EXAM 1 Flashcards
A nurse is posting on social media about an event that occurred during a shift. Which regulation should the nurse consider when sharing information about patients?
A. Nursing Practice Act
B. Health Insurance Portability and Accountability Act (HIPAA)
C. Emergency Medical Treatment and Labor Act (EMTALA)
D. Patient Self-Determination Act
Answer: B. Health Insurance Portability and Accountability Act (HIPAA)
Rationale: HIPAA mandates protection of patient privacy and prohibits sharing identifiable patient information on social media.
Which of the following is the primary responsibility of the Texas Board of Nursing?
A. Advocate for higher wages for nurses
B. Ensure that all nurses maintain continuing education credits
C. Protect the public from unsafe nursing practices
D. Support nurses in legal disputes with employers
Answer: C. Protect the public from unsafe nursing practices
Rationale: The Texas Board of Nursing’s main goal is to protect the public by ensuring nurses are competent in their practice.
A client asks the nurse if they have the right to refuse treatment. The nurse responds by referencing which regulation?
A. Emergency Medical Treatment and Labor Act (EMTALA)
B. Nursing Practice Act
C. Patient Self-Determination Act
D. Affordable Care Act
Answer: C. Patient Self-Determination Act
Rationale: The Patient Self-Determination Act ensures clients have the right to make their own decisions about their healthcare, including the right to refuse treatment.
A nurse is providing care in an emergency department and is aware that the Emergency Medical Treatment and Labor Act (EMTALA) mandates that:
A. Patients must be transferred to a different facility for treatment if they lack insurance
B. Hospitals must provide emergency treatment regardless of a patient’s ability to pay
C. Healthcare providers can withhold treatment for uninsured clients if they are stable
D. Patients have a right to sue for malpractice after receiving emergency care
Answer: B. Hospitals must provide emergency treatment regardless of a patient’s ability to pay
Rationale: EMTALA requires hospitals to provide emergency care to all individuals, regardless of their financial status.
What is the primary purpose of the Texas Nurse Practice Act?
A. To protect the safety of the public
B. To promote the autonomy of nurses
C. To regulate healthcare institutions
D. To advance nursing research
Answer: A. To protect the safety of the public
Rationale: The Texas Nurse Practice Act provides regulations to ensure that nursing practice is safe and in line with professional standards.
A nurse in Texas wants to delegate a task to a Certified Nursing Assistant (CNA). Under the Texas Nursing Practice Act, what must the nurse ensure before delegating the task?
A. The task is within the CNA’s job description
B. The CNA agrees to complete the task
C. The nurse provides direct supervision throughout the task
D. The task is approved by a physician
Answer: A. The task is within the CNA’s job description
Rationale: The nurse must ensure that any delegated task is within the scope of practice and competency of the CNA.
Which of the following statements best describes the role of the ANA Code of Ethics in nursing practice?
A. It is a legal document that enforces nursing regulations
B. It provides a framework for ethical decision-making
C. It outlines specific procedures for nursing practice
D. It protects nurses from legal action
Answer: B. It provides a framework for ethical decision-making
Rationale: The ANA Code of Ethics guides nurses in ethical practice and decision-making but does not function as a legal document.
A nurse refuses to administer a treatment that they believe will cause harm to the client. Which ethical principle is the nurse following?
A. Justice
B. Autonomy
C. Nonmaleficence
D. Beneficence
Answer: C. Nonmaleficence
Rationale: Nonmaleficence is the ethical principle of doing no harm, which the nurse is upholding by refusing to administer harmful treatment.
Which act ensures that patients can amend or request changes to their medical records?
A. Patient Self-Determination Act
B. Health Insurance Portability and Accountability Act (HIPAA)
C. Emergency Medical Treatment and Labor Act (EMTALA)
D. Nurse Practice Act
Answer: B. Health Insurance Portability and Accountability Act (HIPAA)
Rationale: HIPAA allows patients to inspect, request copies of, and amend their medical records.
A nurse is teaching a group of students about professional boundaries. Which of the following statements indicates a breach in professional boundaries?
A. “I accepted a small gift from a client’s family during the holiday season.”
B. “I friended a client on social media after discharge.”
C. “I shared my contact information with a client for follow-up questions.”
D. “I discussed the client’s case with a family member present in the room.”
Answer: B. “I friended a client on social media after discharge.”
Rationale: Engaging with clients on social media after discharge crosses professional boundaries and can lead to ethical and legal complications.
According to the Nursing Practice Act, which of the following actions can result in disciplinary action by the Texas Board of Nursing?
A. Refusing to administer a medication that could harm the patient
B. Failing to renew a nursing license within the required timeframe
C. Administering medication based on a verbal order from a physician
D. Requesting clarification of a physician’s order
Answer: B. Failing to renew a nursing license within the required timeframe
Rationale: Nurses must renew their licenses according to the guidelines set by the Board of Nursing. Failure to do so can result in disciplinary action.
Which law requires healthcare providers to offer treatment to patients with life-threatening conditions, regardless of their ability to pay?
A. Affordable Care Act
B. Emergency Medical Treatment and Labor Act (EMTALA)
C. Nurse Practice Act
D. Americans with Disabilities Act
Answer: B. Emergency Medical Treatment and Labor Act (EMTALA)
Rationale: EMTALA mandates that hospitals provide treatment to individuals with emergency medical conditions, regardless of their financial situation.
A nurse is caring for a patient who has just been diagnosed with a terminal illness. The patient states they do not want to know about further treatment options. Which ethical principle is the nurse prioritizing?
A. Justice
B. Veracity
C. Autonomy
D. Fidelity
Answer: C. Autonomy
Rationale: Autonomy involves respecting the patient’s decision to not receive information about their treatment options.
Which of the following is a negative consequence of not adhering to ethical and legal nursing practices?
A. Improved patient care
B. Enhanced patient advocacy
C. Malpractice litigation
D. Increased patient satisfaction
Answer: C. Malpractice litigation
Rationale: A negative consequence of not following ethical and legal guidelines in nursing practice can be malpractice litigation.
A nurse is performing a comprehensive assessment on a client and discovers discrepancies in the client’s medication list. The nurse’s priority is to follow which standard of practice?
A. Obtaining supervision from a colleague
B. Providing safe and effective care
C. Reporting the discrepancy to the physician
D. Documenting the finding in the electronic medical record
Answer: B. Providing safe and effective care
Rationale: The nurse’s priority is to provide safe and effective care by addressing and resolving any discrepancies.
A nurse receives a new assignment involving the care of clients in a highly specialized unit where they have little experience. According to the Texas Nursing Practice Act, what is the nurse’s best action?
A. Accept the assignment and learn as they go
B. Delegate all complex tasks to more experienced nurses
C. Refuse the assignment and leave the unit
D. Notify the supervisor about the lack of competency
Answer: D. Notify the supervisor about the lack of competency
Rationale: Nurses are responsible for only accepting assignments they are competent to perform. The nurse must notify the supervisor if they lack the required skills.
A nurse witnesses a colleague administering the wrong medication to a patient and failing to report it. Which action is required under the Nursing Practice Act?
A. Document the incident in the colleague’s file
B. Discuss the error with the colleague privately
C. Report the error to the nurse manager
D. Confront the colleague about the mistake
Answer: C. Report the error to the nurse manager
Rationale: The Nursing Practice Act mandates reporting errors to ensure patient safety and prevent further harm.
Under the Health Insurance Portability and Accountability Act (HIPAA), which of the following actions is a violation of patient confidentiality?
A. Reviewing a patient’s chart during a care team meeting
B. Sharing information about a patient’s condition in a public elevator
C. Discussing patient care with the healthcare team during shift handoff
D. Logging off the computer after completing patient documentation
Answer: B. Sharing information about a patient’s condition in a public elevator
Rationale: Discussing patient information in public settings is a violation of HIPAA and patient confidentiality.
The Texas Nursing Practice Act requires nurses to demonstrate which of the following attributes in their practice?
A. Strict adherence to the facility’s policies, regardless of client needs
B. Competency in nursing care and adherence to ethical standards
C. Focus on legal guidelines only, leaving ethics to the employer
D. Fulfilling all tasks assigned by physicians without question
Answer: B. Competency in nursing care and adherence to ethical standards
Rationale: Nurses are required to maintain competency in their practice while adhering to both legal and ethical standards.
A nurse has accepted a client assignment in the ICU but feels unsure about performing complex procedures. Which step should the nurse take according to ethical and legal practice?
A. Ask another nurse to perform the procedures
B. Perform the procedures and hope for the best
C. Inform the charge nurse about the lack of competency
D. Research the procedures while on duty
Answer: C. Inform the charge nurse about the lack of competency
Rationale: Nurses must report any lack of competency or training to ensure patient safety, as required by legal and ethical guidelines.
A nurse who fails to administer a medication within the prescribed time window and does not document the delay is violating which standard of nursing practice?
A. Adherence to patient confidentiality
B. Safe and accurate documentation
C. Proper delegation of tasks
D. Compliance with physician orders
Answer: B. Safe and accurate documentation
Rationale: Proper documentation of all nursing actions, including medication administration, is a critical legal and ethical responsibility.
Under the Nursing Practice Act, which action could be considered unprofessional conduct?
A. Failing to report suspected abuse of a vulnerable client
B. Delegating tasks to unlicensed assistive personnel (UAP)
C. Refusing to participate in an unfamiliar procedure
D. Asking for clarification on an unclear physician order
Answer: A. Failing to report suspected abuse of a vulnerable client
Rationale: Nurses have a legal and ethical obligation to report any suspected abuse of clients under their care.
According to the Nurse Practice Act, which of the following tasks can be delegated to a Certified Nursing Assistant (CNA)?
A. Performing a sterile dressing change
B. Assessing a client’s response to a treatment
C. Administering medication
D. Obtaining vital signs
Answer: D. Obtaining vital signs
Rationale: CNAs can perform tasks such as obtaining vital signs, while tasks that require clinical judgment, such as assessments, are reserved for licensed nurses.
The Patient Self-Determination Act requires healthcare facilities to:
A. Allow nurses to refuse assignments they are uncomfortable with
B. Honor a patient’s advance directives and choices about care
C. Ensure that patients do not leave the hospital without treatment
D. Provide the highest level of care possible regardless of patient wishes
Answer: B. Honor a patient’s advance directives and choices about care
Rationale: The Patient Self-Determination Act ensures that patients’ decisions about their care, including advance directives, are respected.
A nurse is reviewing the ANA Code of Ethics before making a care decision. The nurse is primarily focused on which of the following concepts?
A. Following the law at all costs
B. Protecting the nurse’s license from disciplinary action
C. Promoting the patient’s best interest and upholding professional integrity
D. Ensuring that the hospital’s policy is followed
Answer: C. Promoting the patient’s best interest and upholding professional integrity
Rationale: The ANA Code of Ethics focuses on ethical care, professional integrity, and patient advocacy.
A nurse is explaining to a group of students the importance of the Texas Nurse Practice Act. Which statement by the nurse best summarizes the Act?
A. “It outlines how nurses should advocate for their patients.”
B. “It defines the minimum standard of care and the legal scope of nursing practice.”
C. “It allows nurses to practice without physician oversight.”
D. “It ensures that nurses will not be held accountable for errors.”
Answer: B. “It defines the minimum standard of care and the legal scope of nursing practice.”
Rationale: The Texas Nurse Practice Act establishes the legal scope of practice for nurses and defines the minimum standards they must follow.
Which federal law allows patients to inspect their medical records and request corrections if errors are found?
A. Affordable Care Act
B. Health Insurance Portability and Accountability Act (HIPAA)
C. Emergency Medical Treatment and Labor Act (EMTALA)
D. Nursing Practice Act
Answer: B. Health Insurance Portability and Accountability Act (HIPAA)
Rationale: HIPAA grants patients the right to review and request corrections to their medical records.
A nurse is asked to administer a medication they are unfamiliar with. According to ethical and legal standards, what should the nurse do?
A. Administer the medication as ordered
B. Ask another nurse to administer the medication
C. Refuse the assignment without explanation
D. Research the medication before administering it
Answer: D. Research the medication before administering it
Rationale: Nurses are responsible for understanding the medications they administer. Researching the medication ensures safe and informed care.
A nurse works in a hospital where physicians frequently give verbal orders. According to the Nursing Practice Act, what must the nurse ensure before carrying out a verbal order?
A. The verbal order is immediately documented in the medical record
B. The physician is present while the order is being carried out
C. Another nurse verifies the order
D. The order is repeated back to the physician for confirmation
Answer: D. The order is repeated back to the physician for confirmation
Rationale: To avoid errors, nurses must repeat verbal orders back to the physician to ensure accuracy.
A nurse is preparing to discharge a client but has concerns that the client will not be able to manage at home. Which ethical principle should the nurse apply in this situation?
A. Beneficence
B. Autonomy
C. Nonmaleficence
D. Justice
Answer: A. Beneficence
Rationale: Beneficence involves acting in the best interest of the client, which includes ensuring the client is discharged safely.
A nurse who observes unethical behavior by a colleague is required by the ANA Code of Ethics to:
A. Ignore the behavior if no harm was caused
B. Report the behavior to the appropriate authority
C. Speak to the colleague privately
D. Document the incident without taking further action
Answer: B. Report the behavior to the appropriate authority
Rationale: The ANA Code of Ethics requires nurses to report unethical behavior to protect patients and maintain professional integrity.
Which of the following is an example of a positive consequence of adhering to ethical and legal nursing practices?
A. Disciplinary action
B. Moral distress
C. Patient safety
D. Legal liability
Answer: C. Patient safety
Rationale: Adhering to ethical and legal nursing practices leads to positive outcomes, such as patient safety and quality care.
A nurse is providing care to a client who has an advance directive in place. According to the Patient Self-Determination Act, what is the nurse’s responsibility?
A. Ensure the client’s wishes in the advance directive are followed
B. Convince the client to reconsider their decisions
C. Allow the family to override the advance directive
D. Discuss the directive only if the client asks
Answer: A. Ensure the client’s wishes in the advance directive are followed
Rationale: The Patient Self-Determination Act ensures that the client’s advance directives are respected and followed.
Which of the following situations could lead to litigation under the Nursing Practice Act?
A. Administering a vaccine without the patient’s consent
B. Refusing to administer a harmful treatment
C. Requesting a second opinion on a client’s care
D. Delegating tasks to licensed personnel
Answer: A. Administering a vaccine without the patient’s consent
Rationale: Administering any treatment without a patient’s consent could result in legal action.
A nurse must comply with the Texas Board of Nursing’s standards of practice. Which of the following is one of those standards?
A. Administering medications only under direct physician supervision
B. Maintaining confidentiality and respecting the rights of patients
C. Documenting care only at the end of each shift
D. Reporting only major errors that cause patient harm
Answer: B. Maintaining confidentiality and respecting the rights of patients
Rationale: One of the Texas Board of Nursing standards is maintaining patient confidentiality and ensuring their rights are respected.
A nurse is participating in a healthcare team meeting and is asked to advocate for the client’s wishes. Which ethical principle is the nurse applying?
A. Beneficence
B. Fidelity
C. Justice
D. Autonomy
Answer: D. Autonomy
Rationale: Autonomy refers to respecting and advocating for the client’s decisions and rights.
A nurse in Texas is licensed to practice in multiple states under the Nurse Licensure Compact (NLC). Which of the following is true about this compact?
A. The nurse is only allowed to practice in their home state
B. The nurse can practice in any state that is part of the NLC
C. The nurse must obtain a separate license for each state
D. The nurse must be supervised by a nurse in each new state
Answer: B. The nurse can practice in any state that is part of the NLC
Rationale: The Nurse Licensure Compact allows nurses to practice in multiple states that are part of the agreement without needing separate licenses.
A nurse is caring for a client who has refused treatment. According to the Nursing Practice Act, what is the nurse’s responsibility?
A. Respect the client’s decision and document the refusal
B. Convince the client to change their mind
C. Seek legal intervention to force the treatment
D. Administer the treatment without informing the client
Answer: A. Respect the client’s decision and document the refusal
Rationale: Nurses must respect a client’s right to refuse treatment and document the refusal.
A nurse administering medications realizes they have given the wrong dose. According to ethical and legal standards, what should the nurse do first?
A. Complete an incident report
B. Notify the client’s family
C. Inform the client’s physician
D. Monitor the client for adverse effects
Answer: D. Monitor the client for adverse effects
Rationale: The nurse’s first responsibility is to ensure the client’s safety by monitoring for adverse effects, then report the error appropriately.
Which federal law mandates confidentiality and protection of clients’ health information?
A. Emergency Medical Treatment and Labor Act (EMTALA)
B. Health Insurance Portability and Accountability Act (HIPAA)
C. Patient Self-Determination Act
D. Affordable Care Act
Answer: B. Health Insurance Portability and Accountability Act (HIPAA)
Rationale: HIPAA mandates confidentiality and protection of client health information.
A nurse is administering medications and realizes a near miss occurred when a dose of insulin was almost given to the wrong patient. What should the nurse do first?
A. Complete an incident report
B. Administer the correct medication to the patient
C. Notify the physician immediately
D. Report the near miss to the charge nurse
Answer: D. Report the near miss to the charge nurse
Rationale: Near misses should be reported immediately to the charge nurse to prevent future errors.
Which of the following is an example of a latent error in a healthcare system?
A. Administering the wrong medication
B. Incorrectly labeling laboratory samples
C. A faulty infusion pump that intermittently malfunctions
D. Forgetting to document vital signs
Answer: C. A faulty infusion pump that intermittently malfunctions
Rationale: Latent errors are system errors that may not be immediately apparent but contribute to adverse events.
A nurse realizes that a medication was not administered to a patient during the scheduled time. This is an example of which type of error?
A. Diagnostic error
B. Communication error
C. Treatment error
D. Preventive error
Answer: C. Treatment error
Rationale: A treatment error occurs when there is a failure to administer a treatment, such as medication, at the appropriate time.
A nurse is preparing to perform a wound dressing change for a surgical patient. Which of the following describes surgical asepsis?
A. Cleaning hands with soap and water
B. Using gloves to perform personal care
C. Wearing gloves and a gown during the procedure
D. Maintaining a sterile field during the procedure
Answer: D. Maintaining a sterile field during the procedure
Rationale: Surgical asepsis, or sterile technique, involves maintaining a sterile environment to prevent the introduction of microorganisms.
What is the first step in preventing the transmission of infections in a healthcare setting?
A. Wearing gloves
B. Isolating patients with infections
C. Performing hand hygiene
D. Disinfecting surfaces
Answer: C. Performing hand hygiene
Rationale: Hand hygiene is the most effective way to prevent the transmission of infections.
A patient develops a urinary tract infection after having an indwelling catheter for several days. This is an example of which type of event?
A. Sentinel event
B. Never event
C. Adverse event
D. Near miss
Answer: C. Adverse event
Rationale: An adverse event is an unintended injury caused by medical management rather than the patient’s underlying condition.
A patient experiences a fall while trying to get out of bed without assistance. What should the nurse do first?
A. Document the fall in the medical record
B. Perform a full assessment to check for injuries
C. Assist the patient back into bed
D. Notify the physician
Answer: B. Perform a full assessment to check for injuries
Rationale: After a fall, the priority is to assess the patient for any injuries before taking further action.
What is the purpose of a safety culture in healthcare?
A. To hold individuals accountable for errors
B. To create a blame-free environment where errors can be reported and learned from
C. To ensure patients are punished for not following safety protocols
D. To provide strict disciplinary action for every mistake
Answer: B. To create a blame-free environment where errors can be reported and learned from
Rationale: A safety culture promotes reporting errors without fear of punishment, allowing for learning and improvement.
A nurse is caring for a patient who has tested positive for tuberculosis. What type of precautions should the nurse implement?
A. Contact precautions
B. Droplet precautions
C. Airborne precautions
D. Protective precautions
Answer: C. Airborne precautions
Rationale: Tuberculosis requires airborne precautions, including the use of an N95 respirator and a negative pressure room.
A nurse is reviewing the concept of just culture with colleagues. Which of the following statements is true about just culture?
A. Just culture focuses on blaming individuals for their mistakes
B. Just culture encourages learning from mistakes without fear of retribution
C. Just culture is only relevant for medication errors
D. Just culture promotes harsh punishment for all errors
Answer: B. Just culture encourages learning from mistakes without fear of retribution
Rationale: Just culture seeks a balance between learning from mistakes and ensuring accountability.
What is the most important factor in preventing falls in hospitalized older adults?
A. Using physical restraints
B. Administering sedatives to calm the patient
C. Regularly assessing the patient’s fall risk
D. Encouraging the patient to remain in bed all day
Answer: C. Regularly assessing the patient’s fall risk
Rationale: Regularly assessing fall risk and implementing prevention strategies are key to reducing falls.
A nurse is caring for a patient who has been placed on droplet precautions. Which of the following is an appropriate personal protective equipment (PPE) measure?
A. Wearing a surgical mask when entering the patient’s room
B. Using an N95 respirator for all patient interactions
C. Wearing sterile gloves when touching the patient
D. Wearing protective eyewear only during procedures
Answer: A. Wearing a surgical mask when entering the patient’s room
Rationale: Droplet precautions require wearing a surgical mask to prevent the transmission of infections.
A nurse enters a room to administer a medication and notices the patient’s ID band is missing. What is the best course of action?
A. Administer the medication without checking the ID band
B. Ask the patient to verbally confirm their identity
C. Verify the patient’s identity with another nurse
D. Replace the ID band and then administer the medication
Answer: D. Replace the ID band and then administer the medication
Rationale: The nurse must ensure proper identification by replacing the ID band before administering any medication.
Which of the following is an example of a preventive error?
A. Failure to perform appropriate hand hygiene before wound care
B. Administering a double dose of insulin
C. Delayed response to abnormal lab results
D. Failing to provide follow-up care after surgery
Answer: D. Failing to provide follow-up care after surgery
Rationale: Preventive errors occur when there is inadequate monitoring or follow-up care after treatment.
A patient is being treated for an infection with contact precautions in place. Which of the following PPE is required before entering the patient’s room?
A. Gown and gloves
B. Surgical mask
C. N95 respirator
D. Sterile gloves
Answer: A. Gown and gloves
Rationale: Contact precautions require the use of gown and gloves to prevent transmission through direct contact.
A nurse notices a medication error that was made by another nurse but did not result in harm to the patient. According to the culture of safety, what is the nurse’s next action?
A. Do nothing since no harm occurred
B. Inform the patient about the error
C. Report the error to the nurse manager
D. Reprimand the nurse who made the error
Answer: C. Report the error to the nurse manager
Rationale: Errors should be reported even if no harm occurred, as part of a safety culture that promotes learning from mistakes.
What is a sentinel event in healthcare?
A. A minor error that causes no harm
B. An event that results in serious injury or death
C. An error that is caught before reaching the patient
D. An adverse event that occurs infrequently
Answer: B. An event that results in serious injury or death
Rationale: A sentinel event is an unexpected occurrence involving death or serious physical or psychological injury.
A nurse is caring for a patient on neutropenic precautions. Which of the following should the nurse avoid?
A. Allowing visitors to bring flowers into the room
B. Wearing a gown when entering the room
C. Washing hands before and after patient care
D. Using disposable equipment when available
Answer: A. Allowing visitors to bring flowers into the room
Rationale: Patients on neutropenic precautions are immunocompromised, and fresh flowers can introduce bacteria.
Which of the following is an example of a never event?
A. A patient develops a mild rash from a prescribed medication
B. A nurse administers the wrong blood type during a transfusion
C. A patient experiences nausea after chemotherapy
D. A nurse documents vital signs late in the shift
Answer: B. A nurse administers the wrong blood type during a transfusion
Rationale: A never event is a serious, preventable incident that should never occur, such as administering the wrong blood type.
A nurse enters a patient’s room to administer an injection. The patient’s ID bracelet is missing. What is the nurse’s next action?
A. Administer the injection after verifying the patient’s identity verbally
B. Administer the injection and then replace the ID bracelet
C. Refuse to administer the injection until the ID bracelet is replaced
D. Check the room number to ensure it’s correct and proceed with the injection
Answer: C. Refuse to administer the injection until the ID bracelet is replaced
Rationale: Proper patient identification is critical before administering medications or treatments. The ID bracelet must be replaced first.
A nurse is teaching a new group of nurses about medication safety. Which of the following is the most important step to ensure safe medication administration?
A. Asking another nurse to check your medications
B. Always administering medications on time
C. Identifying the patient using two identifiers
D. Documenting medications immediately after administration
Answer: C. Identifying the patient using two identifiers
Rationale: The most important step in medication safety is verifying the correct patient using two identifiers before administration.
A nurse is preparing to administer a medication but notices that the dosage seems higher than usual. What should the nurse do?
A. Administer the medication as prescribed
B. Ask a colleague if the dosage is correct
C. Contact the prescriber to verify the dosage
D. Administer half the dose to be safe
Answer: C. Contact the prescriber to verify the dosage
Rationale: The nurse should always verify a questionable dose with the prescriber before administration to ensure patient safety.
Which of the following actions can help reduce the risk of infection in patients?
A. Using hand sanitizer after removing gloves
B. Only washing hands when they are visibly soiled
C. Wearing gloves for all patient interactions
D. Changing gloves between tasks with the same patient
Answer: A. Using hand sanitizer after removing gloves
Rationale: Using hand sanitizer after removing gloves helps reduce the risk of infection, as gloves do not provide full protection against pathogens.
What is the first action a nurse should take after a patient falls in their hospital room?
A. Help the patient back into bed
B. Document the fall in the medical record
C. Assess the patient for injuries
D. Notify the physician
Answer: C. Assess the patient for injuries
Rationale: The nurse’s first action should be to assess the patient for injuries following a fall.
A nurse receives an order to administer a medication that the patient is allergic to. What is the most appropriate response by the nurse?
A. Administer the medication with an antihistamine
B. Contact the provider to clarify the order
C. Administer the medication and observe the patient for a reaction
D. Refuse to administer the medication without contacting the provider
Answer: B. Contact the provider to clarify the order
Rationale: The nurse must contact the provider to clarify the order if it conflicts with the patient’s known allergies.
A nurse is about to administer a medication through a feeding tube but realizes the medication should not be crushed. What is the appropriate action?
A. Crush the medication and administer it slowly
B. Dissolve the medication in warm water
C. Contact the provider for an alternative medication form
D. Administer the medication via IV instead
Answer: C. Contact the provider for an alternative medication form
Rationale: If a medication cannot be crushed, the nurse should contact the provider for an alternative form or route.
Which of the following personal protective equipment (PPE) is required when caring for a patient on airborne precautions?
A. Surgical mask
B. N95 respirator
C. Face shield
D. Sterile gloves
Answer: B. N95 respirator
Rationale: Airborne precautions require the use of an N95 respirator to prevent the inhalation of airborne pathogens
A patient is admitted with a deep pressure ulcer. Which assessment tool should the nurse use to evaluate the patient’s risk for skin breakdown?
A. Morse Fall Scale
B. Glasgow Coma Scale
C. Braden Scale
D. Norton Scale
Answer: C. Braden Scale
Rationale: The Braden Scale is used to assess a patient’s risk for skin breakdown and pressure ulcers.
A nurse is reviewing an incident report related to a medication error. Which of the following is the primary purpose of an incident report?
A. To assign blame for the error
B. To ensure the error is documented in the patient’s chart
C. To identify ways to prevent future errors
D. To notify the patient and family of the error
Answer: C. To identify ways to prevent future errors
Rationale: Incident reports are used to analyze errors and develop strategies to prevent them in the future.
A nurse is preparing to assist a patient with ambulation. Which of the following actions will help prevent a fall?
A. Raising the bed to its highest position
B. Encouraging the patient to walk quickly to avoid fatigue
C. Using a gait belt to support the patient
D. Having the patient walk without assistance to build independence
Answer: C. Using a gait belt to support the patient
Rationale: A gait belt provides support during ambulation and helps prevent falls
A nurse is caring for a patient who is agitated and at risk for pulling out their IV line. What is the nurse’s priority action?
A. Apply physical restraints
B. Ask the physician for a sedative order
C. Use therapeutic communication to calm the patient
D. Remove the IV line to prevent injury
Answer: C. Use therapeutic communication to calm the patient
Rationale: The nurse should first use non-invasive techniques such as therapeutic communication to calm the patient.
A patient with a history of falls is admitted to the hospital. Which intervention should the nurse implement to prevent falls?
A. Apply restraints at all times
B. Encourage the patient to stay in bed
C. Place a fall risk sign outside the patient’s room
D. Lower the bed to its lowest position and place the call light within reach
Answer: D. Lower the bed to its lowest position and place the call light within reach
Rationale: Lowering the bed and ensuring the call light is within reach are effective interventions to prevent falls.
A nurse is caring for a patient with contact precautions. Which of the following is the correct method for doffing PPE?
A. Gloves, gown, mask, eyewear
B. Gown, mask, gloves, eyewear
C. Gloves, gown, eyewear, mask
D. Mask, gloves, gown, eyewear
Answer: C. Gloves, gown, eyewear, mask
Rationale: PPE should be removed in this order: gloves first, then gown, followed by eyewear and mask.
A nurse is caring for a patient who is on seizure precautions. Which of the following actions should the nurse take?
A. Place the patient in soft restraints
B. Ensure suction equipment is readily available
C. Administer anti-seizure medication prophylactically
D. Position the patient flat on their back
Answer: B. Ensure suction equipment is readily available
Rationale: Suction equipment should be readily available to clear the airway during or after a seizure.
A nurse is caring for a patient who has a wound that requires sterile dressing changes. Which of the following actions will help maintain sterility during the procedure?
A. Keeping the sterile field below waist level
B. Donning sterile gloves after preparing the sterile field
C. Reaching over the sterile field to grab supplies
D. Touching the edges of the sterile dressing with ungloved hands
Answer: B. Donning sterile gloves after preparing the sterile field
Rationale: Sterile gloves should be donned before handling any sterile items to maintain sterility.
A nurse is performing a time-out before a surgical procedure. Which of the following is the purpose of a time-out?
A. To ensure the patient is aware of the surgery risks
B. To verify the correct patient, procedure, and site
C. To ensure the surgeon is prepared for the procedure
D. To allow the patient to ask any last-minute questions
Answer: B. To verify the correct patient, procedure, and site
Rationale: The purpose of a time-out is to ensure the surgical team verifies the correct patient, procedure, and surgical site.
A patient is admitted to the hospital with pneumonia and is placed on droplet precautions. Which of the following is an appropriate action by the nurse?
A. Place the patient in a private room
B. Wear an N95 respirator when caring for the patient
C. Allow visitors without restriction
D. Provide the patient with a negative-pressure room
Answer: A. Place the patient in a private room
Rationale: Droplet precautions require the patient to be in a private room to reduce the spread of infection.
A nurse is caring for a patient on a neutropenic diet. Which of the following should be included in the dietary restrictions?
A. Avoid all dairy products
B. Avoid raw fruits and vegetables
C. Avoid all cooked meats
D. Avoid all grains
Answer: B. Avoid raw fruits and vegetables
Rationale: Patients on a neutropenic diet should avoid raw fruits and vegetables to reduce the risk of infection.
A patient is being treated for an infection with airborne precautions in place. Which of the following PPE should the nurse wear?
A. Gloves and gown
B. Surgical mask
C. N95 respirator
D. Face shield only
Answer: C. N95 respirator
Rationale: An N95 respirator is required for airborne precautions to prevent the inhalation of infectious particles.
A nurse is caring for a patient who is at high risk for falls. Which of the following interventions should be implemented to prevent falls?
A. Use bed alarms to alert staff when the patient attempts to get up
B. Place the patient in restraints
C. Administer sedatives to keep the patient in bed
D. Lower all four side rails to ensure easy access
Answer: A. Use bed alarms to alert staff when the patient attempts to get up
Rationale: Bed alarms alert staff when a patient at risk for falls attempts to get up, allowing for timely intervention.
A nurse is documenting a medication error that occurred during the administration of a patient’s IV antibiotic. Which of the following should be included in the documentation?
A. A detailed description of the nurse’s role in the error
B. The time the error was discovered and the patient’s response
C. A statement apologizing to the patient
D. A note blaming the pharmacy for the error
Answer: B. The time the error was discovered and the patient’s response
Rationale: Documentation should include objective information about the error, including when it was discovered and the patient’s condition.
A nurse is caring for a patient with contact precautions due to a wound infection. What is the correct order for donning PPE?
A. Gloves, gown, mask
B. Mask, gown, gloves
C. Gown, mask, gloves
D. Mask, gloves, gown
Answer: C. Gown, mask, gloves
Rationale: The correct order for donning PPE is gown first, then mask, followed by gloves.
A nurse is caring for a patient with a high risk for pressure ulcers. Which of the following interventions should the nurse implement?
A. Turn the patient every 4 hours
B. Apply alcohol to bony prominences to keep them dry
C. Use a pressure-reducing mattress
D. Place the patient in a semi-Fowler’s position for long periods
Answer: C. Use a pressure-reducing mattress
Rationale: A pressure-reducing mattress helps distribute weight and reduce the risk of pressure ulcers.
A nurse is reviewing a patient’s fall risk assessment using the Morse Fall Scale. Which of the following factors increases a patient’s fall risk?
A. The patient has a history of falls
B. The patient uses a walker
C. The patient wears eyeglasses
D. The patient is on a fluid restriction
Answer: A. The patient has a history of falls
Rationale: A history of falls significantly increases the risk of future falls and should be considered in the fall risk assessment.
A nurse is documenting care for a patient who experienced a near miss during medication administration. Which of the following should be included in the report?
A. Blaming the physician for the error
B. The patient’s response to the near miss
C. Steps taken to prevent the near miss
D. A detailed description of the nurse’s involvement
Answer: C. Steps taken to prevent the near miss
Rationale: A near miss report should focus on identifying preventive measures to avoid future errors.
A nurse is administering an IV medication and realizes the incorrect dose was given. What is the nurse’s priority action?
A. Notify the physician immediately
B. Document the error in the patient’s chart
C. Monitor the patient for adverse effects
D. Complete an incident report
Answer: C. Monitor the patient for adverse effects
Rationale: The nurse’s first priority is the patient’s safety. The nurse should monitor for any adverse effects and then report the error.
A patient with a history of falls is admitted to the hospital. Which of the following fall prevention strategies should the nurse implement?
A. Keep the patient’s bed in a high position
B. Place a fall risk armband on the patient
C. Restrain the patient to prevent falls
D. Keep the call light out of reach to prevent unnecessary movement
Answer: B. Place a fall risk armband on the patient
Rationale: A fall risk armband helps alert all staff to the patient’s fall risk and prompts extra precautions.
A nurse is preparing to care for a patient with airborne precautions. Which of the following interventions is appropriate?
A. Place the patient in a room with negative airflow
B. Wear a face shield during all patient interactions
C. Limit the use of disposable equipment
D. Allow visitors without restrictions
Answer: A. Place the patient in a room with negative airflow
Rationale: A room with negative airflow is required for airborne precautions to prevent the spread of infectious agents.
A nurse is preparing to assist a patient who has right-sided weakness with ambulation. Which of the following is the correct way to support the patient?
A. Stand behind the patient during ambulation
B. Support the patient from the left side
C. Support the patient from the right side
D. Allow the patient to walk independently
Answer: C. Support the patient from the right side
Rationale: The nurse should stand on the weak side (right side in this case) to provide support during ambulation.
A nurse is teaching a patient with a history of falls about home safety. Which of the following instructions should the nurse include?
A. “Remove all rugs from your home to prevent tripping.”
B. “Use dim lighting to avoid glare when walking at night.”
C. “Avoid installing grab bars in the bathroom.”
D. “Avoid wearing shoes inside the house.”
Answer: A. “Remove all rugs from your home to prevent tripping.”
Rationale: Removing rugs helps prevent tripping, which is a common cause of falls, especially in older adults.
Which of the following is NOT a key component of professionalism in nursing?
A. Self-awareness
B. Ethical values
C. Personal autonomy
D. Advanced practice specialization
D. Advanced practice specialization - Professionalism is more fundamental and is not contingent on specialization.
What is the foundation of professionalism in nursing?
A. Nursing theories
B. Advocacy and integrity
C. Personal and professional values
D. Lifelong learning
C. Personal and professional values - Values drive professional behavior.
Which of the following factors best describes nursing professionalism at its optimal state?
A. Critical thinking and patient-focused care
B. Autonomy and financial success
C. Ethical practice and social status
D. Patient advocacy and minimal supervision
A. Critical thinking and patient-focused care - These are key components of nursing professionalism.
What are some of the consequences of compromised professionalism in nursing? (Select all that apply)
A. Unsafe patient care
B. Loss of professional license
C. Improved patient satisfaction
D. Violation of practice standards
A, B, D - All of these are consequences of compromised professionalism.
The primary goal of nursing is to:
A. Perform medical procedures effectively
B. Administer medications properly
C. Advocate for patient’s legal rights
D. Promote health, prevent illness, and care for patients
D. Promote health, prevent illness, and care for patients - This is the holistic goal of nursing.
Which nursing role encompasses responsibility, autonomy, and accountability?
A. Clinical nurse educator
B. Registered nurse
C. Nurse administrator
D. Nurse researcher
B. Registered nurse - The RN role encompasses autonomy, accountability, and responsibility.
