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Answer: D

The code of ethics is the philosophical ideals of right and wrong that define the principles the nurse will use to provide care to clients. A code of ethics does not ensure identical care to all clients (which would not be acceptable). The nursing code of ethics does not protect clients from harm or improve self-health care.

The nurse practices nursing in conformity with the code of ethics for professional registered nurses. This code:

A) Improves self-health care
B) Protects the client from harm
C) Ensures identical care to all clients
D) Defines the principles by which nurses' provide care to their clients

Answer: C

The nurse is assessing the client. Diagnosis occurs after all assessments are completed. Then a plan is developed and implemented. The process is completed with evaluation.

An 18-year-old woman is in the emergency department with fever and cough. The physician asks the nurse to measure vital signs, auscultate lung sounds, listen to heart sounds, determine the level of comfort, and collect blood and sputum samples for analysis. The nurse is performing what aspect of practice?

A) Diagnosis
B) Evaluation
C) Assessment
D) Implementation

Answer: D


Implementation is the actual delivery of care. Assessment is data gathering. Then the information is developed into a diagnosis and the planning occurs with the diagnosis. Evaluation is the final step of the nursing process.

A client is wheezing and short of breath. The physician orders a medicated nebulizer treatment now and in 4 hours. The nurse is providing what aspect of care?

A) Planning
B) Evaluation
C) Assessment
D) Implementation

Answer: C

An advocate helps speak for the client, communicating the client's concerns and wishes to family and other caregivers. A caregiver assists in meeting all health care needs of the client, including taking measures to restore emotional, spiritual, and social well-being. A manager coordinates all the activities of the members of the nursing staff in delivering nursing care and has personnel, policy, and budgetary responsibilities for a specific nursing unit or agency. An educator explains concepts and facts about health, demonstrates procedures such as self-care activities, reinforces learning or client behavior, and evaluates the client's progress in learning.

The nurse is caring for a client with end-stage lung disease. The client wants to go home on oxygen therapy and be comfortable. The family wants the client to undergo a new surgical procedure. The nurse explains the risk and benefits of the surgery to the family and discusses the client's wishes with the family. The nurse is acting as the client's:

A) Manager
B) Educator
C) Advocate
D) Caregiver

Answer: C

Evidence-based practice is a problem-solving approach to clinical practice that uses the best available evidence, along with the nurse's expertise and the client's preference and values, in making decisions about care. The other answers are incorrect.

Evidence-based practice is defined as:

A) Nursing care based on tradition
B) Scholarly inquiry embodied in the nursing and biomedical research literature
C) A problem-solving approach to clinical practice based on best practices
D) Quality nursing care provided in an efficient and economically sound manner

Answer: D


The RN licensure examination provides a minimum standard of knowledge for nurses. The examination cannot guarantee or ensure care for clients.

The examination for the registered nurse (RN) licensure is exactly the same in every state in the United States. This examination:

A) Guarantees safe nursing care for all clients
B) Ensures standard nursing care for all clients
C) Ensures that honest and ethical care is provided
D) Provides a minimal standard of knowledge for practice

Answer: B


APNs are generally the most independently functioning nurses. An APN can work in a primary, acute, or restorative care setting. The setting may be a private, public, or university facility. The APN may function as a clinician, educator, case manager, consultant, or researcher.

Advanced practice nurses (APNs) generally:

A) Work in acute care settings
B) Function independently
C) Function as unit directors
D) Work in the university setting

Answer: A

The client is the correct choice. The health care facility is where the client goes to receive treatment. The nursing process is how nurses proceed to plan care for the client. Cultural diversity is not the correct choice.

Nursing practice in the twenty-first century is an art and science that is centered on:

A) The client
B) The nursing process
C) Cultural diversity
D) The health care facility

Answer: D

Florence Nightingale is the correct choice. Barton founded the Red Cross. Dix organized hospitals, nurses, and supply lines to support the troops of the Union Army. Wald opened the first community health service for the poor.

Who acted to decrease mortality by improving sanitation in the battlefields, which resulted in a decline in illness and infection?

A) Dorothea Dix
B) Lillian Wald
C) Clara Barton
D) Florence Nightingale

Answer: B

Mary Mahoney, the first African American professional nurse, worked to bring respect to individuals regardless of race, color, background, or religion. Tubman assisted slaves to freedom during the Civil War. Hampton founded the Nurses Associated Alumnae of the United States and Canada, which later became the American Nurses Association (ANA). Nutting was instrumental in the affiliation of nursing education with universities.

The professional nurse responsible for increasing respect for the individual and awareness of cultural diversity was:

A) Harriet Tubman
B) Mary Mahoney
C) Isabel Hampton
D) Mary Adelaide Nutting

Answer: C


Healthy People 2010, a federal document, outlines goals for the public. Notes on Nursing set forth Nightingale's first nursing philosophy. The Last Acts Campaign has developed standards and policies for end-of-life care. Nursing Principles and Practice 2010—current readings in journals are necessary for all nurses in practice.

The document that developed goals and objectives to meet the health of the public is known as:

A) Notes on Nursing
B) Last Acts Campaign
C) Healthy People 2010
D) Nursing Principles and Practice 2010

Answer: B

This process may be carried out with other members of the health care team, and client and family members may be included. All nurses use critical thinking. An advanced care nurse has advanced educational preparation. An evidence-based practitioner draws on research findings as well as clinical expertise and client values. A multidisciplinary practice includes health care members from various fields of activity, such as physical therapy and dietary therapy, along with nursing.

A nurse who uses critical thinking in the decision-making process to provide effective quality care to individuals is known as:

A) An advanced care nurse
B) A clinical decision maker
C) A member of a multidisciplinary practice
D) An evidence-based practitioner

Answer: A

Standards of care describe the competency level of nursing care as described by the ANA. The Nurse Practice Act regulates the licensing and practice of nursing; it describes the scope of practice. Accreditation allows the facility, school, or hospital to operate and be recognized in good standing according to standards set by peers. National council licensure is the standardized national examination that assess for a minimum knowledge base relevant to the client population that the nurse serves.

Which of the following assures clients that they will receive quality care from a competent nurse?

A) Standards of care
B) Nurse Practice Act
C) Accreditation certification
D) National council licensure

Answer: B

The Nurse Practice Act regulates the license and practice of nursing; it describes the scope of practice and is the correct answer. The NCLEX-RN national licensure examination is administered in each state to test that candidates have the minimum knowledge level required for practice. Passage of an examination and requirements for certification signify additional knowledge and competence in a specific area. The ANA Congress for Nursing is an organization that addresses legal aspects of nursing practice.

The licensure and practice of nursing is regulated by:

A) The NCLEX-RN
B) The Nurse Practice Act
C) The certification examination
D) The ANA Congress for Nursing

Answer: C

The nurse who has held the same position for 2 to 3 years and understands the specific area and client population is termed a competent nurse. The expert is a nurse with diverse experience who can focus on a specific problem and offer multidimensional solutions. The proficient nurse has more than 2 to 3 years' experience and applies knowledge and experience to a situation. The advanced beginner nurse has at least some level of experience.

A nurse who has filled a position on the same unit for 2 years understands the unit's organization and the care of the clients on that nursing unit. Benner defines this nurse as able to anticipate nursing care and to formulate long-range goals; this nurse is given the title:

A) Expert nurse
B) Proficient nurse
C) Competent nurse
D) Advanced beginner

Answer: A

Care provider is a staff position, a nurse who provides direct care. The nurse specialist has clinical expertise in a specific area. The nurse practitioner has advanced training in assessment and pharmacology and is able to provide health care in specific settings. The case manager has additional experience and is able to coordinate activities of other members of the health care team.

An APN is the most independently functioning of all professional nurses. All of the following are examples of a clinically focused APN except:

A) Care provider
B) Case manager
C) Nurse specialist
D) Nurse practitioner

Answer: D

Additional training in anesthesia medicine would be required to be a certified registered nurse anesthetist.

An APN is pursuing a job change. Which of the following positions would the APN be unable to fill without meeting additional criteria?

A) Case manager
B) Nurse manager
C) Nurse educator
D) Certified registered nurse anesthetist

Answer: A


National League for Nursing (NLN) is the correct answer. The master of science in nursing (MSN) degree is earned through advanced educational preparation in nursing. Public Health Administration (PHA) is concerned with areas of public health. The National Institutes of Health (NIH) addresses health on a national level.

Which of the following professional organizations was created to address concerns of members in the nursing profession?

A) NLN
B) MSN
C) PHA
D) NIH

Answer: A, B, C, D


Each of the options is an example of a professional role or responsibility of the professional nurse.

Contemporary nursing requires that the nurse possess knowledge and skills to carry out a variety of professional roles and responsibilities. Examples include which of the following? (Select all that apply.)

A) Autonomy and accountability
B) Advocacy
C) Provision of bedside care
D) Health promotion and illness prevention

Answer: C

The federal government, which pays for the Medicare and Medicaid programs, is the biggest consumer of health care. The other options are incorrect.

Which of the following is the biggest consumer of health care?

A) Hospitals
B) Businesses
C) Federal government
D) Private insurance companies

Answer: C

The prospective payment system is one of the most significant factors influencing payment for health care. The prospective payment system groups payments into diagnosis-related groups for Medicare and Medicaid clients. Managed care organizations are systems in which there is administrative control over primary health care services for a defined client population.

Which of the following was most significant in influencing competition in health care costs?

A) Medicare and Medicaid
B) Diagnosis-related groups
C) Prospective payment system
D) Managed care organizations

Answer: B, C, D

Evidence-based practice helps nurses to solve dilemmas in the clinical setting because it combines scientific research with clinical expertise and local values. Evidence-based practice does require nurses to review and critique research and practice findings. Nurses are expected to always meet the standards of practice.

Which of the following statements is true about evidence-based practice? (Select all that apply.) Evidence-based practice:

A) Is based only on the results of research
B) Assists nurses in meeting standards of practice
C) Helps nurses solve dilemmas in the clinical setting
D) Requires nurses to review and critique research and practice findings

Answer: D


Evidence-based practice draws on both research and clinical experience. Competencies are evidence that skills have been demonstrated. Critical thinking is the questioning thought process that nurses need to use in practice. Primary care is health care provided in the community by one caregiver who takes responsibility for managing a client's care.

The nurse found that using tympanic thermometers was quick, easy, and yielded temperatures as reliable as those obtained using oral thermometers. This finding represents:

A) Primary care
B) Critical thinking
C) Competency testing
D) Evidence-based practice

Answer: A

In the staff model of an MCO, the physicians are salaried employees. In the group model, the MCO contracts with a single group practice. An independent practice association is a group of physicians who are under contact to the organization but are not members of it and whose practices include fee-for-service and capitated clients. The MCO contracts with multiple group practices and/or integrated organizations in the network model.

A client is receiving health care from a health care provider who is a salaried employee. Which model is being followed by the managed care organization (MCO) to which the client belongs? (Select all that apply.)

A) Staff model
B) Group model
C) Network model
D) Independent practice association

Answer: D

The utilization review committee reviews admissions, diagnostic procedures, and treatments ordered by physicians. Review of the quality, quantity, and cost of care is more similar to the functions of a professional standards review organization. Review of reimbursement fees and appropriation of funds involves review of diagnosis-related groups. Reviewing the utilization of the payment mechanism is similar to capitation.

The purpose of a utilization review committee is to:

A) Review quality, quantity, and cost of care
B) Review the utilization of the payment mechanism
C) Review reimbursement fees and appropriation of funds
D) Review admissions, diagnostic tests, and treatments ordered by physicians

Answer: C

This is the description of an MCO. In a PPO, choice of care providers is limited to those listed in the group. Medicare is a federally funded national health insurance program. Private insurance is a traditional fee-for-service plan.

The client's health insurance changed, and instead of having a limited number of physicians from whom to choose, the client is voluntarily enrolled in a plan in which medical care is provided by a special group of caregivers. This arrangement is known as:

A) Medicare
B) Private insurance
C) Managed care organization (MCO)
D) Preferred provider organization (PPO)

Answer: A

A positive benefit of a professional nursing staff is a decreased length of stay. The diagnosis-related group has greater influence on the rate of readmission. The ancillary personnel need to remain so that registered nurses can spend the necessary time to assess and manage clients. Nosocomial infections decrease with a professional nursing staff.

Recent research provided evidence that a professional nursing staff affects health care financing. These results indicated that the positive benefit of a professional nursing staff is:

A) Decreased length of stay
B) Decreased rate of readmission
C) Increased rate of nosocomial infections
D) Decreased need to hire ancillary personnel

Answer: C

Health promotion includes dietary counseling. Blood glucose monitoring at the pharmacy is an example of illness prevention. Restorative care is care of a client who, for instance, is recovering from complications of diabetes. Any diagnostic procedure or tests completed in the hospital would be examples of such care.

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) Tertiary care
B) Restorative care
C) Health promotion
D) Illness prevention

Answer: D

Taking blood pressure measurements is illness prevention. Health promotion includes activities like exercise classes. Secondary care is often known as traditional care. It would include rehabilitation after a stroke in an individual with a history of elevated blood pressure.

A nurse volunteers to take blood pressure measurements after church services. This is an example of which level of health care service?

A) Secondary care
B) Restorative care
C) Health promotion
D) Illness prevention

Answer: C

A critical pathway is a multidisciplinary treatment plan with interventions prescribed within a structured framework. A discharge plan includes an assessment and anticipation of the client's needs. Medicare is a federal health insurance plan for those 65 years of age and older. Standard nursing care is the minimum care to be given to a client.

The nurse completes the standard orders on a client's first day postoperatively. The instrument that is used to coordinate the client's care is:

A) A Medicare plan
B) A discharge plan
C) A critical pathway
D) Standard nursing care

Answer: C

Case management is a model of organizing care in which the case manager monitors, directs, and advises the nursing care personnel on specific care issues and the progress of a client. In team nursing, care might be provided by groups composed of registered nurses, licensed practical nurses, and possibly assistive personnel. Nursing process is used to plan the nursing care for a client. Interdisciplinary care is care provided by a team whose members come from a variety of disciplines.

The multidisciplinary care model used to move clients efficiently from admission to discharge is known as:

A) Team nursing
B) Nursing process
C) Case management
D) Interdisciplinary care

Answer: D

Restorative care assists an individual in regaining the maximum possible level of functioning. Home care includes professional and paraprofessional services that are rendered in the home setting. Extended care is intermediate medical or nursing care for individuals with an acute or chronic illness or disability. Assisted care is a setting in which the client is able to function at a higher level of autonomy within a homelike environment but in which care can be given when needed.

A client discharged after suffering a stroke is transferred from a tertiary care facility to another facility for additional care to help the client recover and continue to regain function. This type of care facility is known as:

A) Home care
B) Assisted care
C) Extended care
D) Restorative care

Answer: A


Day care is an example of respite care because it allows the family to maintain normalcy while the client is under their care. A nursing home client receives 24-hour care in the facility. Home care is an intermittent service in which only certain tasks are performed. Nurse extenders may be hired to perform a specific task, such as bathing.

Which of the following is an example of respite care?

A) Day care
B) Home care
C) Nursing home
D) Nurse extender

Answer: C

Obtaining a sterile specimen requires insertion of a catheter, a procedure that must be performed by a licensed nurse. Therefore, this would not be an appropriate task to delegate to an assistive person. Assistive personnel would be able to ambulate a client, give a bed bath, and add to the I&O record.

Which task is it not appropriate for a professional nurse to delegate to assistive personnel?

A) Ambulate a client
B) Complete a bed bath
C) Obtain a sterile urine specimen
D) Complete the intake and output (I&O) record

Answer: B, C


The case manager coordinates the efforts of all disciplines to achieve the most efficient and appropriate plan of care for the client, with a focus on discharge planning. Therefore, coordination of transfer to a step-down rehabilitation unit and follow-up after discharge to evaluate that needs have been met are the correct answers.

A nurse is working in an acute care hospital that uses a case management model. About which of the following activities should the nurse communicate with the case manager? (Select all that apply.)

A) Management of a client transfer to the radiology department
B) Coordination of a client transfer to the step-down rehabilitation unit
C) Follow-up after a client's discharge to evaluate whether needs have been met
D) Permission for a family to bring in special food for a client

Answer: A, C

Clients being discharged home need education regarding how to take their medication and when to call their health care provider. There is not enough information here to determine if options 2 and 4 are appropriate, although hand hygiene after toileting is always important.

A nurse is planning a client's discharge from a subacute care unit to home. Education should be provided on which of the following topics? (Select all that apply.)

A) Medication administration
B) Stress reduction techniques with blood pressure assessment
C) Circumstances in which the client should call the health care provider
D) Hand-washing hygiene when assisting with transfer to the bathroom

Answer: B, D


Extended care encompasses intermediate medical, nursing, or custodial care for clients recovering from acute illness or clients with chronic illnesses or disabilities. Extended care facilities include intermediate care facilities and skilled nursing facilities.

Which of the following clients should be cared for in an extended care facility with skilled nursing? (Select all that apply.)

A) Client who had a stroke, can talk, and has lost bowel and bladder control
B) Severely brain injured client on a ventilator who is receiving intravenous medications
C) Client with Alzheimer's disease who is abusive, combative, and a threat to self and others
D) Young child who recently had a spinal cord injury and is living with quadriplegia and needs to learn a new way of life

Answer: D

Healthy People 2010 was established to create ongoing health care goals, including increasing life expectancy and quality of life, and eliminate health disparities through improved delivery of health care services. Gathering information, assessing needs, and developing and implementing public health policies are steps in achieving the goals set forth by Healthy People 2010.

Healthy People 2010's overall goals are to:

A) Assess the health care needs of individuals, families, or communities
B) Develop and implement public health policies and improve access to care
C) Gather information on incident rates of certain diseases and social problems
D) Increase life expectancy and quality of life and eliminate health disparities

Answer: C

Substance abusers avoid health care for fear of judgmental attitudes by health care providers and concern about being turned in to the criminal authorities. Options 1, 2, and 4 are not primary concerns that result in avoidance of health care.

Substance abusers frequently avoid health care providers because of:

A) Fear of the cost of health care
B) Fear of institutions and people
C) Fear of being turned in to the criminal authorities
D) Fear of being without the recreational drug of choice

Answer: D


Vulnerable population are defined as clients who are more likely to develop health problems as a result of excess risks, who have limits in access to health care services, or who are dependent on others for care.

Vulnerable populations of clients are those who are more likely to develop health problems as a result of:

A) Chronic diseases, homelessness, and poverty
B) Poverty and limits in access to health care services
C) Lack of transportation, dependence on others for care, and homelessness
D) Excess risks, limits in access to health care services, and dependence on others for care

Answer: A

Secondary intervention includes disease prevention after a health issue has been identified. Primary intervention is prevention of a health problem that has not yet occurred in the community. Tertiary intervention occurs after a problem has occurred and aims at preventing long-term negative impacts or recurrences in a population.

The local health department received information from the Centers for Disease Control and Prevention that the flu was expected to be very contagious this season. The nurse is asked to set up flu vaccine clinics in local churches and senior citizen centers. This activity is an example of which level of prevention?

A) Primary intervention
B) Tertiary intervention
C) Nursing intervention
D) Secondary intervention

Answer: A

An educator helps clients, families, and communities gain greater skills and knowledge to provide their own care. An advocate is someone who helps clients walk through the system, identifies services, and plans for accessing appropriate resources. A collaborator is an individual who engages in a combined effort with other individuals to develop a mutually acceptable plan that will achieve common goals. A case manager develops and implements a plan of care.

The local school has an increasing number of adolescent parents. The nurse works with the school district to design and teach classes about infant care, child safety, and time management. These are examples of which nursing role?

A) Educator
B) Advocate
C) Collaborator
D) Case manager

Answer: B

A counselor helps clients identify and clarify health problems and choose appropriate courses of action to solve those problems. An educator helps the community gain greater skills, including through the presentation of educational programs. A collaborator is an individual who engages in a combined effort with other individuals to develop a mutually acceptable plan that will achieve common goals.

A nurse is practicing in an occupational health setting. There are a large number of employees who smoke, and the nurse designs an employee assistance program for smoking cessation. This is an example of which nursing role?

A) Educator
B) Counselor
C) Collaborator
D) Case manager

Answer: C

The community has three components: structure or locale, people, and social systems. To develop a complete community assessment, the nurse must take a careful look at each of the three components to begin to identify needs for health policy, health programs, and health services.

What are the three elements included in a community assessment?

A) Environment, families, and social systems
B) People, neighborhoods, and social systems
C) Structure or locale, people, and social systems
D) Health care systems, geographic boundaries, and people

Answer: C


Option 3 defines the focus of community health nursing. Community health nursing focuses on the individual, family, and community. Educational requirements for community-based nurses are not as clearly defined as those for public health nurses. An advanced degree is not always required.

The focus of community health nursing differs from that of public health nursing because the nursing care:

A) Is directed at the individual client only
B) Is provided by nurses with a graduate degree in community health nursing
C) Provides direct care to subpopulations who make up the community as a whole
D) Is administered to a collection of individuals who have in common one or more personal or environmental characteristics

Answer: B

In Healthy People 2010, the assurance role of public health is defined as making essential community-wide health services available and accessible. In Healthy People 2010, public development and implementation refer to the role of health professionals in providing leadership in development of policies that support the population's health. Population-based public health programs focus on disease prevention, health promotion, and health protection. A healthy environment for each individual, family, and community is the overall goal of Healthy People 2010.

In Healthy People 2010, assurance refers to the role of public health in:

A) Providing disease prevention, health protection, and health promotion
B) Making essential community-wide health services available and accessible
C) Providing leadership in developing policies that support the population's health
D) Achieving a healthy environment for each individual, family, and community

Answer: B

Assessing the learner's needs and readiness to learn are important to increase the success of the learning process. Options A and D are negative responses and would block the learning process. Repeating the old teaching plan is nonproductive and an inefficient application of the nursing process.

A home care nurse educator has repeatedly counseled a 33-year-old male diabetic client concerning the need for dietary compliance. In writing an effective teaching plan the nurse will first:

A) Reprimand the client for noncompliant behavior
B) Assess the client's learning needs and readiness to learn
C) Repeat the old teaching plan to ensure the client's comprehension
D) Provide a detailed description of complications associated with the disease process

Answer: A

Vulnerable populations are defined as specific populations with unique health care problems. Vulnerable populations are not limited to the very young or older adults. Such individuals are those living in poverty, homeless persons, abused clients, substance abusers, and so on. Members of most vulnerable populations come from different cultures and have different beliefs and values. Vulnerable populations are at risk of experiencing poorer outcomes in response to interventions because of the multiple stressors that affect their daily lives.

Vulnerable populations are more likely to develop health problems. Which of the following is true of these populations?

A) They are specific populations with unique health care problems.
B) They are limited to the very young and older adult age groups.
C) They live in communities with similar cultures, beliefs, and values.
D) They frequently experience positive outcomes in response to community health interventions.

Answer: C

A case manager's competency is defined as the ability to establish an appropriate plan of care that is based on assessment of clients and families and coordinates the provision of needed resources and services across a continuum of care. A collaborator's competency is described as engaging in a combined effort with all those involved in care delivery. A change agent's competency is to implement new and more effective approaches to problems. A client advocate presents the client's point of view so that appropriate resources can be obtained.

A competent community-based nurse must be skilled in fulfilling a variety of roles. The ability to establish an appropriate plan of care that is based on assessment of clients and families and coordinates the provision of needed resources and services across a continuum of care defines the competency of:

A) Collaborator
B) Change agent
C) Case manager
D) Client advocate

Answer: D

No individual client assessment should occur in isolation from the environment and conditions of the client's community. Industrial development, types of pollution, and cultural and religious groups are individual elements in the community.

When completing an individual total assessment of a client, the community-based nurse will include consideration of:

A) The type of pollution present in the community
B) The amount of industrial development in the past 5 years in the community
C) The predominant cultural and religious groups found in the community
D) The community structures, the population, and the local social system in which the client lives

Answer: A


When dealing with clients who are at risk for or may have suffered abuse, it is important to provide protection. Educating the mother on the developmental issues of her infant is important but provides no protection for the victim. Providing protection and eliminating the fear of retribution is a priority upon discovery of abuse. By disregarding the mother's situation, the nurse has failed to intervene for the family in crisis in the community.

During a well-baby visit, the community-based nurse observed patterned bruises and skin abrasions on the face, arms, and throat of the infant's 21-year-old mother. In questioning the mother, the nurse discovers that she is a recent victim of spousal abuse. An important principle in dealing with this client is:

A) Ensuring the protection of the mother
B) Informing the authorities of the attack
C) Educating the mother on well-baby developmental issues
D) Continuing with the well-baby examination and disregarding the mother's situation

Answer: D

Change must be perceived as advantageous, compatible with existing values, and easily adaptable to be successful and accepted. Up-front cost, managerial framework, building plans, contractors, compliance with building codes, and regulations for governmental agencies are all incorporated in proposals but do not provide convincing reasoning that leads to change.

A proposal written by a community-based nurse for a new, higher quality older adult care center will have increased probability of acceptance if the proposal includes:

A) All building plans and a list of contractors to complete the job
B) Compliance with the codes and building requirements of local government agencies
C) The up-front cost and managerial framework of the new older adult center
D) Description of how advantageous, realistic, compatible, and adaptable the change will be when implemented

Answer: D


The homeless person's lack of a storage site for medication and inability to obtain nutritious meals are factors that contribute to poor management of chronic disease. Homeless people are often stereotyped as having a lack of concern for their situations. Poor attire and lack of hygiene are not causes of chronic illness exacerbation. They are signs of the client's status as a member of an at-risk population. It is incorrect for the nurse to assume that the client lacks education and the ability to read.

A nurse is caring for a 64-year-old homeless woman with a chronic respiratory disease in the local community-based clinic. The nurse realizes that the client is at risk of experiencing exacerbation of the disease process related to:

A) Poor attire and cleanliness practices
B) The client's lack of education and ability to read
C) The individual's lack of concern about the disease
D) The client's lack of a storage site for medication and the inability to obtain nutritious meals

Answer: A, B, C, D

In this case, all four options are correct. The community health nurse is providing information for the community and helping its members learn to access the help that is available, but not dictating the steps that need to be taken.

A community health nurse is caring for members of a Bosnian community. The nurse determines that the children are undervaccinated and that the community is unaware of this resource. As the nurse assesses the community, the nurse determines that there is a health clinic within 5 miles. The nurse meets with the community leaders and explains the need for immunizations, the location of the clinic, and the process for accessing the health care resources. Which of the following is the nurse doing? (Select all that apply.)

A) Improving children's health care
B) Teaching the community about illness
C) Educating about community resources
D) Promoting autonomy in decision making

Answer: A, B, C, D

All are factors that will impact the client's potential to change.

A nurse at the community clinic nurse cares for a 40-year-old woman who takes insulin to manage diabetes. She is having increasing difficulty controlling the disease, and the nurse wants her to try a new insulin pump to help her manage her diabetes. Which of the following change factors increase the likelihood that she will accept this new insulin pump? (Select all that apply.)

A) The innovation or change must be perceived as more advantageous than other alternatives.
B) The innovation or change must be compatible with existing needs, values, and past experiences.
C) The innovation must be tried on a limited basis.
D) Simple innovations or changes are more readily adopted than those that are complex.

Answer: D


Nursing's paradigm includes four linkages: the person, health, environment/situation, and nursing.

Nursing's paradigm includes:

A) Health, person, environment, and theory
B) Concepts, theory, health, and environment
C) Nurses, physicians, models, and client needs
D) The person, health, environment/situation, and nursing

Answer: C

Prescriptive theories address nursing interventions for a phenomenon and predict the consequence of a specific nursing intervention. Descriptive theories describe the phenomena, speculate on the reason the phenomena occur, and predict nursing phenomena. Grand theories are broad and complex and provide a structural framework for broad, abstract ideas about nursing.

Which of the following statements about prescriptive theories is accurate?

A) They describe phenomena.
B) They have the ability to explain nursing phenomena.
C) They reflect practice and address specific phenomena.
D) They provide a structural framework for broad abstract ideas.

Answer: B


A theory is a set of concepts, definitions, relationships, and assumptions that explains a phenomenon. Theories do not formulate legislation, measure nursing functions, or reflect any domain of nursing practice.

A theory is a set of concepts, definitions, relationships, and assumptions that:

A) Formulates legislation
B) Explains a phenomenon
C) Measures nursing functions
D) Reflects the domain of nursing practice

Answer: C


Theories will be tested to describe or predict client outcomes as nursing is addressed as a science and an art. Scientists will not make nursing decisions, and nursing will base client care on the practice of nursing science, which will be guided by multiple theories.

There is a contemporary move toward addressing nursing as a science or as evidenced-based practice. This suggests that:

A) One theory will guide nursing practice.
B) Scientists will make nursing decisions.
C) Theories will be tested to describe or predict client outcomes.
D) Nursing will base client care on the practice of other sciences.

Answer: C


Interdisciplinary theories provide a systematic view of a phenomenon. Developmental theories, health and wellness theories, and systems theories are examples of other types of theories.

To practice in today's health care environment, nurses need a strong scientific knowledge base in nursing and other disciplines, such as the physical, social, and behavioral sciences. This relates to which of the following?

A) Systems theories
B) Developmental theories
C) Interdisciplinary theories
D) Health and wellness model

Answer: B


Developmental theories discuss human growth from conception to death. The other options are incorrect.

Which theories describe an orderly process beginning with conception and continuing through death?

A) Systems theories
B) Developmental theories
C) Interdisciplinary theories
D) Stress and adaptation theories

Answer: C


The first level of Maslow's hierarchy of needs includes the need for air, food, and water—basic elements of survival. Love and belonging are on the second level, esteem and self-esteem are on the fourth level, and self-actualization is the final level.

Maslow's hierarchy of needs is useful to nurses, who must continually prioritize a client's nursing care needs. The most basic or first-level needs include:

A) Self-actualization
B) Love and belonging
C) Air, water, and food
D) Esteem and self-esteem

Answer: A


The goal of Leininger's theory is to provide the client with culturally specific nursing care, in which the nurse integrates the client's cultural traditions, values, and beliefs into the plan of care.

Leininger's theory of cultural care diversity and universality specifically addresses:

A) Caring for clients from unique cultures
B) Understanding the humanistic aspects of life
C) Identifying variables affecting a client's response to a stressor
D) Caring for clients who cannot adapt to internal and external environmental demands

Answer: D


As a science, nursing draws on scientifically tested knowledge applied in the practice setting.

As an art, nursing relies on knowledge gained from practice and reflection on past experiences. As a science, nursing relies on:

A) Experimental research
B) Nonexperimental research
C) Physician-generated research
D) Scientifically tested knowledge

Answer: C


The domain contains the subject, central concepts, values and beliefs, phenomena of interest, and the central problems of the discipline. A paradigm is a model that explains the linkage of science, philosophy and theory that is accepted and applied by the discipline.

Each science has a domain, which is the perspective of the discipline. This domain:

A) Represents the recipients of the benefits of the science or discipline
B) Is a model that explains the linkage of science, philosophy, and theory that is accepted and applied by the discipline
C) Describes the subject, central concepts, values and beliefs, phenomena of interest, and central problems of the discipline
D) Is a dynamic state of being in which the developmental and behavioral potential of the individual is realized to the fullest

Answer: D


Describing, explaining, predicting, and/or prescribing interrelationships among concepts are stated purposes of research.

A theory is a set of concepts, definitions, relationships, and assumptions or propositions to explain a phenomenon. The purposes of the components of a theory are to:

A) Describe concepts or connect two concepts that are factual
B) Formulate a perceptual experience to describe or label a phenomenon
C) Express the global view about the individual, situations, or factors of interest to a specific discipline
D) Describe, explain, predict, and/or prescribe interrelationships among the concepts that define the phenomenon

Answer: A


Phenomena are defined as aspects of reality that can be consciously sensed or experienced.

Nursing theories focus on the phenomena of nursing and nursing care. Which of the following is true of phenomena?

A) They are aspects of reality that can be consciously sensed or experienced.
B) They convey the general meaning of concepts in a manner that fits the theory.
C) They are statements that describe concepts or connect two concepts that are factual.
D) They are mental formulations of an object or event that come from individual perceptual experience.

Answer: A


Grand theories are described as broad and complex. Middle-range theories are limited in scope, less abstract, address specific phenomena or concepts, and reflect practice. Descriptive theories describe phenomena, speculate as to why the phenomena occur, and describe the consequences of phenomena. Prescriptive theories address nursing interventions and predict the consequence of a specific intervention.

Theories that are broad and complex are:

A) Grand theories
B) Descriptive theories
C) Middle-range theories
D) Prescriptive theories

Answer: D


Middle-range theories are limited in scope, less abstract than grand theories, address specific phenomena or concepts, and reflect practice. Grand theories are described as broad and complex. Prescriptive theories address nursing interventions and predict the consequence of a specific nursing intervention. Descriptive theories describe phenomena, speculate as to why the phenomena occur, and describe the consequences of phenomena.

Mishel's theory of uncertainty in illness focuses on the experience of clients with cancer who live with continual uncertainty. The theory provides a basis for nurses to assist clients in appraising and adapting to the uncertainty and illness response and can be described as:

A) A grand theory
B) A descriptive theory
C) A prescriptive theory
D) A middle-range theory

Answer: C


Prescriptive theory addresses nursing interventions and predicts the consequence of a specific nursing intervention. Middle-range theories are limited in scope, less abstract than grand theories, address specific phenomena or concepts, and reflect practice. Descriptive theories describe phenomena, speculate as to why the phenomena occur, and describe the consequences of phenomena. Grand theories are broad and complex.

The type of theory that tests the validity and predictability of nursing interventions is:

A) A grand theory
B) A descriptive theory
C) A prescriptive theory
D) A middle-range theory

Answer: B


Identified linkages of a nursing paradigm are the person, health, environment/situation, and nursing itself. Concepts, definitions, relationship, and assumptions are components of a theory. The individuals, groups, situations, and interests specific to nursing are potential subjects for middle-range theories. Description, explanation, prediction, and prescription of an interrelationship of nursing are purposes of nursing theory.

The nursing paradigm identifies four linkages of interest to the nursing profession. These four linkages are:

A) Concepts, definitions, relationships, and assumptions
B) The person, health, environment/situation, and nursing
C) The individual, groups, situations, and interests specific to nursing
D) Description, explanation, prediction, and prescription of an interrelationship of nursing

Answer: C


An open system is defined as a system that interacts with the environment, exchanging information between the system and the environment.

The nursing process is an example of an open system. An open system:

A) Is universal and dynamic
B) Represents a relationship between two concepts
C) Interacts with the environment by exchanging information
D) Is a process through which information is returned to the system

Answer: D


The result of theory-generating or theory-testing research is to increase the knowledge base of nursing. As these research activities continue, clients become the recipients of evidence-based nursing care.

Evidence-based nursing practice is the end result of:

A) Prescriptive theory
B) Use of practical knowledge
C) Application of theoretical knowledge
D) Theory-generating and theory-testing research

Answer: B


The question describes the nursing theory developed by Fay Abdellah and others. Rogers' theory considered the individual as an energy field existing within the universe. Henderson's theory defines nursing as "assisting the individual, sick, or well, in the performance of those activities that will contribute to health, recovery, or a peaceful death." Nightingale viewed nursing as providing fresh air, light, warmth, cleanliness, quiet, and adequate nutrition.

The nursing theory that emphasizes the delivery of nursing care for the whole person to meet the physical, emotional, intellectual, social, and spiritual needs of the client and family is:

A) Rogers' theory
B) Abdellah's theory
C) Henderson's theory
D) Nightingale's theory

Answer: B


A qualitative study involves inductive reasoning to develop generalizations or theories from specific observations or interviews. Historical research establishes facts and relationships concerning past events. Correlational research explores the interrelationships among variables of interest without any intervention by the researcher. An experimental study used tightly controlled subject groups, variables, and procedures to eliminate bias and ensure that findings can be generalized to similar groups of subjects.

A nurse researcher interviews senior oncology nurses, asking them to describe how they deal with the loss of a client. The analysis of the interviews yields common themes describing the nurses' grief. This is an example of which type of study?

A) Historical study
B) Qualitative study
C) Correlational study
D) Experimental study

Answer: B


Surgical clients are the client population of interest (P) in the PICO (population, intervention, comparison, outcome) question. Chlorhexidine use is the comparison of interest, and povidone-iodine use is the intervention of interest. The operating room nurse is not an element of the PICO question.

An operating room nurse is talking with colleagues during a meeting and 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 clients? In this example of a PICO question, the P is:

A) Povidone-iodine use
B) Surgical clients
C) Chlorhexidine use
D) Operating room nurses

Answer: A


Because the clients at the clinic are allowed their choice of the traditional versus the new exercise program, the sampling in this study is not random sampling and can bias study results.

A nurse researcher is designing an exercise study that involves 100 clients who attend a wellness clinic. As the clients come to the clinic, each has a choice as to whether they want to be in the new exercise program or remain in the traditional program. The nurse plans to measure the clients' self-report of exercise before and 6 months after the program begins. What factor might influence the results of this study in an unfavorable way?

A) Bias
B) Anonymity
C) Sample size
D) Sampling method

Answer: D


The scientific method is the foundation of research and the most reliable and objective of all methods of gaining knowledge. Experience, critical thinking, and evidence are not the foundation of research.

The foundation of research is which of the following?

A) Evidence
B) Experience
C) Critical thinking
D) Scientific method

Answer: D


Informed consent means that the research subjects are given full and complete information about the purpose of the study, procedures, data collection, potential harm and benefits, and alternate methods of treatment. Confidentiality rules guarantee that any information the subject provides will not be reported to people outside the research team. Bias is any personal opinion or judgment that may be interjected into the results.

A researcher gives a subject full and complete information about the purpose of a study. This is an example of:

A) Bias
B) Anonymity
C) Confidentiality
D) Informed consent

Answer: D


A knowledge-focused trigger is a question regarding new information available on a topic. A problem-focused trigger is one faced while caring for a client or noting a trend. The PICO (population, intervention, comparison, outcome) format is a way to phrase a question to help clarify the question and the parts. A hypothesis is a prediction about the relationship between study variables.

A new nurse on an orthopedic unit is assigned to care for a client 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?

A) Hypothesis
B) PICO question
C) Problem-focused trigger
D) Knowledge-focused trigger

Answer: A


The "Do" step consists of selecting an intervention based on a data review and implementing the change, plus studying the results of the change. The "Plan" step includes reviewing the available data to understand existing practice conditions or problems to identify the need for change. The results of the change are evaluated in the "Study" step. The "Act" step is the incorporation of the findings into current practice.

The nurses on a medical unit have seen an increase in the number of pressure ulcers developing in their clients. The nurses decide to initiate a quality improvement project using the PDSA (plan, do, study, act) model. Which of the following is an example of the "Do" step of that model?

A) Implement a new skin care protocol on all medical units.
B) Review the data collected on clients cared for using the new protocol.
C) Review the quality improvement reports on the six clients who developed ulcers over the previous 3 months.
D) Based on findings from clients who developed ulcers, implement an evidence-based skin care protocol.

Answer: C


The conduct of research must meet ethical standards in which the rights of human subjects are protected. The research participants must be told about the study's purpose and procedure, and their roles in the study. The researcher is always legally responsible for his or her actions. Control of variables is related to the study design, not to informed consent. Confidentiality is part of the ethical nature of research but is not the focus of informed consent.

The nurse researcher obtains informed consent from participants in a study primarily to:

A) Release the researcher from legal liability.
B) Control variables that might affect the study.
C) Ensure that the study subjects understand their roles in the study.
D) Maintain the confidentiality of the researcher and the participants.

Answer: B


Quality client care is always the primary focus of nursing practice. Cost control would be a benefit but is not the primary focus. Research is not about technology. Many "old" procedures can be improved through research. Although research is a professional function of nursing, it is not done to serve the profession.

A priority goal for nursing research is:

A) Controlling cost for hospitals
B) Improving client care
C) Keeping up with technological advances
D) Maintaining the professional climate in nursing

Answer: C


Review of the literature is the first step in the orderly research process to determine what is already known about the problem. Recruiting clients occurs later in the process, after identifying the problem, researching the literature, and designing the study. Experimenting with new nursing procedures that have not been tested or approved is a risk to clients. Surveys are designed to obtain information from large study populations and would not be a first step in the research process.

A clinical nurse develops a better way to secure an intravenous access device in a client and wants to see if it would benefit other clients. The first step in initiating a study should be to:

A) Recruit clients to participate in the study.
B) Use the new technique and gather client feedback.
C) Review current literature related to the clinical problem.
D) Survey clients regarding their preferences and feelings regarding the procedure.

Answer: B


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 to duplicate 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 client at risk.

The nurse researcher who gains new knowledge regarding a procedure can most effectively share the information with the nursing profession by:

A) Duplicating the study using different clients in different settings
B) Communicating the research findings in a professional journal
C) Recruiting clients who are willing to demonstrate the new technique
D) Asking individual nurses to report their experiences related to the new procedure

Answer: A


A nurse who is new to practice has not developed the experience required for research but can begin at the less complicated level of data collection. An experienced researcher is more qualified to identify problems for formal research, although input from all levels of nursing is valuable. Nurses with doctoral-level training are typically prepared for obtaining financial backing. An American Nurses Association position paper cites a master's degree as qualification for implementing research-based change in nursing practice.

Nurses who are new to practice can best contribute to nursing research by:

A) Assisting with data collection
B) Identifying clinical problems in nursing
C) Obtaining financial backing and public interest
D) Implementing research-based change in nursing practice

Answer: C


Evaluation research is aimed at finding out how well a program, practice, policy, or procedure is working. A survey studies a large group to identify general information, opinions, attitudes, or perceptions. A grounded theory is a theory developed through the collection and analysis of qualitative data. Experimental research collects information about human subjects who are divided into a control group and a comparison group.

A nurse manager wants to determine how well a new policy is working in the clinical area. It would be appropriate to use:

A) Survey methods
B) Grounded theory
C) Evaluation research
D) Experimental research

Answer: B


Critical thinking involves analyzing the data, learning, and problem solving to come up with a course of action. Tradition limits the ability to learn new ways and overlooks what research has to offer. The advice of experienced practitioners may limit research because experience may mean doing things the same way they have been done for years. Using personal opinion overlooks the objective data that are available.

The nurse involved in scientific research effectively analyzes the information collected and determines a course of nursing action by:

A) Depending on tradition
B) Using critical thinking
C) Seeking the advice of experienced practitioners
D) Relying on personal perspective or opinion

Answer: B


Effective qualitative research can be carried out, because through narrative interviews the participants' perceptions can be compared and common characteristics can be discovered. It is difficult to collect data about perceptions or feelings without talking to those involved. Quantitative research involves precise measurements and would not be of use in this study of perceptions. Although obtaining suggestions for possible solutions could be useful, it does not help to identify the problems on this specific unit. The data must be collected first.

A nurse manager is researching the effects of staff shortages on job satisfaction among new graduates. It would be most effective for the nurse to gather data by:

A) Directly observing the nursing behaviors on the unit
B) Interviewing staff nurses on the unit regarding their perceptions
C) Setting up an experimental group and a control group for the study
D) Calling on other nurses in the facility to suggest ways of handling the problem

Answer: D


Shortage of staff could mean less time and personnel to conduct and participate in research. Nursing teams that have teamwork skills can aid research. The desire to change is an incentive for research. Pressure from higher levels in the organization is also an incentive to research.

Which of the following could be a barrier to nursing research?

A) Presence of teams in nursing
B) Pressure from the administration
C) Staff wishes to change a policy
D) Shortage of professional nursing staff

Answer: B


Hypertension is often asymptomatic until pressure is very high. Headache (usually occipital), facial flushing, nosebleed, and fatigue are common symptoms of hypertension. Restlessness and dusky or cyanotic skin that is cool to the touch, dizziness, mental confusion, and mottled extremities are all signs and symptoms of hypotension. Unexplained pain and hyperactivity are very vague complaints.

Besides high blood pressure values, what other signs and symptoms may the nurse observe if hypertension is present?

A) Unexplained pain and hyperactivity
B) Headache, flushing of the face, and nosebleed
C) Dizziness, mental confusion, and mottled extremities
D) Restlessness and dusky or cyanotic skin that is cool to the touch

Answer: D


An oxygen saturation of 89% should be addressed first, because this indicates that a client needs oxygen. The high respiratory rate may be a result of hypoxemia and may decrease as the oxygen saturation climbs. The blood pressure is high, but this might be attributed to hypoxemia or anxiety. The heart rate and temperature are within normal limits.

Which of the following values for vital signs would the nurse address first?

A) Heart rate = 72 beats per minute
B) Respiration rate = 28 breaths per minute
C) Blood pressure = 160/86
D) Oxygen saturation by pulse oximetry = 89%
E) Temperature = 37.2° C (99° F), tympanic

Answer: D


This client has a fever, potentially secondary to the pneumonia previously diagnosed. His blood pressure is within normal limits. His oxygen saturation is at 92%, so this will need to be addressed second. His respiratory rate is high, which can be a result of the fever.

An 82-year-old widower brought via ambulance is admitted to the emergency department with complaints of shortness of breath, anorexia, and malaise. He recently visited his health care provider and was put on an antibiotic for pneumonia. The client indicates that he also takes a diuretic and a beta blocker, which helps his "high blood." Which vital sign value would take priority in initiating care?

A) Respiration rate = 20 breaths per minute
B) Oxygen saturation by pulse oximetry = 92%
C) Blood pressure = 138/84
D) Temperature = 39° C (102° F), tympanic

Answer: C


Since the "up ad lib" orders are new and the client has been on bed rest, checking orthostatic blood pressure before allowing the client to ambulate is the correct answer. If no sign of orthostatic hypotension is present, then a nursing assistant could assist him to the bathroom. Giving the client a urinal is not a good choice if the client is asymptomatic when orthostatic blood pressure is checked.

The client, who has been on bed rest for 2 days, asks to get out of bed to go to the bathroom. He has new orders for "up ad lib." What action should the nurse take?

A) Give him some slippers and tell him where the bathroom is located.
B) Ask the nursing assistant to assist him to the bathroom.
C) Obtain orthostatic blood pressure measurements.
D) Tell him it is not a good idea and provide a urinal.

Answer: A


Although early morning temperatures are routinely low, the best practice is for the nurse to check the client's previous temperatures. Clients may routinely have a low temperature. Depending on the client's temperature history, the nurse may retake the temperature with another thermometer to check for a malfunction. If everything seems satisfactory, the nurse should chart the temperature and check the client for signs of hypothermia.

Using an oral electronic thermometer, the nurse checks the early morning temperature of a client. The client's temperature is 36.1° C (97° F). The client's remaining vital signs are in the normally acceptable range. What should the nurse do next?

A) Check the client's temperature history.
B) Document the results; temperature is normal.
C) Recheck the temperature every 15 minutes until it is normal.
D) Get another thermometer; the temperature is obviously an error.

Answer: B


The apical pulse gives the nurse the most information and accuracy when assessing irregular cardiac rhythm. The carotid or femoral pulses are usually used to assess a client in shock. The radial pulse is adequate for determining routine postoperative vital signs and for checking changes in orthostatic heart rate.

The nurse decides to take an apical pulse instead of a radial pulse. Which of the following client conditions influenced the nurse's decision?

A) The client is in shock.
B) The client has an arrhythmia.
C) The client underwent surgery 18 hours earlier.
D) The client showed a response to orthostatic changes.

Answer: D

Postponing this assessment is definitely a judgment call by the nurse. Postponing is appropriate unless the assessment of respiration is a critical aspect of the test and the client is leaving for the test immediately. Otherwise, it is probably not necessary to invade the client's privacy and disrupt the visitation. Agency policy will dictate whether the respiration rate should be documented as "deferred" or whether documentation can wait until the rate is obtained. Respirations should be counted when the client is "at rest"; therefore, counting respirations during the visitation would not be appropriate. Waiting at the bedside until the visitor leaves is an invasion of privacy for the client and a waste of the nurse's time.

The nurse is to measure vital signs as part of the preparation for a test. The client is talking with a visiting pastor. How should the nurse handle measuring the rate of respiration?

A) Count respirations during the time the client is not talking to the visitor.
B) Wait at the client's bedside until the visit is over and then count respirations.
C) Tell the client it is very important to end the conversation so the nurse can count respirations.
D) Document the respiration rate as "deferred" and measure the rate later, since the talking client is obviously not in respiratory distress.

Answer: D


The nurse may delegate vital signs measurement to unlicensed assistive personnel when the client is in stable condition, the results are predictable, and the technique is standard. The preoperative client is the only client listed who meets these guidelines.

Delegation of some tasks may become one of the decisions the nurse will make while on duty. For which of the following clients would it be most appropriate for unlicensed assistive personnel to measure the client's vital signs?

A) A client who recently started taking an antiarrhythmic medication
B) A client with a history of transfusion reactions who is receiving a blood transfusion
C) A client who has frequently been admitted to the unit with asthma attacks
D) A client who is being admitted for elective surgery who has a history of stable hypertension

Answer: D


Therapies such as tepid water or alcohol sponge baths should be avoided because they lead to shivering, which stimulates body heat. Antipyretics, not analgesics, are the medications that lower body temperature.

The client has an oral temperature of 39.2° C (102.6° F). What are the most appropriate nursing interventions?

A) Provide an alcohol sponge bath and monitor laboratory results.
B) Remove excess clothing, provide a tepid sponge bath, and administer an analgesic.
C) Provide fluids and nutrition, keep the client's room warm, and administer an analgesic.
D) Reduce external coverings and keep clothing and bed linens dry; administer antipyretics as ordered.

Answer: D


The anterior hypothalamus controls heat loss by initiating the mechanisms of sweating and vasodilation of blood vessels. Blood is redistributed to surface vessels (flushing of the skin) to promote heat loss, not heat retention. The posterior hypothalamus controls heat production by initiating the mechanisms of shivering, vasoconstriction of blood vessels, and reduction of blood flow to the skin and extremities.

The hypothalamus controls body temperature. The anterior hypothalamus controls heat loss, and the posterior hypothalamus controls heat production. What heat conservation mechanisms will the posterior hypothalamus initiate when it senses that the client's body temperature is lower than comfortable?

A) Vasodilation and redistribution of blood to surface vessels
B) Sweating, vasodilation, and redistribution of blood to surface vessels
C) Vasoconstriction, sweating, and reduction of blood flow to extremities
D) Vasoconstriction, reduction of blood flow to extremities, and shivering

Answer: C


To measure pulse deficit the nurse and a colleague assess the radial and apical pulse rates simultaneously and subtract the radial from the apical pulse rate. The result is the pulse deficit. Tachycardia and bradycardia are assessed by measuring the pulse rate for 1 minute. A rate of more than 100 beats per minute is categorized as tachycardia, whereas a rate of less than 60 beats per minute constitutes bradycardia.

The nurse's documentation indicates that a client has a pulse deficit of 14 beats. The pulse deficit is measured by:

A) Subtracting 60 (bradycardia) from the client's pulse rate and reporting the difference
B) Subtracting the client's pulse rate from 100 (tachycardia) and reporting the difference
C) Assessing the apical pulse and the radial pulse for the same minute and subtracting the difference
D) Assessing the apical pulse and 30 minutes later assessing the carotid pulse and subtracting the difference

Answer: D


Cheyne-Stokes respiration is an irregular respiratory rate and depth with alternating periods of apnea and hyperventilation; it begins with slow breaths and climaxes in apnea before respiration resumes.

The nurse observes that a client's breathing pattern represents Cheyne-Stokes respiration. Which statement best describes the Cheyne-Stokes pattern?

A) Respirations cease for several seconds.
B) Respirations are abnormally shallow for two to three breaths followed by irregular periods of apnea.
C) Respirations are labored, with an increase in depth and rate (more than 20 breaths per minute); the condition occurs normally during exercise.
D) Respiration rate and depth are irregular, with alternating periods of apnea and hyperventilation; the cycle begins with slow breaths and climaxes in apnea.

Answer: D


All questionable blood pressure readings should be rechecked. Ensuring the client's safety is a necessary safeguard, because low blood pressure is generally accompanied by weakness. For the majority of people, low blood pressure (systolic pressure of 90 mm Hg or below) is an abnormal finding and should be reported. Giving a client orange juice may raise blood glucose level but is not recommended to elevate blood pressure. Ambulating a client with hypotension would not be following safety precautions.

The nurse finds that the systolic blood pressure of an adult client is 88 mm Hg. What are the appropriate nursing interventions?

A) Check other vital signs.
B) Recheck the blood pressure and give the client orange juice.
C) Recheck the blood pressure after ambulating the client safely.
D) Recheck the blood pressure, make sure the client is safe, and report the findings.

Answer: A


The general survey focuses on general appearance and behavior, including gender and race, age, signs of distress, body type, posture, gait, hygiene and grooming, dress, affect, mood, and speech. The other actions are carried out in different parts of the assessment.

The nurse conducts a general survey of an adult client, which includes:

A) Checking appearance and behavior
B) Measuring vital signs
C) Observing specific body systems
D) Conducting a detailed health history

Answer: C


The nurse accurately assesses temperature by palpating the skin with the dorsum or back of the hand, because this area of the hand is more sensitive to temperature than is the base of the hands, the fingertips, or the palmar surface.

To correctly palpate the client's skin for temperature, the nurse uses which of the following?

A) Base of the hands
B) Fingertips of the hands
C) Dorsal surface of the hands
D) Palmar surface of the hands

Answer: D


Superficial lymph nodes are gently palpated using the pads of the index and middle fingers. The lymph nodes are small, and any other method would not be helpful.

To assess a client's superficial lymph nodes, the nurse:

A) Deeply palpates using the entire hand
B) Deeply palpates using a bimanual technique
C) Lightly palpates using a bimanual technique
D) Gently palpates using the pads of the index and middle fingers

Answer: C


Pigmented skin lesions that are asymmetrical, have irregular borders, have variegated colors, and are larger than 6 mm in diameter are lesions that are suspect and should be reported to a medical provider.

The nurse teaches the client to inspect all skin surfaces and to report pigmented skin lesions that:

A) Are symmetrical
B) Are uniform in color
C) Have irregular borders
D) Are smaller than 6 mm in diameter

Answer: A


The sounds of lung fields on one side of the body are compared with the sounds of the same fields on the opposite side of the body. The other answers would provide incorrect comparisons.

To auscultate the client's lung fields, the nurse uses a systematic pattern comparing:

A) Side to side
B) Top to bottom
C) Anterior to posterior
D) Interspace to interspace

Answer: B


Rhonchi are loud, low-pitched, rumbling, coarse sounds heard most often during inspiration or expiration. Crackles are moist sounds heard during inspiration that are not cleared with coughing. Normal lungs produce no sounds such as that described. Wheezes are high-pitched continuous muscles sounds such as a squeak heard continuously during inspiration and expiration.

The client's respiratory assessment reveals loud, low-pitched, rumbling, coarse sounds heard during inspiration and expiration. The nurse interprets these sounds as:

A) Normal
B) Rhonchi
C) Crackles
D) Wheezes

Answer: C


The S2 (dub) sound is the second heart sound and indicates closure of the aortic and pulmonic valves. The closing of the mitral and tricuspid valves is the S1 sound.

While auscultating heart sounds, the nurse documents that S2 is best heard at the base. This sound (S2) correlates with closure of which of the following?

A) Aortic and mitral valves
B) Mitral and tricuspid valves
C) Aortic and pulmonic valves
D) Tricuspid and pulmonic valves

Answer: D


The dorsalis pedis pulse is felt on the top of the foot in line with the groove between the extensor tendons of the great toe and the first toe. The popliteal pulse is felt behind the knee. The posterior tibial pulse is felt in the groove behind the medial malleolus. Typically pulses are not palpated behind the lateral malleolus.

To assess the client's dorsalis pedis pulse, the nurse palpates:

A) Behind the knee
B) Over the lateral malleolus
C) In the groove behind the medial malleolus
D) Lateral to the extensor tendon of the great toe

Answer: A


Lying in the supine position with the ipsilateral arm behind the head helps the breast tissue to flatten evenly against the chest wall. The other options do not allow the tissue to spread on the chest wall.

So that breast tissue will be spread evenly over the chest wall during an examination, the nurse asks the client to lie supine with:

A) The ipsilateral arm behind the head
B) Hands clasped just above the umbilicus
C) Both arms overhead with palms upward
D) The dominant arm straight alongside the body

Answer: B


Painless, pea-sized nodules should be checked by a health care provider. Testicular self-examination should be performed monthly and should be done after a bath or shower. The testes feel smooth, rubbery, and free of nodules.

The nurse is teaching a client how to perform a testicular self-examination. The nurse tells the client which of the following?

A) "The testes are normally round, moveable, and have a lumpy consistency."
B) "Contact your health care provider if you feel a painless pea-sized nodule."
C) "The best time to do a testicular self-examination is before your bath or shower."
D) "Perform a testicular self-examination weekly to detect signs of testicular cancer."

Answer: D


Adduction is movement toward the body. Abduction is movement away from the body. Flexion is movement that decreases the angle of the joint, whereas extension is movement that increase the angle of the joint.

The client is being assessed for range of joint movement. The nurse asks the client to move the arm toward the body to evaluate:

A) Flexion
B) Extension
C) Abduction
D) Adduction

Answer: D


This common adage embodies an abstract idea, and explaining it indicates the client's ability to perform abstract reasoning. Judgment involves comparison and evaluation of facts and ideas to understand their relationships and to form appropriate conclusions. Knowledge is understanding or awareness of information gained through learning or experience. Association involves finding similarities between concepts.

The nurse asks the client to interpret the saying, "Don't count your chickens before they're hatched." The client's response provides information about the client's:

A) Judgment
B) Knowledge
C) Association
D) Abstract reasoning

Answer: D


The movement of the head and shoulders is controlled by cranial nerve XI, the spinal accessory nerve. The facial nerve innervates the face. The hypoglossal nerve innervates portions of the tongue. The trigeminal nerve is a sensory and motor nerve enervating the side of the face and jaw.

The nurse asks the client to shrug the shoulders and turn the head side to side against the resistance of the examiner's hand. These actions allow the nurse to evaluate which cranial nerve?

A) VII—Facial
B) V—Trigeminal
C) XII—Hypoglossal
D) XI—Spinal accessory

Answer: D


The nurse begins with inspection and then follows with auscultation. It is important to perform auscultation before palpation and percussion, because palpation and percussion may alter the frequency and character of bowel sounds.

The techniques of physical assessment are inspection, palpation, percussion, and auscultation. The order in which these techniques are used is slightly different during abdominal examination than during examination of other body areas. The nurse should perform which two of the following first?

A) Palpation and inspection
B) Inspection and percussion
C) Palpation and auscultation
D) Inspection and auscultation

Answer: B


Sitting upright provides full expansion of the lungs and provides better visualization of the symmetry of upper body parts. The lateral recumbent position aids in detecting heart murmurs. The dorsal recumbent position is used for abdominal assessment because it allows relaxation of abdominal muscles. The supine position provides easy access to pulse sites.

The nurse should assist the client to a sitting position to provide the best position to examine which of the following?

A) Heart
B) Lungs
C) Abdomen
D) Pulse sites

Answer: D


To assess skin turgor, a fold of skin on the back of the forearm or sternal area is grasped with the fingertips and released. When turgor is good the skin lifts easily and snaps back immediately. The skin stays pinched when turgor is poor. The hands and neck are not the best places to test turgor, because the skin is normally loose and thin in those areas.

Turgor is the skin's elasticity, which can be diminished by edema or dehydration. Which is the best place for the nurse to assess skin turgor in the older adult?

A) Side of the neck
B) Back of the hand
C) Palm of the hand
D) Over the sternal area

Answer: C


Resonance is the low, hollow sound of normal lungs. Hyperresonance can be heard over emphysematous lungs as a booming sound. Tympany is the high-pitched, drumlike sound heard over a gastric air bubble. Dullness is the soft, thudlike sound that is heard over dense organ tissue.

In assessing the client's lungs, the nurse notes that the lungs are normal upon percussion. This means that the nurse detected:

A) Dullness
B) Tympany
C) Resonance
D) Hyperresonance

Answer: C


Pallor would appear as yellowish brown in brown-skinned people. Pallor would manifest as bluish skin in light-skinned people. Pallor would appear as ashen gray skin in black-skinned people. Shiny skin indicates edema.

A common abnormality encountered during inspection of the skin is pallor. Pallor is easily seen in the face, mucosa of the mouth, and nail beds. How would pallor appear in a brown-skinned client?

A) As shiny skin
B) As bluish skin
C) As yellowish skin
D) As ashen gray skin

Answer: D


A normal tympanic membrane is translucent, shiny, and pearly gray. Dark yellow and sticky describes normal moist cerumen (earwax) in front of the tympanic membrane. A white color indicates pus behind the membrane. A pink or red bulging membrane is an indication of inflammation.

Using an otoscope, the nurse can inspect the tympanic membrane. A normal tympanic membrane appears:

A) Round and white
B) Pink and bulging
C) Dark yellow and sticky
D) Translucent, shiny, and pearly gray

Answer: C


Wheezes are adventitious breath sounds that are high-pitched, continuous musical sounds, such as a squeak heard continuously during inspiration or expiration. Pleural friction rub has a dry, grating quality and is heard best during inspiration. Crackles can be fine, high-pitched, short, interrupted crackling sounds; moist, low sounds in the middle of inspiration; or coarse, loud, bubbly sounds. Rhonchi are loud, low-pitched, rumbling, coarse sounds heard during inspiration.

In assessing the client's lungs the nurse hears adventitious breath sounds that are high-pitched, continuous musical sounds, such as a squeak heard continuously during inspiration or expiration, usually louder on expiration. These adventitious breath sounds are known as:

A) Crackles
B) Rhonchi
C) Wheezes
D) Pleural friction rub

Answer: D


Aortic, pulmonic, tricuspid, mitral areas are the sites for auscultation assessment of cardiac function. Auscultation of the carotid arteries is not the same as auscultation of the heart itself. The sternal region is not an appropriate site. There are no costal sites where heart sounds can be heard well. Anterior, posterior, and lateral are too vague.

The nurse should use which anatomical sites for the auscultatory assessment of cardiac function?

A) Inner costal, outer costal, and sternal
B) Aortic, carotid, coronary, and jugular
C) Apical, lateral, anterior, and posterior
D) Aortic, pulmonic, tricuspid, and mitral

Answer: C


Complaints of tenderness in the calf during palpation may indicate phlebitis. Other characteristics of phlebitis are swelling, warmth, redness, and sometimes a positive Homans' sign. Cyanosis, pallor, and brown pigmentation around the ankles as well as ulceration and reduced hair growth are indications of venous or arterial insufficiency, which would not cause tenderness on palpation. Venous distention may be indicative of varicosities, which also are not associated with tenderness.

While the nurse was palpating the calf muscles of the client's right leg, the client complained of tenderness. Further assessment by the nurse should include which of the following?

A) Observation for reduced hair growth and ulceration
B) Observation for venous distention while the client is standing
C) Observation of the area for swelling, warmth, redness, and a positive Homans' sign
D) Observation for cyanosis, pallor, and change in pigmentation around the ankles

Answer: D


Kyphosis (hunchback) is an exaggeration of the posterior curvature of the thoracic spine and is common in older adults. Lordosis (swayback) is increased lumbar curvature. Scoliosis is lateral spinal curvature. Hypotonic muscle has little tone and feels flabby, usually because of atrophy of muscle mass.

During general inspection of the musculoskeletal system of an older client, the nurse notes kyphosis. Kyphosis is:

A) Lateral spinal curvature
B) Loss of or decrease in muscle tone
C) Increased lumbar curvature
D) Exaggeration of the posterior curvature of the thoracic spine

The purpose of assessment is to:
A) Make a diagnostic conclusion.
B) Delegate nursing responsibility.
C) Teach the client about his or her health.
D) Establish a database concerning the client.

D) Establish a database concerning the client.
The purpose of assessment is to establish a database about the client's perceived needs, health problems, and responses to these problems. The data also reveal related experiences, health practices, goals, values, and expectations. The other options are not purposes of assessment.

Assessment data must be descriptive, concise, and complete. In performing an assessment the nurse should not:
A) Include subjective data from the client.
B) Perform a thorough physical examination.
C) Use interpersonal and cognitive skills.
D) Include inferences or interpretative statements not supported with data.

D) Include inferences or interpretative statements not supported with data.
The nurse should not generalize or form judgments 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 client.

A nurse assessing a client who comes to the pulmonary clinic asks, "Tell me what medications you are taking for your breathing problem. I see from your last visit that Dr. Russell recommended routine exercise. Can you also tell me how successful you have been in following his plan?" The nurse's assessment covers which of Gordon's functional health patterns?
A) Value-belief pattern
B) Cognitive-perceptual pattern
C) Coping-stress tolerance pattern
D) Health perception-health management pattern

D) Health perception-health management pattern
The health perception-health management pattern involves the client's self-report of health and well-being, how the client manages his or her health, and knowledge of preventative health practices. The cognitive-perceptual pattern involves sensory-perceptual patterns, language adequacy, memory, and decision-making abilities. The coping-stress tolerance pattern involves the client's ability to manage stress, sources of support, and the effectiveness of the patterns in terms of stress tolerance. The value-belief pattern involves the values, beliefs, and goals that guide the client's choices or decisions.

The nurse asks a client, "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 likely occur during which phase of a client interview?

A) Working

During data clustering, a nurse:
A) Provides documentation of nursing care
B) Reviews data with other health care providers
C) Makes inferences about patterns of information
D) Organizes cues into patterns that lead to identification of nursing diagnoses

D) Organizes cues into patterns that lead to identification of nursing diagnoses
During data clustering, the nurse organizes cues into patterns that indicate individualized nursing diagnoses and identify collaborative problems. The other options are incorrect.

What type of interview technique is the nurse using when the nurse asks the question, "Do you have pain or cramping?"
A) Active listening
B) Open-ended questioning
C) Closed-ended questioning
D) Problem-oriented questioning

C) Closed-ended questioning
The example is a closed-ended question which the client can answer with a one-word reply. Open-ended questions allow the client to answer with more information. The other options are not correct.

Which of the following is subjective information to be entered in the client'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.

B) 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 client's report. The other options are objective data.

Which of the following is objective information to be recorded in the client's medical record?
A) Anxious over upcoming test.
B) Increasing stress over past 2 months.
C) Performs breast self-examination monthly.
D) Expelled 1 tablespoon of yellow sputum.

D) Expelled 1 tablespoon of yellow sputum.
Objective data are measurable data. Options 1, 2, and 3 describe data that cannot be measured by the nurse but depend on the client's reports; thus they are subjective data.

A client who is alert and awake is being transferred to another hospital with a copy of his medical records. Before the transfer the nurse must:
A) Ask the hospital lawyer if this requires approval from the risk management department.
B) Discuss the need to copy the medical records with the client's family.
C) Be certain that the physician writes an order for the record to be copied.
D) Obtain written permission to copy the medical records for the receiving hospital.

D) Obtain written permission to copy the medical records for the receiving hospital.
Obtaining permission to copy the records demonstrates the nurse's understanding of the provisions of the Health Insurance Portability and Accountability Act (HIPAA). Discussing medical records with the client's family is inappropriate because the client's family does not make the decision for a client who is capable of making his own decision. Policies and procedures would already be in place for the nurse with regard to copying medication records. It is not necessary to call the hospital lawyer. Copying a client's medical record does not require

Which of the following is an open-ended question the nurse might use when interviewing a client?
A) "Do you have any concerns right now?"
B) "Is your family worried about your being in the hospital?"
C) "What do you mean when you say, 'I don't feel quite right'?"
D) "How many times do you get up to go to the bathroom at night?"

C) "What do you mean when you say, 'I don't feel quite right'?"
The way the nurse asks question 3 allows the client to respond completely and with more than a one-word answer. The other options allow the client to respond with one word and make it unlikely that the client will give additional information.

The nurse asks the client whether the client has any allergies. This is an example of:
A) Health history data
B) Biographical information
C) History of present illness
D) Environmental history data

A) Health history data
Known allergies are a part of historical data. Biographical data include age, address, occupation, work status, marital status, course of health care, and insurance. The history of the present illness includes when the symptoms began, whether they began suddenly or gradually, whether they come and go, and other information about the illness. The environmental history includes data about the client's home and working environments.

The nursing assessment is which phase of the nursing process?
A) First
B) Second
C) Third
D) Fourth

A) First

What techniques encourage a client to tell his or her full story? (Select all that apply.)
A) Active listening
B) Back channeling
C) Use of open-ended questions
D) Use of closed-ended questions

A) Active listening
B) Back channeling
C) Use of open-ended questions

Options 1, 2, and 3 encourage clients to tell their full stories. Closed-ended questions allow clients to answer with one or two words, which makes it more difficult to obtain all the information required for a full story. The other options give clients the opportunity to tell their stories and feel supported. Active listening helps them feel that they, and their stories, are important.

The nurse gathered the following assessment data. Which of these cues form a pattern? (Select all that apply.)
A) Client is restless.
B) Respirations are 24/min and irregular.
C) Client states feeling short of breath.
D) Fluid intake for 8 hours is 800 ml.
E) Client has drainage from surgical wound.
F) Client reports loss of appetite for over 2 weeks.

A) Client is restless.
B) Respirations are 24/min and irregular.
C) Client states feeling short of breath.

The data in items 1, 2, and 3—rapid irregular breathing, complaints of shortness of breath, and restlessness—form a pattern indicating that the client may be experiencing hypoxia, because all are signs and symptoms characteristic of this condition. The other information, although important, is not related to hypoxia.

The nurse asks the client's spouse, "Mrs. Smith, your husband told me that for the past week he has not been eating the meals you prepare. Do you agree?" This is an example of __________________ of assessment data.

Validation

A review of systems (ROS) is based on information obtained from the client during the interview. This information is an example of ______________ data.

Subjective

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, the nurse would probably be covered by:
A) The nurse's automobile insurance
B) The nurse's homeowner's insurance
C) The Patient Care Partnership, which may grant immunity from suit if the injured party consents
D) The Good Samaritan laws, which grant immunity from suit if there is no gross negligence

D
Good Samaritan laws grant immunity from lawsuits if the nurse follows the standards of care that a nurse of his or her experience would prudently have followed. The other answers are incorrect.

Even though the nurse may obtain the client's signature on a form, obtaining informed consent is the responsibility of:
A) The client
B) The physician
C) The nursing student
D) The supervising nurse

B
Informed consent is part of the health care provider relationship. The person responsible for performing the given procedure has the responsibility for obtaining the consent.

The legal definition of death that facilitates organ donation is cessation of:
A) Pulse
B) Respirations
C) Functions of the entire brain
D) Circulatory and respiratory functions

C
The whole-brain standard of death requires irreversible cessation of all functions of the entire brain, including the brainstem. This definition allows for the recovery of organs for transplantation. Individuals who are not donors typically are pronounced dead when there is a total cessation of circulatory and respiratory functions. The absence of pulse and respirations must occur together to meet the legal definition of death.

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?
A) 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.
B) A living will allows an appointed person to make health care decisions when the client is in an incapacitated state.
C) A living will is invoked only when the client has a terminal condition or is in a persistent vegetative state.
D) The client cannot make changes in the advance directive once the client is admitted into the hospital.

C
A living will directs the client's healthcare in the event of a terminal illness or condition. A durable power of attorney is invoked when the client is no longer able to make decisions on his or her own behalf. The client may change an advance directive at any time.

A nurse notes that the health care unit keeps a listing of clients' names at the front desk in clear view so that health care providers can more efficiently locate clients. The nurse knows that this action is a violation of which act?
A) Health Insurance Portability and Accountability Act
B) Emergency Medical Treatment and Active Labor Act
C) Patient Self-Determination Act
D) Mental Health Parity Act

A
The Health Insurance Portability and Accountability Act provides for client privacy and confidentiality. The Emergency Medical Treatment and Active Labor Act ensures that any individual may receive appropriate emergency care. The Patient Self-Determination Act allows clients to determine their course of care. The Mental Health Parity Act forbids health plans from placing lifetime or annual limits on mental health coverage that are less generous that those placed on medical or surgical benefits.

The Health Insurance Portability and Accountability Act (HIPAA) of 1996 provides clients with basic rights pertaining to their medical records. Which of the following is a violation of HIPAA provisions?
A) Discussing client conditions in the nursing report room at the change of shift
B) Posting daily nursing care information along with the medical condition of clients on a message board in the client's room
C) Allowing nursing students to review client charts before caring for clients to whom they are assigned
D) Releasing client information regarding terminal illness to the family when the client has given permission for information to be shared

B
Posting information including the medical condition of clients on a message board is a violation of HIPAA provisions. This information should be kept confidential and should not be placed in a location where visitors might view it. Option 4 is not a privacy violation because the client has given permission for the family to have the information. Options 1 and 3 represent "need to know" situations. In option 1, the information is being shared in a private setting.

The nurse should understand law primarily because the nurse:
A) Wants to avoid lawsuits
B) Can be an advocate for clients
C) Is mandated to review law to keep licensure
D) Can protect the hospital from minor lawsuits

B
As an advocate for the client, the nurse must make sure that "safe, effective care" is given in conformity with the Nurse Practice Act (NPA). The client is the primary recipient of care and is the most important party in health care relationships. Self, hospital, and physicians are secondary to the outcomes of client care. Nurses should focus on giving correct care to avoid lawsuits. Legal review is a good practice to follow but is not mandated for licensure. The nurse's first responsibility is to the client. Giving proper care will protect an employer from many lawsuits.

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