A nurse is discussing restorative health care with a newly licensed nurse. Which of the following examples should the nurse include in the teaching?
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A. Home health care
B. Rehabilitation facilities
C. Diagnostic centers
D. Skilled nursing facilities
E. Oncology centers
A. home health care
B. rehabilitation facilities
D. skilled nursing facilities
A nurse is explaining the various types of healthcare coverage clients might have To a group of nursing students. Which of the following healthcare financing mechanisms are federally funded? (Select all)
A. Preferred provider organization (PPO)
B. Medicare
C. Long term care insurance
D. Exclusive provider organization (EPO)
E. Medicaid
B. Medicare
E. Medicaid
A nurse manager is developing strategies to care for the increasing number of clients who have obesity. Which of the following actions should the nurse include as a primary health care strategy?
A. Collaborating with providers to perform obesity screenings during routine office visits
B. Ensuring the availability of specialized beds in rehabilitation centers for clients who have obesity
C. Providing specialized intraoperative training regarding surgical treatments for obesity
D. Educating active care nurses on post operative complications related to obesity
A. Collaborating with providers to perform obesity screenings during routine office visits
A nurse is discussing the purpose of regulatory agencies during a staff meeting. Which of the following tasks should the nurse identify as the responsibility of state licensing boards?
A. Monitoring evidence-based practice for clients who have a specific diagnosis
B. Ensuring that healthcare providers comply with regulations
C. Setting quality standards for accreditation of healthcare facilities
D. Determining if medications are safe for administration to clients
B. ensuring that healthcare providers comply with regulations
Rationale: The nurse should identify that state licensing boards are responsible for ensuring that healthcare providers and agencies comply with state regulations
A nurse is caring for a group of clients on a medical-surgical unit. for which of the following client care needs should the nurse initiate a referral for a social worker? (Select all)
A. A client who has terminal cancer request hospice care in her home
B. A client asked about community resources available for older adults
C. A client states that she wants her child baptized before surgery
D. A client requests an electric wheelchair for use after discharge
E. Client states that he does not understand how to use a nebulizer
A. A client who has terminal cancer I request hospice care in her home
B. A client asked about community resources available for older adults
D. A friend request an electric wheelchair for use after discharge
A goal for a client who has difficulty with self-feeding due to rheumatoid arthritis is to use adaptive devices. The nurse caring for the client should initiate a referral to which of the following members of the interprofessional care team?
A. Social worker
B. Certified nursing assistant
C. Registered dietitian
D. Occupational therapist
D. Occupational Therapist
A client who is postoperative following knee arthroplasty is concerned about the adverse effects of the medication he is receiving for pain management. Which of the following members of the interprofessional care team can assist the client in understanding the medications effects? (Select all)
A. Provider
B. Certified nursing assistant
C. Pharmacist
D. Registered nurse
E. Respiratory therapist
A. provider
C. pharmacist
D. registered nurse
A client who has had a cerebral vascular accident has persistent problems with dysphasia (difficulty swallowing). The nurse caring for the client should initiate a referral with which of the following members of the interprofessional care team?
A. Social worker
B. Certified nursing assistant
C. Occupational therapist
D. Speech-language pathologist
D. speech-language pathologist
A nurse is caring for a client who decides not to have surgery despite significant blockages in his coronary arteries. The nurse understands that this client's choice is an example of which of the following ethical principles?
A. Fidelity
B. Autonomy
C. Justice
D. Nonmaleficence
B. Autonomy
A nurse offers pain medication to a client who is postoperative prior to ambulation. The nurse understands that this aspect of care delivery is an example of which of the following ethical principles?
A. Fidelity
B. Autonomy
C. Justice
D. Beneficence
D. Beneficence
A nurse is instructing a group of nursing students about the responsibilities organ donation and procurement involve. When the nurse explains that all clients waiting for a kidney transplant have to meet the same qualifications, the students should understand that this aspect of care delivery is an example of which of the following ethical principles? A. Fidelity
B. Autonomy
C. Justice
D. Nonmaleficence
C. Justice
A nurse questions a medication prescription as too extreme in light of the client's advanced age and unstable status. The nurse understands that this action is an example of which of the following ethical principles?
A. Fidelity
B. Autonomy
C. Justice
D. Nonmaleficence
D. Nonmaleficence
A nurse is instructing a group of nursing students about how to know and what to expect when ethical dilemmas arise. Which of the following situations should the students identify as an ethical dilemma?
A. A nurse on a medical-surgical unit demonstrates signs of chemical impairment. B. A nurse overhears another nurse telling an older adult client that if he doesn't stay in bed, she will have to apply restraints.
C. A family has conflicting feelings about the initiation of enteral tube feedings for their father, who is terminally ill.
D. A client who is terminally ill hesitates to name her spouse on her durable power of attorney form.
C. A family has conflicting feelings about the initiation of enteral tube feedings for their father, who is terminally ill
Rationale: Making the decision about initiating internal team feedings is an example of an ethical dilemma. A review of scientific data cannot resolve the issue and it is not easy to resolve. The decision will have a profound effect on the situation and on the client
A nurse is acquainting a group of newly licensed nurses with the roles of the various members of the healthcare team they will encounter on a medical-surgical unit. When she gives examples of the types of tasks certified nursing assistants (CNAs) may perform, which of the following client activities should she include? (Select all)
A. Bathing
B. Ambulating
C. Toileting
D. Determining pain level
E. Measuring vital signs
A. Bathing
B. Ambulating
C. Toileting
E. Measuring vital signs
1. A nurse observes an assistive personnel (AP) reprimanding a client for not using the urinal properly. The AP tells him she will put a diaper on him if he does not use the urinal more carefully next time. Which of the following torts is the AP committing?
A. Assault
B. Battery
C. False imprisonment
D. Invasion of privacy
A. Assault
Rationale: by threatening the client, the AP is committing assalt. Her threats could make the client become fearful and apprehensive.
A nurse is caring for a competent adult client who tells the nurse that he is thinking about leaving the hospital against medical advice. The nurse believes that this is not in the client's best interest, so she prepares to administer a PRN sedative medication the client has not requested along with his usual medication. Which of the following types of tort is the nurse about to commit?
A. Assault
B. False imprisonment
C. Negligence
D. Breach of confidentiality
B. False imprisonment
Rationale: The nurse gave the medication as a chemical restraint to keep a client from leaving the facility against medical advice. This is false imprisonment because the client neither requested nor consented to receiving the sedative
A nurse in a surgeon's office is providing preoperative teaching for a client who is scheduled for surgery the following week, The client tells the nurse that he will prepare his advance directives before he goes to the hospital. Which of the following statements made by the client should indicate to the nurse an understanding of advance directives?
A. "I'd rather have my brother make decisions for me, but I know it has to be my wife."
B. "I know they won't go ahead with the surgery unless I prepare these forms."
C."I plan to write that I don't want them to keep me on a breathing machine."
D."I will get my regular doctor to approve my plan before I hand it in at the hospital."
C."I plan to write that I don't want them to keep me on a breathing machine."
Rationale: The client has a right to decide and specify which medical procedures he wants when a life-threatening situation arises
A nurse is caring for a client who is about to undergo an elective surgical procedure. The nurse should take which of the following actions regarding informed consent? (Select all that apply) A. Make sure the surgeon obtained the client's consent
B. Witness the client's signature on the consent form.
C. Explain the risks and benefits of the procedure. D. Describe the consequences of choosing not to have the surgery
E. Tell the client about alternatives to having the surgery
A. Make sure the surgeon obtained the client's consent
B. Witness the client's signature on the consent form
Rationale:
A. It is the nurses responsibility to verify that the surgeon obtained the clients consent and that he understands the information the surgeon gave him.
B. It is the nurses responsibility to witness the client signing of the consent form and to verify that he is consenting voluntarily and appears to be competent to do so. The nurse also should verify that he understands information the surgeon gave him
A nurse has noticed several occasions in the past week when another nurse on the unit seemed drowsy and unable to focus on the issue at hand. Today, she found the nurse asleep in a chair in the break room when she was not on a break. Which of the following actions should the nurse take?
A Alert the American Nurses Association.
B. Fill out an incident report.
C. Report the observations to the nurse manager on the unit
D. Leave the nurse alone to sleep.
C. Report the observations to the nurse manager on the unit
Rationale: any nurse who notices behavior that could jeopardize client care or could indicate a substance use disorder has a duty to report the situation immediately to the nurse manager
A nurse is explaining the various levels of healthcare services to a group of newly licensed nurses. Which of the following examples of care or care settings should the nurse classify as Tertiary care? Select all that apply
A. Intensive care unit
B. Oncology treatment center
C. Burn center
D. Cardiac rehabilitation
E. Home health care
A. Intensive care unit
B. Oncology treatment center
C. Burn center
A nurse is preparing information for change-of-shift report. Which of the following information should the nurse include in the report?
A. Input and output for the shift.
B. Blood pressure from the previous day
C. Bone scan scheduled for today
D. Medication routine from the medication administration record
C) Bone scan scheduled for today
A nurse is discussing the HIPAA Privacy Rule with nurses during new employee orientation. Which of the following information should the nurse include? (Select all that apply)
A. A single electronic records password is provided for nurses on the same unit
B. Family members should provide a code prior to receiving client health information.
C. Communication of client information can occur at the nurses' station.
D. A client can request a copy of her medical record.
E. A nurse may photocopy a client's medical record for transfer to another facility
B. Family members should provide a code prior to receiving client health information.
C. Communication of client information can occur at the nurses' station.
D. A client can request a copy of her medical record.
E. A nurse may photocopy a client's medical record for transfer to another facility
A nurse is reviewing documentation with a group of newly licensed nurses. Which of the following legal guidelines should be followed when documenting in a client's record? (Select all that apply)
A. Cover errors with correction fluid, and write in the correct information.
B. Put the date and time on all entries
C. Document objective data, leaving out opinions D. Use as many abbreviations as possible.
E. Wait until the end of the shift to document
B. Put the date and time on all entries
C. Document objective data, leaving out opinions
A nurse is discussing occurences that require completion of an incident report with a newly licensed nurse. Which of the following should the nurse include in the teaching? (Select all that apply).
A. Medication error
B. Needlesticks
C. Conflict with provider and nursing staff
D. Omission of prescription
E. Missed specimen collection of a prescribed laboratory test
A. Medication error
B. Needlesticks
D. Omission of prescription
A nurse is receiving a provider's prescription by telephone for morphine for a client who is reporting moderate to severe pain. Which of the following nursing actions are appropriate? (Select all that apply)
A. Repeat the details of the prescription back to the provider
B. Have another nurse listen to the telephone prescription.
C. Obtain the provider's signature on the prescription within 24 hr.
D. Decline the verbal prescription because it is not an emergency situation.
E. Tell the charge nurse that the provider has prescribed morphine by telephone.
A. Repeat the details of the prescription back to the provider
B. Have another nurse listen to the telephone prescription.
C. Obtain the provider's signature on the prescription within 24 hr.
A nurse on a medical-surgical unit has received change-of-shift report and will care for four clients. Which of the following client's needs should the nurse assign to an assistive personnel (AP)?
A. Updating the plan of care for a client who is postoperative
B. Reinforcing teaching with a client who is learning to walk using a quad cane
C. Reapplying a condom catheter for a client who has urinary incontinence
D. Applying a sterile dressing to a pressure ulcer
C. Reapplying a condom catheter for a client who has urinary incontinence
A nurse manager of a medical-surgical unit is assigning care responsibilities for the oncoming shift. A client is awaiting transfer back to the unit from the PACU following thoracic surgery. To which of the following staff members should the nurse assign this client?
A. Charge nurse
B. RN
C. Practical nurse (PN)
D. Assistive personnel (AP)
B. RN
A nurse is delegating the ambulation of a client who had knee arthroplasty 5 days ago to an AP. Which of the following information should the nurse share with the AP? (Select all that apply.)
A. The roommate ambulates independently
B. The client ambulates with his slippers on over his antiembolic stockings.
C. The client uses a front-wheeled walker when ambulating.
D. The client had pain medication 30 min ago.
E. The client is allergic to codeine.
F. The client ate 50% of his breakfast this morning.
B. The client ambulates with his slippers on over his antiembolic stockings.
C. The client uses a front-wheeled walker when ambulating.
D. The client had pain medication 30 min ago.
An RN is making assignments for a practical nurse (PN) at the beginning of the shift. Which of the following assignments should the PN question?
A. Assisting a client who is 24-hr postoperative to use an incentive spirometer
B. Collecting a clean-catch urine specimen from a client who has a wound infection
C. Providing nasopharyngeal suctioning for a client who has pneumonia
D. Teaching a client who has asthma to use a metered-dose inhaler
D. Teaching a client who has asthma to use a metered-dose inhaler
A nurse is preparing an in-service program about delegation. Which of the following elements should she identify when presenting the five rights of delegation? (Select all that apply)
A. Right client
B. Right supervision. and evaluation
C. Right direction and- communication
D. Right time
E. Right circumstances
B. Right supervision. and evaluation
C. Right direction and- communication
E. Right circumstances
By the second postoperative day, a client has not achieved satisfactory pain relief. Based on this evaluation, which of the following actions should the nurse take, according to the nursing process? A. Reassess the client to determine the reasons for inadequate pain relief.
B. Wait to see whether the pain lessens during the next 24 hr.
C. Change the plan of care to provide different pain relief interventions.
D. Teach the client about the plan of care for managing his pain.
A. Reassess the client to determine the reasons for inadequate pain relief.
A newly licensed nurse is reporting to the charge nurse about the care she gave to a client. She states, "The client said his leg pain was back, so I checked his medical record, and he last received his pain medication 6 hours ago. The prescription reads every 4 hours PRN for pain, so I decided he needs it. I asked the unit nurse to observe me preparing and administering it. I checked with the client 40 minutes later, and he said his pain is going away." The charge nurse should inform the newly licensed nurse that she left out which of the following steps of the nursing process?
A. Assessment
B. Planning
C. Intervention
D. Evaluation
A. Assessment
A charge nurse is reviewing the steps of the nursing process with a group of nurses. Which of the following data should the charge nurse identify as objective data? (Select all that apply)
A. Respiratory rate is 22/min with even, unlabored respirations.
B. The client's partner states, "He said he hurts after walking about 10 minutes."
C. Pain rating is 3 on a scale of 0 to 10
D. Skin is pink, warm, and dry.
E. The assistive personnel reports the client walked with a limp.
A. Respiratory rate is 22/min with even, unlabored respirations.
D. Skin is pink, warm, and dry.
E. The assistive personnel reports the client walked with a limp.
A charge nurse is talking with a newly licensed nurse and is reviewing nursing interventions that do not require a provider's prescription. Which of the following interventions should the charge nurse include? (Select all that apply.)
A. Writing a prescription for morphine sulfate as needed for pain.
B. Inserting a nasogastric (NG) tube to relieve gastric distention.
C. Showing a client how to use progressive muscle relaxation.
D. Performing a daily bath after the evening meal. E. Repositioning a client every 2 hr to reduce pressure ulcer risk.
C. Showing a client how to use progressive muscle relaxation.
D. Performing a daily bath after the evening meal. E. Repositioning a client every 2 hr to reduce pressure ulcer risk.
A nurse is discussing the nursing process with a newly hired nurse. Which of the following statements by the newly hired nurse should the nurse identify as appropriate for the planning step of the nursing process?
A. "I will determine the most important client problems that we should address."
B. "I will review the past medical history on the client's record to get more information.
C."I will go carry out the new prescriptions from the provider."
D."I will ask the client if his nausea has resolved."
A. "I will determine the most important client problems that we should address."
A nurse is caring for a client who is 24 hr postoperative following an inguinal hernia repair. The client is tolerating clear liquids well, has active bowel sounds, and is expressing a desire for "real food." The nurse tells the client that she will call the surgeon and ask. The surgeon hears the nurse's report and prescribes a full liquid diet. The nurse used which of the following levels of critical thinking?
A. Basic
B. Commitment
C. Complex
D. Integrity
A. Basic [Show Less]