Vanyo Final Exam Flashcards

What should the nurse know when observing and interpreting a patient's nonverbal communication?

1. Patients are usually aware of their nonverbal cues
2. Verbal responses are more important than nonverbal cues
3. Nonverbal cues have obvious meaning and are easily interpreted
4. Nonverbal cues provide significant information and need to be validated.

A patient asks the nurse, “When can I go smoke a cigarette?” the patient is told that they cannot smoke while in the hospital. The nurse offers the patient a nicotine patch but the patient refuses. The nurse then walks in the room to find the patient attempting to light a cigarette. Which Patient’s Bill of Responsibilities is being broken?

1. Responsibility to provide feelings, health, history, and medications
2. Responsibility to answer questions and cooperate with health team
3. Responsibility to be respectful of others and try to modify lifestyle
4. Responsibility to accept the consequences if health plan is not followed

The nurse notes that an advance directive is in the client’s medical record. Which of the following statements represents the best description of guidelines a nurse would follow in this case?

1. A durable power of attorney for health care is invoked only when the client has a terminal condition or is in a persistent vegetative state.
2. A living will allows an appointed person to make health care decisions when the client is in an incapacitated state.
3. A living will is invoked only when the client has a terminal condition or is in a persistent vegetative state.
4. The client cannot make changes in the advance directive once the client is admitted into the hospital.

Nurses agree to be advocates for their patients. Practice of advocacy calls for the nurse to:

1. Seek out the nursing supervisor in conflicting situations.
2. Work to understand the law as it applies to the client's clinical condition.
3. Assess the client's point of view and prepare to articulate this point of view.
4. Document all clinical changes in the medical record in a timely manner.

A nurse discovers that a primary care provider has prescribed an unusually large dosage of a medication. Which is the most appropriate action?

1. Administer the medication
2. Notify the prescriber
3. Call the pharmacist.
4. Refuse to administer the medication.

The nurse arrives at work and is told to report (float) to the intensive care unit (ICU) for the day because the ICU is understaffed and needs additional nurses to care for patients. The nurse has never worked in the ICU. The nurse should take which action?

1. A) Refuse to float to the ICU based on lack of unit orientation.
2. B) Clarify with the team leader to make a safe ICU client assignment.
3. C) Ask the nursing supervisor to review the hospital policy on floating.
4. D) Submit a written protest to nursing administration, and then call the hospital lawyer.

The nurse made an error in a narrative documentation of an assessment finding on a client and obtained the client’s record to correct the error. The nurse should take which action to correct the error? Select all that apply.

1. A) Document the correction as a late entry in the client’s record.
2. B) Draw one line through the error, initialing and dating it.
3. C) Try to erase the error for space to write in the correct data.
4. D) Use whiteout to delete the error to write in the correct data.
5. E) Write a concise statement to explain why the correction is needed.
6. F) Document the correct information and end with the nurse’s signature and title

These are effective ways to be a patient advocate except:

1. A) Work with community agencies and lay practitioners.
2. B) Applying personal beliefs of the institution to care for patients.
3. C) Be assertive.
4. D) Communicate with government agencies that may have authority to do something about the client’s needs.

The clinic nurse is preparing to explain the concepts of Kohlberg’s theory of moral development to a parent. The nurse should tell the parent that which factor motivates good and bad actions for a child at the preconventional level?

1. A) Peer pressure
2. B) Social pressure
3. C) Parent’s behavior
4. D) Punishment and reward

The nurse is using SBARR to effectively communicate with the physician. The nurse states “He has a temperature of 101°F, HR of 110bpm, and crackles heard in the lungs bilaterally.” Which part of SBARR is the nurse conducting?

1. Situation
2. Recommendation
3. Assessment
4. Reasoning

A hospitalized patient diagnosed with end-stage cancer has suddenly decided to discontinue treatment. The patient requests no additional treatment, such as antibiotics, tube feedings, and mechanical ventilation. When acting as the patient’s advocate, which action should the nurse take?

1. Respect the patient’s wishes and indicate those wishes on the plan of care.
2. Encourage the patient to share the decision with the family and the patient’s physician.
3. Clarify other treatments that the client wishes to withhold.
4. Wait until additional treatment is required and then decide what to do based on the patient’s condition.

An 80-year-old patient who has end stage renal failure tells the nurse that they wish to have a Do Not Resuscitate (DNR) order. Which ethical principle is the nurse upholding by supporting this decision?

1. Nonmaleficence
2. Beneficence
3. Autonomy
4. Confidentiality

A patient that is receiving end of life care is not fully conscious. When his next dose of morphine is coming up what should the nurse do?

1. The nurse should administer the medication as indicated.
2. The nurse should call the doctor and tell him/her that the patient is not fully conscious.
3. The nurse should withhold the dose of medication.
4. The nurse should administer another form of pain medication.

The nurse is aware that end-of-life planning is often neglected because __________. (Select all that apply.)

1. there is a clear procedure to follow.
   1. people are uncomfortable talking about death. 

   2. young people do not see the need for end-of-life planning. 

   3. end-of-life planning is a relative new concept.

   4. many persons are not sure what they want to do.

The nurse is caring for an adult client who is refusing treatment that his family is insisting he receive. Which actions should the nurse take? Select all that apply.

A.) Provide support to each family member and enhance the family support system.

B.) Respect the clients’ decision concerning their own care.

C.) Tell the family that you will reason with client, assure them that you can help the client to change their mind.

D.) Follow hospital policies.

A patient who is very ill requires a blood transfusion to survive and recover fully. The patient refuses the blood transfusion and states that taking it would be against her religion. What action should the nurse take?

1. Get consent from a family member.
2. Communicate to the patient the risks and let the physician know the patient's wishes.
3. Give the blood transfusion anyway.
4. Discharge patient from hospital.

A new mother of an infant in the NICU tells you she does not like the treatment plan the physician came up with but is too scared to tell him. What is the best step to take?

1. A) Determine why the mother does not like the treatment plan and help her talk to the physician.
2. B) Explain to the mother why this is the best treatment plan for the infant.
3. C) Tell the mother she will not be able to visit the NICU if she does not comply with her infant’s care.
4. D) Ask the father if the treatment plan is acceptable to him since he is a legal guardian as well.

All nurses agree to advocate for their patients. How would a nurse practice advocacy for the patient?

1. Find the nursing supervisor in conflicting situations.
2. Study and understand the law as it applies to the client's clinical condition.
3. Assess the client's point of view and prepare to articulate this point of view.
4. Make sure to document all the clinical changes in the medical record in a timely manner.

You are participating in a clinical care conference for a patient with peptic ulcer disease. You talk with your colleagues about using the nursing code of ethics for nurses to guide care decisions for clients. A non-nursing colleague asks for you to explain the nursing code of ethics. Which of the following statements best describes this code?

1. It has ways to improve the client’s ability to care for one’s self.
2. It is a way to protect the patient's confidentiality.
3. It ensures the same exact care to all patients.
4. It defines the principles of right and wrong to provide patient care.

According to Erikson, which stage of psychosocial development does the school age child (5-12 years) experience?

1. industry v. inferiority
2. trust v. mistrust
3. autonomy v. shame
4. intimacy v. isolation

A nurse is caring for a patient with end-stage renal disease. The patient wants to go home and be comfortable. The family wants the patient to have a new surgical procedure. The nurse explains the risk and benefits of the surgery to the family and discusses the patient's wishes with the family. The nurse is acting as the patient's:

1. Educator
2. Advocate
3. Caregiver
4. Case manager

A nurse discovers that a primary care provider has prescribed an unusually large dosage of a medication. Which is the most appropriate action?

1. Administer the medication
2. Notify the prescriber
3. Call the pharmacist.
4. Refuse to administer the medication.

A patient is terminally ill and is asking for more pain medication but the family refuses to let the nurse give him more pain medication. Which of the following should the nurse do next?

1. Document the encounter and move on to the next patient.
2. Talk to the family so that they might be reasonable.
3. Give the pain medication to the patient.
4. Call the physician and ask him/her to deal with the situation.

A patient told his day nurse, who is conducting an ongoing physical assessment, that the night nurse did not attend his repeated calls. Which of the following interventions is the most appropriate initial action to be taken by the nurse as an advocate?
A. Discuss the complaint with the night nurse and clarify the incident.
B. Report the incidence directly and submit the documentation to the nursing manager.
C. Promise to provide all the care to the patient.
D. Observe the other nurse to determine if this negligence is repeated.

A nurse discovers that a primary care provider has prescribed an unusually large dosage of a medication. Which is the most appropriate action?

A. Administer the medication
B. Notify the prescriber
C. Call the pharmacist.
D. Refuse to administer the medication.

Nurses agree to be advocates for their patients. The practice of advocacy calls for the nurse to:
A. Seek out the nursing supervisor in conflicting situations
B. Work to understand the law as it applies to the client's clinical condition.
C. Assess the client's point of view and prepare to articulate this point of view.
D. Document all clinical changes in the medical record in a timely manner.

Which statement would best explain the role of the nurse when planning care for a culturally diverse population?

1. Include care that is culturally congruent with the staff from predetermined criteria.
2. Focus only on the needs of the client, ignoring the nurse’s beliefs and practices.
3. Blend the values of the nurse that are good for the client and minimize the client’s individual values and beliefs during care.
4. Provide care while aware of one’s own bias, focusing on the client’s individual needs rather than the staff’s practices.

The nurse notes that an advance directive is in the client’s medical record. Which of the following statements represents the best description of guidelines a nurse would follow in this case?

1. A durable power of attorney for health care is invoked only when the client has a terminal condition or is in a persistent vegetative state.
2. A living will allows an appointed person to make health care decisions when the client is in an incapacitated state.
3. A living will is invoked only when the client has a terminal condition or is in a persistent vegetative state.
4. The client cannot make changes in the advance directive once the client is admitted into the hospital.

Ethical principles for professional nursing practice in a clinical setting are guided by the principles of conduct that are written as the:

1. American Nurse’s Association Code of Ethics.
2. Nurse Practice Act written by state legislation.
3. Standards of care from experts in the practice field.
4. Good Samaritan laws for civil guidelines.

A client who had a "do not resuscitate" order passed away. After verifying there is no pulse or respirations, then nurse should next:

1. Have family members say goodbye to the deceased.
2. Call the transplant center.
3. Remove all tubes and equipment (unless organ donation is to take place), clean the body, and position appropriately.
4. Call the funeral director to come and get the body.

A client's family member says to the nurse "The doctor said he will provide palliative care. What does that mean?" The nurse’s best response is:

1. "Palliative care is given to those who have less than 6 months to live."
2. "Palliative care aims to relieve or reduce the symptoms of a disease."
3. "The goal of palliative care is to affect a cure if a serious illness or disease."
4. "Palliative care means the client and family take a more passive role and the doctor focuses on the physiological needs of the client. The location of death will most likely occur in the hospital setting."

To be effective in meeting various ethnic needs, the nurse should:

1. Treat all client alike.
2. Be aware of client’s cultural differences.
3. Act as if he or she is comfortable with the client's behavior.
4. Avoid asking question about the client's cultural background.

A woman in the early years of menopause asks the nurse what changes she can expect as she ages. Which of the following is not a common change for older adults?

1. Vaginal lubrication decreases
2. ‘Liver spots’- clusters of melanocytes are seen on the skin
3. Increased blood glucose levels are common
4. Fat is deposited in the abdominal and hip areas

The night shift nurse has just begun the shift. One of the patients is visibly upset, and informs the nurse that the prior nurse was rough when checking blood glucose levels and administering insulin injections, and repeatedly said for the patient to ‘Just be still. It’s only a prick’. What should the nurse do?

1. Inform the patient that she will have time to recover by the morning.
2. Ban the other nurse from participating in diabetic patient care.
3. Report the situation to a supervisor.
4. Apologize to the patient and administer the insulin injection.

Which of the following are examples of nurses’ obligations in ethical decision making? Select All That Apply

1. Work in accordance with own religious beliefs
2. Carry out hospital policies
3. Maximize client’s well-being
4. Adhere to family’s wishes
5. Balance client’s need for autonomy with family’s responsibilities

Which statement would best explain the role of the nurse when planning care for a culturally diverse population? The nurse will plan care to:

1. Include care that is culturally congruent with the staff from predetermined criteria.
2. Focus only on the needs of the client, ignoring the nurse’s beliefs and practices.
3. Blend the values of the nurse that are for the good of the client and minimize the client’s individual values and beliefs during care.
4. Provide care while aware of one’s own bias, focusing on the client’s individual needs rather than the staff’s practices.

A nurse learns that a patient who is paralyzed from the waist down and lives alone with no one to care for her is about to be released from the hospital. What is the best course of action for the nurse?

1. Sign the patient up for a nursing home.
2. Assume the patient will figure out a plan of care for themselves.
3. Discuss options with the patient including home nurses, family who she may be able to live with, or moving into an assisted living facility.
4. Tell the doctor the patient is not ready to leave the hospital because she is unstable.

A registered nurse (RN) is supervising an unlicensed assistive personnel (UAP). Which principle would the nurse follow when delegating tasks?

1. a) The RN must directly supervise all delegated tasks.
2. b) Follow-up with a delegated task is only necessary if the UAP is untrustworthy.
3. c) After a task is delegated, it’s no longer the RN’s responsibility.
4. d) The RN delegates a task based on the UAP’s skill set.

The nurse is making team assignments and is assigning tasks to the unlicensed assistive personnel (UAP). What information should the nurse know before delegating tasks to the UAP?

1. a) Whether the UAP has previously completed and practiced the delegated activities.
2. b) All nursing activities performed by the UAP should be directly supervised by a registered nurse.
3. c) Some nursing activities performed by the UAP should be directly supervised by a registered nurse.
4. d) The UAP’s level of knowledge and comfort level in performing specific nursing activities should be considered.

An unlicensed assistive personnel (UAP) is providing care to a client with left-sided paralysis. Which action by the UAP requires the nurse to provide further instruction?

1. a) elevating the foot of the bed to reduce edema
2. b) providing passive range of motion exercises to the left extremities during the bed bath
3. c) pulling up the client under the left shoulder when getting the client out of bed to a chair
4. d) putting high top tennis shoes on the client after bathing

The nurse is reviewing her yearly evaluations and sees her supervisor lists altruism as one of her strong assets as a nurse. Altruism can be defined as:

1. “The concern of well being and welfare of others.”
2. “Honesty and providing car according to code of ethics.”
3. “Treats all patients fairly and equally.”
4. All of the above

Barriers to coordinated care may include:

1. Deficient patient knowledge.
2. Limited access to resources.
3. Non-adherence to the care plan.
4. All of the above

Group members feel dissatisfied with their inflexible and impersonal leadership. The leader relies on rules and policies to direct the group’s efforts. Which leadership style best reflects this example?

1. Shared leadership
2. Laissez-faire leader
3. Bureaucratic leader
4. Situational leader

The registered nurse is planning the client assignments for the day. Which is the most appropriate assignment for an unlicensed assistive personnel (UAP)?

1. A) A client requiring a colostomy irrigation.
2. B) A client receiving continuous tube feedings.
3. C) A client who requires urine specimen collections.
4. D) A client with difficulty swallowing food and fluids.

A nurse is completing discharge teaching for a client who is about to be discharged to home following a total hip replacement. The client asks the nurse why there is a case manager involved and expresses confusion about who is in charge. The client states, "I thought the doctor manages my care." Which is the best response by the nurse?

1. A) "No, I manage your care."
2. B) "You are correct; the doctor is responsible for managing your care."
3. C) "A case manager coordinates everyone involved in your care to ensure your needs are met."
4. D) "The case manager delegates your care to the nurse.”

Samantha the nurse manager has realized that one of her nurse’s is experiencing burnout. Which of the following is the best thing for her to do?

1. Advise the nurse to take a long vacation.
2. The nurse manager should ignore what she has observed it will be resolved without intervention.
3. Remind the nurse of her loyalties to the hospital.
4. Let the nurse verbalize her feelings and ask how she could help.

Samantha has been promoted as the new nurse manager. She wants to be an effective leader who exhibits dedication for serving her staff rather than being served. She wants to take the time to listen, prefers to be a teacher first before being a leader, which is a characteristic of?

1. Transformational leader
2. Charismatic leader
3. Servant leader
4. Transactional leader

According to Benner et al. (2010) the definition of professional behaviors is:

1. effective nursing actions that form helping relationships based on technical knowledge and expertise.
2. a process that facilitates the transformation of an individual from a lay person to a professional nurse.
3. adherence to a strict moral or ethical code.
4. any attempt to use one’s position or authority to shame, control, demean, humiliate, or denigrate another individual in order to gain emotional, psychological, or physical advantage over that individual.

When delegating to other nurses, the delegator must use critical thinking and professional judgment and must follow the __________?

_________is the belief in the importance and moral worth of work.

_________is the means by which an interdisciplinary team works with a client to ensure that the client receives the care necessary to meet his needs across the healthcare continuum.

A float nurse is assigned to a surgical unit. The nurse is receiving 2 clients from the post anesthesia care unit (PACU) at the same time. When delegating tasks to other PACU personnel who are not known to the nurse, which question would be most important to ask?

1. A) Are you comfortable in performing the tasks being assigned?
2. B) What is your highest educational level?
3. C) How long have you worked on the floor?
4. D) Who provided you the unit training?

The selection of a nursing care delivery system (NCDS) is critical to the success of client care in a nursing area. Which factor is essential to the evaluation of an NCDS?

1. A) Identifying who will be responsible for making client care decisions.
2. B) Determining how planned absences, such as vacations, will be scheduled so that all staff are treated fairly.
3. C) Deciding what dress code will be implemented.
4. D) Identifying salary ranges for various types of staff.

A client reports of a headache to an unregulated care provider (UCP). The UCP reports the client’s concerns to the nurse, who is busy with other clients. What is the best action by the nurse to address the client’s headache?

1. A) Have the UCP inform another nurse that the client needs assistance.
2. B) Delegate the UCP to administer acetaminophen.
3. C) Ignore the UCP and continue with other clients.
4. D) Ask UCP to do a thorough assessment of patient and determine best action.

A nurse is caring for a patient with an order for placement of an indwelling urinary catheter. The nurse knows it is appropriate to delegate this task to which of the following personnel?

A – This task can be delegated to the certified nursing assistant (CNA).

B – This task can be delegated to the licensed practical nurse (LPN).

C – This task can be delegated to the unlicensed assistive personnel (UAP).

D – This task may only be performed by a registered nurse (RN).

Which of the following must be done by an RN and not a nursing assistant? Select all that apply.

A – Admitting a patient from the post-anesthesia care unit

B – Ambulation post-op day 1

C – Ambulation post-op day 4

D – Normal skin care

E – Patient teaching

F – Suctioning

A nurse who is young unit manager is in charge of staff nurses who are senior to her, very articulate, confident, and sometimes aggressive. The nurse believes that she is the scapegoat of everything that goes wrong in her department. Which of the following is the best action for the nurse to take?

1. Identify the source of conflict and understand the points of friction.
2. Disregard what she feels and continue to work independently.
3. Seek help from the Director of Nursing.
4. Quit her job and look for other employment.

Jenna is a nurse from the medical-surgical unit of a tertiary hospital. She was asked to float to the orthopedic floor, in which she has no prior experience working. Which client should be assigned to her?

1. Client who had a total hip replacement two days ago and needs blood glucose monitoring.
2. Client with a cast for a fractured femur and who has numbness and discoloration of the toes.
3. A client with balanced skeletal traction and needs assistance with morning care.
4. A client who had an above-the-knee amputation yesterday and has currently has a temperature of 101.4ºF.

The nurse is helping a nursing assistant who is giving a bed bath to a comatose patient who is incontinent. The nurse should intervene if she notices which of the following actions?

1. The nursing assistant log rolls the patient to perform back care.
2. The nursing assistant places an incontinence pad under the patient.
3. The nursing assistant elevates the patient's head and rolls them onto their left side.
4. The nursing assistant answers the phone with gloves on.

Which of the following is not a goal of functional nursing?

1. Emphasize use of group collaboration
2. One-to-one nurse patient ratio
3. Provides continuous, coordinated and comprehensive nursing services
4. Concentrates on tasks and activities

Which task would you not delegate to a nurse’s assistant?

1. Reposition patients every two hours.
2. Taking patients vitals.
3. Administer ordered Tylenol to patient.
4. Give an immobile patient a bed bath.

A document that lists the medical treatment a person chooses to refuse if unable to make decisions is the:

1. Durable power of attorney.
2. Informed consent.
3. Will.
4. Advance directive.

The RN knows that an example of a diagnostic error is:

1. A failure to act on critical lab results reported.
2. The failure of an IV pump to infuse at the programmed rate.
3. Error in administering a PO medication.
4. Error in calculating an IV drug dose.

The charge nurse is assigning patients to a floating nurse in the emergency room. Which of the following patients should be assigned to the floating nurse?
A) a patient who cannot sleep
B) a patient complaining of chest pain
C) a 20 year old with asthma who has audible wheezes
D) a patient with sudden shortness of breath and cyanosis

A charge nurse tells a new nurse, "You really need to get your skills up to speed." The statement hurts and embarrasses the new nurse. How can she best handle the situation?
A) Tell the charge nurse she feels hurt by her statement.
B) Ask for a private meeting to explore the charge nurse's concerns in detail.
C) Tell the charge nurse she needs to be more specific about what she means.
D) Discuss her feelings with a coworker in order to vent.

At a staff meeting, a nurse manager shares that the unit is over budget by 2% and needs to reduce costs. A staff nurse suggests that report could be shortened so that nurses could finish their shifts on time. How should the nurse manager measure the success of this idea?

1. Observe the change of shift report to determine how many nurses are leaving on time at the end of the shift.
2. Delegate end-of-shift monitoring to the charge nurses
3. Review the capital budget on a monthly basis
4. Monitor for a reduction in hours per client day

A registered nurse on telemetry floor is preparing to discharge a patient. The patient has a 22 gauge IV on the left forearm that needs to be removed. While the preparing for the patient's discharge instructions, the registered nurse can delegate this task to which of the following?

1. Charge nurse
2. Unlicensed assistant personnel (UAP)
3. The physician
4. Licensed practical nurse (LPN)

The charge nurse is going over the Rights of Delegation with a staff nurse. The charge nurse recognizes that further teaching is needed when the staff nurse names which of the following as a Right of Delegation?

1. Right room
2. Right task
3. Right supervision
4. Right direction