Test 2

  1. The nurse is caring for a nurse who provided care to soldiers during the Vietnam War. What information in this patient’s history should the nurse use to understand the patient’s nursing career?
    1. The patient was still a student when serving in the war.
    2. The patient’s first patient care experiences were during a time of war.
    3. The patient decided to leave the profession after serving in the war.
    4. The patient contracted long-term illnesses from being overseas in a war.
    Correct Answer: 2
  2. The nurse is reviewing public health and health promotion roles for available for nurses.To which leader should the nurse attribute the development of these roles?
    1. Clara Barton
    2. Lillian Wald
    3. Mary Brewster
    4. Florence Nightingale
    Correct Answer: 4
  3. The nurse has been asked to participate on the hospital’s Shared Governance
    Committee. To which nurse leader should the nurse attribute the ability for nurses to
    control the profession?
    1. Mary Breckinridge
    2. Lavinia Dock
    3. Margaret Higgins Sanger
    4. Virginia Henderson
    Correct Answer: 2
  4. While a nurse is conducting a health assessment, the individual asks why the term
    “patient” is being used. What should the nurse explain about the implication of the term
    “patient”?
    1. The person is seeking assistance because of illness.
    2. The individual is proactive in his or her health care needs.
    3. The person is a collaborator in his or her care.
    4. The individual is using a service or commodity.
    Correct Answer: 1
  5. The nurse is creating a community education program on health promotion and
    wellness. Which topic should the nurse use for this program?
    1. Prenatal and infant care
    2. Prevention of sexually transmitted disease
    3. Exercise class for clients who have had a stroke
    4. Home accident prevention
    Correct Answer: 4
  6. The nurse is offering free occult blood screening at a community health fair. Which
    level of practice is the nurse providing?
    1. Promoting health and wellness
    2. Illness prevention
    3. Restoring health
    4. Rehabilitation
    Correct Answer: 3
  7. The nurse has starting working in a state other than the one in which the nursing
    education program was located. Which of the following should the nurse consult in
    order to understand the implications of this change of venue?
    1. American Nurses Association (ANA)
    2. National League for Nursing (NLN)
    3. National Council of State Boards of Nursing (NCSBN)
    4. Nurse State Practice Act
    Correct Answer: 4
  8. A seasoned nurse is a mentor for a new graduate. Which of the standards of
    professional performance is the seasoned nurse practicing?
    1. Collaboration
    2. Leadership
    3. Collegiality
    4. Evaluation
    Correct Answer: 3
  9. The nurse ensures that a patient is covered during a bath. In which nursing role is the
    nurse functioning?
    1. Caregiver
    2. Communicator
    3. Teacher
    4. Client advocate
    Correct Answer: 1
  10. A client wishes to discontinue cancer treatment. If acting as the client advocate, which
    statement should the nurse make to the client's physician?
    1. "The client is making his own decision."
    2. "The client would benefit from additional information about treatment options."
    3. "The family must be involved in this decision."
    4. "Let's educate the family about the consequences of this decision."
    Correct Answer: 1
  11. The nurse has accepted a position as a case manager. What should the nurse expect to
    perform when functioning in this role?
    1. Managing a client’s hospital stay
    2. Delegating activities to other nurses
    3. Evaluating the performance of ancillary workers
    4. Identifying areas of client concern or problems
    Correct Answer: 1
  12. The manager identifies that a nurse is practicing professionalism. What did the manager
    observe to come to this conclusion?
    1. Recognizing characteristics considered to be professional
    2. Maintaining specific character and spirit
    3. Learning about the influences of Florence Nightingale
    4. Promising to uphold the standards of the profession
    Correct Answer: 2
  13. The nurse is caring for several acutely ill patients. What nursing action demonstrates
    professional autonomy?
    1. Delivering medications and prescribed treatments in a timely manner
    2. Prioritizing client according to client needs
    3. Communicating with peers when help is needed
    4. Informing the supervisor about high acuity level and staff-to-client ratio
    Correct Answer: 2
  14. The student nurse contacts a number of other students to create a study group. What
    behavior is the student nurse demonstrating?
    1. Governance
    2. Socialization
    3. Service orientation
    4. Specialized education
    Correct Answer: 2
  15. The nursing instructor is explaining the present economic challenges in health care to
    students in a community health course. What should the instructor emphasize as being
    important for the students to be aware of?
    1. Passage of the Affordable Care Act
    2. Consumer presence on the boards of nursing associations and regulatory agencies
    3. Diagnostic-related groups (DRGs)
    4. Advances in science and technology
    Correct Answer: 1
  16. The community health nurse is caring for teenage mothers and their children. For what
    should the nurse assess these patients when determining their degree of vulnerability?
    1. Distance separation from their nuclear families
    2. Increased levels of poverty
    3. Raising children without the support of family
    4. The normal difficulties of adolescence
    Correct Answer: 4
  17. A client tells the nurse about research information on the Internet to learn more about a
    new health problem. What should the nurse respond to this client?
    1. "Information from the Internet isn't always accurate."
    2. "It’s best to check this information with your physician."
    3. "Bring your information to the clinic so we can go through it together."
    4. "I'd prefer you rely on information you haven't received from our office."
    Correct Answer: 3
  18. The nurse practitioner is working with a staff nurse to change the plan of care for a
    client with a terminal illness. In which areas of nursing practice are these nurses
    functioning?
    1. Promoting health and wellness
    2. Preventing illness
    3. Restoring health
    4. Caring for the dying
    Correct Answer: 4
  19. The nurse is scheduled to attend a continuing education program to learn about the
    latest urinary catheterization care. Which type of credential should the nurse expect to
    earn after attending this program?
    1. None because this program is designed to enhance a skill
    2. Advanced degree
    3. Certification as a renal nurse
    4. Credit hours toward an advanced degree
    Correct Answer: 1
  20. The nurse is planning to apply to graduate school to earn a master’s degree in nursing.
    On what should the nurse expect the program’s curriculum to focus?

    1. An advanced leadership role
    2. Case manager
    3. Wound care specialist
    4. Intravenous therapy specialist
    Correct Answer: 1
  21. The staff nurse is considering membership in the National League for Nurses. What
    should the nurse expect as a member of this organization?
    1. Members that are non-nurses
    2. Assistance with getting into graduate school
    3. Opportunities to be awarded scholarships
    4. Assistance with finding employmen
    Correct Answer: 1
  22. The nurse is consulting other professionals as well as educating, supporting, and
    managing a client’s chemotherapy regimen. In which role is this nurse functioning?
    1. Nurse practitioner
    2. Clinical nurse specialist
    3. Nurse educator
    4. Nurse entrepreneur
    Correct Answer: 2
  23. A staff nurse is serving as a preceptor for nursing students. In which level of Benner’s
    proficiency is this nurse practicing?
    1. Stage II
    2. Stage III
    3. Stage IV
    4. Stage V
    Correct Answer: 3
  24. The nurse is explaining the definition of being a nurse to a new nursing assistant. Which
    themes should the nurse include when talking with the assistant?
    Standard Text: Select all that apply.
    1. Adaptive
    2. Client-centered
    3. Goal-directed according to the needs of the client
    4. Diagnosis and treatment of disease
    5. An art
    6. A science
    Correct Answer: 1, 2, 5, 6
  25. A registered nurse is supervising several LPNs who provide patient care. Which
    responsibility should the registered nurse expect to complete?
    1. Evaluating the care provided to the client
    2. Administering intramuscular (IM) medications
    3. Performing dressing changes
    4. Delegating appropriate tasks to unlicensed client care providers (such as a nurse’s
    aide)
    Correct Answer: 1
  26. A faculty member is speaking to prospective students interested in enrolling in the BSN
    program at the university. What should the faculty member emphasize as a major
    incentive for students to select a BSN program over an ADN program?
    1. Ability to work in critical care areas
    2. Easier transition to graduate school
    3. Better opportunity for career advancement
    4. Liberal arts education
    Correct Answer: 3
  27. The ANA’s proposal for entry level for professional practice initiated debate among
    nurses. Which nurse would be at greatest risk if the ANA proposal were implemented?
    1. An RN with an associate degree who has a head nurse position
    2. An RN with a BSN who is a staff nurse
    3. An RN with a diploma who works overtime
    4. An RN with an associate degree who is currently in school
    Correct Answer: 1
  28. A high school graduate is considering entering a nursing program that offers a
    baccalaureate degree. What organization accreditation should the nurse use to help
    select a nursing program?
    1. NLN (National League for Nursing)
    2. CCNE (Commission on Collegiate Nursing Education)
    3. NCLEX® (National Council Licensure Examination)
    4. NCSBN (National Council of State Boards of Nursing)
    Correct Answer: 2
  29. The student nurse is reviewing the code of ethics prior to beginning a clinical assignment. On
    what areas should the nurse focus when providing client care?
    Standard Text: Select all that apply.
    1. Support lifelong learning.
    2. Ensure the safety of all clients.
    3. Maintain client confidentiality.
    4. Provide care in a professional manner.
    5. Collaborate with students and faculty.
    Correct Answer: 2, 3, 4
  30. The nurse is interested in specializing in forensics. What should the nurse expect to learn prior to
    assuming the role of a forensics nurse?
    Standard Text: Select all that apply.
    1. Knowledge about the legal system
    2. Approaches to collecting evidence
    3. Budgeting, staffing, and planning programs
    4. Information necessary when providing testimony in court
    5. Training in identification, evaluation, and documentation of injuries
    Correct Answer: 1, 2, 4, 5
  31. A client was given the wrong dose of medication and died. The case is being tried in
    court and similar cases are used by the court in comparison to arrive at a decision.
    Which doctrine should the nurse’s attorney explain is applied to this situation?
    1. Common law
    2. Public law
    3. Administrative law
    4. Stare decisis
    Correct Answer: 4
  32. The nurse is notified about new state practice act regulations. Which type of law should
    the nurse expect to implement and enforce the nurse practice act regulations?
    1. Statutory law
    2. Administrative law
    3. Common law
    4. Public law
    Correct Answer: 2
  33. The admitting nurse explains the process of signing forms to allow for the client's
    insurance company to be billed for services. If the insurance fails to pay for services,
    the client is responsible for payment. Which type of law did the nurse explain to the
    client?
    1. Contract law
    2. Tort law
    3. Statutory law
    4. Administrative law
    Correct Answer: 1
  34. The nurse forgets to put the call light within the client's reach and then leaves the room.
    The client reaches for it and falls out of bed. With what should the nurse expect to be
    charged?
    1. Assault
    2. Battery
    3. Negligence
    4. Criminal intent
    Correct Answer: 3
  35. A client is suing the hospital for malpractice. Before the case goes to court, the attorney
    meets with staff and reads the medical record. The nurse realizes that the attorney is
    performing which activity?
    1. Burden of proof
    2. Complaint
    3. Discovery
    4. Civil action
    Correct Answer: 3
  36. Before applying for re-licensure, the nurse attends continuing education programs.
    Which action is the nurse performing to adhere to the state board of nursing
    expectation?
    1. Licensure
    2. Competency
    3. Credentialing
    4. Certification
    Correct Answer: 3
  37. The high school graduate desiring to attend nursing school reviews the schools for
    accreditation. Which regulatory body’s actions is the student analyzing?
    1. State board of nursing
    2. NLNAC
    3. CCNE
    4. ANA
    Correct Answer: 1
  38. The nurse carries out a medication order, incorrectly written by the physician and
    subsequently filled by the pharmacist. Who, in this situation, is legally liable for the
    action?
    1. Physician
    2. Pharmacist
    3. Hospital
    4. Nurse
    Correct Answer: 4
  39. A hospital receives notice of being sued for an action performed by a nurse. The nurse
    realizes that which doctrine is being implemented in this case?
    1. Contractual relationship
    2. Stare decisis
    3. Respondeat superior
    4. Res ipsa loquitur
    Correct Answer: 3
  40. A client being prepared for an invasive procedure questions some of the terminology in
    the consent form. Which response should the nurse make?
    1. "Just sign the form, and I'll make sure your physician talks to you before he begins
    the procedure."
    2. "I'll explain whatever you don't understand."
    3. "You should have asked your physician when he was in here."
    4. "I'll call your physician back in the room to answer your questions."
    Correct Answer: 4
  41. The client presents her hand when the nurse makes this statement: "I need to start an IV
    so you can get your antibiotics." Which behavior did the client demonstrate?
    1. Informed consent
    2. Express consent
    3. Implied consent
    4. Compliance
    Correct Answer: 3
  42. An adult client who cannot read needs surgery and is competent to make his own
    decisions. What is the best action that the nurse should take?
    1. Tell the client in the nurse's own words what the surgical procedure involves.
    2. Read the consent form to the client and have the client state understanding.
    3. Make sure the physician explains the procedure to the client.
    4. Have a family member who can read sign the consent form
    Correct Answer: 2
  43. An older adult fell at home and fractured a hip, which requires surgical repair. After
    admittance to the emergency department, the client was given sedation for pain before a
    surgical permit was signed. What should be done to obtain consent?
    1. The physician should have the client's wife sign the consent form.
    2. The physician should wait until the effects of the medication wear off and have the
    client sign the form.
    3. Because the client has been medicated, the nurse should thoroughly explain the
    consent form to the client.
    4. This would be considered an emergency situation and consent would be implied.
    Correct Answer: 1
  44. A client is brought to the emergency department after being involved in a motor vehicle
    crash. Although the client is conscious, her condition is critical and will require
    emergency surgery. The client does not speak English. Which action should the nurse
    take?
    1. Read the consent form and have the client sign it anyway.
    2. Explain the form to the best of the nurse’s ability using pictures and gestures.
    3. Have the hospital interpreter explain the procedure.
    4. Proceed with surgery, as implied consent would be the case in this situation.
    Correct Answer: 3
  45. The nurse manager learns that vital signs delegated to unlicensed assistive personnel
    (UAP) were not recorded accurately. With which care provider should the manager
    discuss this finding?
    1. The UAP
    2. The nurse
    3. Both the UAP and the nurse
    4. The team leader
    Correct Answer: 2
  46. A nurse is caring for a client in the emergency department (ED) who was brought in by
    her adult child for vague, flu-like symptoms. While helping the client to change into a
    gown, the nurse notices numerous bruises on the client's back and arms. When
    questioned, the client is distracted and ambiguous with her answers. Which action
    should the nurse take?
    1. Report the situation to law enforcement.
    2. Report the situation to social services.
    3. Question the adult child who brought the client to the ED.
    4. File a written report in the client's chart.
    Correct Answer: 2
  47. A nurse who has been a longtime employee of a hospital, providing bedside care to
    clients, was seriously injured and is paralyzed from the shoulders down, with limited
    use of the upper arms. Through rehabilitation, the nurse is able to mobilize with a
    wheelchair and has no cognitive or psychological deficits. The nurse wants to return to
    the same position held prior to the injury. Under the guidelines of the ADA, what
    should the hospital do?
    1. The hospital is required to accommodate the nurse.
    2. The hospital must find another job for the nurse.
    3. The hospital should claim undue hardship to accommodate this nurse.
    4. The hospital terminate the nurse's employment.
    Correct Answer: 3
  48. A nurse on the unit notices that a co-worker exhibits a pattern of behavior suggestive of
    drug abuse. What should the nurse do?
    1. Report the situation to the unit charge nurse.
    2. Send an anonymous letter to the director of nursing.
    3. Let other co-workers know about the situation.
    4. Report the situation, then let management take care of it.
    Correct Answer: 1
  49. A nurse who is opposed to abortion works in a hospital where abortions are performed.
    According to the Supreme Court's conscience clause, which action should the nurse
    take?
    1. The nurse should not take action, because the nurse cannot interfere with a woman's
    constitutional right to privacy.
    2. The nurse should voluntarily terminate employment.
    3. The nurse should counsel women before they have an abortion.
    4. The nurse should refuse to participate in abortions.
    Correct Answer: 4
  50. A nurse's co-worker makes a practice of telling offensive jokes or stories with a sexual
    undertone during the shift. Which action should the nurse take first?
    1. Ignore the co-worker and walk away.
    2. Report the incident to the nurse manager.
    3. Tell the co-worker to stop the activity because the conduct is offensive.
    4. Ask to be scheduled opposite this co-worker.
    Correct Answer: 3
  51. A client woke in the middle of the night, confused and unaware of the surroundings.
    Although the call light was within reach, the client got out of bed unassisted, tripped on
    the bedside chair, and fell. Which element of malpractice should the client’s attorney
    realize is missing in this case?
    1. Foreseeability
    2. Damages
    3. Injury
    4. Duty
    Correct Answer: 1
  52. A client scheduled for surgery has signed the consent form but refuses to have a Foley
    catheter placed, saying "That's not part of the surgery." What should the nurse do?
    1. Explain that this is part of the surgical prep and continue with the procedure.
    2. Explain that the client has already signed the consent, and place the catheter.
    3. Respect the client's wishes and document accordingly.
    4. Offer to call the physician.
    Correct Answer: 3
  53. The nurse documents in a client's medical record: "The client is a drug addict and is
    always asking for more medication than what is necessary." With what might the nurse
    be charged?
    1. Defamation
    2. Slander
    3. Libel
    4. Incompetence
    Correct Answer: 3
  54. The nurse is reviewing the Good Samaritan acts. For which situation should the nurse
    realize that these laws apply?
    1. Giving CPR to a client brought to the emergency department, when the client later is
    found to have a "Do Not Resuscitate" order
    2. Giving first aid to a child injured in a sporting event
    3. Permitting a nursing student to try to insert an airway in an unconscious client
    4. Leaving the scene of an emergency to call for help
    5. Helping deliver the baby of a neighbor during a snowstorm
    Correct Answer: 5
  55. When providing client care the nurse demonstrates practices that are designed to
    provide legal protections from liability. Which actions is the nurse demonstrating?
    Standard Text: Select all that apply.
    1. Checking the client’s name band prior to the administration of a preoperative
    medication
    2. Asking for help when moving a comatose client because the client can not be safely
    handled by one nurse
    3. Attending an in-service on the appropriate use of a new piece of equipment used in
    the facility
    4. Delegating only those tasks that he or she can’t personally perform
    5. Reviewing the five rights of medication administration when the client states, “This
    doesn’t look like my usual pill”
    Correct Answer: 1, 2, 3, 5
  56. The clinical nursing instructor determines that a nursing student understands the legal
    responsibilities to clients when providing care. What did the instructor observe to come
    to this conclusion?
    Standard Text: Select all that apply.
    1. Prepared to discuss the client’s medical diagnosis in pre-conference
    2. Overheard stating, “My care is held to the same standards as that of the unit nurses”
    3. Offers to stay with the client who is about to experience a painful diagnostic
    procedure
    4. Addresses the staff and clients respectfully and by their full names
    5. Asks for help with a dressing change involving techniques he or she has not yet
    performed alone
    Correct Answer: 1, 2, 5
  57. While working a scheduled shift the nurse focuses on actions to protect the privacy of a client
    with local notoriety. What actions should the nurse take at this time?
    Standard Text: Select all that apply.
    1. Secure the client’s medical record.
    2. Review the client’s care with the media.
    3. Remove the client’s name from the door.
    4. Permit family to view the client’s record.
    5. Fax the client’s lab values with a cover sheet.
    Correct Answer: 1, 3, 5
  58. The nurse manager is concerned that a staff nurse’s care demonstrates gross negligence. What
    actions did the manager use to make this determination?
    Standard Text: Select all that apply.
    1. Removed a client’s central line
    2. Reconnected contaminated intravenous tubing to a client
    3. Accessed the computerized documentation system with a password
    4. Walked a client with a blood pressure of 70/58 mm Hg to the bathroom
    5. Delegated nasotracheal suctioning for a client to unlicensed assistive personnel
    Correct Answer: 1, 2, 4, 5
  59. A student is attending a school with a high first-time pass rate on the NCLEX®. Which
    student statement articulates a belief that the nursing student has about faculty in the
    program?
    1. Expect high academic standards from their students
    2. Are concerned with job placement of their graduates
    3. Are most concerned with the successful licensure of each student
    4. Work hard to make sure students are successful
    Correct Answer: 3
  60. A nurse manager has a staff nurse who observes certain religious holidays. The
    manager tries to make sure that these observances can be met if possible. Which value
    is the manager practicing?
    1. Human dignity
    2. Social justice
    3. Autonomy
    4. Altruism
    Correct Answer: 4
  61. Parents of a terminally ill child have decided to remove their child from life support, a
    decision that has met with little positive support. Which nursing action demonstrates
    autonomy regarding the parents’ decision?
    1. Showing respect for the family
    2. Respecting the parents' decision
    3. Referring the parents to social services
    4. Asking to be assigned to a different client
    Correct Answer: 2
  62. A nurse is working with a local agency to provide care to the inadequately insured by
    helping to staff an after-hours clinic. Which professional value is the nurse
    demonstrating?
    1. Human dignity
    2. Altruism
    3. Social justice
    4. Integrity
    Correct Answer: 3
  63. A nurse mistakenly gave a client who was NPO a morning breakfast tray. After
    realizing the mistake, the nurse notified the physician as well as the client; explained
    the consequences of this mistake, which included a delay in the client's scheduled
    procedure; and documented the situation in the client's medical record. What did this
    nurse demonstrate?
    1. Altruism
    2. Integrity
    3. Social justice
    4. Human dignity
    Correct Answer: 2
  64. A pregnant client says her main concern is that her baby will be born healthy, even
    though she admits to drinking alcohol on a regular basis. With what should the nurse
    realize this client is struggling?
    1. Values transmission
    2. Values clarification
    3. Morals
    4. Ethics
    Correct Answer: 2
  65. A client who has been blinded as result of an injury informs the rehabilitation staff of
    planning to return to her counseling practice and working full-time. The nurse should
    realize that this client is demonstrating which aspect of values clarification?
    1. Choosing
    2. Prizing
    3. Acting
    4. Clarifying
    Correct Answer: 3
  66. A client has been complaining of pain, even though the nurse has given the client the
    maximum amount of medication as ordered by the physician. Which action
    demonstrates the nurse's respect for the client's autonomy?
    1. Telling the client that he will have to "tough it out"
    2. Calling the physician for further orders
    3. Telling co-workers that this client has no pain tolerance
    4. Believing the client is drug seeking
    Correct Answer: 2
  67. A client has chosen to discontinue hemodialysis. His family is not supportive of his
    decision. Which statement should the nurse make that demonstrates the theory of
    principles-based reasoning?
    1. "This client is of sound mind and is capable of making his own decisions regarding
    health care. It really is his decision to make."
    2. "I need to try and help the family understand the client's decision so they can work
    through this situation together."
    3. "This client's health is so deteriorated that the treatment is not saving his life. It is
    prolonging the ultimate outcome, which is his death."
    4. "The client understands his decision and the advanced stage of his disease. If he quits
    treatment, he will die."
    Correct Answer: 1
  68. The administration of a hospital, along with nursing services, is planning to incorporate
    a struggling private clinic into the infrastructure of the hospital. Although relocating the
    clinic may cause transportation difficulty for some clients, keeping the clinic running
    will allow current employees as well as clients the continued benefit of the clinic.
    Which moral framework did the hospital leadership use to make this decision?
    1. Teleological theory
    2. Deontological theory
    3. Utilitarianism
    4. Caring theory
    Correct Answer: 3
  69. A decision has been made for an older client to receive aggressive cancer therapy
    despite knowing that the therapy will actually be more harmful than the disease and
    subject the client to harmful chemicals. With which ethical principle is this nurse caring
    for this client struggling?
    1. Autonomy
    2. Justice
    3. Beneficence
    4. Nonmaleficence
    Correct Answer: 4
  70. The nurse needs to insert an intravenous access device into a toddler who is crying and
    scared. The parent asks if the procedure is painful. When practicing veracity, what
    should the nurse respond to the parent?
    1. "I won't lie to you. It may be easier for you if you step out until we get the line in."
    2. "We'll take every care not to hurt your child."
    3. "It shouldn't be too bad and I'll be quick."
    4. "We do this all the time, so don't worry."
    Correct Answer: 1
  71. A student nurse accidentally left the call light outside the reach of an older client.
    Another nurse discovered the situation and was able to rectify the matter before
    something happened. The student apologizes and states the need to double check for
    call light placement before leaving a client’s room. What behavior did the student
    demonstrate?
    1. Justice
    2. Fidelity
    3. Responsibility
    4. Accountability
    Correct Answer: 4
  72. The nurse is reviewing the ANA (American Nurses Association) Code of Ethics for
    Nurses. What should the nurse identify as a characteristic of this code?
    1. It is a formal statement.
    2. It contains the same standards as legal standards.
    3. It is shared by group members.
    4. It reflects legal judgments.
    5. It serves as a standard for professional actions
    Correct Answer: 5
  73. A 20-year-old client with Down syndrome is diagnosed with an illness. Even though
    the client is able to live in an assisted environment and work part-time for a local
    bookstore, the parents of the client are adamant about not initiating a course of
    treatment whose side effects are unknown with Down syndrome clients. According to
    the nursing code of ethics, to whom is the nurse's first loyalty?
    1. The client
    2. The parent
    3. The physician
    4. The nurse
    Correct Answer: 1
  74. A hospice nurse has been working closely with a client who, on several occasions, has
    asked about guidance and support in ending her life. What information should the nurse
    use when making an ethical and moral decision about this client’s request?
    1. Passive euthanasia is an easy decision to arrive at.
    2. Legal issues are not the same as moral or ethical ones.
    3. Active euthanasia is supported in the Code for Nurses.
    4. Assisted suicide is illegal in all states.
    Correct Answer: 2
  75. A client with terminal cancer is refusing food and fluids, and pushes the caregiver's
    hands away when attempts are made to feed the client or offer any kind of fluid. The
    family is considering placing a gastrostomy tube because they feel the client is
    "starving to death." What should the nurse do?
    1. Honor the family's wishes and have them sign a consent form.
    2. Talk to the physician so he or she can move forward with the family's wishes.
    3. Honor the client's refusal and help the family come to terms with the situation.
    4. Take the case to the hospital's ethics committee.
    Correct Answer: 3
  76. A client with a sexually transmitted illness (STI) asks the nurse to not tell anyone about
    the diagnosis. According to the Health Insurance Portability and Accountability Act
    (HIPAA) of 1996, what must the nurse do?
    1. Honor the client's wishes.
    2. Not disclose any information to anyone.
    3. Respect the client's privacy and confidentiality.
    4. Communicate only necessary information.
    Correct Answer: 4
  77. The nurse learns that a home care client is diluting prescribed nutritional supplements
    because of the cost. What should the nurse do to advocate for this client?
    1. Help the client look for available community resources that may be of assistance.
    2. Tell the client that she needs to take the prescribed amount.
    3. Report the situation to the physician.
    4. Weigh the client on a weekly basis to monitor weight gain or loss
    Correct Answer: 1
  78. The nurse is reviewing the preamble of the International Council of Nurses Code of
    Ethics. On which responsibilities should the nurse focus when reviewing this
    preamble?
    Standard Text: Select all that apply.
    1. Promote health.
    2. Restore health.
    3. Inform the public about minimum standards of nursing conduct.
    4. Provide self-regulation in the profession.
    5. Prevent illness.
    6. Alleviate suffering.
    Correct Answer: 1, 2, 5, 6
  79. The nurse manager determines that a staff nurse demonstrates understanding of the
    professional responsibility to advocate for a client’s health, safety, and rights. What did
    the manager observe to come to this conclusion about the staff nurse?
    Standard Text: Select all that apply.
    1. Reporting a medication error that he was responsible for making
    2. Notifying the unit manager that a nurse is showing signs of being under the influence
    of alcohol
    3. Being sure the computer screen is not visible to visitors when charting
    4. Asking the client to explain in her own words the purpose of the research project she
    asked to act in as a participant
    5. Calling the health care provider to clarify a confusing prescription for a client’s pain
    Correct Answer: 2, 3, 4, 5
  80. The school of nursing professor is preparing a classroom activity to assist the students in
    acquiring professional values. Which actions should the professor select for this assignment?
    Standard Text: Select all that apply.
    1. Discuss codes of ethics with the students.
    2. Recommend that the students avoid ethical issues.
    3. Encourage the students to discuss experiences.
    4. Invite other professors to participate in a discussion.
    5. Have the students interview each other about experiences
    Correct Answer: 1, 3, 4, 5
  81. The nurse is reviewing the Healthy People 2020 primary goals. Which plan should the
    nurse realize is in alignment with one of the goals?
    1. Providing free screening to schoolchildren
    2. Opening a wellness clinic
    3. Developing better insurance controls
    4. Developing new pharmacological treatments
    Correct Answer: 2
  82. Several nurses are working to open a clinic that focuses on health promotion. Which
    activity should the nurses expect to perform once this clinic opens?
    1. Teaching biofeedback techniques for stress reduction
    2. Providing immunization clinics
    3. Evaluating regional industrial centers for environmental pollution
    4. Teaching smoking cessation classes to adolescents
    Correct Answer: 1
  83. A client is in the end stages of cancer. Which type of service should the nurse consider
    as being the best for this client?
    1. Rehabilitation
    2. Health restoration
    3. Acute care
    4. Palliative care
    Correct Answer: 4
  84. Several nurses are looking for an agency to sponsor a program that would meet the
    needs of a community group lacking in health promotion education. Which agency
    should the nurse approach to fill this need?
    1. State health department
    2. Local health department
    3. Local hospital
    4. Federal government
    Correct Answer: 2
  85. The nurse is hired to provide care in a hospital that offers services in all specialty areas.
    How should the nurse categorize this type of health care facility?
    1. General hospital
    2. Specialty hospital
    3. Long-term care hospital
    4. Short-term hospital
    Correct Answer: 1
  86. A client being discharged from an acute care hospital requires IV antibiotics, is not able
    to complete activities of daily living without assistance, and has no family available to
    assist in the recovery phase. Which type of recommendation should the nurse make for
    this client?
    1. Stay in the hospital until the client is fully capable of self-care.
    2. Remain in the hospital until the antibiotic course is completed.
    3. Be discharged to an extended care facility.
    4. Go to a nursing home.
    Correct Answer: 3
  87. An older client has no family in the same community, lives alone in a small house, and
    is having greater difficulty with mobility due to advanced osteoarthritis. Cognitively,
    this client is alert, is able to manage her own business matters, and does her own cooking, but does not enjoy "cooking for one." The home health nurse who visits has noticed that the client is losing weight and does not have as much energy or interest in
    activities as on previous visits. What should the nurse recommend for this client?
    1. See a psychiatrist because the client appears to be depressed.
    2. Check out joint replacement options for the osteoarthritis.
    3. Start thinking about long-term care.
    4. Consider moving to an assisted living facility.
    Correct Answer: 4
  88. The spouse of a client diagnosed with Stage I/II Alzheimer's disease must continue to
    work full-time. The spouse tells the occupational health nurse that the client has started
    to wander outside the house, forgets to turn off the stove after preparing food, and tries
    to drive the car if the keys are available. What should the nurse recommend for this
    family?
    1. The client should be placed in long-term care.
    2. The spouse should consider early retirement.
    3. The client should be placed in an adult day-care environment.
    4. An increase in the client's medications should be considered to slow the progress of
    the disease.
    Correct Answer: 3
  89. The spouse of a client referred to hospice care asks why the client needs the change in
    services. How should the nurse respond to this question?
    1. "So we can see if there's any way to improve your spouse's life."
    2. "There is no need for acute care any longer."
    3. "It's best for your spouse to be cared for at home."
    4. "Hospice care is cheaper than acute care."
    Correct Answer: 1
  90. A nurse is interviewing a client at a clinic near a shelter for the homeless.
    Understanding the increased risk a poor physical environment creates for this client, on
    what should the nurse focus during the intake phase of the interview?
    1. Lack of social support
    2. Recent history of chills and body aches
    3. Improper nutrition
    4. Few personal resources
    Correct Answer: 2
  91. A nurse is working in a clinic that emphasizes cost control, customer satisfaction,
    health promotion, and preventive services. In which type of health system is this nurse
    providing care?
    1. Managed care
    2. Case management
    3. Differentiated practice
    4. Patient-focused care
    Correct Answer: 1
  92. The manager of a small clinic has cross-trained the nurses to provide basic nursing care,
    and perform ECG testing, phlebotomy, and some respiratory therapy interventions.
    Which type of care delivery model has the manager implemented?
    1. Managed care
    2. Case management
    3. Patient-focused care
    4. Critical pathways
    Correct Answer: 3
  93. A new graduate nurse is looking for employment and is hoping to find a facility that
    utilizes nursing personnel based on their educational preparation and skill set. In which
    type of facility should the new graduate apply for a position?
    1. Patient-focused care
    2. Shared governance
    3. Differentiated practice
    4. Managed care
    Correct Answer: 3
  94. The nurse is considering leaving a position in an organization that utilized
    differentiated practice. Which type of delivery system should the nurse consider as
    being the most similar to differentiated practice?
    1. Case method
    2. Shared governance
    3. Functional method
    4. Team nursing
    Correct Answer: 4
  95. A seasoned RN is especially competent in knowledge of the computerized charting
    system in a facility and is able to assume the team leader role on a regular basis. In
    which type of care delivery system is this nurse most likely providing care?
    1. Primary nursing
    2. Team nursing
    3. Differentiated practice
    4. Case method
    Correct Answer: 1
  96. A 68-year-old client is concerned about paying for extended hospitalization and
    expensive medications to treat his health problem. What should the nurse respond to
    this client?
    1. "Don't worry. I'm sure everything will work out OK."
    2. "You need to focus on recovering, not worrying about finances."
    3. "Much of your care will be covered by Medicare."
    4. "I'll have someone from the business office come and talk to you about your bill."
    Correct Answer: 3
  97. A clinic in a rural area depends primarily on the services of a nurse practitioner. Which
    legislation provided the opportunity for the nurse practitioner to have this position?
    1. Medicare
    2. Medicaid
    3. Rural Health Clinics Act
    4. National Health Planning and Resources Development Act
    Correct Answer: 3
  98. The nurse is reviewing the principles of the Affordable Care Act with a client. What
    information should the nurse include when discussing the act with the client?
    1. Individuals will be fined if they do not have health insurance.
    2. Employers must offer health insurance if they meet identified requirements.
    3. Insurance can be purchased through exchanges.
    4. Individuals with preexisting health conditions cannot be denied health insurance
    coverage.
    5. Health insurance is free
    Correct Answer: 1, 2, 3, 4
  99. A client asks the nurse to explain the difference between an HMO and a PPO. What
    should the nurse include when responding to the client?
    1. "You'll have good health care benefits, so don't worry."
    2. "Both the HMO and PPO are covered by your employer, so it's really not your
    concern."
    3. "Your PPO offered you a choice in your health care provider as well as services.
    Now, you will choose a primary care provider who will evaluate your health and will
    coordinate all of your care."
    4. "You really should be happy about the HMO. You'll pay little, if any, out-of-pocket
    expense."
    Correct Answer: 3
  100. The nurse is reviewing changes occurring within the health care industry. What should
    the nurse identify as factors that have an effect on health care delivery?
    Standard Text: Select all that apply.
    1. Increased use of complementary and alternative medicine
    2. More knowledgeable consumers
    3. Increase in the number of elderly
    4. Decrease in chronic disease
    5. Technological advances
    6. Economics
    Correct Answer: 2, 3, 5, 6
  101. A client in the hospital is concerned about the cost of receiving hospitalized care. What
    should the nurse realize is causing the increase in the client’s medical expenses?
    Standard Text: Select all that apply.
    1. Health care of the older adult
    2. Number of uninsured population
    3. Changes in birth rate over last 20 years
    4. Cost of prescription drugs
    5. State of inflation
    6. Amount of diagnosed chronic illnesses
    Correct Answer: 1, 2, 4, 5, 6
  102. In order to comply with the U.S. Department of Health and Human Services’ most
    current health care goals as stated in Healthy People 2020, what should the nurse do?
    Standard Text: Select all that apply.
    1. Plan a depression screening for senior citizens who regularly have lunch at the senior
    center.
    2. Attend an educational in-service on the use of a new automated blood pressure
    monitor
    3. Advocate for psychiatric health care for those with no private insurance coverage.
    4. Organize a park “cleanup day” to assure that the community’s children have a safe
    place to play.
    5. Counsel older clients regarding programs available to assist them to live in their
    homes independently.
    Correct Answer: 1, 3, 4, 5
  103. The nurse is reviewing sources of federal funding for health care services provided to
    clients. For which clients should the nurse recognize as most likely having health care
    paid through a federal funding source?
    Standard Text: Select all that apply.
    1. 35-year-old self-employed house painter
    2. 72-year-old retired schoolteacher
    3. 52-year-old nurse who runs the family farm
    4. 29-year-old mentally challenged sheltered workshop employee
    5. 40-year-old factory worker
    Correct Answer: 2, 4
  104. The nurse is concerned that the hospital will not receive payment for care provided to a client.
    Which client health problems are causing the nurse this concern?
    Standard Text: Select all that apply.
    1. Intravenous fluids were prescribed for 4 days.
    2. X-rays of the left leg and left arm were prescribed.
    3. A stage II pressure ulcer developed on the client’s heels.
    4. A urinary tract infection occurred because of an indwelling urinary catheter.
    5. Physical therapy treatments were prescribed for 7 days for crutch walking.
    Correct Answer: 3, 4
  105. The nurse is considering a position with a home health agency. What type of care should the
    nurse realize will be provided when working for this type of agency?
    Standard Text: Select all that apply.
    1. Providing ventilatory support
    2. Completing a health and wellness visit
    3. Instructing about care of a surgical wound
    4. Providing intravenous antibiotics once a day
    5. Teaching about medications for self-management of diabetes
    Correct Answer: 3, 4, 5
  106. The nurse is providing care to a group of clients. For which situation would the nurse’s
    use of critical thinking be a priority?
    1. Administering IV push meds to critically ill clients
    2. Educating a home health client about treatment options
    3. Teaching new parents car seat safety
    4. Assisting an orthopedic client with the proper use of crutches
    Correct Answer: 2
  107. A client recovering from a stroke does not want to perform prescribed shoulder
    exercises. What should the nurse say to the client that demonstrates critical thinking
    with creativity?
    1. "You'll only get worse if you don't do these exercises."
    2. "As soon as you get these into your routine, you'll feel better."
    3. "Your physician wouldn't have ordered these if they weren't important."
    4. "Here's a marker. See how many circles you can make on this board in 10 minutes."
    Correct Answer: 4
  108. A student nurse resists when encouraged to be creative when providing client care.
    What should the nurse educator say to encourage this student to be creative?
    1. "Creativity allows unique solutions to unique problems."
    2. "Not all your answers are going to be from your textbook."
    3. "Creativity makes nursing more fun."
    4. "You'll get bored if you don't learn to be creative."
    Correct Answer: 1
  109. The nurse educator assigns students an activity to implement Socratic questioning in
    their daily lives. Which question provided by a student demonstrates this reasoning
    technique?
    1. "What makes you think cramming for a test is an ineffective way to study?"
    2. "What other ways of studying could you implement?"
    3. "If you didn't study for your test, what is the probability you will fail?"
    4. "If you study all the unit outcomes, what effect will that have?"
    Correct Answer: 1
  110. A client is experiencing a productive cough, audible coarse crackles, elevated
    temperature of 102.3°F, chills, and body aches. What did the nurse use to determine
    that this patient is experiencing respiratory compromise?
    1. Deductive reasoning
    2. Inductive reasoning
    3. Socratic questioning
    4. Critical analysis
    Correct Answer: 1
  111. A client with a PhD in epidemiology has been to numerous physicians and has had
    numerous laboratory tests, all of which were abnormal, and exploratory surgery, but no
    one is able to explain the etiology of his problem. The client also states that he has a rare
    form of a neurological disorder. Which statement should the nurse make that
    demonstrates critical thinking?
    1. "Why don't you just tell your physician what you think you have?"
    2. "Did you bring your prior tests and results with you, so we don't repeat anything?"
    3. "If you know what you have, what do you want from us?"
    4. "Describe what tests you've had and explain the symptoms of this disorder."
    Correct Answer: 4
  112. A nurse educator has always believed that lectures with focused outlines are the best
    way to present theory content in class. A colleague, who teaches the same group of
    students, but a different subject, utilizes group work and in-class activities to teach
    difficult content and finds that students perform as well, or better, on their tests. The
    first educator in this situation is starting to rethink her position. What behavior is the
    first educator demonstrating?
    1. Integrity
    2. Perseverance
    3. Fair-mindedness
    4. Humility
    Correct Answer: 1
  113. The nurse who just moved from an urban area to a sparsely populated rural area
    understands that certain customs and practices the nurse follows may be quite foreign to
    the people in the new area. Which attitude of critical thinking is the nurse
    demonstrating?
    1. Fair-mindedness
    2. Insight into egocentricity
    3. Intellectual humility
    4. Intellectual courage to challenge the status quo and rituals
    Correct Answer: 2
  114. The nurse implements a quicker way to set up and initiate an intravenous infusion while
    still following safe practice. Which attitude of critical thinking is this nurse practicing?
    1. Independence
    2. Intellectual courage to challenge the status quo or rituals
    3. Integrity
    4. Confidence
    Correct Answer: 1
  115. The nurse questions the practice of administering rectal suppositories to residents in a
    long-term care facility at bedtime, rather than earlier in the day. When told that this is
    the best time for staff and that's the routine that has been practiced for a long time, the
    nurse continues to research whether there would be a better time, especially in the best
    interest of the residents. Which critical thinking attitude is this nurse demonstrating?
    1. Confidence
    2. Perseverance
    3. Curiosity
    4. Integrity
    Correct Answer: 3
  116. A seasoned nurse uses past experiences and knowledge gained from previous care
    situations to care for a client with complex health issues. Which attribute of critical
    thinking is this nurse practicing?
    1. Reflection
    2. Context
    3. Dialogue
    4. Time
    Correct Answer: 1
  117. While listening to a client describe current symptoms, the nurse considers the client’s
    entire situation. Which attribute of critical thinking is the nurse practicing?
    1. Reflection
    2. Context
    3. Dialogue
    4. Time
    Correct Answer: 2
  118. A client complaining of shortness of breath has no pallor, cyanosis, or use of accessory
    muscles with respirations. The client's respiratory rate is 16 breaths per minute. The
    nurse is concerned that the client's report and the physical findings conflict. Which
    standard of critical thinking is the nurse using?
    1. Clarity
    2. Accuracy
    3. Logical reasoning
    4. Significance
    Correct Answer: 3
  119. The nurse enters the room of a critically ill child after sensing that "something" isn't
    right. Once the nurse determines the child is stable, the nurse continues to perform a
    check of all the lines and equipment in the room and finds that the last IV solution hung
    by the previous nurse was not the correct solution. Which problem-solving method did
    this nurse use?
    1. Trial and error
    2. Intuition
    3. Judgment
    4. Scientific method
    Correct Answer: 2
  120. The nurse systematically tries a variety of products to help with healing of a client’s
    wound. Which problem-solving method is the nurse using?
    1. Intuition
    2. Scientific method
    3. Research process
    4. Trial and error
    Correct Answer: 4
  121. A client with unstable cardiac dysrhythmias has orders for medications, one of which is
    by oral route, the other by IV delivery. The nurse realizes that the IV route would be
    fastest, but is also concerned about the side effects that this drug may produce and the
    fact that the client has never taken the drug, so any adverse effect is unknown. Which
    part of the decision-making process is the nurse using?
    1. Identify the purpose
    2. Seek alternatives
    3. Project
    4. Implement
    Correct Answer: 2
  122. Prior to providing client care, the nurse reviews previous shift charting and the
    responses to nursing interventions. Which decision-making action is the nurse using?
    1. Set the criteria
    2. Examine alternatives
    3. Implement
    4. Evaluate the outcome
    Correct Answer: 4
  123. Parents ask why invasive diagnostic tests were prescribed for their ill child. The nurse
    has just gotten out of report and has not had a chance to review additional information.
    What should the nurse respond to the parents?
    1. "I'm not sure I can answer your question just now."
    2. "It's a good idea to listen to what your physician wants."
    3. "Your child's doctor is the best there is. I don't see why you wouldn't follow his
    advice."
    4. "Maybe you should get another opinion if you're not comfortable with your doctor."
    Correct Answer: 1
  124. A client complaining of "extreme" low back pain is pale and diaphoretic and walks bent
    at the waist. Before taking vital signs, the nurse suspects that the blood pressure and
    heart rate will be elevated. What thought process did the nurse use to come to this
    conclusion?
    1. Fact
    2. Inference
    3. Judgment
    4. Opinion
    Correct Answer: 2
  125. The nurse completes collecting data from a client and determines a list of problems.
    Which step in the nursing process should the nurse perform next?
    1. Assess
    2. Diagnose
    3. Plan
    4. Evaluate
    Correct Answer: 3
  126. While caring for a client of a different culture, the nurse becomes disturbed when the
    client's spouse makes all the decisions about care and treatments. What behavior is this
    nurse demonstrating?
    1. Inference
    2. Judgment
    3. Opinion
    4. Evaluation
    Correct Answer: 3
  127. The staff nurse asks why unlicensed assistive personnel are responsible for stocking the
    unit refrigerator with refreshments when dietary personnel place the items on the shelf
    in the kitchen. What characteristic of critical thinking is this nurse demonstrating?
    1. Curiosity
    2. Clinical reasoning
    3. Setting priorities
    4. Developing rationales
    Correct Answer: 4
  128. A clinical instructor senses that a student has been struggling with clinical skills learned
    in lab. To combat this, the educator pairs the student with a staff nurse who has clients
    with a variety of treatments and cares. Which type of problem solving is the instructor
    using?
    1. Trial and error
    2. Intuition
    3. Research process
    4. Experience
    Correct Answer: 2
  129. The nurse desires to improve critical thinking skills when providing client care. On
    which attributes should the nurse focus when developing these skills?
    Standard Text: Select all that apply.
    1. Independence
    2. Egocentricity
    3. Intellectual humility
    4. Fair-mindedness
    5. Confidence
    6. Perseverance
    Correct Answer: 1, 3, 4, 5, 6
  130. During a clinical conference, a staff nurse states that critical thinking is essential when
    providing client care. What additional statements should this nurse make to support the
    use of critical thinking?
    Standard Text: Select all that apply.
    1. “Patient acuity is so much greater than it was even 10 years ago.”
    2. “Care delivery systems are only as good as the nurses delivering care.”
    3. “Nurses have always relied on commonsense thinking to provide quality, appropriate
    nursing care.”
    4. “With health care being so expensive, nursing has to take on responsibility to keep
    the costs controlled.”
    5. “My practice involves caring for clients who require care that didn’t even exist when
    I went to school.”
    Correct Answer: 1, 2, 4, 5
  131. The nurse manager determines that a new staff nurse is demonstrating characteristics of
    a critical thinker. What did the manager observe the nurse perform?
    Standard Text: Select all that apply.
    1. Listening with empathy to a client who recently has been diagnosed.
    2. Waiting for the medical team to determine the focus of the client’s supportive care.
    3. Questioning a medication order that does not appear to meet the client’s needs for
    pain management.
    4. Exhibiting a willingness to try alternate methods of addressing a client’s care needs.
    5. Practicing nursing in a culturally competent fashion.
    Correct Answer: 1, 3, 4, 5
  132. The staff nurse is helping a new graduate understand the relationship between care concepts and
    planned interventions. What value would it be for the staff nurse to encourage the new graduate
    to use a concept map?
    Standard Text: Select all that apply.
    1. Used to highlight key areas
    2. Provides a visual representation
    3. Can be quicker than taking notes
    4. Takes years to study how to create
    5. Aids in developing critical thinking
    Correct Answer: 1, 2, 3, 5
  133. The nurse is planning to create a concept map to explain relationships between concepts and
    associated attributes. Which types of concept maps should the nurse consider creating?
    Standard Text: Select all that apply.
    1. Spider
    2. Systems
    3. Flowchart
    4. Definitions
    5. Hierarchical
    Correct Answer: 1, 2, 5
  134. The nurse is providing care within the total care context. What should the nurse
    consider when using this care approach?
    1. The individualism of the client
    2. Principles applicable to the client at this moment
    3. Principles general to all clients of the same age and condition
    4. The person’s self-identity
    Correct Answer: 3
  135. The nurse is practicing the concept of holism with a client. Which action is the nurse
    most likely making?
    1. Considering how the loss of a client's job will affect the regulation of the client's
    diabetes
    2. Making sure to do complete teaching regarding pharmacological interventions
    3. Following physician treatments on schedule
    4. Prioritizing the needs of the client assigned according to Maslow's hierarchy
    Correct Answer: 1
  136. Psychologic homeostasis is maintained by a variety of mechanisms. Which client
    should the nurse identify as being the most likely candidate to obtain psychologic
    homeostasis?
    1. A child who is used to getting ready for school alone
    2. A teenager whose circle of friends includes single parents of the same age
    3. An elderly person who has just moved to a long-term care facility
    4. A young adult who is in a long-term relationship
    Correct Answer: 4
  137. A client is having difficulty with feelings of self-loathing and disgust after being
    attacked and raped. According to Maslow’s human needs theory, at which level should
    the nurse recognize that the client is struggling?
    1. Physiological
    2. Safety and security
    3. Love and belonging
    4. Self-esteem
    Correct Answer: 4
  138. A client is hospitalized with numerous acute health problems. According to Maslow’s
    basic needs model, which nursing diagnosis should the nurse identify as being the
    highest priority for this client?
    1. Risk for Injury related to unsteady gait
    2. Altered Nutrition, Less Than Body Requirements related to inability to absorb
    nutrients
    3. Self-Care Deficit related to weakness and debilitation
    4. Powerlessness related to chronic disease state
    Correct Answer: 2
  139. The nurse is using Kalish’s adaptation of Maslow’s hierarchy of needs when planning
    client care. Which client should the nurse identify as exhibiting a level of Kalish’s
    adaptation?
    1. Has a homosexual encounter for the first time
    2. Has a need to participate in school sports and be “on the team”
    3. Strives to become the CEO of a company
    4. Is sleep deprived because of musculoskeletal discomfort
    Correct Answer: 1
  140. A nurse is delivering a workshop regarding health promotion to a group of elderly
    clients. In describing Healthy People 2010, which goal should the nurse emphasize for
    this group?
    1. Eliminating health disparities
    2. Believing that individual health is closely related to community health
    3. Increasing quality and years of life
    4. Developing partnerships between individual and community health
    Correct Answer: 3
  141. A client comes to the clinic seeking information regarding smoking cessation classes
    and ways to improve respiratory function. This client is modeling which behavior?
    1. Health promotion
    2. Health protection
    3. Tertiary prevention
    4. Primary prevention
    Correct Answer: 2
  142. A community health nurse wants to provide health promotion classes through the local
    hospital. Which topics should the nurse include in this endeavor?
    Standard Text: Select all that apply.
    1. Time management
    2. Healthy eating habits
    3. Exercise after stroke
    4. Bicycle safety for children
    5. Performing self-examination of the breasts
    Correct Answer: 1, 2, 4
  143. A client has joined a fitness club and is working with the nurse to design a program for
    weight reduction and increased muscle tone. The client has tried exercise in the past
    with success, but has not been participating in a program for some time. In order to
    assess the potential for success with this client, the nurse should evaluate which of the
    behavior-specific cognitions?
    1. Interpersonal influences
    2. Perceived benefits of action
    3. Situational influences
    4. Perceived self-efficacy
    Correct Answer: 2
  144. A client has been working hard in rehabilitation following a traumatic brain injury. She
    has a weak support system in that her family lives a far distance away and her
    coworkers are not involved. On which behavior-specific cognitions should the nurse
    focus to assist this client with success in the rehabilitation program?
    1. Situational influences
    2. Perceived benefits of action
    3. Perceived barriers to action
    4. Interpersonal influences
    Correct Answer: 4
  145. A client is learning how to manage his asthma. In providing teaching, the nurse stresses
    the importance of using the peak flow meter every morning to help determine changes
    in respiratory status. The nurse is stressing which health promotion behavior?
    1. Competing preferences
    2. Competing demands
    3. Situational influences
    4. Interpersonal influences
    Correct Answer: 1
  146. Several nursing students have been discussing the benefits of joining a study group.
    They realize the importance of applying nursing knowledge to the clinical area and
    determine that together they may be more effective in retaining this information than if
    they continued in their individual settings. Which stage of behavior change are they
    exemplifying?
    1. Termination stage
    2. Preparation stage
    3. Contemplation stage
    4. Action stage
    Correct Answer: 3
  147. A client with diabetes wants to have better control over her blood sugar levels. She has
    set a goal that she will have laboratory values that reflect this, and she has been
    monitoring her blood sugar twice a day for the past month. Along with regular checks,
    she has kept all appointments with her nutritionist. This client is modeling which stage
    of health behavior change?
    1. Termination stage
    2. Maintenance stage
    3. Contemplation stage
    4. Action stage
    Correct Answer: 4
  148. The health nurse of a busy university campus is implementing a health promotion
    activity by placing posters about proper hand washing in all of the public restrooms on
    campus. Which type of health promotion program is the nurse implementing?
    1. Environmental control
    2. Information dissemination
    3. Health risk appraisal and wellness assessment
    4. Lifestyle and behavior change
    Correct Answer: 2
  149. The nurse is preparing information packets for incoming college students regarding
    sexually transmitted disease, drug and alcohol abuse, and the use of stimulants among
    this age group. In this situation, the nurse has assumed which role?
    1. Facilitator
    2. Advocate
    3. Teacher
    4. Coordinator of services
    Correct Answer: 3
  150. The nurse suggests that a client make a list of past experiences that have brought joy,
    peace, and hope into the client’s life. What action is the nurse assisting the client to
    complete?
    1. Lifestyle assessment
    2. Social support systems review
    3. Health beliefs review
    4. Spiritual health assessment
    Correct Answer: 4
  151. A client has received a high score on the Life-Change Index. For which part of the
    client’s assessment should the nurse use this information?
    1. Life stress review
    2. Social support systems review
    3. Lifestyle assessment
    4. Health beliefs review
    Correct Answer: 1
  152. The client is a high school student who is also a single parent. She is attending
    parenting classes while studying full time and living in an apartment with her child. The
    student also meets twice a week with a teen peer group and participates in a nutrition
    program through the county. Which is the most appropriate diagnosis for this client?
    1. Risk for Situational Low Self-Esteem
    2. High Risk for Caregiver Role Strain
    3. Readiness for Enhanced Coping
    4. Readiness for Enhanced Nutrition
    Correct Answer: 3
  153. The nurse educator provides developmental testing for kindergarten through
    third-grade students. Which level of prevention is the nurse performing?
    1. Primary
    2. Secondary
    3. Tertiary
    4. Community
    Correct Answer: 2
  154. A client has had a severe brain injury and has been in a rehabilitation hospital for
    several months. Recently, the client developed pneumonia and is currently on
    intravenous antibiotic therapy. Which level of prevention should the nurse use to
    address the health problem of pneumonia?
    1. Primary
    2. Secondary
    3. Tertiary
    4. Acute
    Correct Answer: 2
  155. A nurse in charge of an assisted living complex that includes independent living
    apartments understands the unique needs of individuals of this age group. When
    planning health promotion strategies, what factor should the nurse take into
    consideration?
    1. Rest and exercise
    2. Adjusting to physiologic changes and limitations
    3. High obesity percentages
    4. Safety promotion and injury prevention
    Correct Answer: 2
  156. A nurse is working with various cultures while implementing health promotion
    activities for the community center. Bringing the minister of the church into the
    planning stage of these activities would be sensitive to which cultural groups?
    1. Latino American
    2. Asian American
    3. Native American
    4. African American
    Correct Answer: 4
  157. The nurse is reviewing the characteristics of homeostatic mechanisms prior to assessing
    a client. Which characteristics should the nurse keep in mind during this assessment?
    Standard Text: Select all that apply.
    1. They are self-regulating.
    2. They are compensatory.
    3. They are regulated by negative feedback systems.
    4. They can require several feedback mechanisms to correct only one physiologic
    imbalance.
    5. They are related to a closed system.
    Correct Answer: 1, 2, 3, 4
  158. The nurse is an advocate for health promotion activities. Which nursing actions
    demonstrate this nurse’s advocacy?
    Standard Text: Select all that apply.
    1. Participating in a community-focused 5-mile run.
    2. Attending the local high school’s football games.
    3. Providing an educational program to senior citizens on blood pressure–control
    strategies.
    4. Attending a community meeting that is promoting the creating of a walking path in
    the city park.
    5. Encouraging an anxious client to practice relaxation techniques.
    Correct Answer: 1, 3, 4, 5
  159. The nurse is reviewing information collected while providing client care. Which
    findings should the nurse identify as being a homeostatic mechanism?
    Standard Text: Select all that apply.
    1. The client’s heart rate increases when walking up a flight of stairs.
    2. The client shivers when core body temperature drops.
    3. A child’s bone growth occurs in spurts.
    4. Decreased secretion of insulin occurs when food is not ingested.
    5. Lactation occurs in a pregnant woman.
    Correct Answer: 1, 2, 4
  160. The nurse is structuring activities that take a client’s developmental stage into consideration.
    Which activities should the nurse include?
    Standard Text: Select all that apply.
    1. Implementing seizure precautions
    2. Creating a schedule for daily wound care
    3. Monitoring intake, output, and daily weights
    4. Preparing newborn care classes for new parents
    5. Scheduling instruction sessions on self-administration of insulin
    Correct Answer: 4, 5
  161. During a home visit, the nurse is planning to complete a physical fitness assessment of a client.
    What should the nurse include in this assessment?
    Standard Text: Select all that apply.
    1. Flexibility
    2. Range of motion
    3. Body composition
    4. Muscle endurance
    5. Cardiorespiratory endurance
    Correct Answer: 1, 3, 4, 5
  162. A client is attending classes on building positive relationships with significant others as
    well as learning skills to be open-minded and respectful to those whose opinions are
    different. The nurse realizes that this client is focusing on which component of
    wellness?
    1. Physical
    2. Social
    3. Emotional
    4. Environment
    Correct Answer: 2
  163. The nurse is assisting a client and his family after the client had a stroke and is no longer
    able to return to his previous employment. The nurse has made a referral to vocational
    rehabilitation for assistance in retraining the client in a different occupation. With
    which component of wellness is the nurse assisting this client?
    1. Intellectual
    2. Environmental
    3. Occupational
    4. Emotional
    Correct Answer: 3
  164. A nurse educator is explaining the concept of health and parallels this with interruption
    of body systems and symptoms of disease or injury. This educator is interpreting health
    according to which model?
    1. Health–illness continua
    2. Eudemonistic
    3. Adaptive
    4. Clinical
    Correct Answer: 4
  165. A nurse is working in a rehabilitation center with a client who had a serious injury. Part
    of the client's care plan includes working on coping with her current limitations since
    the injury. This nurse is working within which model of health?
    1. Role performance
    2. Adaptive
    3. Eudemonistic
    4. Clinical
    Correct Answer: 2
  166. A nurse is conducting a community assessment to determine which diseases are
    prevalent and most likely to occur. The nurse is basing the assessment on which model
    of health?
    1. Role performance
    2. Eudemonistic
    3. Ecological
    4. Adaptive
    Correct Answer: 3
  167. A nurse is assessing a client who practices yoga for relaxation, is following a
    nutritionally sound diet, and has supportive, sound relationships with her spouse and
    children. According to Dunn's high-level wellness grid, this client would exemplify
    which health characteristic?
    1. Emergent high-level wellness in a favorable environment
    2. Emergent high-level wellness in an unfavorable environment
    3. Protected health in a favorable environment
    4. High-level wellness in a favorable environment
    Correct Answer: 4
  168. A nurse has volunteered to go on a health mission to rural Haiti, where the majority of
    the people do not have access to health care and live in poverty. According to Dunn's
    high-level wellness grid, the nurse will be working with clients in which quadrant?
    1. Emergent high-level wellness in an unfavorable environment
    2. Protected poor health in a favorable environment
    3. Poor health in an unfavorable environment
    4. Protected poor health in an unfavorable environment
    Correct Answer: 3
  169. The nurse educator is reviewing internal variables that affect people's health status. On
    which variables is this nurse focusing?
    Standard Text: Select all that aply.
    1. Genetic makeup
    2. Age
    3. Developmental level
    4. Environment
    5. Spiritual and religious beliefs
    Correct Answer: 1, 2, 3, 5
  170. An occupational health nurse is surveying employees. Which employee should the
    nurse identify as being predisposed to an illness?
    1. An employee who is in a middle-management position and takes stress from
    administration as well as the employees
    2. An employee who works in the janitorial department
    3. An employee who works 12-hour days, 3 days a week
    4. An employee who works 4 days on and 3 days off
    Correct Answer: 1
  171. A community health nurse is testing the theory of locus of control (LOC). Which client
    demonstrates the internal control concept of this theory?
    1. A client who takes an active role in all health decisions
    2. A client who allows the primary care provider to make all the decisions
    3. A client who does not make any decisions without his or her spouse's input
    4. A client who relies on information from the local hospital for his or her health needs
    Correct Answer: 1
  172. The nurse case manager is concerned about a particular client being discharged from
    the hospital. Which factors should alert the nurse to possible problems with this client’s
    adherence to treatment?
    1. The prescribed therapy is costly and of unknown duration.
    2. The therapy will require no lifestyle changes of the client.
    3. The client has not had difficulty understanding the regimen.
    4. The client's culture is supportive of Western medicine
    Correct Answer: 1
  173. During a home visit with a new community member, the nurse suspects that a client has a
    chronic illness. What did the nurse assess to make this clinical decision?
    Standard Text: Select all that apply.
    1. Experienced symptoms for 8 months
    2. Has periods where the symptoms disappear
    3. Altered activities of daily living because of the illness
    4. Problem disappeared with over-the-counter medication
    5. Symptoms appeared abruptly and disappeared after treatment
    Correct Answer: 1, 2, 3
  174. The nurse determines that an older client is in the medical care contact stage of an illness. What
    did the client demonstrate to cause the nurse to make this decision?
    Standard Text: Select all that apply.
    1. The client asked if the illness can be treated or recovery is possible.
    2. The client asked if the symptoms experienced are a part of an illness.
    3. The client asked if the symptoms can be explained in plain language.
    4. The client stated that the illness is not acceptable and wants a second opinion.
    5. The client stated that treatment is accepted and will be completed as identified.
    Correct Answer: 1, 2, 3, 4
  175. The nurse is planning care for an older client. Which safety hazard should the nurse
    take into consideration when planning this care?
    1. Burns
    2. Drowning
    3. Poisoning
    4. Suffocation
    Correct Answer: 1
  176. The nurse is preparing materials to instruct the parents of a newborn. What should the
    nurse identify as a safety hazard in an infant?
    1. Exposure to alcohol consumption
    2. Drowning
    3. Pedestrian accidents
    4. Suffocation in the crib
    Correct Answer: 4
  177. The nurse is reviewing safety hazards with a pregnant client. What should the nurse
    include when instructing this client about safety and the developing fetus?
    1. Banging into objects
    2. Bicycle rides
    3. Recreational activities
    4. X-rays
    Correct Answer: 4
  178. The nurse would like to improve communication among caregivers. How should the
    nurse use the Joint Commission 2013 National Patient Safety Goals to achieve this
    objective?
    1. Review a list of look-alike/sound-alike drugs used in the organization.
    2. Use a verification process to confirm the correct procedure.
    3. Report critical results of tests and diagnostic procedures on a timely basis..
    4. Use the client's room number as an identifier.
    Correct Answer: 3
  179. The nurse is planning care for a client who is prone to falling. Which nursing diagnoses
    should the nurse use for this client?
    1. Deficient Knowledge
    2. Risk for Injury
    3. Risk for Disuse Syndrome
    4. Risk for Suffocation
    Correct Answer: 2
  180. The nurse is identifying care goals for a client who is prone to getting hurt. Which care
    goal should the nurse select for this client?
    1. Assess the client's mental status.
    2. Keep the client dependent on the staff for all care.
    3. Make all choices for the client.
    4. Remain free from injury
    Correct Answer: 4
  181. As a member of the safety committee, the nurse’s task is to identify actions to prevent
    falls within the organization. Which intervention should the nurse emphasize as
    important to prevent falls?
    1. Display the phone number to the nurses' station.
    2. Keep electrical cords under the bed.
    3. Keep the environment tidy.
    4. Read label directions.
    Correct Answer: 3
  182. The home care nurse wants to ensure the safety of an older client who lives at home
    alone. Which intervention should the nurse identify as a way to prevent this client from
    falling?
    1. Check vision every 5 years.
    2. Exercise regularly.
    3. Place socks on feet.
    4. Turn the light on after getting out of bed.
    Correct Answer: 2
  183. The mother of a 2-year-old expresses concern to the nurse that her child continually
    climbs out of the crib at home. What should the nurse advise the mother to do?
    1. Omit the afternoon nap.
    2. Place a crib net over the top of the crib.
    3. Remove all objects from around the crib.
    4. Restrain the child if he gets up more than once.
    Correct Answer: 2
  184. While the nurse is performing morning care, a client begins to have a seizure. What
    should the nurse do to help this client?
    1. Insert a tongue blade into the client's mouth.
    2. Loosen any clothing around the neck and chest.
    3. Restrain the client.
    4. Turn the client to the supine position if possible.
    Correct Answer: 2
  185. The nurse is considering the use of restraints for a client. In which situation can the
    nurse apply restraints to a client?
    1. Client wanders around the care area.
    2. Client is picking at the access site for intravenous infusion of chemotherapy.
    3. Client needed to use the bathroom and waited for help but didn’t want to soil the bed
    and fell while attempting to walk to the bathroom.
    4. Client does not want to stay in bed but wants to sit in the lounge with others
    Correct Answer: 2
  186. The nurse is applying restraints to a client. After securing a health care provider’s order,
    what should the nurse do?
    1. Assess the restraints every 10 minutes.
    2. Pad bony prominences.
    3. Secure the restraint to the side rail.
    4. Tie the restraint with a square knot.
    Correct Answer: 2
  187. An older client diagnosed with Alzheimer's disease continually tries to get out of bed at
    night. Which safety measure should the nurse consider using with this client?
    1. Explain all procedures and treatments.
    2. Place a bed safety monitoring device on the bed.
    3. Orient the client to surroundings.
    4. Use relaxation techniques.
    Correct Answer: 2
  188. The nurse is caring for a client who is confused and wanders. Which alternative to a
    restraint can the nurse use for this client?
    1. Assign this client to the farthest room from the nurses' station.
    2. Place a rocking chair in the client’s room.
    3. Pull up all of the side rails on the bed.
    4. Wedge pillows against the side rails on the bed.
    Correct Answer: 2
  189. The nurse is identifying outcomes for an older client prone to injuries. Which outcome
    should the nurse identify as appropriate for this client?
    1. The client will demonstrate an understanding of all limitations.
    2. The client will establish a buddy system.
    3. The client will make uninformed choices when addressing health issues.
    4. The client will take his medication as desired
    Correct Answer: 2
  190. The nurse is reviewing safety with a home-care client. What should the nurse include in
    this teaching?
    1. Always pull a plug at the plug-in from the wall outlet.
    2. Keep plants in the home.
    3. Use overloaded outlets when necessary.
    4. Remove labels from containers and refill for recycling.
    Correct Answer: 1
  191. The nurse is attending a seminar on bioterrorism. What should the nurse identify as
    being the highest concern for homeland security?
    1. Cancer
    2. Seasonal flu
    3. Tuberculosis
    4. Smallpox
    Correct Answer: 4
  192. While eating in a restaurant, a nurse notices that a customer at the next table begins to
    clutch his throat while eating a steak. What should the nurse do first?
    1. Ask the customer if he is choking.
    2. Attempt to give five back blows.
    3. Perform the Heimlich maneuver.
    4. Start chest compressions.
    Correct Answer: 1
  193. The nurse is admitting an older client to the care area. What can the nurse do to promote
    a safe environment for the client?
    1. Keep clutter to a minimum in the client's room.
    2. Have the client wear terry-cloth slippers.
    3. Provide adequate lighting.
    4. Turn off alarms to reduce noise.
    Correct Answer: 3
  194. The nurse is determining a client’s risk for injury. What should the nurse assess in this
    client?
    Standard Text: Select all that apply.
    1. Age
    2. Mobility
    3. Hearing
    4. Vision
    5. Dietary intake
    Correct Answer: 1, 2, 3, 4
  195. An older client is observed having difficulty moving from a sitting to standing position,
    and has an unsteady gait. What should the nurse assess in this client to promote home
    safety?
    Standard Text: Select all that apply.
    1. Presence of grab bars in the bathroom
    2. Absence of scatter rugs on the floors
    3. Correct use of cane to ambulate
    4. Ability to stand in place for a minute before ambulating
    5. Alcohol use with prescribed medications
    Correct Answer: 1, 2, 3
  196. A client is being transferred from an acute care facility to a long-term care facility.
    What information should the nurse provide to the long-term care facility about the
    client’s medications?
    1. Nothing, as the medications all need to be reordered at the long-term care facility.
    2. Have the client’s medication prescriptions filled before going to long-term care
    facility
    3. Instruct the client to tell the nurses at the long-term care facility what medications are
    prescribed.
    4. Inform the nurse at the long-term care facility what medications the client is
    prescribed, and document that this information was provided.
    Correct Answer: 4
  197. A client is prescribed seizure precautions. The nurse places functioning oral suction
    equipment in the client’s room for what reason?
    1. Suctioning might be needed to prevent the aspiration of oral secretions.
    2. The client has difficulty swallowing liquids.
    3. There was a spare oral suction set up, and the nurse did not want to return it to the
    engineering department.
    4. It helps when the client is brushing her teeth.
    Correct Answer: 1
  198. The nurse is evaluating teaching provided to a client about home safety. Which
    observation indicates that teaching has been effective?
    1. Smoke alarm functioning with new batteries installed
    2. Scatter rugs located in the kitchen and bathroom only
    3. Cord for a space heater stretched across a hallway
    4. Light bulbs burned out in the bathroom and living room
    Correct Answer: 1
  199. The nurse is installing a bed safety-monitoring device for a client. What should the
    nurse do after testing the device and alarm sound?
    1. Place the leg band on the client with the leg in a straight horizontal position.
    2. Place the sensor under the mattress near the shoulder region.
    3. Set a time delay for 30 seconds.
    4. Connect the sensor pad to the control unit.
    Correct Answer: 1
  200. The nurse is identifying activities and skills to delegate to unlicensed assistive
    personnel (UAP). Which action can the nurse safely delegate?
    1. Provide oral fluids to a newly extubated client.
    2. Irrigate the indwelling urinary catheter of a client recovering from prostate surgery.
    3. Apply a wrist restraint to a client.
    4. Administer oral pain medication to a client before the client attends physical therapy
    Correct Answer: 3
  201. A client is prescribed seizure precautions. What can the nurse safely delegate to UAP to
    complete when implementing the precautions?
    1. Placing a tongue blade at the head of the bed
    2. Padding the client’s bed
    3. Installing oxygen
    4. Checking the oral suction apparatus
    Correct Answer: 2
  202. After ambulating a client to the bathroom, the unlicensed assistive personnel did not
    reattach the client’s bed safety-monitoring device, and the client fell out of bed. What
    should the nurse document?
    1. Client fell out of bed; bed safety-monitoring device malfunctioning.
    2. Client fell out of bed; client removed leg band of bed safety-monitoring device.
    3. Client fell out of bed; no observable injuries.
    4. Client fell out of bed; bed safety-monitoring device not activated
    Correct Answer: 4
  203. A client who is on seizure precautions experiences a seizure while ambulating in the
    room. What should the nurse include in this client’s documentation?
    Standard Text: Select all that apply.
    1. Who assisted the client back to bed
    2. Location of the seizure
    3. Duration of the seizure
    4. Status of airway and use of oxygen
    5. Who discovered the client
    Correct Answer: 2, 3, 4
  204. The nurse is preparing to assess a client who has a history of falls. Which methods
    should the nurse use to assess this client’s risk for injury?
    Standard Text: Select all that apply.
    1. Cognitive awareness
    2. Mobility
    3. Nursing history
    4. Physical examination
    5. Health status
    Correct Answer: 3, 4
  205. The nurse is appointed to be a member of committee whose focus is to identify and address
    workplace safety issues. Which issues should the nurse recommend for analysis by this
    committee?
    Standard Text: Select all that apply.
    1. Lifting clients
    2. Inadequate lighting
    3. Bending and walking
    4. Exposure to infectious agents
    5. Exposure to hazardous medications
    Correct Answer: 1, 3, 4, 5
  206. During a home visit, the nurse determines that a toddler is at risk for injury. What did the nurse
    assess to identify this client’s risk?
    Standard Text: Select all that apply.
    1. Unscreened windows
    2. Electrical outlets uncovered
    3. Yard with a built-in pool unfenced
    4. Cleaning solution in the bottom cabinet
    5. Pots on stove with handles turned inward
    Correct Answer: 1, 2, 3, 4
Author
TopShot102
ID
353159
Card Set
Test 2
Description
STudy
Updated