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Question 1

1. Which teaching method is most effective when providing instruction to members of special populations?
2. Teach-back
3. Video instruction
4. Written materials
5. Verbal explanation

Answer 1

1. Answer: 1 Teach-back

Rationale: When providing education to members of special populations, return explanation and demonstration (teach-back) are of particular importance to ensure safety and mutual understanding. This method is the most reliable in confirming client understanding of the instructions. Video instruction, written materials, and verbal explanation are helpful and may be incorporated with the teach-back method.

Question 2

2. Which health concern(s) should the nurse be aware of as risk factors when caring for clients of African American descent? Select all that apply.
3. Cancer
4. Obesity
5. Hypertension
6. Heart disease
7. Hypothyroidism
8. Diabetes mellitus

Answer 2

2. Answer:
3. Cancer
4. Obesity
5. Hypertension
6. Heart disease
7. Diabetes mellitus

Rationale: Obesity, diabetes mellitus, hypertension, heart disease, asthma, and cancer are prevalent among this population. Hypothyroidism is not a particular risk factor. It is important to understand risk factors associated with health and the interplay of genetics, which can result in trends or patterns for specific ethnic groups.

Question 3

3. The nurse is planning care for a client of Native Hawaiian descent who recently had a baby. The nurse develops a teaching plan and includes information about which measure that is related to a newborn complication within this ethnic group?
4. Safe sleeping
5. Car seat safety
6. Breast-feeding
7. Baby-proofing

Answer 3

3. Answer: 1. Safe sleeping

Rationale: The Native Hawaiian population has a disproportionately higher rate of infant mortality compared with other ethnic groups. Sudden infant death syndrome (SIDS) is a major cause of infant mortality. Safe sleeping is an important measure to prevent this newborn complication. Car seat safety, breast-feeding, and baby-proofing are important safety measures but are not specific to Native Hawaiians.

Question 4

4. The nurse is planning care for an assigned client. The nurse should include information in the plan of care about prevention of human immunodeficiency virus (HIV) for which individuals specifically at risk?
5. Lesbian persons
6. Men-who-have-sex-with-men (MSM)
7. Women-who-have-sex-with-women (WSW)
8. Female-to-male (FTM) transgender persons

Answer 4

4. Answer: 2. Men-who-have-sex-with-men (MSM)

Rationale: MSM (men-who-have-sex-with-men) are at a higher risk for HIV and acquired immunodeficiency syndrome (AIDS). Although anyone who is sexually active should be counseled on prevention of sexually transmitted infection, the other populations mentioned are not at an increased risk for HIV/AIDS.

Question 5

5. Which therapeutic communication technique is most helpful when working with transgender persons?
6. Using open-ended questions
7. Using their first name to address them
8. Using pronouns associated with birth sex
9. Anticipating the client’s needs and making suggestions

Answer 5

5. Answer: 1. Using open-ended questions

Rationale: The use of open-ended questions is most helpful in communicating with transgender persons because it assists in refraining from judgment and allows the client the opportunity to express their thoughts and feelings. The nurse should address the client with the name that the client prefers, so the first name may not necessarily be their preference. For the transgender person, it is likely that they would like to be addressed using pronouns associated with the sex they identify with now, which typically is not their birth sex. Anticipating the client’s needs and making suggestions may be seen as passing judgment, so the nurse should refrain from doing this.

Question 6

6. Which special population should be targeted for breast cancer screening by way of mammography?
   Select all that apply.
7. Male-to-female (MTF)
8. Female-to-male (FTM)
9. Men-who-have-sex-with-men (MSM)
10. Women-who-have-sex-with-men (WSM)
11. Women-who-have-sex-with-women (WSW)

Answer 6

6. Answer:
7. Male-to-female (MTF)
8. Female-to-male (FTM)
9. Women-who-have-sex-with-men (WSM)
10. Women-who-have-sex-with-women (WSW)

Rationale: Transgender persons who have undergone sexual reassignment surgery should have the respective preventive screenings. For example, MTF should have breast cancer screening by way of mammography if they are older than 50 years. Additionally, FTM should still have mammography routinely as indicated due to the risk for residual breast tissue to develop cancerous growth. WSW and WSM should have screening as well.

Test-Taking Strategy: Note the subject, indications for mammography. Recalling that this test is primarily indicated for females will direct you to the correct options.

Question 7

7. The nurse is volunteering with an outreach program to provide basic health care for homeless people. Which finding, if noted, should be addressed first?
8. Blood pressure 154/72 mm Hg
9. Visual acuity of 20/200 in both eyes
10. Random blood glucose level of 206 mg/dL (11.47 mmol/L)
11. Complaints of pain associated with numbness and tingling in both feet

Answer 7

7. Answer:
8. Complaints of pain associated with numbness and tingling in both feet

Rationale: The nurse should address the complaints of pain and numbness and tingling in both feet first with this population. If the client perceives value to the service provided, they will be more likely to return for follow-up care. While the blood pressure, blood glucose, and vision results are concerning, the client’s stated concern should be addressed first.

Test-Taking Strategy: Note the subject, the finding to be addressed, and focus on the strategic word, first. Recalling that adherence is a problem for this population will direct you to the correct option. Also note that the correct option is the only subjective finding

Question 8

8. The nurse is preparing discharge resources for a client being discharged to the homeless shelter. When looking at the discharge medication reconciliation form, the nurse determines there is a need for follow-up if which medication was prescribed?
9. Glipizide
10. Lisinopril
11. Metformin
12. Beclomethasone

Answer 8

8. Answer:
9. Glipizide

Rationale: There are a number of medications that should be avoided, if possible, for the homeless person due to the safety risks. Glipizide is an oral hypoglycemic medication and is classified as a sulfonylurea. A major side effect of this medication is hypoglycemia, which presents a safety risk to the homeless person. Lisinopril is an angiotensin-converting enzyme inhibitor. Although there are side effects that should be included in discharge instructions, there is less of a threat to safety with this medication, and the benefits of it are important. Metformin is an oral biguanide and is used for type 2 diabetes mellitus. Hypoglycemia is less of a concern with this medication compared with other oral hypoglycemics. Beclomethasone is an inhaled corticosteroid used for obstructive lung disease, and although there are side effects that the client should know about, there is not a particular safety risk associated with this medication for the homeless person.

Test-Taking Strategy: Note the strategic words, need for follow-up. Specific knowledge about the medications identified in the options and knowledge of the medications that should be avoided with the homeless clients is needed to answer this question. Remember that sulfonylureas present the risk of hypoglycemia.

Question 9

9. The nurse is completing the admission assessment for a client who is intellectually disabled. Which part of the client encounter may require more time to complete?
10. The history
11. The physical assessment
12. The nursing plan of care
13. The readmission risk assessment

Answer 9

9. Answer:
10. The history

Rationale: Intellectually disabled clients tend to be poor historians, and it may be necessary to take more time to ask questions in a variety of different ways when collecting the history data. The physical assessment, nursing plan of care, and readmission risk assessment portions, although they rely on the history, take less time because they require less client questioning.

Test-Taking Strategy: Note the subject, conducting an admission assessment for an intellectually disabled client and the part that may take more time to complete. Recalling that individuals in this special population group are poor historians and that use of questioning in a variety of ways may be necessary will direct you to the correct option.

Question 10

10. The nurse working in a correctional facility is caring for a new prisoner. The client asks about health risks associated with living in a prison. How should the nurse respond?
11. “Health care is very limited in the prison setting.”
12. “Living in a prison isn’t different than living at home.”
13. “Living in a prison can predispose a person to different health conditions.”
14. “Living in a prison is similar to living in a condominium complex or dormitory.”

Answer 10

10. Answer:
11. “Living in a prison can predispose a person to different health conditions.”

Rationale: The environment of a prison can predispose a person to different health conditions, such as tuberculosis, human immunodeficiency syndrome, sexually transmitted infections, or other infectious diseases. Option 1 does not address the client’s question. Options 2 and 4 convey incorrect information.

Test-Taking Strategy: Note the subject, health conditions associated with living in a prison. Remember that the prison is a confined environment, and a variety of infectious diseases are prevalent.

Question 11

11. The nurse is caring for a female client in the emergency department who presents with a complaint of fatigue and shortness of breath. Which physical assessment findings, if noted by the nurse, warrant a need for follow-up?
12. Reddened sclera of the eyes
13. Dry flaking noted on the scalp
14. A reddish-purple mark on the neck
15. A scaly rash noted on the elbows and knees

Answer 11

11. Answer: 3
    Rationale: The client in this question should be screened for abuse. Battered women experience bruises, particularly around the eyes, red or purple marks on the neck, sprained or broken wrists, chronic fatigue, shortness of breath, muscle tension, involuntary shaking, changes in eating and sleeping, sexual dysfunction, and fertility issues. Mental health issues can also arise, including post-traumatic stress disorder, nightmares, anxiety, uncontrollable thoughts, depression, anxiety, low self-esteem, and alcohol and drug abuse. Reddened sclera, a dry rash on the elbows, and flaking of the scalp do not pose an indication of abuse.

Test-Taking Strategy: Note the strategic words, need for follow-up. Also focus on the data in the question and select the option that indicates the most concern and is indicative of abuse. Remember that battered women often present with bruising around the eyes or on the neck.

Question 12

12. The nurse working in a community outreach program for foster children plans care knowing that which health conditions are common in this population?

Select all that apply.

1. Asthma
2. Claustrophobia
3. Sleep problems
4. Bipolar disorder
5. Aggressive behavior
6. Attention-deficit hyperactivity disorder (ADHD)

Answer 12

12. Answer:
13. Sleep problems
14. Bipolar disorder
15. Aggressive behavior
16. Attention-deficit hyperactivity disorder (ADHD)

Rationale: Foster children are at risk for a variety of health conditions later in life, including ADHD, aggressive behavior, anxiety disorder, bipolar disorder, depression, mood disorder, post-traumatic stress disorder, reactive detachment disorder, sleep problems, prenatal drug and alcohol exposure, and personality disorder. Claustrophobia and asthma are not specifically associated with foster children.

Test-Taking Strategy: Note the subject, health concerns for foster children. Recall that mental health is a major concern for this population. This will assist in directing you to the correct options.

Question 13

13. The nurse planning care for a military veteran should prioritize nursing interventions targeted at managing which condition, if present, that commonly occurs in this population?
14. Hypertension
15. Hyperlipidemia
16. Substance abuse disorder
17. Post-traumatic stress disorder

Answer 13

13. Answer:
14. Post-traumatic stress disorder

Rationale: Post-traumatic stress disorder (PTSD) is extremely common in this population. Identifying and treating mental health disorders assists in mitigating suicide risk. Treatment of comorbid conditions such as PTSD may also help address any substance use disorder. Use of screening tools in identifying substance use disorder is helpful. Treatment of PTSD includes exposure therapy, psychotherapy, and family/group therapy. Hypertension and hyperlipidemia are important but not the priority; the risk of suicide and other safety concerns associated with PTSD are the priority for this population.

Test-Taking Strategy: Note the strategic word, prioritize. This phrase indicates that although all options may be important, one option is a priority due to safety considerations. Also note that options 1 and 2 are comparable or alike and therefore can be eliminated. Although substance abuse may be a concern, PTSD is the priority.

Question 14

14. The nurse caring for a refugee considers which health care need a priority for this client?
15. Access to housing
16. Access to clean water
17. Access to transportation
18. Access to mental health care services

Answer 14

14. Answer:
15. Access to mental health care services

Rationale: Mental health problems are the primary issue for this population as a result of tortuous events. While all other options are important for all clients, they do not address the specific needs of this special population.

Test-Taking Strategy: Note the strategic word, priority. This indicates that all options are important and are most likely correct. It is necessary to recall that due to the potential trauma experienced by refugees, mental health is a priority.

Question 15

15. Which action by the nurse will best facilitate adherence to the treatment regimen for a client with a chronic illness?
16. Arranging for home health care
17. Focusing on managing a single illness at a time
18. Communicating with one provider only to avoid confusion for the client
19. Allowing the client to teach a support person about their treatment regimen

Answer 15

15. Answer:
16. Arranging for home health care

Rationale: Nursing follow-up visits are important in promoting health for individuals with chronic illness; therefore, arranging for home health care is an important strategy.

Focusing on a single illness does not effectively manage an individual with multiple chronic diseases—rather, the “big picture” needs to be understood in managing these clients. Interprofessional collaboration is important in safely managing individuals with chronic diseases, and often involves consulting with specialist providers. Nurses play a key role in facilitating communication between providers and specialists. Inclusion of the client and support person(s) in health care decisions helps increase adherence to a complex health care regimen, and the nurse should be the facilitator of this communication.

Test-Taking Strategy: Note the strategic word, best. Recalling that these clients often have complex histories and health care needs will assist you in choosing the option that relates to nursing support services.

Question 16

16. The nurse hears a client calling out for help, hurries down the hallway to the client’s room, and finds the client lying on the floor. The nurse performs an assessment, assists the client back to bed, notifies the primary health care provider, and completes an occurrence report. Which statement should the nurse document on the occurrence report?
17. The client fell out of bed.
18. The client climbed over the side rails.
19. The client was found lying on the floor.
20. The client became restless and tried to get out of bed.

Answer 16

16. Answer:
17. The client was found lying on the floor.

Rationale: The occurrence report should contain a factual description of the occurrence, any injuries experienced by those involved, and the outcome of the situation. The correct option is the only one that describes the facts as observed by the nurse. Options 1, 2, and 4 are interpretations of the situation and are not factual information as observed by the nurse.

Test-Taking Strategy: Focus on the subject, documentation of events, and note the data in the question to select the correct option. Remember to focus on factual information when documenting, and avoid including interpretations. This will direct you to the correct option.

Question 17

17. A client is brought to the emergency department by emergency medical services (EMS) after being hit by a car. The name of the client is unknown, and the client has sustained a severe head injury and multiple fractures and is unconscious. An emergency craniotomy is required. Regarding informed consent for the surgical procedure, which is the best action?
18. Obtain a court order for the surgical procedure.
19. Ask the EMS team to sign the informed consent.
20. Transport the victim to the operating room for surgery.
21. Call the police to identify the client and locate the family.

Answer 17

17. Answer:
18. Transport the victim to the operating room for surgery.

Rationale: In general, there are two situations in which informed consent of an adult client is not needed. One is when an emergency is present and delaying treatment for the purpose of obtaining informed consent would result in injury or death to the client. The second is when the client waives the right to give informed consent. Option 1 will delay emergency treatment, and option 2 is inappropriate. Although option 4 may be pursued, it is not the best action because it delays necessary emergency treatment.

Test-Taking Strategy: Note the strategic word, best. Also note that an emergency is present. Recalling that a delay in treatment for the purpose of obtaining informed consent could result in injury or death will direct you to the correct option.

Question 18

18. The nurse has just assisted a client back to bed after a fall. The nurse and primary health care provider have assessed the client and have determined that the client is not injured. After completing the occurrence report, the nurse should implement which action next?
19. Reassess the client.
20. Conduct a staff meeting to describe the fall.
21. Contact the nursing supervisor to update information regarding the fall.
22. Document in the nurse’s notes that an occurrence report was completed.

Answer 18

18. Answer:
19. Reassess the client.

Rationale: After a client’s fall, the nurse must frequently reassess the client, because potential complications do not always appear immediately after the fall. The client’s fall should be treated as private information and shared on a “need to know” basis. Communication regarding the event should involve only the individuals participating in the client’s care. An occurrence report is a problem-solving document; however, its completion is not documented in the nurse’s notes. If the nursing supervisor has been made aware of the occurrence, the supervisor will contact the nurse if status update is necessary.

Test-Taking Strategy: Note the strategic word, next. Using the steps of the nursing process will direct you to the correct option. Remember that assessment is the first step. Additionally, use Maslow’s Hierarchy of Needs theory, recalling that physiological needs are the priority. The correct option is the only option that addresses a potential physiological need of the client.

Question 19

19. The nurse arrives at work and is told to report (float) to the intensive care unit (ICU) for the day because the ICU is understaffed and needs additional nurses to care for the clients. The nurse has never worked in the ICU. The nurse should take which best action?
20. Refuse to float to the ICU based on lack of unit orientation.
21. Clarify the ICU client assignment with the team leader to ensure that it is a safe assignment.
22. Ask the nursing supervisor to review the hospital policy on floating.
23. Submit a written protest to nursing administration, and then call the hospital lawyer.

Answer 19

19. Answer:
20. Clarify the ICU client assignment with the team leader to ensure that it is a safe assignment.

Rationale: Floating is an acceptable practice used by hospitals to solve understaffing problems. Legally, the nurse cannot refuse to float unless a union contract guarantees that nurses can work only in a specified area or the nurse can prove the lack of knowledge for the performance of assigned tasks. When encountering this situation, the nurse should set priorities and identify potential areas of harm to the client. That is why clarifying the client assignment with the team leader to ensure that it is a safe one is the best option. The nursing supervisor is called if the nurse is expected to perform tasks that he or she cannot safely perform. Submitting a written protest and calling the hospital lawyer is a premature action.

Test-Taking Strategy: Note the strategic word, best. Eliminate option 1 first because of the word refuse. Next, eliminate options 3 and 4 because they are premature actions.

Question 20

20. The nurse who works on the night shift enters the medication room and finds a coworker with a tourniquet wrapped around the upper arm. The coworker is about to insert a needle, attached to a syringe containing a clear liquid, into the antecubital area. Which is the most appropriate action by the nurse?
21. Call security.
22. Call the police.
23. Call the nursing supervisor.
24. Lock the coworker in the medication room until help is obtained.

Answer 20

20. Answer:
21. Call the nursing supervisor.

Rationale: Nurse practice acts require reporting impaired nurses. The board of nursing has jurisdiction over the practice of nursing and may develop plans for treatment and supervision of the impaired nurse. This occurrence needs to be reported to the nursing supervisor, who will then report to the board of nursing and other authorities, such as the police, as required. The nurse may call security if a disturbance occurs, but no information in the question supports this need, and so this is not the appropriate action. Option 4 is an inappropriate and unsafe action.

Test-Taking Strategy: Note the strategic words, most appropriate. Eliminate option 4 first, because this is an inappropriate and unsafe action. Recall the lines of organizational structure to assist in directing you to the correct option.

Question 21

21. A hospitalized client tells the nurse that an instructional directive is being prepared and that the lawyer will be bringing the document to the hospital today for witness signatures. The client asks the nurse for assistance in obtaining a witness to the will. Which is the most appropriate response to the client?
22. “I will sign as a witness to your signature.”
23. “You will need to find a witness on your own.”
24. “Whoever is available at the time will sign as a witness for you.”
25. “I will call the nursing supervisor to seek assistance regarding your request.”

Answer 21

21. Answer:
22. “I will call the nursing supervisor to seek assistance regarding your request.”

Rationale: Instructional directives (living wills) are required to be in writing and signed by the client. The client’s signature must be witnessed by specified individuals or notarized. Laws and guidelines regarding instructional directives vary from state to state, and it is the responsibility of the nurse to know the laws. Many states prohibit any employee, including the nurse of a facility where the client is receiving care, from being a witness. Option 2 is nontherapeutic and not a helpful response. The nurse should seek the assistance of the nursing supervisor.

Test-Taking Strategy: Note the strategic words, most appropriate. Options 1 and 3 are comparable or alike and should be eliminated first. Option 2 is eliminated because it is a nontherapeutic response.

Question 22

22. The nurse has made an error in documentation of the dose administered of an opioid pain medication in the client’s record. The nurse draws 1 mg from the vial and another registered nurse (RN) witnesses wasting of the remaining 1 mg. When scanning the medication, the nurse entered into the medication administration record (MAR) that 2 mg of hydromorphone was administered instead of the actual dose administered, which was 1 mg. The nurse should take which action(s) to correct the error in the MAR?

Select all that apply.

1. Complete and file an occurrence report.
2. Right-click on the entry and modify it to reflect the correct information.
3. Document the correct information and end with the nurse’s signature and title.
4. Obtain a cosignature from the RN who witnessed the waste of the remaining 1 mg.
5. Document in a nurse’s note in the client’s record detailing the corrected information.

Answer 22

22. Answer:
23. Right-click on the entry and modify it to reflect the correct information.
24. Document the correct information and end with the nurse’s signature and title.
25. Obtain a cosignature from the RN who witnessed the waste of the remaining 1 mg.
26. Document in a nurse’s note in the client’s record detailing the corrected information.

Rationale: Electronic health records (EHR) will have a time date stamp that indicates an amendment has been entered. If the nurse makes an error in the MAR, the nurse should follow agency policies to correct the error. In the MAR, the nurse can click on the entry (usually right-click) and modify it to reflect the corrected information. Since this is an opioid medication, the nurse should obtain a cosignature from the RN who witnessed the wasting of the excess medication, to validate that 1 mg, rather than 2 mg, was given. A nurse’s note should be used to detail the event and the corrections made, and the nurse’s name and title will be stamped on the entry in the EHR. An occurrence report is not necessary in this situation.

Test-Taking Strategy: Focus on the subject, correcting a documentation error, and use principles related to documentation. Recalling the purpose of an occurrence report will assist in eliminating option 1. From the remaining options, focusing on the subject of the question and using knowledge regarding the principles related to documentation will direct you to the correct options.

Question 23

23. Which identifies accurate nursing documentation notation(s)?

Select all that apply.

1. The client slept through the night.
2. Abdominal wound dressing is dry and intact without drainage.
3. The client seemed angry when awakened for vital sign measurement.
4. The client appears to become anxious when it is time for respiratory treatments.
5. The client’s left lower medial leg wound is 3 cm in length without redness, drainage, or edema.

Answer 23

23. Answer:
24. The client slept through the night.
25. Abdominal wound dressing is dry and intact without drainage.
26. The client’s left lower medial leg wound is 3 cm in length without redness, drainage, or edema.

Rationale: Factual documentation contains descriptive, objective information about what the nurse sees, hears, feels, or smells. The use of inferences without supporting factual data is not acceptable, because it can be misunderstood. The use of vague terms, such as seemed or appears, is not acceptable because these words suggest that the nurse is stating an opinion.

Test-Taking Strategy: Focus on the subject, accurate documentation notations. Eliminate options 3 and 4 because they are comparable or alike and include vague terms (seemed, appears).

Question 24

24. A nursing instructor delivers a lecture to nursing students regarding the issue of clients’ rights and asks a nursing student to identify a situation that represents an example of invasion of client privacy. Which situation, if identified by the student, indicates an understanding of a violation of this client right?
25. Performing a procedure without consent
26. Threatening to give a client a medication
27. Telling the client that he or she cannot leave the hospital
28. Observing care provided to the client without the client’s permission

Answer 24

24. Answer:
25. Observing care provided to the client without the client’s permission

Rationale: Invasion of privacy occurs with unreasonable intrusion into an individual’s private affairs. Performing a procedure without consent is an example of battery. Threatening to give a client a medication constitutes assault. Telling the client that the client cannot leave the hospital constitutes false imprisonment.

Test-Taking Strategy: Focus on the subject, invasion of privacy. Noting the words without the client’s permission will direct you to this option.

Question 25

25. Nursing staff members are sitting in the lounge taking their morning break. An assistive personnel (AP) tells the group that she thinks that the unit secretary has acquired immunodeficiency syndrome (AIDS) and proceeds to tell the nursing staff that the secretary probably contracted the disease from her husband, who is supposedly a drug addict. The registered nurse should inform the AP that making this accusation has violated which legal tort?
26. Libel
27. Slander
28. Assault
29. Negligence

Answer 25

25. Answer:
26. Slander

Rationale: Defamation is a false communication or a careless disregard for the truth that causes damage to someone’s reputation, either in writing (libel) or verbally (slander). An assault occurs when a person puts another person in fear of a harmful or offensive contact. Negligence involves the actions of professionals that fall below the standard of care for a specific professional group.

Test-Taking Strategy: Note the subject, the legal tort that was violated. Focus on the data in the question and eliminate options 3 and 4 first because their definitions are unrelated to the data. Recalling that slander constitutes verbal defamation will direct you to the correct option from the remaining options.