NSG 2113 Midterm Flashcards
1
Q
A nurse is teaching the importance of childhood immunizations to a group of postpartum mothers. This is considered which level of preventive care?
A
Primary prevention.
2
Q
Advocating for an increase in welfare incomes is an example of which health promotion strategy?
A
Building healthy public policy.
(An increase in welfare income requires policy change. Healthy public policy has a positive effect on health. Income is the most influential determinant of health.)
3
Q
Efforts to decrease obesity by focusing on factors such as household income, food advertising and marketing exemplify which approach to health?
A
Socioenvironmental.
4
Q
Which definition of health is the most congruent with a health promotion approach?
A
The 1984 WHO definition.
5
Q
Which one of the following best defines health promotion activities?
A
Activities that enable people to increase control over the determinants of health and thereby improve their health.
6
Q
The major outcome of the Lalonde Report was its emphasis on which of the following determinants?
A
Lifestyle.
(The Lalonde Report shifted emphasis from a medical to a behavioural approach to health. Although all of listed options were identified in the document, the area that received the most emphasis was lifestyle and its relationship to health outcomes was lifestyle.)
7
Q
Which of the following factors would be most improved by an upstream nursing approach to health?
A
Socioenvironmental risk conditions
(Socioenvironmental risk conditions such as poverty, education, and housing (i.e., social determinants of health) can influence health directly but also indirectly through psychosocial risk factors, behavioural risk factors, and physiological risk factors. “Upstream” approaches include advocating for policies that ensure affordable housing, financial support to patients with low incomes, and safe, fulfilling work environments.)
8
Q
The belief that health is a societal responsibility is most congruent with which approach to health?
A
Socioenvironmental.
9
Q
The statement “To change behaviour, it may be necessary to change more than behaviour” most clearly reflects which approach to health?
A
Socioenvironmental
10
Q
Which one of the following documents identifies the role of the private sector in health promotion?
A
Jakarta Declaration.
11
Q
Which of the following is the most “upstream” strategy to reduce health disparities due to poverty?
A
Advocating living wages and income support
12
Q
Secondary prevention activities are most closely related to which stage of the natural history of disease?
A
Pathogenesis.
(Secondary prevention activities focus on early detection of disease (pathogenesis stage) to facilitate prompt treatment, such as screening for signs of disease before symptoms occur. Primary prevention activities protect against a disease before signs and symptoms occur (prepathogenesis stage of disease). Tertiary prevention activities occur in the convalescent state of disease and are directed toward minimizing residual disability and helping people to live productively with limitations.)
13
Q
Providing flexible workplace hours and quality child care at places of employment exemplifies which health promotion strategy?
A
Creating supportive environments.
14
Q
Which one of the following statements accurately reflects current working conditions in Canada?
A
More than one quarter of Canadian workers believe that their workplaces are “unhealthy.”
15
Q
Which of the following statements accurately reflect the population health promotion model? (Select all that apply.)
A
The “what” refers to the determinants of health
The “how” identifies the five health promotion strategies from the Ottawa Charter.
The “why” reflects evidence-informed decision making, values, and assumptions.
16
Q
Which of the following are social determinants of health? (Select all that apply.)
A
Social exclusion.
Employment security.
Early childhood development.
17
Q
Which of the following exemplify the health promotion strategy of strengthening community action? (Select all that apply.)
A
Empowerment of individuals.
Public participation in needs identification.
Participation of community organizations.
18
Q
Which of the following factors have been identified as strong determinants of health disparities? (Select all that apply.)
A
Socioeconomic status.
Indigenous identity.
Geographic location.
19
Q
The nurse found that using tympanic thermometers was quick and easy and yielded temperatures as reliable as those obtained using oral thermometers. This finding represents which of the following?
A
Evidence-informed practice.
20
Q
The Canadian social safety net refers to which of the following?
A
Social programs such as Medicare and employment insurance.
21
Q
Federal, provincial, and territorial governments have undertaken to reconstruct a health care system that balances current and future political, legal, economic, and social realities. This process has been referred to as which of the following?
A
Health reform.
22
Q
Which of the following is the major conclusion of the Romanow Report?
A
Medicare is sustainable.
(The Romanow report clearly outlined a road map to the future for Canadian health care. Emphasis was on a move to community- and home-based services, increasing primary health care, and modernizing (not rewriting) the Canada Health Act. The report stated unequivocally that Medicare is sustainable.)
23
Q
The nurse is giving discharge instructions to a client with newly diagnosed diabetes. The nurse discusses with the client what the dietary intake should be. This is an example of which health care service?
A
Health promotion.
24
Q
The nurse volunteers to take blood pressure measurements after church services. This is an example of which level of health care service?
A
Illness prevention.
25
Primary health care refers to which of the following?
An integrated approach to health.
26
Which of the following is an example of respite care?
Adult day care.
(Day care is an example of respite care because it allows the family to take a break from the responsibilities of caring for a family member. A patient in a nursing home or assisted-living arrangement receives 24-hour care in the facility. Home care is an intermittent service in which only certain tasks are performed.)
27
A family member asks a nurse what palliative care is. What is the best response by the nurse?
“It is a multidisciplinary approach that allows a person with a terminal illness to be comfortable and maintain independence and dignity.”
(Palliative care is an interdisciplinary end-of-life approach to care, which manages life-threatening or serious illnesses, regardless of age or condition, with the intention of improving quality of life, addressing physical and psychological symptoms, and facilitating a dignified death.)
28
Which of the following are true regarding provincial and territorial jurisdiction in Canadian health care? (Select all that apply.)
Such jurisdiction aligns services and delivery with Canada Health Act principles
Such jurisdiction determines the location of facilities and staffing.
Such jurisdiction develops and administers its health care insurance plan.
29
Which of the following are included in the four pillars of primary health care? (Select all that apply.)
- teams
- healthy living
- access
- information
30
The Canada Health Act guarantees all eligible Canadians health care rooted in which of the following principles? (Select all that apply.)
It is publicly administered.
It is portable.
(The Canada Health Act outlines five principles—public administration, portability, accessibility, universality, and comprehensiveness—by which all Canadian health care is guided.)
31
Which of the following statements about evidence-informed practice are true? (Select all that apply.)
Evidence-informed practice assists nurses in meeting standards of practice.
Evidence-informed practice helps nurses to solve dilemmas in the clinical setting.
Evidence-informed practice requires nurses to review and critique research and practise findings.
32
Which of the following historical factors contributed to the model of health care in Canada? (Select all that apply.)
Urbanization.
The Great Depression.
Physician payment and autonomy issues.
33
The five levels of health care include which of the following? (Select all that apply.)
REHABILITATIVE
CURATIVE
(The five levels of health care are promotive, preventive, curative, rehabilitative, and supportive. Assisted living is one type of supportive health care; public health is both promotive and preventive.)
34
Which of the following statements are true? (Select all that apply.)
Home care and community-based services are becoming increasingly important in the Canadian health care system.
E-health is both a potential challenge and an opportunity within the Canadian health care system.
35
Nursing’s metaparadigm includes which of the following?
Person, health, environment or situation, and nursing.
36
Which of the following statements about prescriptive theories is accurate?
They reflect practice and address specific phenomena.
37
A theory is a set of concepts, definitions, relationships, and assumptions that does which of the following?
Explains a phenomenon.
38
There is a contemporary move toward addressing nursing as a science or as evidence-informed practice. This suggests which of the following?
Theories will be tested to describe or predict patient outcomes.
39
To practise in today’s health care environment, nurses need a strong scientific knowledge base in nursing and other disciplines, such as the physical, social, and behavioural sciences. This relates to which of the following?
Interdisciplinary theories.
40
Which theories describe an orderly process beginning with conception and continuing through death?
Developmental theories.
41
Maslow’s hierarchy of needs is useful to nurses, who must continually prioritize a patient’s nursing care needs. The most basic or first-level needs include which of the following?
Air, water, and food.
42
Leininger’s theory of cultural care diversity and universality specifically addresses which of the following?
Caring for patients from diverse cultures.
43
As an art, nursing relies on knowledge gained from practice and reflection on past experiences. As a science, nursing relies on which of the following?
Scientifically tested knowledge
44
A theory is a set of concepts, definitions, relationships, and assumptions or propositions to explain a phenomenon. What is the purpose of the components of a theory?
To describe, explain, predict, and prescribe interrelationships among the concepts that define the phenomenon.
45
Nursing theories focus on the phenomena of nursing and nursing care. Which of the following is true of phenomena?
They are aspects of reality that can be consciously sensed or experienced.
46
Which types of theories are broad and complex?
Grand theories.
47
Which of the following theories address specific phenomena or concepts and reflect practice?
A middle-range theory.
48
Which type of theory tests the validity and predictability of nursing interventions?
A prescriptive theory
49
The nursing diagnosis phase is part of the nursing process. What is the purpose of this phase?
It allows the nurse to apply theory to practice in a reliable manner
50
The nursing process is an example of an open system. Which of the following statements defines an open system?
An open system interacts with the environment by exchanging information.
51
Evidence-informed nursing practice is the end result of which of the following?
Theory-generating and theory-testing research.
52
You are a nurse researcher interviewing senior oncology nurses, asking them to describe how they deal with the loss of a patient. The analysis of the interviews yields common themes describing the nurses’ grief. This is an example of which type of study?
Qualitative study.
53
An operating room nurse is talking with colleagues during a meeting. She asks, “I wonder if we would see fewer wound infections if we used chlorhexidine instead of povidone-iodine to clean the skin of our surgical patients? What does the P represent in this example of a PICOT question?
Surgical patients.
(Surgical patients are the patient population of interest (P) in the PICOT (patient population, intervention, comparison, outcome, time) question. The intervention is the cleaning of the skin, and the comparison of interest is between chlorhexidine use and povidone-iodine use. Operating room nurses are not an element of the PICOT question.)
54
A nurse researcher is designing an exercise study that involves 100 patients who attend a wellness clinic. As the patients come to the clinic, each has a choice as to whether he or she wants to be in the new exercise program or remain in the traditional program. The nurse plans to measure the patients’ self-report of exercise before and 6 months after the program begins. What factor might influence the results of this study in an unfavourable way?
Sampling method.
(Because the patients at the clinic are allowed their choice of the traditional versus the new exercise program, the sampling in this study is not random sampling.)
55
The foundation of research is which of the following?
Scientific method
56
A researcher gives a subject full and complete information about the purpose of a study. This is an example of which of the following?
Informed consent.
57
A new nurse on an orthopedic unit is assigned to care for a patient undergoing skeletal traction. The nurse asks a colleague, “What is the best practice for cleaning pin sites in skeletal traction?” This question is an example of which of the following?
Knowledge-focused trigger.
58
The nurses on a medical unit have seen an increase in the number of pressure injuries developing in their patients. The nurses decide to initiate a quality improvement project with the plan, do, study, act (PDSA) model. Which of the following is an example of the “do” step of that model?
Implement a new skin care protocol on all medical units.
59
The nurse researcher obtains informed consent from participants in a study primarily for which reason?
To ensure that the study subjects understand their roles in the study.
60
Which of the following is a priority goal for nursing research?
Improving patient care.
61
A clinical nurse develops a better way to secure an intravenous access device in a patient and wants to see whether it would benefit other patients. Which of the following should be the first step in initiating a study?
Review current literature related to the clinical problem.
62
The nurse researcher who obtains new knowledge regarding a procedure can most effectively share the information with the nursing profession by doing which of the following?
Communicating the research findings in a professional journal.
(Publication of research results provides other nurses with the scientific background of the study before they apply its findings in practice. Study subjects and setting should be similar in order to replicate a study. Nurses should not change from accepted to unproven ways of providing care without careful research and collaboration with colleagues. Experimenting with new nursing measures is inappropriate and may place a patient at risk.)
63
Nurses who are new to practice can best contribute to nursing research by doing which of the following?
Assisting with data collection.
64
A nurse manager wants to determine how well a new policy is working in the clinical area. Which of the following would be appropriate to use?
Evaluation research
65
The nurse involved in scientific research effectively analyzes the information collected and determines a course of nursing action by doing which of the following?
Using critical thinking.
66
A nurse manager is researching the effects of staff shortages on job satisfaction among new graduates. Which of the following would be the most effective way to gather data?
By interviewing staff nurses on the unit regarding their perceptions
67
Which of the following could be a barrier to nursing research?
Shortage of professional nursing staff.
68
Reflective journal writing is a tool used by the nurse. What is the purpose of this tool?
To help the nurse identify how previously learned knowledge can be applied in the future.
69
A patient tells the nurse, “I'm not happy with the way my bath was done this morning. The technician just seemed to be in a hurry and did not wash my back like I asked.” The nurse decides to talk with the technician to learn his side of the story as well. What is the nurse exhibiting?
Fairness.
(Fairness involves analyzing all viewpoints to understand the situation completely before making a decision. Curiosity gives the critical thinker the motivation to continue to ask questions and learn more. Risk taking involves trying different ways to solve problems.)
70
The surgical unit has initiated the use of a pain rating scale to assess the severity of patients’ pain during their postoperative recovery. The nurse assigned to a patient can look at the pain flow sheet to see the patient’s pain scores over the last 24 hours. Use of the pain scale is an example of adherence to which intellectual standard?
Consistency.
71
During the day, the nurse spends time instructing a patient in how to self-administer insulin. After discussing the technique and demonstrating an injection, the nurse asks the patient to try it. After the patient makes two attempts, it is clear that the patient does not understand how to prepare the correct dose. The nurse discusses the situation with the charge nurse and asks for suggestions. This is an example of which of the following?
Problem solving.
72
A nurse uses the institution’s procedure manual to confirm how to insert a Foley catheter. Which level of critical thinking is the nurse using?
Basic critical thinking.
(At the basic level of critical thinking, a learner trusts the experts and follows a procedure step by step. Complex critical thinkers analyze and examine choices more independently. Commitment is the third level of critical thinking in which the person anticipates the need to make choices without assistance from others. The scientific method is a process of problem solving.)
73
The nurse refers to a patient’s postsurgical written plan of care, noting that the patient has a drainage device that is collecting wound drainage. The surgeon is to be notified when drainage in the device exceeds 100 mL for the day. The nurse carefully notes the amount of drainage currently in the device. This is an example of which of the following?
Assessment.
74
The nurse asks a patient how she feels about impending surgery for breast cancer. Before initiating the discussion, the nurse reviewed information about loss and grief in addition to therapeutic communication principles. Which critical thinking component is involved in the nurse’s review of the literature?
Knowledge application.
75
Before performing a procedure for the first time at a new agency, what does the nurse do?
Reads about the procedure in the policy and procedure manual.
76
Which of the following is the most accurate information to give a nurse during change-of-shift reporting?
Patient reports sharp pain in left anterior knee
77
On entering a patient’s room during change-of-shift rounds, the nurse notice that the patient and spouse have their backs turned to each other, and both have their arms folded across their chests. Which of the following is the best action for the nurse to take at this time?
Ask the patient and spouse if they need some time alone right now.
78
The nurse is assessing the urinary history of a middle-aged married woman. The nurse asks her if she gets up to go to the bathroom at night. She replies, “Yes.” What other question should the nurse ask?
“Is there something that is causing you to get up at night?”
(Perhaps the patient’s husband is getting up in the middle of the night because of a prostate problem, and this is why she is awakened. The nurse should not assume nocturia without further assessment questions.)
79
A patient with diabetes mellitus who takes daily insulin injections is scheduled for surgery the next day. The patient is to take nothing by mouth after midnight. The nurse questions whether insulin should be given the morning of surgery. This is an example of which of the following?
Scientifically based clinical judgement.
80
The patient is a 65-year-old overweight woman with multiple medical diagnoses, including diabetes mellitus type 2, hypertension, and residual right-sided weakness that resulted from a previous cerebrovascular accident. What tool should be used to plan her care?
Concept map
(A concept map is a visual representation of patient problems and interventions that shows their relationships to each other and allows easy synthesis of data about the patient.)
81
A patient newly admitted to the hospital begins to have chest pain. Before calling the physician, the nurse should gather what additional data? (Select all that apply.)
```
Pain intensity.
Location of the pain.
Character of the pain.
Radiation of the pain.
Meaning of pain to the patient.
Family history of myocardial infarctions.
```
```
Pain intensity.
Location of the pain.
Character of the pain.
Radiation of the pain.
Meaning of pain to the patient.
```
(The nurse should gather the data the physician will need to determine whether the chest pain represents a myocardial infarction. Family history is important in comprehensive pain assessment; however, taking time to obtain this information is inappropriate in this critical situation.)
82
What is the purpose of assessment?
To establish a database concerning the patient.
83
The nurse asks a patient, “Ms. Neil, describe for me your typical diet over a 24-hour day. What foods do you prefer? Have you noticed a change in your weight recently?” This series of questions would probably occur during which phase of a patient interview?
Working.
84
During data clustering, the nurse performs which of the following tasks?
Organizing cues into patterns that lead to identification of nursing diagnoses.
85
What type of interview technique is the nurse using when the nurse asks the question, “Do you have pain or cramping?”
Closed-ended questioning.
86
Which of the following is subjective information to be entered in the patient’s medical record?
Pain intensity 8 out of 10.
(Pain is purely a subjective phenomenon. Although the pain intensity rating is an objective number, it depends on the patient’s report. The other options are objective data.)
87
Which of the following is objective information to be recorded in the patient’s medical record?
Voided 250 mL of clear yellow urine.
88
Which of the following is an open-ended question the nurse might use when interviewing a patient?
“What do you mean when you say, ‘I don’t feel quite right’?”
89
The nurse asks the patient whether he or she has any allergies. This is an example of which of the following?
Health history data.
90
The nursing assessment is which phase of the nursing process?
First.
91
Which of the following defines a nursing diagnosis?
A clinical judgement about individual, family, or community responses to actual and potential health problems or life processes.
92
The nurse reviews data regarding a patient’s pain symptoms, comparing the defining characteristics of acute pain with those of chronic pain. The patient’s pain has lasted a few weeks. In the end, the nurse selects Acute pain as the correct nursing diagnosis. This is an example of avoiding which type of error?
Error in data clustering.
93
Which of the following is one purpose of using standard formal nursing diagnostic statements?
To facilitate understanding of patient problems by different health care providers.
94
The nursing diagnosis Readiness for enhanced communication is an example of which of the following?
Wellness nursing diagnosis.
95
The nursing diagnosis Hypothermia is an example of which of the following?
Actual nursing diagnosis.
96
In the examples given below, which nurse is acting to avoid a data collection error?
The nurse who assesses the edema in a patient’s lower leg is unsure of its severity and asks a co-worker to check it with her.
97
“Unhappy and worried about health” is not a scientifically based nursing diagnosis, and it can lead to error in which of the following
Diagnostic label.
98
After establishing a nursing diagnosis of Acute pain, the nurse develops which appropriate patient-centred goal?
Reducing pain intensity to the level of a patient rating of 3 or below during the patient’s hospital stay.
99
In a review of systems, asking about the last time a patient had a tuberculosis (TB) skin test is a question that would fit under which of the following categories?
Lower respiratory system.
(TB affects the lower respiratory system, not the upper respiratory system. A TB skin test is not a laboratory test. There is no immunization vaccine against TB.)
100
The nurse is assigned to a patient who has returned from the recovery room after surgery for a colorectal tumour. After an initial assessment, the nurse anticipates the need to monitor the patient’s abdominal dressing, intravenous (IV) infusion, and drainage tubes. The patient is in pain and will not be able to eat or drink until intestinal function returns. The nurse will have to establish priorities of care in which of the following situations?
The patient’s vital signs change, showing a drop in blood pressure.
101
The nurse has set a time limit for expected outcomes. What is the purpose of establishing such a time frame?
Indicate when the patient is expected to respond in the desired manner.
102
A patient-centred goal is a specific and measurable behaviour or response that reflects which of the following?
The patient’s highest possible level of wellness and independence in function.
103
Which of the following is an example of an expected outcome statement in measurable terms?
Patient will report pain intensity of less than 4 on a scale of 0 to 10.
104
The nurse anticipates that a right-handed patient with a fractured right arm will require assistance with activities of daily living. What skill is the nurse demonstrating?
Cognitive skill.
(The nurse is using sound judgement and clinical decisions to provide individualization of care. A decision is made without direct interaction with the patient but is based on knowledge about the patient. No psychomotor skill is involved in this decision-making process. There is no such thing as a behavioural skill.)
105
Which of the following characteristics of a goal is missing from the statement “Patient will ambulate daily”?
Measurable
106
Interdisciplinary care plans represent which of the following?
Contributions of all disciplines in caring for the patient
107
Environmental factors heavily affect a patient’s care. The nurse’s first concern for the patient includes which of the following?
Safety
108
Assessment data must be descriptive, concise, and complete. In performing an assessment, the nurse should do which of the following? (Select all that apply.)
Include subjective data from the patient.
Perform a thorough physical examination.
Use interpersonal and cognitive skills.
109
What techniques encourage a patient to tell his or her full story? (Select all that apply.)
Active listening.
Back-channelling.
Use of open-ended questions.
110
The nurse has gathered the following assessment data about a patient. Which of these cues form a pattern? (Select all that apply.)
Patient is restless.
Respirations are 24 breaths per minute and irregular.
Patient reports feeling short of breath.
(The rapid irregular breathing, complaints of shortness of breath, and restlessness are part of a pattern indicating that the patient may be experiencing hypoxia because all are signs and symptoms characteristic of this condition. The other information, although important, is not related to hypoxia.)
111
Which of the following are defining characteristics for the nursing diagnosis of Impaired urinary elimination? (Select all that apply.)
Nocturia.
Frequency.
Urinary retention.
112
When determining a patient’s ability to perform instrumental activities of daily living, which of the following skills does the nurse assess? (Select all that apply.)
Ability to take medications.
Ability to write cheques.
Ability to cook meals.
(The correct options are skills that allow the patient to live independently in society. They may or may not be performed on a daily basis. The other options are activities of daily living._
113
A manager is reviewing the nurses’ notes in a patient’s medical record. She finds the following entry: “Patient is difficult to care for, refuses suggestion for improving appetite.” Which of the following directions should the manager give to the staff nurse who entered the note?
Enter only objective and factual information about the patient.
114
A patient tells the nurse, “I have stomach cramps and feel nauseated.” This is an example of which type of data?
Subjective.
115
As the nurse enters the patient’s room, the nurse notices that he is anxious to say something. The patient quickly exclaims, “I don’t know what’s going on; I can’t get an explanation from my doctor about the results of my test. I want something done about this.” Which of the following is the most appropriate documentation of the patient’s emotional status?
The patient stated that he felt frustrated by the lack of information he has received regarding his diagnostic tests.
116
Patients frequently request copies of their medical records. The nurse understands that which of the following is correct?
Patients have the right to read their records.
117
Accurate entries are an important characteristic of good documentation. Which of the following charting entries is most accurate in the way it is written?
Patient ambulated 15 m and back down hallway with assistance from nurse, heart rate 88 and regular before exercise, 94 and regular after exercise.
118
Which of the following represents a breach of confidentiality and privacy?
A nurse telephones the patient’s church to have the patient’s name placed on a prayer list.
119
Which of the following is one purpose of the patient’s medical record?
Education and research
(The purposes of keeping a medical record include communication, legal documentation, financial billing, education, research, and auditing–monitoring. An effective way to learn the nature of an illness and the individual patient’s response to it is to read the patient’s record. It is a valuable educational tool. Research may also be conducted on the basis of data collected from medical records. Different types of permissions must be secured before patient records are reviewed for any kind of research or data analysis. Change-of-shift reports are not part of the medical record. Incident reports are documented in a record that is not part of the patient’s medical record. Procedure guidelines are found in procedure manuals, not in the patient’s medical record.)
120
Which of the following is a guideline for legally sound documentation?
If an order is questioned, record that clarification was sought
(If the nurse carries out an order known to be incorrect, the nurse is just as liable for prosecution as is the physician. Therefore, the nurse should clarify the order with the physician and document having done so. All entries should be recorded legibly and in black ink. Black ink is more legible when records are photocopied or transferred to microfilm. To increase accuracy and decrease unnecessary duplication, care activities should be documented at the time they are performed. The nurse should not erase, apply correction fluid, or scratch out errors made while recording because it makes the charting illegible and may create the appearance that the nurse was attempting to hide or deface a record. A single line should be drawn through the error, the word error should be written above it, and the nurse should sign his or her name or initials. Then the note can be recorded correctly.)
121
Which of the following is the best example of quality documentation?
6-cm incision on right lower quadrant, edges pink and well approximated with sutures; no drainage noted.
122
When a nurse follows the SOAP method of charting, the information the nurse would record under “O” would be which of the following?
Right foot is red with +4 pitting edema and capillary refill less than 3 seconds.
123
Which of the following is a method of charting in which the nurse writes a progress note only when the standardized statement on the form is not met?
Charting by exception.
124
Why are critical pathways a valuable tool in patient care?
They provide members of the health care team with a way to document their contributions to the patient’s total plan of care.
(Critical pathways are multidisciplinary care plans that include patient problems, key interventions, and outcomes expected within an established time frame. Critical pathways promote integration of information so that each discipline has access to notes written by others. Nurses are not the only ones who use the critical pathway. The nurse and other team members, such as physicians, dietitians, social workers, physiotherapists, and respiratory therapists, use the same critical pathway to monitor the patient’s progress. The use of critical pathways does reduce duplication and the amount of charting. Variances are unexpected outcomes, unmet goals, and interventions not specified within the critical pathway time frame. A variance is not something the physician develops but rather an outcome for the patient. A variance is the situation in which the activities on the critical pathway are not completed as predicted or the patient does not meet the expected outcomes. A variance can be positive or negative.)
125
Which of the following is one advantage of standardized care plans?
They establish clinically sound standards of care for similar groups of patients.
126
A nursing instructor is helping a student nurse with discharge planning for a patient. The instructor realizes that further education is needed when the student nurse says which of the following?
“I really can’t start discharge planning until the physician writes the discharge orders.”
127
The nurse is giving a change-of-shift report. Which of the following is the most appropriate report statement?
“David Jackson, in 121-1, a 92-year-old patient of Dr. Able, is here with pneumonia. He is receiving oxygen at 2 L per nasal cannula. He has crackles in his right lower lobe, clear rest. He can get up with assistance of one. He has been coughing up thick, yellow-tinged sputum after his breathing treatments. He gets them every 6 hours. His next treatment will be at 0800.”
128
A patient is complaining of pain at 0400 hours. The nurse telephones Dr. Rice and receives an order for oxycodone hydrochloride, 5 mg, one tablet every 4 hours as needed. It is wise for the nurse to do which one of the following?
Repeat the prescribed order back to the physician.
129
According to the guidelines, quality documentation and reporting should be which of the following? (Select all that apply.)
The five guidelines call for documentation and reporting to be factual, accurate, complete, current, and organized.
130
According to the World Health Organization what is the best definition of health?
Involving the total person and the environment
131
Accountability is a critical aspect of nursing care. Which of the following is an example of a specific decision-making process of accountability?
Evaluating patient outcomes after implementing care
132
How is the idea of a theory best explained?
A purposeful set of assumptions that identify relationships between concepts
133
A nurse has provided care to a patient. Which entry should the nurse document in the patient's record?
Left abdominal incision 5 cm in length without redness, edema or drainage
134
The R in SBAR stands for:
Recommendation
135
A patient comes to the clinic and asks the nurse for an explanation of the Medicare system. What is the best response?
Canada's national health insurance system
136
What is the primary purpose of registration laws for the nursing profession?
To protect the public against unqualified and incompetent practitioners
137
Vulnerable populations include patients who are more likely than others to develop health problems as a result of what?
Exposure to excessive risk
138
Risk factors can be placed into the following interrelated categories: genetics, environment, age and lifestyle. The presence of any of these risk factors means which of the following.
The chances of getting the disease is increased
139
What are characteristics of critical thinking?
Considering what is important in a given situation
140
In caring for patients, it is essential for the nurse to realize that evidence-informed decision-making is which of the following?
Dependent on patient value and expectations
141
The nurse needs to complete all of the following tasks. Which task does the nurse perform first?
Notify the health care provider of the decreased level of consciousness of the patient who had a stroke yesterday.
142
The charge nurse on a surgical unit is doing staff assignments for the 3:00 to 11:00 shift. Which of the following patients should the charge nurse assign to the licensed practical nurse?
The patient who had a vaginal hysterectomy two days ago.
(The patient who had a vaginal hysterectomy should be the most stable of these patients and should require the least amount of nursing assessment. A registered nurse (RN) should be responsible for the patient being discharged, especially if teaching needs to be done. An RN should also care for the patient who had a laryngectomy because the procedure was done fairly recently and life-threatening complications can arise, as well as for the patient who underwent mastectomy because the surgery occurred only this morning.)
143
Which type of care management approach entails coordination of health care services for patients and their families while streamlining costs and maintaining quality?
Case management.
(Case management is the management approach that coordinates health care services for patients and their families while streamlining costs and maintaining quality. Total patient care is the original care model in which an RN directs all care for a patient. In team nursing, an RN leads a team of nurses and technicians to provide care. In primary nursing, an RN directs implementation of the care plan for each patient.)
144
While administering medications, the nurse realizes he has given the wrong dose of medication to a patient. The nurse acts by completing an incident report and notifying the patient’s physician. The nurse is exercising which of the following?
Accountability: is to the answerability of individuals for their actions. Authority is the legitimate power to give command and make final decisions. Responsibility is concerned with the duties and actions that an individual is employed to perform. Decision making is the process of critically appraising information and generating a conclusion.
145
Many managers distribute biweekly newsletters describing ongoing unit or health care agency activities and post minutes of committee meetings in an accessible location for all staff to read. This is an example of which of the following?
Staff communication.
(Staff communication occurs through vehicles such as newsletters and practices such as making meeting notes accessible. Nursing practice councils may or may not communicate with staff. Nurse–physician collaborative practice is a model, as is interdisciplinary collaboration.)
146
During the morning rounds, the nurse assesses the condition of a patient who underwent major open-heart surgery 2 days earlier. The patient complains of lower leg pain at the site where the vein graft was removed. The nurse finds that the intravenous (IV) infusion is being delivered at the appropriate rate but that only 100 mL remains in the bag. An order exists for the IV infusion to continue. What is the nurse’s first-order priority?
Administer an analgesic to the patient to treat the leg pain.
(Pain is always a first-order priority. If 100 mL of solution remains in the infusion bag, the nurse has a small window of time to focus on replacing the IV bag, which can be done after the pain medication is administered. The nurse should verify pharmacy deliveries while obtaining the new IV bag. Wound healing instruction can be instituted after action has been taken on the higher priority issues.)
147
A patient is experiencing an anxiety attack. What is the priority of this patient’s nursing need?
High (first-order) priority.
(High (first-order) priority issues are those that create an immediate threat to a patient’s survival and safety. An anxiety attack is such a high-priority issue because of the safety aspect. Issues of intermediate (second-order) priority are those that do not have a potential to cause immediate harm. Issues of low (third-order) priority and nonemergency priority are those that may or may not be related to the acute phase of the patient’s illness and can wait until other problems have been addressed.)
148
The nurse checks on a patient who was admitted to the hospital with pneumonia. The patient has been coughing profusely and has required nasotracheal suctioning. The patient is febrile and is receiving an IV infusion of antibiotics. The patient asks the nurse for a bath because of profuse perspiring. Which task does the nurse delegate to the nursing assistant working with her today?
Administering a bed bath
149
Which of the following tasks is appropriate for an RN to delegate to the nursing assistant?
Measuring vital signs for a patient who is having an abdominal CT scan later in the morning.
150
Which of the following team members is essential for empowering a nursing team?
Nurse executive.
(Without the nurse executive’s involvement in the organization, it is unlikely that anyone will advocate for the values and goals of nursing. The team members named in the other options are important but are not essential for the nursing team to move forward.)
151
In what way is the interprofessional collaborative practice model unique?
It ensures that health care providers can practise to the full potential of their role and competencies.
(The interprofessional collaborative practice model is used by nursing teams and other health care providers who are members of the interprofessional team. The entire health care team, not just one provider, is accountable for the care delivered to the patient. The focus is on the patient, not on any health care provider.)
152
A staff nurse has concerns about a procedural aspect of patient care. What is the most effective way for the nurse to ensure that this concern is addressed?
Discuss concerns with the unit manager.
153
Which of the following statements represents a nurse-sensitive outcome?
The patient ate 50% of lunch.
(The patient’s intake is a nurse-sensitive outcome that can be achieved as a result of nursing care. Family visitation shows a family focus. The inability of a patient to report pain intensity indicates a problem, not an outcome. Completing patient education indicates the completion of an intervention, not the attainment of an outcome.)
154
The five rights of delegation include which of the following?
Right task, circumstances, person, communication, and supervision
155
The nurse instructs an unregulated care provider (UCP) to change the central line dressing of a patient after the patient finishes lunch. This is an example of violating which of the five “rights” of delegation? (Select all that apply.)
Task.
Person.
(UCPs are not qualified to change central line dressings. This is an inappropriate delegation of a task to this person.)
156
What is the purpose of assessment?
To establish a database concerning the patient.
157
The nurse asks a patient, “Ms. Neil, describe for me your typical diet over a 24-hour day. What foods do you prefer? Have you noticed a change in your weight recently?” This series of questions would probably occur during which phase of a patient interview?
Working.
158
During data clustering, the nurse performs which of the following tasks?
Organizing cues into patterns that lead to identification of nursing diagnoses.
159
What type of interview technique is the nurse using when the nurse asks the question, “Do you have pain or cramping?”
Closed-ended questioning.
160
Which of the following is subjective information to be entered in the patient’s medical record?
A) Skin warm and dry.
B) Pain intensity 8 out of 10.
C) Breath sounds clear to auscultation.
D) Amber urine in sufficient quantities.
Pain intensity 8 out of 10.
- Pain is purely a subjective phenomenon. Although the pain intensity rating is an objective number, it depends on the patient’s report. The other options are objective data.
161
Which of the following is objective information to be recorded in the patient’s medical record?
A) Anxious over upcoming test.
B) Increasing stress over past 2 months.
C) Performs breast self-examination monthly.
D) Voided 250 mL of clear yellow urine.
D) Voided 250 mL of clear yellow urine.
162
Which of the following is an open-ended question the nurse might use when interviewing a patient?
“What do you mean when you say, ‘I don’t feel quite right’?”
163
The nurse asks the patient whether he or she has any allergies. This is an example of which of the following?
Health history data.
164
The nursing assessment is which phase of the nursing process?
First.
The nursing process cannot proceed unless the nurse first conducts a patient assessment. The other phases of the nursing process occur after assessment.
165
Which of the following defines a nursing diagnosis?
A clinical judgement about individual, family, or community responses to actual and potential health problems or life processes.
166
The nurse reviews data regarding a patient’s pain symptoms, comparing the defining characteristics of acute pain with those of chronic pain. The patient’s pain has lasted a few weeks. In the end, the nurse selects Acute pain as the correct nursing diagnosis. This is an example of avoiding which type of error?
Error in data clustering.
(Errors in data clustering occur when data are clustered prematurely, incorrectly, or not at all. For the patient, pain has not continued for longer than six months, so this patient’s information does not support a diagnosis of chronic pain. There is no indication that the data collected or the data interpretation is correct. The diagnostic statement has not been presented.)
167
Which of the following is one purpose of using standard formal nursing diagnostic statements?
To facilitate understanding of patient problems by different health care providers.
168
The nursing diagnosis Readiness for enhanced communication is an example of which of the following?
Wellness nursing diagnosis.
(The term readiness reflects a wellness nursing diagnosis. An actual nursing diagnosis describes a human response to health conditions or life processes in an individual, a family, or a community. A potential nursing diagnosis indicates a “risk for” a condition.)
169
The nursing diagnosis Hypothermia is an example of which of the following?
Actual nursing diagnosis.
170
In the examples given below, which nurse is acting to avoid a data collection error?
A) The nurse asks a colleague to chart her assessment data.
B) The nurse considers conflicting cues in deciding on the correct nursing diagnosis.
C) The nurse who assesses the edema in a patient’s lower leg is unsure of its severity and asks a co-worker to check it with her.
D) After performing an assessment, the nurse critically reviews his own level of comfort and competence with interviewing and physical assessment skills.
The nurse who assesses the edema in a patient’s lower leg is unsure of its severity and asks a co-worker to check it with her.
(A nurse who is uncertain and asks a colleague to consult is avoiding a data collection error. The nurse reviewing his level of comfort and competence is being complete but can miss his own errors. Considering conflicting clues and asking a colleague to chart data do not help avoid data collection errors.)
171
“Unhappy and worried about health” is not a scientifically based nursing diagnosis, and it can lead to error in which of the following?
Diagnostic label.
(The diagnostic label is the name of the nursing diagnosis as approved by the North American Nursing Diagnosis Association International. The question does not address data collection, medical diagnosis, or data clustering.)
172
After establishing a nursing diagnosis of Acute pain, the nurse develops which appropriate patient-centred goal?
Reducing pain intensity to the level of a patient rating of 3 or below during the patient’s hospital stay.
(measurable and objective)
173
In a review of systems, asking about the last time a patient had a tuberculosis (TB) skin test is a question that would fit under which of the following categories?
Lower respiratory system
174
The nurse is assigned to a patient who has returned from the recovery room after surgery for a colorectal tumour. After an initial assessment, the nurse anticipates the need to monitor the patient’s abdominal dressing, intravenous (IV) infusion, and drainage tubes. The patient is in pain and will not be able to eat or drink until intestinal function returns. The nurse will have to establish priorities of care in which of the following situations?
The patient’s vital signs change, showing a drop in blood pressure.
(A drop in blood pressure indicates a possible emergency situation, including bleeding at the surgical site. Concern about pain control, including a thorough assessment focusing on the patient’s pain, would be the second priority. The end-of-shift report and the family’s visit are lower priorities.)
175
The nurse has set a time limit for expected outcomes. What is the purpose of establishing such a time frame?
Indicate when the patient is expected to respond in the desired manner
(The time limit sets measurable points to evaluate the patient’s response and movement toward meeting the outcome goals.)
176
A patient-centred goal is a specific and measurable behaviour or response that reflects which of the following?
The patient’s highest possible level of wellness and independence in function.
177
Which of the following is an example of an expected outcome statement in measurable terms?
Patient will report pain intensity of less than 4 on a scale of 0 to 10
178
The nurse anticipates that a right-handed patient with a fractured right arm will require assistance with activities of daily living. What skill is the nurse demonstrating?
Cognitive skill.
(The nurse is using sound judgement and clinical decisions to provide individualization of care. A decision is made without direct interaction with the patient but is based on knowledge about the patient. No psychomotor skill is involved in this decision-making process. There is no such thing as a behavioural skill.)
179
Which of the following characteristics of a goal is missing from the statement “Patient will ambulate daily”?
Measurable
(Goals must be measurable, such as, “Patient will ambulate 5 m daily.” The other characteristics are met in this goal statement.)
180
Interdisciplinary care plans represent which of the following?
Contributions of all disciplines in caring for the patient.
(Interdisciplinary care plans include the contributions of all disciplines involved in the patient’s care. The patient’s advance directives and express wishes may be included, as well as nursing and physician input, but other involved disciplines also contribute their plans.)
181
Environmental factors heavily affect a patient’s care. The nurse’s first concern for the patient includes which of the following?
Safety.
(Patient safety is an environmental factor and is always the first concern. Pain relief, staffing, and confidentiality are important but are not environmental factors.)
182
Assessment data must be descriptive, concise, and complete. In performing an assessment, the nurse should do which of the following? (Select all that apply.)
A) Include subjective data from the patient.
B) Perform a thorough physical examination.
C) Use interpersonal and cognitive skills.
D) Include inferences or interpretative statements not supported with data.
A) Include subjective data from the patient.
B) Perform a thorough physical examination.
C) Use interpersonal and cognitive skills.
(The nurse should not generalize or form judgements not supported by the collected data. Inferences and interpretive statements must be supported by data. Assessments do include conducting a thorough physical examination, using interpersonal and cognitive skills, and obtaining subjective data from the patient.)
183
What techniques encourage a patient to tell his or her full story? (Select all that apply.)
Active listening.
Back-channelling.
Use of open-ended questions
184
The nurse has gathered the following assessment data about a patient. Which of these cues form a pattern? (Select all that apply.)
A) Patient is restless.
B) Respirations are 24 breaths per minute and irregular.
C) Patient reports feeling short of breath.
D) Fluid intake for eight hours is 800 mL.
E) Patient has drainage from surgical wound.
F) Patient reports loss of appetite for over two weeks.
A) Patient is restless.
B) Respirations are 24 breaths per minute and irregular.
C) Patient reports feeling short of breath.
(The rapid irregular breathing, complaints of shortness of breath, and restlessness are part of a pattern indicating that the patient may be experiencing hypoxia because all are signs and symptoms characteristic of this condition. The other information, although important, is not related to hypoxia.)
185
Which of the following are defining characteristics for the nursing diagnosis of Impaired urinary elimination? (Select all that apply.)
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A) Nocturia.
B) Frequency.
C) Urinary retention.
D) Inadequate urinary output.
E) Receipt of intravenous fluids.
F) Sensation of bladder fullness.
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A) Nocturia.
B) Frequency.
C) Urinary retention.
186
When determining a patient’s ability to perform instrumental activities of daily living, which of the following skills does the nurse assess? (Select all that apply.)
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A) Ability to cook meals.
B) Ability to feed oneself.
C) Ability to write cheques.
D) Ability to bathe oneself.
E) Ability to take medications.
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A) Ability to cook meals.
C) Ability to write cheques.
E) Ability to take medications.
(The correct options are skills that allow the patient to live independently in society. They may or may not be performed on a daily basis. The other options are activities of daily living.)
187
A postsurgical patient calls for the nurse and asks to be repositioned. The nurse finds that the patient’s drainage tube is disconnected and the IV line has 100 mL of fluid remaining. Which of the following should be performed first?
Reconnect the drainage tube.
(The nurse should reconnect the drainage tube first to ensure that the wound is properly draining. The patient should then be turned (with care taken to ensure that the tubing remains connected), followed by replacing the IV fluid bag, checking the IV site, and restarting the IV fluid. With 100 mL left, the nurse has a bit of time to replace the IV bag before it runs dry, and so caring for the patient’s wound and comfort should come first.)
188
When discussing the patient’s care with a nurse’s aide, the nurse instructs the aide to report any coughing by the patient during meals; the patient recently suffered a stroke and requires feeding. In this situation, the nurse is acting in which following nursing role?
Delegator.
189
The nurse prepares a patient for a lumbar puncture. Before the start of the procedure, the nurse makes sure to do which one of the following?
Have the patient void.
(The nurse takes care of physical needs (voiding) that could interrupt the procedure and possibly increase the risk of complications. The patient assumes the fetal position or sits upright with arms over a bedside table. Because lidocaine is used for lumbar puncture, analgesics are not essential. Peripheral IV catheters are not required for this procedure.)
190
A family is in spiritual distress because of the recent, but expected, death of a family member. The nurse who provides counselling to the family implements which of the following interventions?
Reminiscing with the family.
191
The nurse requests a stimulant laxative for a patient who is receiving an opioid around the clock. What is the nurse demonstrating?
Control of adverse reactions.
(The nurse is demonstrating knowledge of opioid side effects and being proactive by asking for an intervention that will probably prevent constipation, a side effect of opioids. The intervention does not promote health; it is aimed at preventing a side effect of an opioid. Safety is not an issue. Requesting a laxative does not provide education.)
192
A 34-year-old patient had a surgical repair of an abdominal hernia in the morning. At 1200 hours, the nurse records the patient’s vital signs on the recovery room flowsheet. This is an example of what?
Indirect care measure.
193
In order to determine whether an intervention was successful, the nurse evaluates the success of attaining a goal. Which of the following is an example of an evaluation?
Wound is filling in with granulation tissue that is red to pink without signs of infection.
(Evaluation occurs after an intervention and indicates the degree of goal attainment. The qualifier “will” indicates that this is a future event and the current attainment of goal is not being evaluated. Performing an intervention is not evaluating, regardless of its effectiveness.)
194
A patient was in pain after surgery. The nurse administered the prescribed analgesics, but the patient’s pain rating stayed the same (8 out of 10). What should the nurse recognize?
The pain plan needs changing.
195
The Nursing Intervention Classification (NIC) system includes common interventions recommended for various North American Nursing Diagnoses Association nursing diagnoses. What is the purpose of the NIC system?
To provide standardization of the nomenclature of nursing interventions
196
A nurse caring for a patient with pneumonia sits the patient up in bed and suctions the patient’s airway. After the suctioning, the patient describes some discomfort in his abdomen. The nurse auscultates the patient’s lung sounds and provides the patient with a glass of water. Which of the following is an evaluative measure used by the nurse?
Auscultating lung sounds.
197
The evaluation process, which determines the effectiveness of nursing care, includes five elements. One element is interpreting findings. Which of the following is an example of interpretation?
Matching the results of evaluative measures with expected outcomes to determine the patient’s status
(Matching the results with the expected outcome to determine the patient’s status represents interpretation. Establishing goals and outcome statements is a function of planning. Selecting an observable or measurable state or behaviour that will reflect goal achievement is part of goal setting. Evaluating the patient’s response to selected nursing interventions is data collection.)
198
A goal specifies an expected behaviour or response when it indicates which of the following?
Resolution of a nursing diagnosis or maintenance of a healthy state. Correct
199
A patient is recovering 1 day after surgery to remove an ovarian tumour. She has an abdominal incision and dressing; therefore, the nurse has selected the nursing diagnosis Risk for infection. Which of the following is an appropriate goal statement for this diagnosis?
Patient’s wound will remain free of infection until discharge.
200
For the past three days the nurse has cared for a patient with a nursing diagnosis of “Impaired physical mobility,” and the nurse observes that the patient is not eating as expected. The nurse recognizes the need to do which one of the following?
Change the nursing diagnosis to “Feeding self-care deficit.”
(The nurse has assessed the problem and now recognizes that the focus should be on self-feeding. Nursing diagnoses should change as the patient’s condition changes and be based on assessment findings.)
201
The nurse determines that the current care plan for a patient must be changed because the goal has not been reached even after a sufficient period of time. New interventions are implemented. What is essential for the nurse to do after implementation of these new interventions?
Re-evaluate the goal.
(The nurse must continuously re-evaluate new interventions to see whether they are helping to alleviate the problem, attain the goal, or both. Only through re-evaluation can the nurse determine the effectiveness of the interventions. The other options are all important considerations, but they should be performed before, not after, an intervention is implemented.)
202
In order to complete the evaluation phase of the nursing process, the goal must be worded correctly. Which of the following demonstrates a correctly worded goal?
The patient will tolerate ambulation to the end of the hall by December 20
203
A patient is experiencing nausea and abdominal distension postoperatively. The nurse initiates the interventions listed as follows. Which of the interventions are examples of an independent intervention? (Select all that apply.)
A) Provide frequent mouth care.
B) Maintain IV infusion at 100 mL/hour.
C) Administer prochlorperazine (Compazine) via rectal suppository.
D) Consult with the dietitian on initial foods to offer the patient.
E) Control aversive odours and unpleasant visual stimulation that trigger nausea.
A) Provide frequent mouth care.
E) Control aversive odours and unpleasant visual stimulation that trigger nausea.
204
Which of the following are nurse-provided indirect care activities? (Select all that apply.)
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A) Delegating.
B) Documenting.
D) Evaluating new products.
C) Administering medications.
E) Providing patient counselling.
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A) Delegating.
B) Documenting.
D) Evaluating new products.
205
Which steps does the nurse follow when he or she is asked to perform a procedure with which he or she is unfamiliar? (Select all that apply.)
A) Seek necessary knowledge.
B) Reassess the patient’s condition.
C) Collect all equipment necessary.
D) Have an experienced nurse available to assist.
E) Consider all possible consequences of the procedure.
A) Seek necessary knowledge.
B) Reassess the patient’s condition.
C) Collect all equipment necessary.
D) Have an experienced nurse available to assist.
E) Consider all possible consequences of the procedure.
206
If goals are unmet and partially met, the nurse must do which of the following? (Select all that apply.)
A) Redefine priorities.
B) Continue intervention.
C) Discontinue the care plan.
D) Gather assessment data on a different nursing diagnosis.
E) Compare the patient’s response with that of another patient.
A) Redefine priorities.
| B) Continue intervention.
207
An advanced-practice nurse in the community has completed a research project showing that follow-up care for women who have experienced gestational diabetes is not adequate. As a member of an interdisciplinary team, the nurse writes a policy guiding follow-up standards for all postpartum women. In effecting change, the nurse would be involving which principle?
Social justice.
208
It may seem redundant that health care providers pledge to “do no harm” to patients. The purpose of this oath is to reassure the public that the health care team will work to heal patients with as little pain and harm as possible. Which principle underlies this pledge?
Nonmaleficence.
209
A child’s immunization may cause discomfort during administration, but the benefits of protection from disease outweigh the temporary discomforts. Which principle applies to this situation?
Beneficence
210
In most ethical dilemmas, the solution to the dilemma requires negotiation among members of the health care team. Why is the nurse’s point of view valuable?
Nurses develop a relationship with the patient that is unique among all health care providers.
211
Ethical dilemmas often involve a conflict of opinion. Once the nurse has determined that the dilemma is ethical, which of the following would be a critical first step in negotiating the difference of opinion?
Gather all relevant information regarding the clinical, social, and spiritual aspects of the dilemma.
212
Which of the following sets forth ethical principles for professional nursing practice in a clinical setting?
Code of Ethics for Registered Nurses of the Canadian Nurses Association.
213
Which of the following statements concerning informed consent is correct?
The goal of informed consent is to protect the patient’s right to autonomy.
214
Withdrawal of food and hydration at the end of life is an ethical issue that nurses may face, particularly if a patient is near death or in a vegetative state. Which of the following is an accurate statement that the nurse could reveal to the patient’s family?
It is appropriate to withhold food and fluids only after careful examination of the patient’s status because artificial hydration may not be benefiting the patient
215
The experience of “moral distress” is captured by which of the following statements?
Moral distress occurs when inconsistency exists between a nurse’s beliefs and values and how he or she is able to act.
216
To distinguish an ethical problem from other types of problems encountered, the nurse should be aware that which of the following statements about ethical problems is true?
The answer is not determined by logical deduction.
217
After researching the scientific literature and confirming that an issue is an ethical dilemma, which of the following should the nurse do next?
Perform a values clarification
(In the sequence of steps to resolve an ethical dilemma, once the dilemma has been identified, the nurse should examine what issues contribute to the dilemma. The nurse’s examination of his or her own values helps reveal any hidden bias in the situation and allows the situation to be viewed in a more neutral manner. Verbalization of the problem follows values clarification and is not the next step after identification of the dilemma. Once the nurse identifies his or her own bias, then the nurse can be confident of using a neutral approach to solving the dilemma. Negotiation of options is the penultimate step in the process. Family input should be a small part of the second step during the information-gathering process, so that all relevant facts can be reviewed together. Not involving the family or getting their input early in the process can result in a lack of satisfaction with the solution to the problem and may not be in the patient’s best interests.)
218
Which of the following represents utilitarian allocation of scarce resources?
Distribution of resources to achieve the greater good of the larger group.
219
When the nurse describe a patient as “that nasty old man in 354,” the nurse is exhibiting which of the following?
Gender bias and ageism.
220
Values clarification is a process that involves which of the following?
Appraising one’s personal values that arise from careful reflection.
(Values clarification occurs when nurses choose to reflect on their values in order to understand how those values might affect their personal or professional behaviour. As nurses experience new situations, their values may change. A process of reflection, not following rules blindly without reflection, helps appraise values. Not all nurses may accept certain values.)
221
Which of the following are true regarding advance care planning? (Select all that apply.)
A) It includes the expression and comprehension of a patient’s beliefs and values.
B) It is a multidimensional process that involves health care providers.
C) The patient’s family is not included in this planning.
D) Patients can also identify surrogate decision makers, should they become unable to make their own health care decisions.
E) The number of unwanted medical interventions is increased.
F) This approach remains underutilized in health care.
A) It includes the expression and comprehension of a patient’s beliefs and values.
B) It is a multidimensional process that involves health care providers.
D) Patients can also identify surrogate decision makers, should they become unable to make their own health care decisions.
F) This approach remains underutilized in health care.
222
When a nurse stops to help in an emergency at the scene of an accident, if the injured party files suit and the insurance of the nurse’s employing institution does not cover the nurse, she would probably be covered by which of the following?
A provincial/territorial Good Samaritan law, which grants immunity from suit if there is no gross negligence
223
Even though the nurse may obtain the patient’s signature on a form, who has the responsibility to obtain informed consent?
The physician
| The person responsible for performing the given procedure has the responsibility for obtaining the informed consent.
224
The standard-practice legal definition of death that facilitates organ donation is cessation of which of the following?
Functions of the entire brain.
225
The nurse notes that an advance directive is in the patient’s medical record. The nurse recognizes which correct interpretation of advance-directive provisions?
A proxy directive allows an appointed person to make health care decisions when the patient is in an incapacitated state.
226
The nurse notes that the health care unit keeps a list of patients’ names at the front desk in clear view so that health care providers can more efficiently locate patients. The nurse knows that this action is a violation of which of the following?
Common law tort relating to invasion of privacy.
227
Canadian common law provides patients with basic privacy rights pertaining to their medical records. Which of the following is a violation of these provisions?
Posting daily nursing care information along with the medical condition of patients on a message board in the patient’s room.
228
What is the primary reason that the nurse should understand law?
The nurse can be an advocate for patient rights.
229
Nurses are bound by a variety of laws. Which of the following descriptions of types of law is correct?
Statutory law is created by elected legislatures, such as the provincial or territorial legislature that defines the nursing practice act.
230
Which of the following regulates hospitals to ensure safety in the provision of services, establishes criteria that must be met for a hospital to receive funding from the government, and provides for penalties if guidelines are not followed?
Canadian Council on Health Services Accreditation
231
Which of the following is an appropriate task that a nursing student may perform while employed as a nursing aid?
Give a bed bath.
232
A patient who is confused is left alone in bed with the side rails down and the bed in a high position, and the patient falls and breaks a hip. In legal terms, what has occurred?
Negligence.
233
When the nurse signs a form as a witness, the nurse’s signature shows which of the following regarding the patient?
The patient has signed that form and the witness saw it being done. Correct
234
Which of the following persons can legally give consent to a procedure?
A legal guardian of a child
235
Which of the following statements is correct?
Consent for medical treatment may be given by anyone who understands the risks, benefits, and consequences of both having and not having a treatment or procedure.
236
Most litigation involving hospital care is related to which of the following situations?
The nurse follows an order that is incomplete or incorrect
237
A patient can be admitted to a mental health facility and treated without his or her consent under which of the following circumstances?
The patient has threatened to harm himself or herself or others.
238
The best way for a nurse to avoid being liable for negligence might be to do which of the following? (Select all that apply.)
A) Follow standards of care. B) Give safe, competent care in a caring manner.
C) Document assessments, interventions, and evaluations as soon as possible after performing them.
D) Choose not to report someone whose professional behaviour you question.
A) Follow standards of care. B) Give safe, competent care in a caring manner.
C) Document assessments, interventions, and evaluations as soon as possible after performing them.
239
The nurse working on a cardiac unit is taking care of a patient who recently underwent coronary bypass surgery. Which of the following represent legal sources of standards of care that nurses use to deliver safe health care? (Select all that apply.)
A) Information provided by the head nurse.
B) Regulations identified by the provincial/territorial association or college manual.
C) Policies and procedures of the employing hospital.
D) Nursing practice act of the province/territory in which the nurse is working.
E) Canadian Nurses Association standards of nursing practice.
B) Regulations identified by the provincial/territorial association or college manual.
C) Policies and procedures of the employing hospital.
D) Nursing practice act of the province/territory in which the nurse is working.
E) Canadian Nurses Association standards of nursing practice.
240
A nurse is sued for failure to monitor a patient appropriately. Which statements are correct about professional negligence lawsuits? (Select all that apply.)
A) The nurse is the plaintiff. B) The person filing the lawsuit has the burden of proof.
C) The defendant must prove injury, damage, or loss.
D) The plaintiff must prove that a breach in the prevailing standard of care caused an injury.
B) The person filing the lawsuit has the burden of proof.
D) The plaintiff must prove that a breach in the prevailing standard of care caused an injury.
241
The nurse must follow standards of care to avoid potential litigation such as negligence suits. Which of the following describe a potential nursing malpractice situation? (Select all that apply.)
A) Failure to question a health care provider about the appropriateness of a patient order.
B) Failure to make a nursing diagnosis.
C) Failure to properly use medical equipment ordered for patient monitoring.
D) Failure to follow the “seven rights” of medication administration.
E) Failure to provide discharge instructions.
A) Failure to question a health care provider about the appropriateness of a patient order.
B) Failure to make a nursing diagnosis.
C) Failure to properly use medical equipment ordered for patient monitoring.
D) Failure to follow the “seven rights” of medication administration.
E) Failure to provide discharge instructions.
242
A nursing student is unsure about the legal liability of using skills associated with placement as a student. Which of the following is true about legal liability for a nursing student? (Select all that apply.)
A) Student nurses, like all other nurses, are accountable for their own actions.
B) The institution where a student is placed has no responsibility to monitor the actions of a student.
C) It is the nursing instructor’s role to inform patients that they are being cared for by a student nurse
D) Usually faculty members are responsible for instructing and observing students; however, there are some situations in which staff nurses may share these responsibilities.
E) Nursing students should never perform tasks they have not been taught; instructors should supervise all new skills that are being performed.
A) Student nurses, like all other nurses, are accountable for their own actions.
D) Usually faculty members are responsible for instructing and observing students; however, there are some situations in which staff nurses may share these responsibilities.
E) Nursing students should never perform tasks they have not been taught; instructors should supervise all new skills that are being performed.
243
Socialization in Canada of a 6-year-old child from Mexico into the Mexican culture is best described as which of the following terms?
Enculturation.
244
A 46-year-old woman from Bosnia came to Canada six years ago. Although she did not celebrate Christmas when she lived in Bosnia, she celebrates Christmas with her family now. This woman has experienced assimilation into the culture of Canada for which of the following reasons?
She adapted to and adopted the Canadian culture.
245
For a nursing student to enhance cultural awareness, the student will need to make an in-depth self-examination of which of the following?
Background, including recognition of biases and prejudices.
246
Cultural competence is the process of which of the following?
Acquiring specific knowledge, skills, and attitudes toward the appreciation of different cultures.
247
Ethnocentrism is the root of which of the following?
Biases and prejudices.
248
Which of the following results when a person acts on his or her prejudices?
Discrimination occurs.
249
Which of the following is true regarding the dominant values in Canadian society of individual autonomy and self-determination?
These values may be in direct conflict with the values of diverse groups.
250
The best explanation of Canada’s multicultural policy is that it allows the freedom to do which of the following?
Retain one’s unique cultural differences.
251
Which of the following best describes the nurse’s role in planning care for a culturally diverse population?
Providing care while remaining aware of his or her own bias and focusing on the patient’s individual needs rather than the staff’s practices.
252
Which of the following statements related to cultural conflicts is an accurate definition?
Discrimination is treating people unfairly on the basis of their group membership.
253
When addressing cultural needs during the postpartum period, the nurse knows that which of the following statements is correct?
Members of non-Western cultures have fewer problems with postpartum depression because attention is given to the mother’s recovery for a longer period of time.
(Canadians are often more autonomous and have fewer friends and relatives who come for extended times to assist in the recovery period. Hindu beliefs call for bathing rituals that are performed only after bleeding has stopped because blood is associated with pollution. Dietary practices call for consuming not only liquids but also foods that are thought to balance the mother after delivery. In Eastern cultures, the practice is to allow the mother to rest and be waited on for at least a month. Ritualistic cleansing is an Eastern cultural practice, not a North American or Western practice.)
254
In reviewing topics for a cultural assessment to identify the needs of an Orthodox Jew while hospitalized, the nurse should expect which special needs?
Circumcision of all newborn boys.
255
Which factors are least significant during assessment when gathering information about cultural practices?
Biocultural needs.
256
Transcultural nursing involves which of the following?
Using a comparative study of cultures to understand similarities and differences across human groups to provide specific individualized care that is culturally appropriate.
257
Which statement about cultural safety is correct?
Cultural safety is part of a stepwise progression.
(Cultural safety is the desired outcome in a stepwise progression that begins with cultural awareness. Cultural awareness and cultural sensitivity are terms for separate concepts, and those terms are not interchangeable with cultural safety. The outcome of cultural safety is that patients who receive care acknowledge that it is safe care. Cultural awareness is a beginning step toward understanding that there are differences. The nurse is not expected to know every cultural practice of every patient.)
258
Which of the following statements about culture is correct?
Culture is not inherited but is a result of socialization.
259
Which of the following should the nurse do when planning nursing care for a patient whose cultural background is different from the nurse’s?
Identify how these cultural variables affect the health problem.
260
Noncommunicable diseases necessitate taking action to prevent premature death. Of the main types of noncommunicable diseases, which of the following necessitates increased attention from nurses?
Diabetes.
(There are four main types of noncommunicable diseases: cardiovascular diseases, chronic respiratory diseases, cancers, and diabetes. Diabetes is one of the main noncommunicable diseases that necessitates close attention from nurses.)
261
Which activities would be expected by the nurse to meet the cultural needs of the patient? (Select all that apply.)
A) Developing the structure and process for meeting cultural needs on a regular basis and the means to avoid overlooking these needs in patients.
B) Expecting the patient's family to keep an interpreter present at all times, day and night, to assist in meeting the communication needs of the patient while hospitalized.
C) Promoting and supporting attitudes, behaviours, knowledge, and skills to respectfully meet the patient's cultural needs despite the nurse’s own beliefs and practices.
D) Ensuring that the interpreter understands not only the patient's language but also the feelings and attitudes behind cultural practices to make sure an ethical balance can be achieved.
A) Developing the structure and process for meeting cultural needs on a regular basis and the means to avoid overlooking these needs in patients.
C) Promoting and supporting attitudes, behaviours, knowledge, and skills to respectfully meet the patient's cultural needs despite the nurse’s own beliefs and practices.
D) Ensuring that the interpreter understands not only the patient's language but also the feelings and attitudes behind cultural practices to make sure an ethical balance can be achieved.
262
Which statements about Chinese cultural practices are correct? (Select all that apply.)
A) Mourners may be hired to demonstrate grief.
B) Beliefs include a balance between yin and yang.
C) The Chinese believe that eating hot soup will bring heat to the body. Correct
D) Herbal medicines are just as significant as and are used with or instead of Western medicines.
B) Beliefs include a balance between yin and yang.
C) The Chinese believe that eating hot soup will bring heat to the body. Correct
D) Herbal medicines are just as significant as and are used with or instead of Western medicines.
(Hiring of mourners is a common practice in Korean culture, not Chinese culture. In grief and death, the family protects the grieving persons and makes decisions for them in a very private manner. In traditional Chinese culture, good health means to have a balance between yin and yang—eating “hot” or “cold” foods and using various herbal medicines are ways of bringing the body back into balance when someone is unwell. The belief is that all body systems interact with each other and the environment to produce a balanced state of wellness.)
263
As a community nurse, you are caring for an Indigenous patient who has requested a traditional shaman to aid in healing. This request demonstrates which view of health?
Holistic.
264
An Indigenous patient is in need of a mental health assessment. There has been a delay in the service because of funding issues and availability of the specialist to visit the reserve. This is an example of which of the following?
Structural racism.
265
As a home care nurse, you are meeting an Indigenous patient for the first time. Which of the following statements by the nurse demonstrates that he or she has an understanding of the most important step in building trust as an essential part of the nurse-patient relationship?
“Listen to the patient to find out who the patient is and what his or her needs are, and adapt to the family’s and community’s cultural necessities.”
266
As a result of colonialism and residential schools, many Indigenous people have experienced destruction of their practices and structure. This destruction included removing their basic rights and not allowing them to practice their faith. This is known as which of the following?
Cultural genocide
267
A nurse has recently accepted a position at a medical clinic on a reserve. To adhere to the recommendations made by the Truth and Reconciliation Commission of Canada, what is the best way to become a settler ally?
Engage in a personal reflection, including self-awareness and self-education.
268
Determinants of health affect the level of health for Indigenous people. To address the proximal determinants of health, what would a nurse do?
Provide a list of nutritious foods and culturally considerate meals.
269
An Indigenous patient is being admitted to the hospital. As part of the assessment, the nurse should address the emotional, physical, spiritual, and mental health of the patient. The nurse understands that this is important for which reason?
Poor health results if there is disharmony or imbalance of these four components.
270
How should a nurse and office staff respond to an Indigenous patient who chronically misses or is late for appointments?
Explore with the patient what day or time would work better for the appointments.
271
How should a nurse approach a colleague about his or her culturally insensitive behaviour or remarks to an Indigenous patient?
Speak honestly, but respectfully, to the colleague about the importance of creating an atmosphere of respect and trust.
272
Which of the following approaches should a nurse take initially to assist an Indigenous patient with type 2 diabetes to lose weight?
Recognizing the importance of traditional eating patterns and reviewing the patient’s cultural heritage and personal preferences.
273
How should a nurse approach a patient with type 2 diabetes who also regularly visits an herbalist healer?
Complete a history of all alternative medicines/therapies that are currently being used by the patient to avoid any interactions.
274
Structural racism has resulted in chronic and continuous substandard outcomes for Indigenous peoples. Which of the following are examples of these disparities? (Select all that apply.)
A) Increased rates of assault of Indigenous women.
B) Increase in numbers of Indigenous children in government care.
C) Higher rates of childhood poverty among Indigenous children than among non-Indigenous children.
D) Increased life expectancy rates for Indigenous men and women.
E) Incarceration of greater numbers of Indigenous people than of non-Indigenous people.
F) Decreased numbers of human immunodeficiency virus (HIV) infections among Indigenous people.
A) Increased rates of assault of Indigenous women.
B) Increase in numbers of Indigenous children in government care.
C) Higher rates of childhood poverty among Indigenous children than among non-Indigenous children.
E) Incarceration of greater numbers of Indigenous people than of non-Indigenous people.
275
How can the nurse support a hospitalized Indigenous patient who wishes to participate in the spiritual practice of sweet grass burning? (Select all that apply.)
A) Determine where this patient can hold this ceremony within the hospital.
B) Assist in locating an Indigenous helper or Elder who can perform this ceremony.
C) Respect the patient through active listening to explore his or her needs.
D) Educate the patient that this ceremony cannot be performed in the facility because of the risk of fire.
E) Plan for this ceremony to be performed for all Indigenous patients that are admitted to your facility.
A) Determine where this patient can hold this ceremony within the hospital.
B) Assist in locating an Indigenous helper or Elder who can perform this ceremony.
C) Respect the patient through active listening to explore his or her needs.
276
An Indigenous woman felt a lump in her breast 1 year ago and has not sought medical attention. Since that time, this lump has tripled in size. A nurse with an awareness of Indigenous people understands that the reason why she did not seek care for this might be which of the following? (Select all that apply.)
A) She is fearful of the screening process.
B) Her role as a caretaker does not allow her time to see the doctor.
C) Her risk of cancer is significantly lower than that of non-Indigenous people.
D) She might feel there is an unequal power relationship with health care professionals.
E) She is fearful of a diagnosis of cancer.
F) Her diet and traditional health practices would support a low risk for cancer.
A) She is fearful of the screening process.
B) Her role as a caretaker does not allow her time to see the doctor.
D) She might feel there is an unequal power relationship with health care professionals.
E) She is fearful of a diagnosis of cancer.
277
Which of the following statements are correct with regard to identifying Indigenous patients at risk for HIV infection? (Select all that apply.)
A) The HIV infection rate is about 3.5 times higher among Indigenous persons than among non-Indigenous persons.
B) Only homosexual Indigenous patients should be considered at risk for HIV infection.
C) Only patients who use intravenous drugs should be considered at risk for HIV infection.
D) An Indigenous patient with a diagnosis of HIV infection has increased self-abusive behaviours.
E) A monogamous heterosexual Indigenous woman is not considered at risk for HIV infection.
F) There has been an increase in culturally safe programming and education initiatives that resonate for Indigenous youth.
A) The HIV infection rate is about 3.5 times higher among Indigenous persons than among non-Indigenous persons.
D) An Indigenous patient with a diagnosis of HIV infection has increased self-abusive behaviours.
F) There has been an increase in culturally safe programming and education initiatives that resonate for Indigenous youth
278
A nursing student gives herself positive messages regarding her ability to do well on a test. This is an example of what level of communication?
Intrapersonal.
279
The nurse demonstrates active listening by doing which of the following?
Assuming a relaxed posture and leaning toward the patient.
280
During the orientation phase of the helping relationship, the nurse might do which one of the following?
A) Comment on the cards and flowers in the room.
B) Work together with the patient to establish goals.
C) Review the patient’s history to identify possible health concerns.
D) Use therapeutic communication to manage the patient’s confusion.
Comment on the cards and flowers in the room.
281
If the nurse is working with a patient who has expressive aphasia, it would be most helpful for the nurse to do which of the following?
Allow extra time for the patient to respond.
282
The professional nurse can best be said to be engaging in collaboration with others to develop the patient’s plan of care when the nurse does which of the following?
Works with colleagues and patients’ families to take advantage of combined expertise in planning care.
283
The nurse tells the patient, “I’m not sure I understand what you mean by ‘sicker than usual.’ What is different now?” Which therapeutic technique is the nurse using?
Clarifying.
284
The nurse says to the patient, “We’ve talked a lot about your medications, but let’s look more closely at the trouble you’re having in taking them on time.” Which therapeutic technique is the nurse using?
Focusing.
285
When working with an older person, what should the nurse remember to avoid?
Shifting from subject to subject.
286
The nurse may facilitate verbal communication with patients by doing which of the following?
Using short sentences that express an idea simply and directly.
(Verbal communication should be clear and brief. Fewer words result in less confusion. Communication that is simple, brief, and direct is more effective. Medical jargon may sound like a foreign language to patients unfamiliar with the health care setting and should be used only with other health team members. Nurses should carefully select words that cannot be easily misinterpreted, especially when explaining a patient’s medical condition or therapy. Speaking slowly and deliberately can convey a condescending attitude. Long pauses and rapid shifts to another subject may give the impression that the nurse is hiding the truth.)
287
The nurse feels frustrated because she is behind in administering her patients’ medications. The nurse comes to one patient’s bedside hurriedly with a frown on her face and sighs while she is waiting for the patient to swallow the medication. The nurse then says brightly, “Isn’t it a relaxing day?” The nurse should remember which of the following?
When incongruity exists between verbal and nonverbal communication, the receiver usually “hears” the nonverbal message as the true message.
288
A patient’s family member wipes her eyes as she cries at the loss of a loved one and says, “It’s no big deal. I mean, we all have to die sometime, right?” The nurse is engaging in metacommunication when he responds with which of the following statements?
“Losing a loved one can be really difficult. It looks like you’re pretty upset. I’d like to help.”
(Metacommunication uncovers the deeper message beneath what is being overtly said.)
289
A nurse–patient helping relationship is characterized by which of the following actions by the nurse?
Conveying nonjudgemental acceptance with a willingness to hear a message or to acknowledge feelings
290
A patient with diabetes is hospitalized with a sore on his foot that has failed to heal. While the nurse is gathering a videotape and some printed material on diabetes to begin teaching the patient, he calls the nurse asking for something to decrease his pain. In terms of the elements of the communication process, which is the referent in this situation?
The patient’s pain.
291
Which of the following illustrates the focus of the nurse’s interaction during the working phase of the nurse–patient helping relationship?
A) That nurse says to the patient, “Hi, Mr. Owen. My name is Gwen, and I’ll be your nurse today.”
B) The nurse asks the patient, “What do you think would help you recover more quickly from your surgery?”
C) The nurse asks another nurse while receiving a report, “What did the laboratory report indicate for Mr. Owen?”
D) The nurse tells the patient, “My shift will be over in about 30 minutes, but I’ll see you again tomorrow. You did really well with physiotherapy today.”
B) The nurse asks the patient, “What do you think would help you recover more quickly from your surgery?”
(During the working phase, the nurse helps the patient with self-exploration and goal setting. Option D illustrates the termination phase, in which the nurse reminds the patient that termination is near and evaluates goal achievement with the patient. Option C exemplifies the preinteraction phase, in which the nurse reviews available data and talk with other caregivers who may have information about the patient. Option A demonstrates the orientation phase, in which the nurse, using introductions and social talk, begins to establish a relationship that initially is superficial. The nurse sets the tone for the relationship in a caring manner and clarifies the nurse’s role and the patient’s role.)
292
A nursing instructor notices that a student nurse is showing a lack of professionalism when the student does which of the following?
Shares personal information about his assigned patient with other students not involved in the patient’s care.
293
Which of the following is an example of a positive outcome of a nurse–health team relationship?
A) The nurse becomes an effective change agent in the community.
B) The nurse better understands the family dynamics that affect the patient.
C) The nurse better appreciates what the patient perceives as meaningful from the patient’s perspective.
D) The nurse receives encouragement and support from co-workers to cope with the many stresses associated with the nursing role.
D) The nurse receives encouragement and support from co-workers to cope with the many stresses associated with the nursing role.
294
The nurse is meeting a 3-year-old for the first time. Communication with the child will be facilitated if the nurse does which of the following?
The nurse kneels down while holding and talking to a teddy bear.
295
To facilitate communication with an older person who is hard of hearing, the nurse should do which one of the following?
Face the patient and maintain eye contact
296
A patient says to the nurse, “It was a stupid thing that I did. If I had just stayed home, this car accident wouldn’t have happened.” Which of the following is the nurse’s best response?
A) “So, why did you go out?”
B) “Why would you say that?”
C) “If I were you, I’d quit worrying about it. You can’t change the past.”
D) “You feel responsible for the accident, as though it could’ve been prevented.”
D) “You feel responsible for the accident, as though it could’ve been prevented.”
(Option D demonstrates the therapeutic communication technique of paraphrasing. Paraphrasing is restating another’s message more briefly using one’s own words. Through paraphrasing, the nurse send feedback to indicate that he or she is actively involved in the patient’s search for understanding. Asking for explanations is a nontherapeutic communication technique. Giving one’s personal opinion is also nontherapeutic. Asking personal questions that are not relevant to the situation to satisfy the nurse’s curiosity is both nontherapeutic and nonprofessional.)
297
The nurse says to the patient, “We’ve talked a lot about your surgery and the implications for you when you go home. Let’s discuss some of the exercises you can do.” This is an example of which following communication technique?
Focusing.
298
Which of the following is an example of transpersonal communication?
Prayer.
299
Which of the following statements by the nurse would be nontherapeutic and tend to block communication? (Select all that apply.)
“Why are you so nervous?”
“If I were you, I’d have the surgery.”
“I’m sure the test results will come out fine.”
300
A nurse who engages in communication with a patient by using relational practice would include which of the following techniques? (Select all that apply.)
```
A) Empathy.
B) Self-observation.
C) Secondary information.
D) Reflection.
E) Evidence-informed details.
F) Mutuality.
```
A) Empathy.
B) Self-observation.
D) Reflection.
F) Mutuality.
(Relational practice is guided by conscious participation with patients through the use of a number of relational skills including listening, questioning, empathy, mutuality, reciprocity, self-observation, reflection, and a sensitivity to emotional contexts.)
301
If an infectious disease can be transmitted directly from one person to another, it is called which of the following?
A communicable disease.
302
A patient who has been admitted to the unit has been identified as being colonized by (a carrier of) methicillin-resistant Staphylococcus aureus (MRSA). Which measure should be taken to prevent the spread of MRSA to other patients on the unit?
Placing the patient in a single or a private room, and placing the patient on contact precautions.
303
The nurse is assigned to care for a patient with a deep wound infection. Which action would result in the contamination of sterile gloves?
The nurse pulls up the sheet over the patient’s perineum for better draping.
(If the nurse touches a sheet (nonsterile) with sterile gloves, the gloves are contaminated. The other actions do not contaminate sterile gloves.)
304
A patient is isolated because he has pulmonary tuberculosis. The nurse notes that the patient seems angry but knows this is a normal response to isolation. What is the best intervention?
Explain the isolation procedures, and provide meaningful stimulation.
305
When should the nurse wear a gown?
If blood or body fluids may get on the nurse’s clothing from a task the nurse plans to perform.
306
When the nurse is performing surgical hand hygiene, what is the appropriate position for the hands?
Above the elbows
307
To remove a glove that is contaminated, what should the nurse do first?
Grasp the outside of the cuff or palm of the glove and pull it away from the hand without touching the wrist or fingers.
308
What is the most effective method by which the nurse can break the chain of infection?
Wash hands between procedures and patients.
309
Which of the following statements reflects the current trend in the directives from the Centers for Disease Control and Prevention for minimizing the risks of infection?
Keep all drainage tubing below the level of the waist or site of insertion.
(Keeping the solution in drainage tubes draining away from the drainage site on the body reduces the risk for bacteria growth. Running any solution backward in the tubing puts the patient at risk by bringing any bacteria that may be present lower in the system back to the body; cross-contamination will occur. As in surgical areas, anything below the waist should be considered at potential risk for infection. Needles are not to be recapped or cut because of the increased risk for puncture wounds while this is done. Dressings do not need to be placed in red bags. Bottles of solution that are sitting in the patient’s room should be closed to prevent airborne contaminants from entering and creating an unsterile situation._
310
The nurse has just admitted a patient to rule out Alzheimer’s disease. The patient is confused and spitting on everyone who enters the room. What should the nurse do?
Use gloves, a mask, a face shield, and a gown when entering the room to perform the initial assessment
311
For which airborne disease would the nurse be required to use gloves, respiratory devices, and a gown when in close contact with an affected patient?
Chickenpox.
(An N95 mask is required for both chickenpox and tuberculosis because in these diseases, small particles float in the air. A respiratory protection device is form-fitted to the face to prevent the escape of air around the seal. Mycobacterium tuberculosis must be in an airborne droplet nucleus to be spread; gloves and a gown are not required. However, for chickenpox, transmission is airborne via droplet and direct contact from vesicle fluid and respiratory secretions; therefore, gloves and a gown are also worn, in addition to an N95 mask, to prevent contamination and transport of infective particles to other patients. For viral pneumonia, a regular mask is used as a barrier because the particles do not float in the air and are more likely to be found on surfaces. Scabies is spread by contact, and gloves and a gown would be necessary; masks would not be needed.)
312
Before the nurse washes hands when leaving an isolation room, what is the last clothing item that the nurse removes?
Goggles
(Goggles are the least contaminated item and the last to be removed before hand hygiene. The gown and gloves are removed first. Head covers are usually not worn in isolation rooms as a barrier. The mask is considered contaminated, and it should be untied and discarded after the gown is removed to minimize contamination from the gown or gloves.)
313
The nurse is setting up a sterile field for the physician. Which of the following statements concerning a sterile field is correct?
A 2.5-cm area around the border should be considered to be the barrier between the sterile field and under the table.
314
When transferring a sterile item to a sterile field, what should the nurse do?
Open the package by peeling back the cover without touching the inner package, and drop the item within the sterile field without touching the 2.5-cm border.
315
Which comparison between a surgical scrub and a regular hand hygiene session is correct?
The fingers are held down to rinse in routine hand hygiene but are held upright when performing a surgical scrub.
316
Which part of a sterile glove is considered contaminated once the glove is applied by the open gloving method?
The inner cuff of each glove.
317
Which of the following laboratory tests will show elevated results if a bacterial infection is present?
White blood cell count.
318
The interval during which a patient manifests signs and symptoms specific to a type of infection is which of the following?
Illness stage
319
What is the term for inflammatory exudate that is yellow/green in colour?
Purulent drainage.
| Purulent exudate is thick, yellow/green drainage that contains pus.
320
The nurse discovers an electrical fire in a patient’s room. What would the nurse’s first action be?
Evacuate any patients or visitors in immediate danger
321
A parent calls the pediatrician’s office frantic because her 2-year-old son drank a bottle of bathroom cleaner. Which of the following is the most important instruction the nurse can give to this parent?
Call the poison control centre.
322
A couple has brought in their adolescent daughter for a school physical examination. The parents tell the nurse that they are worried about all the safety risks for this age group. As the nurse plans to teach the parents about these risks, the nurse remembers that adolescents are at a greater risk for injury from which of the following?
Automobile accidents, suicide, and substance abuse.
323
During the night shift, a patient is found wandering the hospital halls looking for a bathroom. After taking the patient to the bathroom, what would the nurse’s initial intervention be?
Provide scheduled toileting during the night shift.
324
Lisa, a trained unregulated care provider, is working with the nurse during the nurse’s shift. One of the nurse’s patients has upper limb restraints. In delegating care of this patient to Lisa, the nurse would tell her to do which of the following?
Report any signs of redness, excoriation, or constriction of circulation under the restraint.
325
The family of a confused ambulatory patient insists that all four side rails be up when the patient is alone. Which is the best way to handle this situation?
Inform them of the risks associated with side rail use.
326
During the nurse’s assessment of a 56-year-old man, he reports increased alcohol consumption because of stress at work. Which of the following is one of the expected outcomes for this patient?
The patient will attend stress management classes.
327
A child for whom the nurse is caring in the hospital starts to have a grand mal (tonic-clonic) seizure while playing in the playroom. What is the most important nursing intervention during this situation?
Clear the area around the child to protect the child from injury.
328
When providing health maintenance teaching to new employees in the food-handling department, the nurse emphasizes the need to perform hand hygiene after using the bathroom to prevent which of the following?
Spread of hepatitis A.
-The hepatitis A virus is spread via fecal contamination of food, water, or milk. It is essential that food handlers wash their hands anytime they use the bathroom. Food poisoning can be due to bacterial contamination of food from a variety of sources, but not usually feces. Bacterial contamination, including Salmonella contamination, usually arises from uncooked eggs.
329
Which action by the nurse is most effective in limiting the transfer of microorganisms?
Hand hygiene.
330
A student nurse is designing a health fair project aimed at reducing motor vehicle accidents. For which group of patients would this subject be most appropriate?
Adolescents.
331
As a member of the hospital’s bioterrorism team, the nurse understands the importance of knowing how an organism is transmitted. Smallpox has the potential to spread quickly because its route of transmission is which of the following?
Airborne.
332
After the nurse assists a patient with a history of seizures to a recliner chair, the patient begins to have a seizure. What should the nurse do immediately?
Slide the patient to the floor and cradle the patient’s head.
(The nurse’s lap is the safest position for the patient’s head, and the patient is less likely to sustain an injury if he or she is already on the floor. Attempting alone to move the patient laterally could result in injury to the patient, the nurse, or both. Placement in a reclining position could cause excess secretions to accumulate in the oral pharynx and obstruct the airway. Turning the patient onto his or her stomach would decrease access to the airway.)
333
Helen Chow, an 89-year-old patient, has a history significant for confusion, impaired judgement, and incontinence. Her cousin remarks that Ms. Chow is “cheerful” and “kind.” Living alone, Ms. Chow may be at risk for which of the following?
Falls.
334
Which of the following types of restraint is commonly used with an infant or small child?
Mummy restraint.
(A mummy restraint consists of a sheet or blanket wrapped around the child to control movement of the torso and extremities. Wrist and waist restraints are not commonly used for infants and children.)
335
A student nurse is preparing medication for a patient. The clinical instructor identifies an error before administration and reviews the error with the student. This event would be considered which of the following:
A near miss
(A near miss is an incident that did not reach the patient (no harm resulted). A no-harm incident is an incident that reached the patient, but no discernible harm resulted. A harmful incident is an incident that resulted in patient harm. A critical error is not considered a patient safety incident.)
336
Which of the following statements is true regarding restraints? (Select all that apply.)
A) An example of an environmental restraint is a locked nursing unit.
B) Mechanical restraints should be applied when the nurse is busy.
C) Chemical restraints are psychoactive medications.
D) Restraints must not be considered punitive.
A) An example of an environmental restraint is a locked nursing unit.
C) Chemical restraints are psychoactive medications.
D) Restraints must not be considered punitive.
337
The nurse is having difficulty reading a prescriber’s order for a medication. The nurse knows that the prescriber is very busy and does not like to be called. What should the nurse do?
Call the prescriber to have the order clarified.
338
The patient has an order for two tablespoons of milk of magnesia. The nurse converts this dose to the metric system. How much should the nurse give the patient?
30 mL.
339
Most medication errors occur when the nurse does which of the following?
Fails to follow standard precautions and routine practices
340
A patient is to receive cephalexin (Keflex), 500 mg by mouth. The pharmacy has sent 250-mg tablets. How many tablets does the nurse give?
2 tablets
341
When identifying a new patient before administering medications, the nurse asks the patient to state his name. The patient does not give the correct name. The nurse asks again, and the patient states yet another name. What is the nurse’s next action?
Look at the patient’s identification bracelet to correctly identify the patient. Reorient the patient to person, place, and time, and report patient confusion to the primary health care provider.
342
A patient is transitioning from the hospital to the home environment. A home health referral has been obtained. In terms of safe medication administration, what is the nurse’s priority as the discharge nurse?
Ensuring that the home health care agency is aware of medication and health teaching needs.
343
The nurse is about to administer an antibiotic to a patient. The patient asks what the medication is and why he should take it. What should the nurse tell the patient?
Provide the name of the medication and a description of its desired effect.
344
The nurse is administering a sustained-release capsule to a new patient. The patient insists that he cannot swallow pills. Which is the best course of action?
Ask the physician to change the order.
345
The nurse selects the route for administering medication according to which of the following protocols?
The prescriber’s orders.
346
A patient is receiving medication by intravenous (IV) push. If this type of drug infiltrates into the outer tissues, what will the nurse do?
Follow facility policy or the drug manufacturer’s directions. Notify the prescriber if necessary.
347
If a patient who is receiving IV fluids develops tenderness, warmth, erythema, and pain at the site, what does the nurse suspect?
Phlebitis.
(Warmth, redness, and tenderness of an IV site indicate phlebitis. Infiltration usually manifests as a cool, swollen, and pale IV site. Sepsis is an infection, and signs of sepsis may or may not be present at the site. Fluid overload will not produce specific changes at the IV site.)
348
A nurse administering medications has many responsibilities. Among these responsibilities is a knowledge of pharmacokinetics. Which statement is the best description of pharmacokinetics?
The study of how medications enter the body, reach their site of action, are metabolized, and exit the body.
349
When the nurse delivers a medication to a patient, who has the ultimate responsibility for the medication that is being administered?
Both the prescriber and the nurse administering the medication.
350
The following orders were written by a prescriber. Which order is written correctly?
A) Aspirin, 2 tablets prn.
B) Haloperidol (Haldol), ½ tablet at bedtime.
C) Zolpidem (Ambien), 5 mg by mouth at bedtime prn.
D) Levothyroxine (Synthroid), 0.05 mg 1 tablet.
C) Zolpidem (Ambien), 5 mg by mouth at bedtime prn.
(The order for zolpidem is the only medication order that contains the essential components of a drug order: name of medication, dose, route of administration, and frequency.)
351
To better control the patient’s blood glucose level, the physician orders a high regular insulin dosage of 20 units of U-500 insulin. The nurse has only a U-100 syringe. How many units will be given?
4.
352
The nurse is administering an intramuscular (IM) injection. Why is the Z-track method a suggested method for IM injections?
It minimizes local skin irritation by sealing the medication in muscle tissue.
353
What is the best nursing practice for administrating a controlled substance if part of the medication must be discarded?
The nurse documents on the medication administration record and the control inventory form and has a second nurse witness the medication being discarded.
354
When administering medications, it is essential for the nurse to have an understanding of basic arithmetic to calculate doses. The physician has ordered 250 mg of a medication that is available in a 1-g amount. The vial reads 2 mL = 1 g. What dose would the nurse give?
0.5 mL.
355
While the nurse is administering medication, the patient says, “This pill looks different from what I usually take.” What is the best action for the nurse to take?
Recheck the medication order, taking along the medication.
356
The patient is a 40-year-old man who weighs 72.7 kg and is 175.26 cm tall. The order is for 5 mL of a medication to be given as a deep IM injection. What size syringe and what gauge and length of needle should the nurse use for best practice?
Two 3-mL syringes, 20- to 23-gauge, 3.8-cm needle
(A medication dose of 5 mL administered IM is unlikely to be absorbed properly in this patient. Therefore, dividing the dose is correct. Dividing the doses equally allows 2.5 mL to be given in two different sites, so the nurse will need two 3-mL syringes. A deep IM injection must pass through subcutaneous tissue and penetrate deep muscle; therefore, the needle must be long enough (3.8 cm) and the gauge heavy enough (20 to 23 is the best choice).)
357
A site that was formerly a traditional location for IM injections is no longer recommended because its use carries the risk of striking the underlying sciatic nerve or major blood vessel. What is the name of this site?
Dorsogluteal.
358
Which of the following describes the correct method for applying a patient’s eye ointment?
Apply the ointment to the lower conjunctiva, from the inner canthus to outer canthus.
359
Which two factors contribute to the projected increase in the number of older persons?
Aging of the baby boom generation and the growth of the population segment over age 85.
360
Which of the following is true about aging?
No single theory explains aging.
361
Which three common conditions affect cognitive function in older persons?
Delirium, depression, and dementia.
362
Sexuality is recognized as a part of life for older persons. Which of the following is true?
All older persons, whether healthy or frail, need to express sexual feelings.
363
Although the older person’s libido does not decrease, changes occur in sexual activity. Which of the following is correct with regard to these changes?
The frequency of and opportunities for sexual activity may decline.
364
Visual acuity declines with age. Presbyopia is a progressive decline in which of the following?
Ability of the eyes to accommodate for close, detailed work.
(Presbyopia is a decrease in accommodation (inability to focus sharply) for near vision. Other visual acuity problems that develop with age include poor colour perception and difficulty adjusting to changes from light to dark.)
365
Which term is used for a common age-related change in auditory acuity?
Presbycusis.
(Presbycusis is the loss of sensitivity to high-frequency tones that occurs with aging. Presbyopia is the loss of visual accommodation for near vision that usually begins in middle age. Calcification is the hardening of previously soft or flexible structures. Hypertrophy is an enlargement.)
366
In older people, taste buds atrophy and lose sensitivity, and appetite may decrease. Which of the following are older people therefore less able to discern?
Salty, sour, sweet, and bitter tastes.
367
Which of the following characterizes kyphosis, a change in the musculoskeletal system?
Changes in the configuration of the spine that affect the lungs and thorax.
368
What is it important for the nurse to do when caring for the older person?
Treat the patient as an individual with a unique history of his or her own.
(Although many older persons may share the same physiological changes of aging, each individual should be assessed for his or her own personal strengths and limitations. To treat older persons otherwise would distort the caregiver’s understanding of the individual. A common stereotype of older persons is that they are forgetful, yet many centenarians have good memories. An effective teaching technique is to draw on the older person’s past experiences. It also helps demonstrate respect for the older person as a unique and valued individual. A common misconception is that older persons are not interested in sex and that any interest in sexual activities is abnormal and should be discouraged. Older persons report continued enjoyment of sexual relationships. Speaking in a louder voice is appropriate for a person who is hard of hearing; however, not all older persons are hard of hearing.)
369
Which statement about older persons in Canada is correct?
The number of older persons is rising because of the increase in the average lifespan and the aging of the baby boom generation.
370
When assessing the older person, the nurse should know which findings represent common physiological changes associated with aging and which are abnormal findings. Which of the following is a normal and common physiological change?
A) Urinary incontinence.
B) Increase in saliva production and small intestine motility.
C) Increase in the time required for the heart rate to return to baseline after exercise.
D) Coldness of feet, caused by a decrease in muscle mass and a decrease in the number of neurons.
C) Increase in the time required for the heart rate to return to baseline after exercise.
(An older person’s body tries to compensate for decreased cardiac output by increasing the heart rate during exercise. After exercise, however, it takes longer for the older person’s heart rate to return to baseline. Older persons have decreased saliva flow and slowing of peristalsis. Decreased motility of the small intestine may increase an older person’s risk for developing constipation. Urinary incontinence is an abnormal condition, not a normal physiological response to aging. Older people do have decreased muscle mass and strength; however, coldness of the feet is more likely to be the result of decreased cardiac output and decreased circulation in the lower extremities, as evidenced by weaker peripheral pulses in the feet.)
371
To meet the psychosocial needs of the older person, the nurse may do which of the following?
Acknowledge the older person’s role transitions and changes
372
An older person with a recent diagnosis of urinary tract infection displays a sudden onset of confusion. Which of the following is she most likely experiencing?
Delirium.
373
To enhance effectiveness in teaching the older person, the nurse should do which of the following?
Speak in clear, low-pitched tones.
374
General health promotion and illness prevention measures the nurse may recommend to older persons include which of the following?
Exercising regularly.
(Regular exercise is a general preventive measure that the nurse may recommend. Other measures include weight reduction if the patient is overweight, management of hypertension, smoking cessation, and updating of immunizations. Older persons should take medications as prescribed. Annual immunization against influenza is strongly recommended for all older persons, with special emphasis on residents of long-term care facilities and patients of any age with chronic cardiovascular, pulmonary, and metabolic disorders. Immunization with the pneumococcal pneumonia vaccine is recommended for all adults older than 65 years. Unlike influenza vaccine, pneumococcal pneumonia vaccine is given only once, although some authorities recommend revaccination 6 to 8 years after the initial vaccination.)
375
Nurses have the responsibility to dispel myths and replace stereotypes of older persons with accurate information. Which of the following does the nurse know is true about most older persons?
A)They are confused.
B) They are forgetful and rigid.
C)They have a reduced ability to respond physically to stress.
D) They are unable to understand and learn new information.
C)They have a reduced ability to respond physically to stress.
(Hormone production is altered in older people, and ability to respond to stress is therefore decreased. A common misconception about aging is that cognitive impairments are widespread among older persons, but confusion is not a normal aging change; in fact, centenarians are described as having good memories, broad social contacts and interests, and tolerance for others. Although the process of learning may be affected by age-related changes in vision or hearing or by reduced energy and endurance, older persons are lifelong learners.)
376
The older person is at risk for falls for various reasons. What might the nurse do to help prevent falls?
Instruct the older person to use a night light in the bathroom
377
Which of the following is not a normal physiological change associated with aging?
Osteoporosis.
(Bone demineralization may occur in older persons, but osteoporosis is not a normal physiological change of aging. Decreased contractile strength of the myocardium results in decreased cardiac output. Eye changes include a reduced ability to see in darkness and to adapt to abrupt changes from dark to light (and the reverse). Presbyopia, a progressive decline in the ability of the eyes to accommodate for close, detailed work, is also common. Age spots, or senile lentigo, may be present, initially appearing on the backs of the hands and the forearms.)
378
Acute care settings pose an increased risk for adverse events such as which one of the following?
Falls.
379
Why are most older persons comfortable with the idea of their mortality?
It would be wrong to assume that the older person is comfortable with the idea.
(Death is not a focus or an expectation for the older person. Many older persons consider themselves to be middle-aged in their seventh decade, and every adult is unique and individual. The nurse may be the only person to whom the older person will turn for understanding and for coping with death and loss. Despite the older person 's previous experiences with loss and grief, it would be wrong to assume that anyone is comfortable with the notion of mortality.)
380
An older man is being cared for at home by his wife, who is also an older person. His wife is having difficulty meeting his nutritional and personal care needs; as a result, he has developed a stage 3 pressure injury. This would be an example of which of the following?
Neglect
381
When assessing the older person, the nurse should review the patient's achievement of developmental tasks. For the older person, these may include which of the following? (Select all that apply.)
A) Coping with the loss of the work role.
B) Accepting himself or herself as aging. Correct
C) Redefining relationships with children.
D) Engaging in more introspective, self-focused activities.
A) Coping with the loss of the work role.
B) Accepting himself or herself as aging. Correct
C) Redefining relationships with children.
382
What should the nurse be aware of with regard to a request for organ and tissue donation at the time of death?
Specially educated personnel make these requests
383
The home health nurse is asked by a family member what he should do if the patient’s chronic illness continues to worsen even with increased medical interventions. The nurse recognizes that the family member is posing a question about goals of care at the end of life. What should the nurse do?
Begin the discussion by asking the family member what he believes the goals should be.
384
A patient’s family member remarks to the nurse, “The doctor said he will provide palliative care. What does that mean?” Which of the following is the nurse’s best response?
“Palliative care aims to relieve or reduce the symptoms of a disease.”
385
A woman experiences the loss of a very early term pregnancy. Her friends do not mention the loss, and someone suggests to her that she can “always try again.” The woman feels confusion over her sadness and stops talking about it with others. Which type of grief may the woman be experiencing?
Disenfranchised.
386
A family member of a recently deceased patient talks casually with the nurse at the time of the patient’s death and expresses relief that she will not have to visit at the hospital anymore. Which of the following may apply to this family member in terms of her grief?
Denial.
(In the denial stage, a person acts as though nothing has happened and refuses to accept the fact of a loss. This is a normal stage and a self-protective mechanism. Anticipatory grief is the unconscious process of disengaging or letting go, before the actual loss or death occurs, especially in situations of prolonged or predicted loss. In dysfunctional grief, the grieving person has a prolonged or significantly difficult time moving forward after a loss. Emotional outbursts of tearful sobbing and acute distress characterize Bowlby’s second stage of grief, termed yearning and searching.)
387
When the nurse is caring for dying and grieving patients, a self-care goal might be which of the following?
e nurse should maintain life balance and reflect on the meaning of his or her work.
388
During post-mortem care, the nurse should give priority to which of the following?
Providing culturally and religiously sensitive care in body preparation
389
A patient has recently been told he has terminal cancer. As the nurse enters the room, he yells, “My eggs are cold, and I’m tired of having my sleep interrupted by noisy nurses!” The nurse interprets the patient’s behaviour as which of the following?
An expression of the anger stage of dying.
390
When helping a patient work through grief, the nurse knows that which of the following is true?
The stages of grief may occur in the standard order, they may be skipped, or they may recur
(Grief is manifested in a variety of ways that are unique to the individual and based on personal experiences, cultural expectations, and spiritual beliefs. The coping mechanisms that were effective in the past are repeated as a first response to the pain of a loss. When older coping strategies are unsuccessful, new coping mechanisms are attempted. The type of loss and the perception of the loss influence the depth and duration of grief that a person experiences. The nurse must not assume that patients want to be left alone. If a patient chooses not to share feelings or concerns, the nurse should convey a willingness to be available when needed. Sometimes patients need to begin resolving their grief before they can discuss their loss.)
391
It is one day after the patient underwent a mastectomy for the treatment of her breast cancer. The patient is crying when the nurse enters the room. Which of the following is the nurse’s best response?
“You seem upset. Would you like to tell me about what is bothering you?
392
A patient in the end stage of terminal cancer is hospitalized. His family members are sitting at his bedside. What can the nurse do to best aid the family at this time?
Find simple and appropriate care or comfort activities for the family to perform.
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