3, 4
Rationale: The decision to withhold or withdraw treatment is up to the patient. The nurse must respect the patient’s wishes, even if they do not coincide with the wishes of the patient’s family. Giving a patient a lethal does of medication, a means to kill themselves, is not legal in the U.S. and legality is to be considered when making ethical decisions. |
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A client with chronic back pain asks a nurse about mind-body therapies. The nurse's best response is:
A. "Yoga is a mind-body therapy that could help with your back pain." B. "I can provide you with a list of recommended chiropractors." C. "Complimentary therapies are unfounded and will likely provide little or no relief." D. "I know of a great acupuncturist, let me get the phone number for you." |
The correct answer is A
Rationale: Yoga is the only mind-body therapy mentioned. Choice C is incorrect because while mind-body therapies are not based in traditional western medicine, they have been shown to reduce fears, worries, doubts, and pain. |
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While giving an initial assessment, the young patient tells the nurse that she has started to become sexually active. The nurse recommends regular gynecology check ups, and locates several free clinics for the girl to get free condoms and birth control to encourage safe sex. This is an example of which level of prevention?
a. Tertiary prevention b. Secondary prevention c. Early prevention d. Primary prevention |
Correct answer: D
Rationale: This is an example of primary prevention because of the health promotion. The nurse is promoting preventative care to avoid any treatment of a sexually related illness/infection. |
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The nurse is using an interpreter to communicate with a non-English speaking patient. How should the nurse communicate with the patient despite the language barrier?
a. Speak slowly, loudly, and clearly and maintain eye contact. b. Speak primarily to the interpreter and sometimes point towards the patient. c. When the patient is speaking, listen and maintain appropriate eye contact to show understanding and attentiveness. d. Allow the interpreter to ask all of the questions and take notes. |
Correct answer: C
Rationale: It is important for the nurse to use non-verbal communication (i.e. body language, eye contact, para-language), especially when unable to verbally communicate. The patient needs to feel comfortable and taken care of to ensure the best treatment and experience possible. |
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The nurse is developing a care plan for a diabetic patient. The patient practices Buddhism and regularly fasts for days at a time. How should the nurse respond?
a. “I’m sorry, but you can’t fast with diabetes.” b. “I will develop a care plan that respects your lifestyle but fasting will be seriously harmful to your health. Can you tell me more about your fasting habits?” c. “I’ll go get the doctor who can explain everything to you.” d. “Fasting isn’t smart when you have diabetes.” |
Correct answer: B
Rationale: The nurse should let the patient know that the nurse is respecting the religious beliefs and developing a care plan that best fits the patient’s wants and needs. |
