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NUR 102 Fundamentals of Nursing Exam 1 Test Bank,Complete answers.

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Fundamentals of Nursing Exam Ch. 1 A nurse manager is teaching staff how to use a new piece of hospital equipment. What educational setting would be most appropriate for this process? Which of t... he following nursing pioneers established the Red Cross in the United States in 1882? Which of the following nursing interventions would be the most appropriate for a new mother that calls the nursery for help with breastfeeding? Which age group in the population is expanding most rapidly, resulting in changes in the delivery of healthcare? A student has completed a nursing program accredited by the Commission on Collegiate Nursing Education. Which of the following is true about the organization? Nurse H. graduated several years ago from a 2-­year nursing program that he took at a community college near his home city. Recently, Nurse H. has considered moving from providing direct patient care into an administrative role, but he recognizes the need to further his education in order to be considered for such a position. Nurse H. most likely possesses which of the following nursing qualifications? In what time period did nursing care as we now know it begin? A nurse conducts a smoking-­cessation program for patients of a neighborhood clinic. This is an example of which of the following aims of nursing? A man age 61 years is distraught because he has just learned that his most recent computed tomography (CT) scan shows that his colon cancer has metastasized to his lungs. Which of the following nursing aims should the nurse prioritize in the immediate care of this patient? The nurse working with an LPN understands which of the following about LPNs? A registered nurse wishes to work as a nurse researcher. Which of the following is true regarding nurse researchers? A nurse educator is discussing the role of nursing based on the American Nurses Association (ANA). Which statement best describes this role? The nurse recognizes that immunizations are an example of: A nurse is caring for a client with quadriplegia who is fully conscious and able to communicate. What skills of the nurse would be the most important for this client? What is the primary purpose of standards of nursing practice? Which of the following organizations is the best source of information when a nurse wishes to determine whether an action is within the scope of nursing practice? Which of the following might a nurse need to do to ensure the continuation of his/her nursing license? A nurse is thinking about pursuing a master's degree in nursing and is reviewing information about various programs. Which of the following would the nurse expect to find about such programs? Which one of the following examples of nursing actions would be considered an ethical/legal skill? The registered nurse communicates with the physical therapist that a client is now on strict bed rest due to bradycardia. Which statement best explains the standard exemplified by the nurse? A nurse is gathering information about a person's culture and beliefs related to health and how these beliefs influence the person. The nurse is evaluating which functional health pattern? Which of the following nursing interventions would be the most appropriate for a new mother that calls the nursery for help with breastfeeding? During the clinical rotation, a nurse documents the vital signs of a client on the bedside chart. What role is the nurse playing in such a situation? A nurse is providing care for patients in a long-­term care facility. Based on the definitions of nursing in the textbook, what should be the central focus of this care? The nursing process is: Which of the following is a characteristic of nursing practiced from early civilization to the 16th century? Ch.10 A nurse has come on day shift and is assessing the client's intravenous setup. The nurse notes that there is a mini-­bag of the client's antibiotic hanging as a piggyback, but that the bag is still full. The nurse examines the patient's medication administration record (MAR) and concludes that the night nurse likely hung the antibiotic but failed to start the infusion. As a result, the antibiotic is three hours late and the nurse has consequently filled out an incident report. In doing so, the nurse has exhibited which of the following? Nursing is a profession in a rapidly changing health care environment. What is the most important reason for the nurse to develop critical thinking and clinical reasoning? A group of student nurses are working on developing various nursing skills and are at various stages of skill acquisition. The instructor determines that which student is at the novice stage? The nurse caring for a client formulates client outcomes based on the understanding that the outcomes should be which of the following? Two nurses have disagreed about the role of intuition in nursing practice, with one nurse characterizing it as "hocus-­pocus" and the other nurse advocating it as a superior problem-­solving strategy. Which of the following statements best conveys the role of intuition in nurses' problem solving? Based on an established plan of care, a nurse turns a client every two hours. What part of the nursing process is the nurse using? Based on an established plan of care, a nurse turns a client every two hours. What part of the nursing process is the nurse using? Which of the following are involved in the implementation step in the nursing process? What nursing organization first legitimized the use of the nursing process? The nurse employs interpersonal skills of communication when caring for and interacting with clients. Which of the following is the best example of establishing a therapeutic nurse-­client relationship? Which step of the nursing process is the nurse performing when analyzing client data to identify client strengths and health problems that independent nursing interventions can prevent or resolve? Then nurse is making morning rounds after receiving reports on clients. The nurse takes the opportunity to greet the clients and do an initial observation. The nurse is actually accomplishing which step of the nursing process? Which of the following activities is the clearest example of the evaluation step in the nursing process? Select the best description of how the nurse applies the nursing process in caring for patients. The nurse: Once the nurse has administered pain medication, it is the nurse's responsibility to determine its effect and any other results. When accomplishing this followup with the client, the nurse is utilizing which step of the nursing process? The nurse has measured from the tip of the client's nose to his earlobe and then down to the xiphoid process before inserting a nasogastric (NG) tube and attaching it to low suction. Which of the following components of the nursing process has the nurse demonstrated? Your patient has had major abdominal surgery and just returned to the unit from the operating room. Your nursing priority is to: The nursing student is working with an experienced nurse in ICU. As the nursing student enters the room of the client diagnosed with a cerebral hemorrhage, the experienced nurse immediately says, “This patient is getting worse.” This is an example of the experienced nurse using ... The nursing student uses evidence-­based practice findings in the development of a care plan. This is an example of which type of nursing skill? A home health nurse reviews the nursing care with the client and family and then mutually discusses the expected outcomes of the nursing care to be provided. Which step of the nursing process is the nurse illustrating? A nurse has gathered data through interview, observation, and physical assessment of a client and has formulated diagnostic statements. Which of the following would the nurse do during the outcome identification phase? Which of the following is a true statement regarding critical thinking in nursing? Which of the following interpersonal skills is essential to the practice of nursing? Nursing is a profession in a rapidly changing health care environment. What is the most important reason for the nurse to develop critical thinking and clinical reasoning? The nurse, after gathering data, analyzes the information to derive meaning. The nurse is involved in which phase of the nursing process? The nursing process provides a framework for the patient and nurse to work together. Recording prioritized outcomes in the plan of care ensures which benefit? Your patient is admitted with multiple injuries, including a head injury, fractured ribs, and hypoventilation. Vital signs are: BP 110/84, T. 98.8, P. 88, Resp. 28. The nursing care priority is which of the following? A patent airway is always the priority of nursing care, particularly for patients with a head injury and hypoventilation. Which of the following statements is true of the nursing process? Which of the following is an important element of implementation? Use of the nursing process in healthcare allows the nurse to address the needs of the client. The nursing process: After developing the plan of care for a client, the nurse implements that plan. Which of the following would the nurse most likely use? The American Nurses Association (ANA) has published the standards of care for which the nurse is responsible. The Standards of Practice are: A male nursing student is writing a paper for a class assignment and is integrating critical thinking skills for thinking. While reviewing the paper, the student asks himself which question to ensure that the breadth of the subject matter has been covered? Which of the following statements indicates that a plan to assist a patient in developing and following an exercise program has been effective? Self-­evaluation is a method that nurses use to promote their own development, and to grow in confidence in their nursing roles. This process is referred to as what? A nursing instructor is describing the nursing model of 'person-­centered care' to a class. Which of the following would the instructor include as a characteristic of 'person-­centered care'? Use of the nursing process in healthcare allows the nurse to address the needs of the client. The nursing process: CH.11 Of the following data, what type would be collected during a physical assessment? After performing the admission assessment on an older adult client, the nurse documents the following, "Client observed fidgeting with covers;; facial grimacing when turning from side to side." This documentation is an example of which type of data? How should a nurse best document the assessment findings that have caused her to suspect that a client is depressed following his below-­the-­knee amputation? When charting the assessment of a client, the nurse writes,"Client is depressed." This documentation is an example of which of the following? The nursing instructor is teaching the students how to do an interview on a client. Which of the following statements made by a student indicates a need for further instruction? Who or what is the primary source of information for a nursing history? The nurse is interviewing a client with complaints of chills, fever, malaise, and cough. During the working phase of the client interview, the nurse: The nurse is performing an assessment of a client who has a small wound on the knee, collecting cues about the client's health status. Which of the following would the nurse identify as a subjective cue? A student takes an adult patient's pulse and counts 20 beats/min. Knowing this is not the normal range for an adult pulse, what should the student do next? A client reports to a health care facility with complaints of abdominal pain and vomiting. The client's wife informs the nurse that the client had gone out for dinner the previous night. Which of the following would be the primary source of assessment data? Angina-­ A type of chest pain caused by reduced blood flow to the heat. A nursing student is performing an assessment on a client. Which of the following would the student record as subjective data? Select all that apply. A nurse is assisting with lunch at a nursing home. Suddenly, one of the residents begins to choke and is unable to breathe. The nurse assesses the resident's ability to breathe and then begins CPR. Why did the nurse assess respiratory status? The nurse is performing an admission assessment on a young client admitted to the unit. Which of the following are considered objective data? Select all that apply. A nurse is assessing a client admitted to the health care facility with angina. Which of the following would be most appropriate for the nurse to use to collect subjective data? When performing an assessment, the nurse should focus on the developmental stage for which of the following clients? Which of the following group of terms best defines assessing in the nursing process? How should a nurse best document the assessment findings that have caused her to suspect that a client is depressed following his below-­the-­knee amputation? Which of the following qualities does the nursing student identify as being helpful in inviting the confidence of clients when first working with them? Select all that apply. A nurse performs an assessment of a client in a long-­term care facility and records baseline data. The nurse reassesses the client a month later and makes revisions in the plan of care. What type of assessment is the second assessment? The nurse is performing a physical assessment of a client admitted with emphysema. How will the nursing physical assessment differ from a medical physical assessment? During the nursing examination, the nurse notices that the patient, an elderly female, becomes very tired, but there are still questions that need to be addressed in order to have data for planning care. Which action would be most appropriate in this situation? A client comes to her health care provider's office because she is having abdominal pain. She has been seen for this problem before. What type of assessment would the nurse do? A nurse is assessing a client with chronic back pain and asking specific questions to obtain a focus assessment. Which of the following are features of focus assessment? A group of nursing students is reviewing information about assessment and sources of information. The students demonstrate a need for additional review when they identify which of the following as a secondary source? The nursing instructor is teaching the students how to do an interview on a client. Which of the following statements made by a student indicates a need for further instruction? The nurse is interviewing a client who is admitted to the healthcare facility with difficulty breathing. When beginning the interview, the nurse observes that the client is too breathless to answer. Which of the following would be most appropriate for the nurse to do? An older adult male with a history of benign prostatic hyperplasia presents to the emergency room with complaints of urinary retention. The nurse collects data related to the patient's voiding patterns, weight gain, fluid intake, urine volume in the bladder, and level of suprapubic discomfort. What type of assessment is the nurse performing? Which of the following patient situations most likely warrants a time-­lapsed nursing assessment? A nurse in the emergency department is completing an emergency assessment for a teenager just admitted from a car crash. Which of the following is objective data? Nurses collect objective and subjective data during the patient interview. Which patient data is subjective data? (Select all that apply.) A nurse is collecting information from a client with dementia. The client's daughter accompanies the client. Which of the following statements by the nurse would recognize the client's value as an individual? A client comes to her health care provider's office because she is having abdominal pain. She has been seen for this problem before. What type of assessment would the nurse do? A focused assessment is completed by the nurse to gather data about a specific problem that has already been identified. It is also used to identify new or overlooked problems. The nurse is performing a physical assessment of a newly admitted client. During the assessment the nurse notices the client grimacing and holding the abdomen. When the nurse asks the client is there is any pain the answer is "no." What is the best thing for the nurse to do next? Which type of assessment would the nurse be expected to perform on the client who is one day post-­op following a cholecystectomy? While doing an assessment, the nurse identifies questionable data. Which of the following should the nurse do first? Which of the following group of terms best defines assessing in the nursing process? A nursing student is learning about how to perform a thorough assessment in a health assessment class. Which of the following is the best source of information for the student to learn data collection for an assessment? A nursing student is learning about how to perform a thorough assessment in a health assessment class. Which of the following is the best source of information for the student to learn data collection for an assessment? A nurse is conducting an interview with a patient who complains of abdominal distress. What is an appropriate interview question for this patient? The nurse is conducting a nursing assessment with a client who is unwilling to participate in the interview process. If the nurse makes a diagnostic error it would most likely be because of: The diagnostic process is dependent on complete and accurate data. A nursing assessment with a client who is unwilling to participate in the interview process would most likely result in incomplete data. Omission of pertinent data would lead to diagnostic error CH. 12 A nursing diagnosis of "Ineffective airway clearance" has been chosen by the nurse caring for a client with respiratory problems. Which assessment data would be appropriate evidence of this diagnosis? (Select all that apply An ineffective cough, abnormal breath sounds, and labored respirations are all indications of ineffective airway clearance. Viral pneumonia is a medical diagnosis. Oxygen being administered per nasal cannula is a treatment for respiratory problems. The care plan for a client who has been frequently admitted to the hospital for exacerbation of COPD (chronic obstructive pulmonary disease) has a nursing diagnosis of "Noncompliance related to lack of knowledge as evidenced by frequent admissions to the hospital." What is the most appropriate method for the nurse to use to validate the nursing diagnosis? A client with diabetes mellitus has been admitted to the hospital in diabetic ketoacidosis. During the admission assessment of the client, the nurse learns that the client is not following the prescribed therapeutic regimen. The client states, "I don't really have diabetes. My doctor overreacts." What is the most appropriate diagnosis for this client's health problem? A nurse formulates a nursing diagnosis of "constipation related to adverse effect of opioid analgesic as evidenced by no bowel movement in 4 days." The nurse identifies which of the following as the defining characteristics? The defining characteristics are the observable cues or inferences that cluster as manifestations, which in this case is the lack of a bowel movement in 4 days. Constipation is the diagnostic label. Adverse effect of the medication is the related factor. Opioid analgesic is part of the related factor A new chemical plant is being built in the community. The nurse is concerned about the possibility of environmental pollution adversely affecting the health of the residents. What nursing diagnosis would the nurse use to address this concern? Which of the following are positive outcomes of the use of nursing diagnoses? (Select all that apply.) A client is being admitted from the emergency room with complaints of shortness of breath, wheezing, and coughing. Which of the following would the nurse as an appropriate nursing diagnosis Which example of patient care is not the responsibility of the nurse? A nurse is caring for an elderly client who is scheduled for a cystoscopy the next day to determine the cause of an over-­distended bladder. The client informs the nurse that this the first time that she has been admitted to a healthcare facility for an illness. Which of the following is a diagnostic label the nurse would use to formulate the nursing diagnosis? The nurse has selected a nursing diagnosis of "Impaired home maintenance" for an elderly client. What assessment data would evidence this diagnosis? A nurse is caring for a toddler who has been treated on two different occasions for lacerations and contusions due to the parents’ negligence in providing a safe environment. What is an appropriate nursing diagnosis for this patient? A nurse is caring for a client diagnosed with arthritis. The client is experiencing pain that is interfering with her ability to ambulate. The nurse accurately documents which of the following as a nursing diagnosis in the client's records? A client diagnosed with advanced lung cancer has a nursing diagnosis of ineffective coping. What assessment data would provide evidence to the nurse for this diagnosis? A nurse is formulating a nursing diagnosis for a client with a respiratory disease. Which of the following would be correct? When reviewing the client's history, the nurse notes that it has been recorded that the client's last bowel movement was 2 days ago. Before the nurse identifies a diagnosis of "Constipation," what assessment must the nurse make? In order to validate the diagnosis, the nurse must determine what is the normal for the client. Dietary habits may contribute to the constipation, but do not evidence the nursing diagnosis. Assessing bowel sounds would be important data, but would not evidence the diagnosis of constipation. There is no standard elimination pattern;; it is highly individualized. A nurse is interviewing an elderly client who has experienced a drastic weight loss following a CVA (cerebrovascular accident). The client states, "I have trouble getting groceries since I can no longer drive, so I don't have much food in the house." Based on this evidence, what would be the most appropriate nursing diagnosis Of the following types of nursing diagnoses, which one is validated by the presence of major defining characteristics? During a home health care visit, the nurse identifies a nursing diagnosis of "Caregiver role strain" for a parent who is caring for a ventilator dependent child. What subjective assessment data would support the nurse's diagnosis? The nurse makes a diagnostic error when the: What association meets every 2 years to further progress in defining, classifying, and describing nursing diagnoses? The nurse has identified a collaborative problem of risk for complications of electrolyte imbalance for a client with diarrhea. The client begins to exhibit a decrease in level of consciousness. What is the nurse's most appropriate action? Which of the following nursing diagnoses is an example of a wellness diagnosis? After assessing a client, a nurse identifies the nursing diagnosis, "Ineffective Airway Clearance related to thick tracheobronchial secretions." The nurse would classify this nursing diagnosis as which type? Ineffective Airway Clearance related to thick tracheobronchial secretions" is an actual diagnosis because it describes a human response to a health problem that is being manifested. A wellness diagnosis is a diagnostic statement that describes the human response to levels of wellness in an individual, family, or community that has a potential for enhancement to a higher state. A risk nursing diagnosis describes human responses to health conditions or life processes that may develop in a vulnerable individual, family, or community. A possible nursing diagnosis is made when not enough evidence supports the presence of the problem, but the nurse thinks that it is highly probable and wants to collect more information A client recently diagnosed with pancreatic cancer tells the nurse, "I don't see any hope for my future." What would be the most appropriate nursing diagnosis for the nurse to formulate to address this health problem? A pregnant client asks the nurse for information on breastfeeding her baby. What type of nursing diagnosis would the nurse formulate? The client is seeking information related to healthy practices. Wellness diagnoses are formulated to assist the client to meet that need. The client has no health problem or possible problem, so an actual diagnosis, a risk diagnosis, and a possible diagnosis are inappropriate. A newly graduated nurse is unable to determine the significance of data obtained during an assessment. What would be the nurse's most appropriate action? A nurse in the emergency room, who is unfamiliar with pediatric clients, assesses the vital signs of a one month old infant with a heart rate of 124 and a respiratory rate of 36. What would be the most appropriate measure for the nurse to take to analyze the significance of the infant's vital signs? A nursing diagnosis is written as Disturbed Self-­Esteem related to presence of large scar over left side of face. What does the phrase “Disturbed Self-­Esteem” identify? A client has been diagnosed with a recent myocardial infarction. What collaborative problem would be the priority for the nurse to address? A student identifies Fatigue as a health problem and nursing diagnosis for a client receiving home care for treatment of metastatic cancer. What statement or question would be best to validate this client problem? The nurse is caring for an adolescent verbalizing a desire to seek counseling for grief related to the death of a close friend. The nurse determines that an appropriate nursing diagnosis for this patient is Readiness for Enhanced Coping. What type of nursing diagnosis is Readiness for Enhanced Coping? A student is reviewing a client's chart before giving care. She notes the following diagnoses in the contents of the chart: “appendicitis” and “acute pain.” Which of the diagnoses is a medical diagnosis? Which of the following provides the nurse with the most reliable basis on which to choose a nursing diagnosis? A client with diabetes mellitus has been admitted to the hospital in diabetic ketoacidosis. During the admission assessment of the client, the nurse learns that the client is not following the prescribed therapeutic regimen. The client states, "I don't really have diabetes. My doctor overreacts." What is the most appropriate diagnosis for this client's health problem? A homeless client in the public health clinic has a strong body odor and is wearing clothes that are visibly soiled. What nursing diagnosis would be most appropriate for the nurse to identify? After educating a group of students on the different types of nursing diagnoses, the instructor determines that the education was successful when the students identify wellness diagnoses statements as consisting of how many parts? A nurse is planning education about prescription medications for a client newly diagnosed with asthma. What nursing diagnosis would be most appropriate for the nurse to select? The nurse enters a postoperative client's room and finds that the client is bleeding profusely from the surgical incision. What would be the nurse's most appropriate initial response? After assessing a client, the nurse formulates several nursing diagnoses. Which of the following would the nurse identify as an actual nursing diagnosis? Which of the following reflects the diagnosis phase? Recognition of a client health problem that can be prevented or resolved by independent nursing intervention, such as activity intolerance, is the focus of diagnosing. Performing wound care is an example of implementation. Setting a tolerable pain rating with the client is an example of planning. Documenting the client’s response to pain medication is an example of evaluation A female client undergoing chemotherapy for breast cancer has lost all her hair. The client states, "I cannot stand to see myself without hair. I am disgusting." What would be the most appropriate nursing diagnosis for the nurse to use to address this client's problem? A staff nurse comments to the charge nurse that it is unnecessary to know how to formulate nursing diagnoses because the computerized documentation system generates them automatically. What is the most appropriate response by the charge nurse? CH. 13 A male client has been recently diagnosed with diabetes after receiving emergency treatment for a hyperglycemic episode. Which of the client's actions indicates that he has achieved a cognitive outcome in the management of his new health problem? When the nurse enters the room to assess a client's vital signs, the client insists that the nurse perform hand washing. What is the nurse's most appropriate action? One hour after receiving blood pressure medication, the client complains of feeling lightheaded and dizzy. What is the nurse's best first action? According to the American Nurses Association, who determines the scope of nursing practice? At the beginning of prenatal care, the goal for the client was to gain 25 pounds by the end of the pregnancy. At 30 weeks of pregnancy, the client has only gained 1 pound. Which of the following would help the nurse most appropriately interpret this data? A nurse caring for an elderly patient who has dementia observes another nurse putting restraints on the patient without a physician’s order. The patient is agitated and not cooperating. What would be the best initial action of the first nurse in this situation? The mother of a pediatric client being discharged confides to the nurse that her husband is abusive and she is afraid to return home. What is the nurse's most appropriate action? The nurse is discussing diabetes mellitus with the family members of a client recently diagnosed. In order to promote the health of the family members, what would be the most important information for the nurse to include? The focus of a hospital's current quality assurance program is a comparison between the health status of clients upon admission and at the time of discharge. This form of quality assurance is characteristic of what? Outcome evaluation focuses on measurable changes in the health status of the client or the end results of nursing care. Whereas the proper environment for care and the right nursing actions are important aspects of quality care, the critical element in evaluating care is demonstrable changes in client health status. Process evaluation addresses performance expectations during the various stages of the nursing process. Structure evaluation addresses the environment of care. A nursing audit focuses on the review of records The nurse is preparing to give the client a bath early in the morning. The client states, "I prefer to take my bath at night. It helps me sleep." What is the nurse's most appropriate action? The nurse is caring for a client who is experiencing an asthma attack. Ten minutes after administering an inhaled bronchodilator to the client, the nurse returns to ask if the client’s breathing is easier. The nurse is engaging in which phase of the nursing process? A nurse suspects that the client with Crohn's disease does not understand the medication regimen or diet modifications required to manage the illness. What is the nurse's most appropriate action? Discharge plans for a client with a mental health disorder include living with family members. The nurse learns that the family is no longer willing to allow the client to live with them. What is the nurse's most appropriate action? The discharge needs of this client are complicated and the nurse will need the assistance of other disciplines to make a successful discharge plan. The client should have input into the future living arrangements, but the client does not have the resources to make the arrangements alone. The physician may be involved in the discharge plan, but additional orders are not necessary. It is not true and would be inappropriate to tell the family that discharge plans cannot be changed. If the family is unwilling to take the client, the placement will be unsuccessful The nurse is planning instruction on wound care to an adult client. What variables would cause the nurse to alter the teaching plan? Mark all that apply. While implementing the plan of care for a client, the nurse uses interpersonal skills. Which of the following would the nurse most likely use? The nurse has assisted the client to ambulate for the first time. After returning the client to bed, what is the nurse’s priority intervention? A client on the medical-­surgical unit is scheduled for several diagnostic tests. The nurse is concerned that the tests will be too tiring for the client. What would be the nurse's most appropriate action? A nurse delegates a specific intervention to a UAP. What implications does this have for the nurse? UAPs are trained to function in an assistive role to the RN in client activities as delegated and supervised by the RN. Delegation is the transfer of responsibility of an activity to another individual while retaining accountability for the outcome. Nurses have identified the following outcome in the care of a client who is recovering from a stroke: "Client will ambulate 100 feet without the use of mobility aids by 12/12/2011." Several nurses have evaluated the client's progression towards this outcome at various points during her care. Which of the following evaluative statements is most appropriate? As the nurse bathes a patient, she notes his skin color and integrity, his ability to respond to simple directions, and his muscle tone. Which statement best explains why such continuing data collection is so important? Which nurse is using criteria to determine expected standards of performance? An 84-­year-­old male has been admitted to the hospital several times in the past few months for exacerbations of chronic obstructive pulmonary disease (COPD) and elevated blood glucose. Which statement by the client could help identify the most likely reason for the changes in his health status? One of the outcomes that has been identified in the care of a client with a new suprapubic catheter is that he will demonstrate the correct technique for cleaning his insertion site and changing his catheter prior to discharge. When should this outcome be evaluated? A nurse manager notes an increase in the frequency of client falls during the last month. To promote a positive working environment, how would the nurse manager most effectively deal with this problem? Ch.6 A nurse provides client care within a philosophy of ethical decision making and professional expectations. What is the nurse using as a framework for practice? A nurse is caring for a client who has undergone coronary angioplasty. The cardiac monitor is showing abnormal ECG waves, indicating arterial fibrillation. The nurse does not recognize the importance of the sign;; as a result, the client's condition deteriorates and the client has to be taken up for an emergency procedure. Which of the following describes the nurse's legal liability? A client rings the call bell to request pain medication. Upon performing the pain assessment, the nurse informs the client that she will return with the pain medication. The nurse's promise to return with the pain medication is an example of which principle of bioethics? In some cases, the act of providing nursing care in unexpected situations is covered by the Good Samaritan laws. Which nursing actions would most likely be covered by these laws? A client is received in a postoperative nursing unit after undergoing abdominal surgery. During this time the nurse failed to recognize the significance of abdominal swelling, which significantly increased during the next 6 hours. Later, the client had to undergo emergency surgery. The lack of action on the nurse's part is liable for action. Which of the following legal terms describes the case? Which of the following words is best described by the following: the protection and support of another’s rights? Using the nursing process to make ethical decisions involves following several steps. Which step is the nurse implementing when he or she reflects on the decision-­making process and the role it will play in making future decisions? The nursing student talks with the student’s family about an AIDS client from the clinical experience yesterday. Which tort has the student committed? A registered nurse enters a patient's room and observes the nursing assistant pushing a patient down on the bed. The patient starts crying and informs the nursing assistant that he needs to go to the bathroom. The nursing assistant holds the patient down and tells him he was just in the bathroom. The nurse observing this incident is aware that the nursing assistant's action is an example of which of the following? A client who is mentally incapacitated is scheduled to undergo surgery. The nurse demonstrates understanding of the principle of autonomy and checks the client's medical record to ensure that consent has been obtained from which person? In the delivery of care, the nurse acts in accordance with nursing standards and the code of ethics and reports a medication error that she has made. The nurse is most clearly demonstrating which of the following professional values? A nurse is being sued for malpractice in a court of law. What elements must be established to prove that malpractice or negligence has occurred? (Select all that apply.) The elements that must be established to prove that malpractice or negligence have occurred include duty, breach of duty, and causation. Intent to harm would be intentional torts. Fraud is willful and purposeful misrepresentation that could cause, or has caused, loss or harm to a person or property. Punitive damages are monetary compensation awarded in a legal case to the injured party Nurses practicing in a critical care unit must acquire specialized skills and knowledge to provide care to the critically ill patient. These nurses can validate this specialty competence through what process? A nurse is aware that the principle of autonomy is being applied in which of the following situations? The principle of autonomy respects the client's right to make his or her own decisions. The other choices do not reflect this as the client is not making the decisions. A registered nurse has had her license suspended after being convicted of being impaired at work. What governing body has the authority to revoke or suspend a nurse's license? A nurse is administering evening medications and notices that a medication was omitted during the day shift. Which of the following statements demonstrates the principle of accountability? Nurses may commit both intentional and unintentional torts when practicing within the profession. What are examples of intentional torts in nursing practice? (Select all that apply.) A nurse is providing client care in a hospital setting. Who has full legal responsibility and accountability for the nurse's actions? After reporting to work for a night shift, the nurse learns that the unit will be understaffed because two RNs called out sick. As a result, each nurse on the unit will need to provide care for an additional four acute clients in addition to his or her regular client assignment. Which of the following statements is true for this nurse when working in understaffed circumstances? A nurse working in a long-­term care facility has an elderly male client who is very confused. What ethical dilemma is posed when using restraints in a long-­term care setting? What is the term for the beliefs held by the individual about what matters? A group of nurse researchers has proposed a study to examine the efficacy of a new wound care product. Which of the following aspects of the methodology demonstrates that the nurses are attempting to maintain the ethical principle of nonmaleficence? Which of the following is the most frequent reason for revocation or suspension of a nurse's license? A client age 46 years has been diagnosed with cancer. He has met with the oncologist and is now weighing his options to undergo chemotherapy or radiation as his treatment. This patient is utilizing which ethical principle in making his decision? Which of the following is a characteristic of the care-­based approach to bioethics? A nurse volunteers to serve on the hospital ethics committee. Which of the following indicates that the nurse knows what the purpose of an ethics committee is? A client is brought to the emergency department in an unconscious state with a head injury. The client requires surgery to remove a blood clot. What would be the appropriate nursing intervention in keeping with the policy of informed consent prior to a surgical procedure? The nurse should ensure that the client's family signs the consent form. However, in some states and heath care facilities, it is the physician who ensures that the client's family signs the consent form. The client cannot sign the consent if he is not in an alert state or is unable to communicate. If the client is not in a condition to the sign the consent, a family member can sign the consent on his behalf. Advance directives are written statements identifying a competent person's wishes concerning terminal care and are not applicable here. A living will is an instructive form of advance directive;; that is, it is a written document that identifies a person's preferences regarding medical interventions to use in a terminal condition, irreversible coma, or persistent vegetative state with no hope of recovery A client states that his recent fall was caused by the fact that his scheduled antihypertensives were mistakenly administered by two different nurses, an event that is disputed by both of the nurses identified by the client. Which of the following measures should the nurses prioritize when anticipating that legal action may follow? During a clinical placement on a subacute, geriatric medicine unit, a student nurse fed a stroke client some beef broth, despite the fact that the client's diet was restricted to thickened fluids. As a result, the client aspirated and developed pneumonia. Which of the following statements underlies the student's potential liability in this situation? Nurses complete incident reports as dictated by the agency protocol. What is the primary reason nurses fill out an incident report? Which of the following illustrates the activity of acting in values clarification? A male client age 56 years is experiencing withdrawal from alcohol and is placing himself at risk for falls by repeatedly attempting to scale his bedrails. Benzodiazepines have failed to alleviate his agitation and the nurse is considering obtaining an order for physical restraints to ensure his safety. The nurse should recognize that this measure may constitute what? Paternalism involves the violation of a client's autonomy in order to maximize good or minimize harm, a situation that requires careful consideration in light of ethical principles. Deception is unlikely to occur and the risk for harm is likely decreased by the use of restraints. Advocacy is the protection and support of another's rights Nurses who value patient advocacy follow what guideline? Professional regulations and laws that govern nursing practice are in place for which of the following reasons? Which of the following nursing students would most likely be held liable for negligence? A nursing student is studying the principle of autonomy. Which of the following examples most accurately depicts this principle? A nurse does not assist with ambulation for a postoperative client on the first day after surgery. The client falls and fractures a hip. What charge might be brought against the nurse? A client nearing the end of life requests that he be given no food or fluids. The physician orders the insertion of a nasogastric tube to feed the client. What situation does this create for the nurse providing care? During the orientation to the hospital, the staff development educator discusses unit and institutional-­based policies. What is the source of the practice rules that result in unit and institutional-­based policies? Which ethical principle refers to the obligation to do good? Nursing students in an ethics class have been asked to define “ethics”. What would be the best definition of ethics? Which of the following actions most clearly demonstrates a nurse's commitment to social justice? Which of the following is the nurse's best legal safeguard? [Show More]

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