Ch. 4A primary care provider's orders indicate that a surgical form needs to be signed. Since the nurse was not present when the primary care provider discussed the surgical procedure, which statement best illustrates the nurse fulfilled the client advocate role?a) the doctor has asked that you sign this consent form.b) do you have any questions about the procedure?c) what were you told about the procedure you are going to have?d) remember that you can change your mind and cancel the procedure.c) what were you told about the procedure you are going to have?Ch. 4Although the client refused the procedure, the nurse insisted and inserted a nasogastric tube in the right nostril. The administrator of the hospital decides to settle the lawsuit because the nurse is most likely to be found guilty of which of the following?a) an unintentional tortb) assaultc) invasion of privacyd) batteryd) batteryCh. 4A nurse discovers that a primary care provider has prescribed an unusually large dosage of a medication. Which is the most appropriate action?a) Administer the medicationb) Notify the prescriberc) Call the pharmacistd) Refuse to administer the medicationb) Notify the prescriberCh. 4A primary care provider prescribes 1 tablet, but the nurse accidentally administers 2. After notifying the Dr, the nurse monitors the client carefully for untoward effects of which there are none. Is the client likely to be successful in suing the nurse for malpractice?a) No, the client was not harmedb) No, the nurse notified the primary care providerc) Yes, a breach of duty existsd) Yes, foreseeability is presenta) No, the client was not harmedCh. 4A is nursing student working as an unlicensed assistive personnel (UAP). The nurses know the UAP is graduating from a nursing program soon. The UAP is asked to help by doing a urinary catheterization on a postsurgical client. Select the best response?a) "Let me get permission from the client first"b) "Sure, Which client is it?"c) "I can't do it unless you supervise me"d) "I can't do it. Is there something else I can help you with?"d) "I can't do it. Is there something else I can help you with?"Ch. 4The Dr. wrote a DNR order. The nurse knows that which applies in the planning of nursing care?a) The client can't make decisions about careb) The client and family know that the client will most likely die within the next 48 hoursc) The nurses will continue to implement all tx focused on comfort & symptom managementd) A DNR order from a previous admission is valid for the current admissionc) The nurses will continue to implement all tx focused on comfort & symptom managementCh. 4The nurse's partner/spouse undergoes exploratory surgery at the hospital where the nurse is

employed. Which practice is most appropriate?a) Because the nurse is an employee, access to the chart is allowedb) The relationship with the client provides the nurse special access to the chartc) Access to the chart needs a signed release formd) The nurse can ask the surgeon to discuss the outcome of the surgeryc) Access to the chart needs a signed release formCh. 4After a motor vehicle crash, a nurse stops to help. Which actions is/are most appropriate? SATAa) Should know the Good Samaritan Act for the stateb) The nurse is not held liable unless there is gross negligencec) After assessing, the nurse can leave to get helpd) The nurse can expect compensation for helpinge) The nurse offers to help but cannot insist on helpinga) Should know the Good Samaritan Act for the stateb) The nurse is not held liable unless there is gross negligencee) The nurse offers to help but cannot insist on helpingCh. 4The nurse notices that a colleague's behaviors have changed the past month. Which could indicate signs of impairment? SATAa) Increasingly absent from the unit during shiftb) Interacts well with othersc) Doesn't logout after admin. controlled substancesd) Offers to give prn opiods for other nurses' clientse) Is able to say "no" to requests to work more shiftsa) Increasingly absent from the unit during shiftc) Doesn't logout after admin. controlled substancesd) Offers to give prn opiods for other nurses' clientsCh. 4Which nursing actions could result in malpractice? SATAa) Learns about a new piece of equipmentb) Forgets to complete the assessment of a clientc) Does not follow up on client's complaintsd) Charts client's drug allergiese) Questions primary care provider about an illegible orderb) Forgets to complete the assessment of a clientc) Does not follow up on client's complaintsCh. 5When an ethical issue arises, one of the most important nursing responsibilities in managing client care situations is which of the following?a) be able to defend the morality of one's own actionsb) remain neutral and detached when making ethical decisionsc) ensure that a team is responsible for deciding ethical questionsd) follow the client and family's wishes exactlya) be able to defend the morality of one's own actionsCh. 5Which is a clear violation of the principles of professional nursing ethics?a) policy allows internal fetal monitors for labor, there are articles to support and refute the valueb) when asked about a medication, a nurse says, "I never look them up I just give what is prescribed"c) The nurses agree to fundraise to support a labor strike proposed by nurses at another facilityd) a client says he didn't tell the Dr the truth when asked about his therapeutic dietb) when asked about a medication, a nurse says, "I never look them up I just give what is

prescribed"Ch. 5 After a motor vehicle crash, the parents refuse withdrawal of life support from the child with no brain function. The nurse thinks the child should be allowed to die and organ donation considered, but supports their decision. Which moral principle is the basis for the nurse's actions?a) Respect for autonomyb) Nonmaleficencec) Beneficenced) Justicea) Respect for autonomyCh. 5 Which statement would be most helpful when a nurse is helping clients clarify values?a) "That was a poor decision. Why would it work?"b) "The most important thing is to follow the plan of care. Did you follow all your doctor's orders?"c) "Some people might have made a different decision. What led you to make your decision?"d) "If you had asked me, I would have given you my opinion about what to do. Now, h0w do you feel about your choice?"c) "Some people might have made a different decision. What led you to make your decision?"Ch. 5 After recovering from her hip replacement, an elderly client wants to go home. The family wants her to go to a nursing home. If the nurse were acting as a client advocate, the nurse would perform which of the following actions?a) Tell the family the client can decide on her ownb) Ask the Dr. to discharge the client homec) Suggest the client hire a lawyerd) Help the client and family communicate their views to each otherd) Help the client and family communicate their views to each otherCh. 5Values, moral frameworks, & codes of ethics influence the professional RN's moral decisions in which of the following ways?a) the nurse will provide direct client care that is consistent with the nurse's personal valuesb) the nurse will seek to ensure that the client's values and the nurse's are the samec) the choice of moral framework determines what the client outcome will bed) the nurse is bound to act accordingly to the nurses' code of ethics even if the nurse's values are differentd) the nurse is bound to act accordingly to the nurses' code of ethics even if the nurse's values are differentCh. 18The major factor contributing to the increased emphasis on the need for proficiency in cultural nursing practice in the United States is which of the following?a) an increased birth rateb) increased access to health care servicesc) demographic changesd) a decreasing rate of immigrationc) demographic changesCh. 18Which behavior is an initial step in cultural responsive nursing practice?a) help the client recognize the need to adapt health practices to fit commonly accepted practicesb) discuss the meaning of the medical regimen with the clientc) inform the client that lack of adherence to the medical regimen may be detrimentald) ask a cultural broker to explain the relevance of the interventionb) discuss the meaning of the medical regimen with the clientCh. 18

In initiating care for a pt from a different culture than the nurse, which of the following would be an appropriate statement?a) "Since, in your culture, people dont drink ice water, I will bring you hot tea."b) "Do you have any books I could read about people of your culture?"c) "Please let me know if I do anything that is unacceptable in your culture."d) "You will need to set aside your usual customs and practices while you are in the hospital."c) "Please let me know if I do anything that is unacceptable in your culture."Ch. 18Which behavior is most representative of a culturally competent nurse?a) helps clients of Native American heritage identify ways to relate more to their cultureb) helps parents of Latino heritage recognize that their children need to speak Englishc) interprets and validates beliefs of a client with African American heritaged) asks a nurse of Japanese heritage to teach others dosage calculations since Asians are good at mathc) interprets and validates beliefs of a client with African American heritagenursing action primarily supports restoring HEALTH using traditional methodsa) herbal teasb) prayerc) wearing symbolic objectsd) exercisea) herbal teasCh. 18A client with strong preferences for folk healing methods would prefer which of the following to treat a sinus infection?a) hospitalizationb) steam humidifierc) antibiotic therapyd) watch and waitb) steam humidifierCh. 18Which of the following factors are most likely to be influenced by culture as opposed to personal characteristics? SATAa) value of older people in societyb) gender rolesc) nonverbal gesturesd) skill and technologye) intelligencef) dieta) value of older people in societyb) gender rolesc) nonverbal gesturesf) dietCh. 18What is the most productive method of gathering assessment data regarding heritage?a) physical examb) medical historyc) blood analysisd) traditional beliefs and practices checklistd) traditional beliefs and practices checklistCh. 18A client who speaks limited English requires instructions for a test. No one at your agency speaks the person's language. What is the nurse's best approach?a) provide the instructions in writing.b) locate a professional interpreter.

c) ask a family member to translate on the phoned) document that the required instruction is not possibleb) locate a professional interpreter.statements is not true of ethics in nursing? SATAa) it deals with issues of human conductb) it is concerned with actions, motives, and outcomesc) it prescribes the right answer when an ethical dilemma is presentd) it defines processes to explore factors that constitute proper conducta) it deals with issues of human conductb) it is concerned with actions, motives, and outcomesd) it defines processes to explore factors that constitute proper conductCh. 3Which of the following choices is a core nursing value that involves promoting good, preventing harm, and removing the patient from harm?a) malfeasanceb) beneficencec) autonomyd) veracityb) beneficenceCh. 3Which of the following choices is one possible indication that a situation poses an ethical dilemma?a) a personal injury attorney has filed a lawsuitb) scientific information alone does not provide the answerc) government agencies have been unable to agree on a course of actiond) legislation has been proposed but not enacted into lawb) scientific information alone does not provide the answerCh. 3Which of the following laws has been enacted primarily to protect patient confidentialitya) tort lawb) DNR (do not resuscitate) ordersc) Health Insurance Portability and Accountability Act (HIPAA)d) Model Nurse Practice Act (MNPA)c) Health Insurance Portability and Accountability Act (HIPAA)Ch. 3Who is able to give legal consent to his or her own treatment?a) a 17-year-old honor student who has been accepted to the nursing program at a local collegeb) a recently retired man who is showing unexplained signs of confusionc) a known drug user who says she does not understand the procedure but trusts the nurse's judgmentd) a pregnant woman who says she does understand the proposed procedure and trusts the nurse's judgmentd) a pregnant woman who says she does understand the proposed procedure and trusts the nurse's judgmentCh. 3Which of the following statements about DNR orders is true?a) the orders should be reviewed regularly in case the patient's status changesb) even if a written order exists, the physician on call may legally choose to resuscitate a patient if he or she thinks survival is likelyc) if a patient is especially ill or is an older adult, the health care team may decide to initiate a "slow code"d) the health care institution cannot be held liable for ignoring DNR orders if its staffing falls below a predetermined minimal levela) the orders should be reviewed regularly in case the patient's status changes

the following choices is a core nursing value that involves promoting good, preventing harm, and removing the patient from harm?a) malfeasanceb) beneficencec) autonomyd) veracityb) beneficenceCh. 3Which of the following choices is one possible indication that a situation poses an ethical dilemma?a) a personal injury attorney has filed a lawsuitb) scientific information alone does not provide the answerc) government agencies have been unable to agree on a course of actiond) legislation has been proposed but not enacted into lawb) scientific information alone does not provide the answerCh. 3Which of the following laws has been enacted primarily to protect patient confidentialitya) tort lawb) DNR (do not resuscitate) ordersc) Health Insurance Portability and Accountability Act (HIPAA)d) Model Nurse Practice Act (MNPA)c) Health Insurance Portability and Accountability Act (HIPAA)Ch. 3Who is able to give legal consent to his or her own treatment?a) a 17-year-old honor student who has been accepted to the nursing program at a local collegeb) a recently retired man who is showing unexplained signs of confusionc) a known drug user who says she does not understand the procedure but trusts the nurse's judgmentd) a pregnant woman who says she does understand the proposed procedure and trusts the nurse's judgmentd) a pregnant woman who says she does understand the proposed procedure and trusts the nurse's judgmentCh. 3Which of the following statements about DNR orders is true?a) the orders should be reviewed regularly in case the patient's status changesb) even if a written order exists, the physician on call may legally choose to resuscitate a patient if he or she thinks survival is likelyc) if a patient is especially ill or is an older adult, the health care team may decide to initiate a "slow code"d) the health care institution cannot be held liable for ignoring DNR orders if its staffing falls below a predetermined minimal levela) the orders should be reviewed regularly in case the patient's status changesAccording to the Standards of Practice and Educational Competencies of Graduates of Practical/Vocational Nursing Programs, graduates of LVN/LPN programs are able to: SATAa) incorporate interpersonal and therapeutic communication skillsb) collect holistic assessment data from multiple sourcesc) independently plan or revise patient plans of cared) demonstrate a caring and empathetic approach to care of each clienta) incorporate interpersonal and therapeutic communication skillsb) collect holistic assessment data from multiple sourcesd) demonstrate a caring and empathetic approach to care of each clientCh. 3Select the options that describe a focused assessment as performed by an LVN/LPN. SATAa) supports ongoing data collection

b) yields a comprehensive evaluation of all available patient datac) replaces the registered nurse's assessmentd) appraises an individual's status and situation at handa) supports ongoing data collectiond) appraises an individual's status and situation at handCh. 3In a state where the law permits LVNs/LPNs to delegate to nursing assistive personnel, what factor or factors determine the tasks, functions or activities that can be delegated? SATAa) the willingness of the nursing assistive personnel to perform the taskb) the knowledge and skill of the nursing assistive personnelc) nursing assistive personnel functions as defined by the board of nursingd) patient consent for the nursing assistive personnel to perform the taskb) the knowledge and skill of the nursing assistive personnelc) nursing assistive personnel functions as defined by the board of nursingCh. 3According to HIPAA, which of the following actions violates a patient's privacy? SATAa) having patient's names on their odorb) providing patient information to a relative with the patient's permissionc) having clinic patients sign in on a sheet with no sensitive informationd) posting patients' name, diagnosis, and physician where staff and visitors can see itd) posting patients' name, diagnosis, and physician where staff and visitors can see it

1. As a nurse manager, you observe a staff nurse who over the past few weeks has become withdrawn and has had several absences due to minor ailments. Your best action would be to:a. Ask the nurse if she is okay during report.b. Refer the nurse to the employee assistance program.c. Ask the nurse to meet with you for a few minutes before she leaves for the day.d. Write a note to the nurse advising her that her work attendance must improveANS: CStress can lead to emotional symptoms such as depression and a variety of ailments. Meeting with the nurse privately may assist in identifying stress and possible solutions.2. The nurse manager of a unit has lost many staff members, and the unit is now staffed with a large number of agency and traveling nurses. She knows that the agency and traveling nurses are all contracted to stay on the unit for the next 3 months. One way to improve morale and decrease stress in the unit would be to:a. Plan a social event and include the agency and traveling nurse staff members.b. Plan unit-based social events for your remaining permanent staff members.c. Request hospital-based "floating" nurses to substitute for the temporary staff.d. Implement team nursing. ANS: ASocial support, in the form of positive work relationships, can be an important way to buffer the effects of a stressful work environment. Including all staff in the social event enables those who are not normally part of the team to experience this support and provides an opportunity for the staff as a whole to develop supportive relationships.3. As a nurse manager, the one activity you should not overlook is:a. Posting the yearly rotation schedule.b. Reviewing vacation requests.c. Scheduling staffing for holidays 6 months in advance.d. Anticipating staff sick days. ANS: BFree time and vacation time are needed for individuals to recharge. If time for work is more than 60% of wake time, or when self-time is less than 10% of wake time, stress levels increase.

4. A nurse manager has decided that she must institute some personal time management steps to survive work and home life. Her first step should be to:a. Determine what takes up so much of her time and energy.b. Organize her personal and work spaces.c. Purchase a handheld personal digital assistant to help remind her of important meetings.d. Determine her personal and professional goals. ANS: DPersonal time management refers, in part, to "the knowing of self." Self-awareness is a critical leadership skill, and being self-aware and setting goals helps managers determine how their time is best spent.5. A hospice nurse has been feeling very stressed at work because of both the physical strain and the emotional drain of working with clients with AIDS. She tries to walk 1 to 2 miles three times a week and to talk regularly with her husband about her work-related feelings. One reasonable stress management strategy would be to:a. Start taking yoga lessons.b. Make an appointment to meet with a psychiatrist.c. Start jogging 5 to 6 miles every day.d. Plan to go out for a drink with fellow nurses after work every day. ANS: AStress relief techniques include 30 minutes of exercise five times a week, as well as techniques such as yoga that relieve mental stress.6. The nurse manager is implementing a shared governance model to help with communication and decision making. Although staff members like the concept, change is difficult. Staff nurses feel:a. More empowered.b. More communicative.c. Less stressed.d. More powerless and devalued. ANS: DChange can lead to feelings of being overwhelmed and powerless, especially if complexity compression or rapid, intense changes have been involved.

7. The chief nursing officer listens to nurse managers verbalize their feelings of internal stress. One common source of internal stress seems to be:a. The death of a loved one.b. Perfectionism.c. Getting married.d. Losing a job.ANS: BLosing a job, the death of a loved one, and getting married are examples of external stress.8. The staff development educator presents a series of programs on stress management to the nurse managers. Research has indicated that an individual's ability to deal with stress is moderated by psychological hardiness. Psychological hardiness is a composite of:a. Commitment, control, and challenge.b. Commitment, powerlessness, and passivity.c. Commitment, control, and passivity.d. Decreased isolation, challenge, and passivity. ANS: ASome people have the capacity to accept changes in life with good humor and resilience, which, in turn, influences behavior that prevents illness. Hardiness involves the capacity to manage time and stress, to reframe situations positively, and to commit.9. The chief nursing officer understands that a nurse manager can exhibit stress that is related to management mistakes. An example of a management mistake is:a. Achieving excellence on the job.b. Following others' expectations.c. Organizing the desktop.

d. Organizing the calendar of events. ANS: BFollowing the expectations of others is attributed to role strain. Role strain involves a subjective state that occurs when social stress is present.10. In helping nurse managers to manage their time, the chief nursing officer suggests that they:a. Maintain a perfectionistic attitude.b. Set up a complaint list.c. Have good negotiation skills.d. Have good information literacy skills. ANS: DTime can be saved by using information technology effectively, as it assists with effective data retrieval and information gathering and with communication related to a variety of needs in the management setting.

11. Which of the following statements would best define stress? Stress is:a. The comfortable gap between how we like our life to be and how it actually is.b. Everyday life, both the highs and the lows.c. A consequence or response to an event or stimulus that can be positive or negative.d. Identical to distress. ANS: CStress is defined as a consequence or response to an event or stimulus. It is not inherently bad (distress), and whether highs and lows are seen as distress or eustress is dependent on each individual's interpretation of the event.12. In a job interview for a nursing position, Joa can be assured that which of the following will occur?a. Both eustress and distressb. Only eustressc. Only distressd. Neither eustress nor distress ANS: AEustress is defined as stress that is pleasant in nature, and distress is defined as stress of an unpleasant nature. One can assume that every interview has both of these stresses.13. Which one of the following statements has been proven to be true?a. Recent research has found that women do not have a unique physiologic response to stress.b. Both men and women interpret the same stressor in the same manner without regard to past experiences.c. Stress influences the immune system in one complex manner.d. Stressors that are identical do not have the same effect on each individual. ANS: DResearch has shown that what is perceived as a stressor is unique for all individuals.14. An example of role conflict occurs when:a. The director of ICU and the manager of the surgical unit wish to hire the same new employee.b. Two part-time staff members are hired to work in a unit, but the job expectations for them are not clear, and the head nurse expresses disappointment in their performance.c. The nurse manager for ICU believes he does not receive as many resources as the nurse manager for nephrology.d. Line managers believe that support staff use their technical knowledge to intrude on their authority. ANS: BFailure to comply with expectations can lead to role conflict. Role conflict and role ambiguity are major sources of conflict for nurses.15. A staff nurse approaches the unit manager and indicates to her that because of her father's death in the previous month, she is now finding it very difficult to do her work

effectively. This would be considered a(n) ________ stress.a. Internal source b. Familial c. Burnout d. External ANS: DExternal stress is outside and removed from the work setting, but it is considered work-related stress because of the impact it has on the worker.

16. Sources of occupational stress in nursing include all except which of the following?a. Authoritarian leadershipb. Concern about moral wrong doing by colleaguesc. Multiple changes in a short timed. Job insecurity ANS: AEthical distress, complexity compression, job insecurity, high acuity levels, rotating shifts, and workload are all sources of work-related stress for nurses.

17. Mr. T. Jones and Mr. R. Smith are both going to become residents in Sunny Haven Lodge. Mr. Jones views it as an opportunity to socialize and meet new friends. Mr. Smith views this as abandonment by his family and is worried that the care will be inadequate. Each senior perceives the situation differently. This is a good example of stress that is:a. Both a positive stressor and a negative stressor.b. Occurring only because of age.c. Positive in both cases.d. Harmful in both cases. ANS: ASome researchers have determined that stress is a person-environment process in which the personal appraises the situation as taxing or not. Appraisal is an important concept that explains why two people react in different ways to the same situation.18. Jeff, an RN in his 30s, has lost a parent, just purchased a new home, and is laid off with 6 months' severance pay. A the same time, Jerry, an RN in his 50s, is financially secure and is asked to take early retirement with a buyout. How will the two men react to the emotional and physical influences and the sequence of stress?a. The younger man will feel more stress.b. The two men may or may not feel the same amount of stress.c. The older man will feel more stress.d. Neither man will experience any stress.. ANS: BThe amount of stress is unpredictable. Responses to stress are affected by factors such as age, gender, personality, culture, lifestyle, health, and life experiences

19. Social stressors are considered a major factor in the stress nurses experience in the healthcare system. Which of the following is not considered to be a social stressor?a. High amounts of stress in the nurse home environmentb. Changes in the current healthcare system such as nursing strategiesc. Disruptive behavior coming from physicians and other healthcare workersd. Personal stress triggers such as self-criticism and overanalyzing ANS: DPersonal stress triggers such as self-criticism are considered intrapersonal stressors; environmental factors such as change, work environment, and interactions with others are considered social stressors.

20. Angel, a psychiatric nurse, is assigned to four patients. The patient that would be at greatest risk for psychological compromise is the patient who has experienced:

a. The death of a spouse.b. The death of a distant friend.c. A recent job layoff.d. A divorce. ANS: AMost studies that have been concerned with "life stressors" have found that the death of a spouse produces the greatest stress.21. "Stress-buffering" behaviors can be elicited to reduce stress. All of the following behavioral coping responses can be used by nurse managers to reduce and manage stress except:a. Distancing oneself from work.b. Using cognitive reframing to change irrational thoughts.c. Journaling and keeping an informal diary of daily events and activities.d. Exercising regularly. ANS: AAchieving balance between work and leisure is a useful strategy for stress reduction. Distancing, however, can be a sign of depersonalization that includes negative attitudes as well and is a characteristic of burnout.

22. The education consultant at St. Luke's Hospital is giving a workshop on Cognitive Reframing. The consultant explains that Cognitive Reframing reduces stress by:a. Aiding individuals in identifying positive stressors.b. Helping people realize that negative thinking causes emotional distress.c. Eliminating negative stressors.d. Replacing positive self statements with negative irrational beliefs. ANS: BCognitive Reframing is a therapy that aids individuals in discovering that their irrational thoughts can be replaced with responses that are more rational. It enables individuals to gain a sense of control over the situation and can change "I'll never ..." to "I can ..." or "She always ..." to "Sometimes she ..." It is an approach that allows individuals to replace negative thoughts and statements with others that are more realistic and helpful.

23. Time management is very essential for the nurse manager. Which of the following is not a good time-management technique?a. Decide what not to do.b. Learn to say "No."c. Learn to delegate.d. Break down your workload into large manageable tasks. ANS: DTo manage time successfully, it is important to break down your workload into smaller, manageable tasks. Developing PERT and Gantt charts will aid in dealing with larger, complex projects. Both charts can be used to outline how an individual will approach a large project.24. As a unit manager, you chair the unit meetings. For each meeting, you consider and establish the purpose of the meeting. Second, you prepare an agenda. Arrange the following steps in an order that would make the meetings productive and successful.1. Distribute an agenda.2. Control the flow of interactions.3. Select team members.4. Start on time.5. Keep the meeting focused and directed toward accomplishing the set objectives.

Select the correct order from the following options:a. 1, 2, 4, 5, 3b. 4, 1, 2, 5, 3c. 3, 1, 4, 5, 2d. 3, 4, 2, 1, 5 ANS: CPlanning, organizing, and keeping the group on task are critical in ensuring that meetings are productive and that time is managed well.

MULTIPLE RESPONSE1. High levels of work-related stress affect all but which of the following? (Select all that apply.)a. Job satisfactionb. Absenteeism and turnoverc. Nurses' healthd. Client welfare ANS: A, B, C, DMany writers and researchers have found that these work-related areas are adversely affected by stress.

The manager in the coronary care unit believes that the most important ethical considerations in performance evaluations are that they include the employee’s good qualities and that they give positive direction for professional growth. This belief is an example of:Nonmaleficence.2. A staff nurse in the area that you manage has excelled in the delivery of client education. You are considering implementing a new job description that would broaden her opportunity to teach client and orient new staff members to the value of client education. The ethical principle that you are most directly reinforcing is:Paternalism

3. A client refuses a simple procedure that you believe is in the client’s best interest. The two ethical principles that are directly in conflict in such a situation are:Autonomy and beneficence

4. An applicant in a wheelchair is applying for the position of receptionist in an outpatient clinic. The nurse manager understands that the Americans with Disabilities Act of 1990 requires that employers:Make reasonable accommodations for persons who are disabled.

5. A staff nurse who was fired for reporting client abuse to the appropriate state agency files a whistleblower lawsuit against the former employer. Reasons that the court would use in upholding a valid whistleblower suit claiming retaliation include that the nurse:Had previously reported the complaint, in writing, to hospital administration.

6. In keeping with standards of The Joint Commission (TJC), the nurse manager organizes an orientation for new staff members. As part of the orientation, the nurse manager reviews the employee handbook. Employers may be bound to statements in the employee handbook:

Based on the employee’s or the employer’s expectations.

7.7. To reduce the incidence of falls in a skilled nursing unit, the nurse manager contacts the risk manager. Risk management is a process that attempts to identify potential hazards and:

Eliminate these risks before anyone else is harmed.

8.8. One means of ensuring that nurses floated to other patient care areas in healthcare organizations are qualified to work in those areas is:

Cross-educating staff members to other areas of the institution.

9.9. A colleague asks you to give her your password access so that she can view her partner’s healthcare record. This request violates the patient’s right to:

Privacy10.10. On your nursing unit, you employ LPNs, RNs, and advanced practice nurses. You will need to be familiar with at least:

One nursing practice act and a medical act.

11.11. A nurse on your inpatient psychiatric unit is found to have made sexually explicit remarks toward a patient with a previous history of sexual abuse. The patient sues, claiming malpractice. Which of the following conditions would likely not apply in this situation?

Injury12.12. As a charge nurse, you counsel your RN staff member that he has satisfied his duty of care by notifying a child’s physician of his concerns about deterioration in the child’s status at 0330 hours. The physician does not come in. The child dies at 0630 hours. As the charge nurse, you could be held liable for:

Professional negligence.

13.13. The parents of a toddler who dies after being brought to the ER launch a lawsuit, claiming that the failure of nurses to pursue concerns related to their son’s deteriorating condition contributed to his death. The senior nurse executive is named in the suit:

Under the doctrine of respondeat superior.

14.14. During a staff shortage, you hire an RN from a temporary agency. The RN administers a wrong IV medication that results in cardiac arrest and a difficult recovery for the patient. Liability in this situation:

May depend on the patient’s belief regarding the employment relationship.

15.15. You volunteer at a free community clinic. A 13-year-old girl claims to have been diagnosed with SLE and presents with chlamydia. The team leader at the clinic advises that:

Care can be provided as long as consent is voluntary and information about treatment and options is provided.

16.16. Three gravely ill patients are candidates for the only available bed in the ICU. As the supervisor, you assign the bed to the patient with the best chance of recovery. This decision reflects which of the following ethical principles?

Beneficence17.17. Which ethical principle is primarily involved in informed consent?

Autonomy18.18. The principle that requires nurses to uphold a professional code of ethics, to practice within the code of ethics, and to remain competent is which of the following?

Fidelity19.19. Mr. M. complains to you that one of your staff asked him details about his sexual relationships and financial affairs. He says that these questions were probing and unnecessary to his care, but he felt that if he refused to answer, the nurse would be angry with him and would not provide him with good care. Mr. M.’s statements reflect concern with:

Privacy20.20. To satisfy duty of care to a patient, a nurse manager is legally responsible for all except:Supervising the practice of the physician.

22.MULTIPLE RESPONSE

1. One of your staff nurses asks for your advice because a patient refuses to sign a consent for surgery. The patient says that he won’t sign because he doesn’t understand the nature of the surgery. You advise that (select all that apply):

Consent must not be coerced.

The patient has a right to choose not to consent.

Witnessing a consent is related only to the voluntary nature of the signature.

23.2. With regard to nursing practice, nurse managers are held responsible for (select all that apply):

Practicing within legal guidelines established under state law and nurse practice acts.

Ensuring that nursing staff under their supervision are currently licensed to practice.

24.MULTIPLE CHOICE

1. The risk manager informs the nurse manager of an orthopedic unit that her unit has had an increase in incident reports about patients falling during the 11-7 shift. The nurse manager knows that the best way to resolve the problem is to:

Identify the problem.

25.2. The nurse manager of a rehab unit wants to purchase a new anti-embolic stocking. To make a high-quality decision, the nurse manager would:

Involve the rehab staff in the decision.

26.3. Several nurses on an adolescent psychiatric unit complain that the teens are becoming unmanageable on the 11-7 shift. To resolve this problem, the nurse manager decides that the staff should have a brainstorming session. The goal of brainstorming is to:

Generate as many solutions as possible.

27.4. During a fire drill, several psychiatric patients become agitated. The nurse manager quickly assigns a staff member to each patient. This autocratic decision style is most appropriate for:

Crisis situations.

28.5. After the nurses who work on an adolescent psychiatric unit have had a brainstorming session, they are ready to resolve the problem of teenagers who are unmanageable. To maximize group effectiveness in decision making and problem solving, the nurse manager has:

Encouraged equal participation among members.

29.6. To solve a problem, the nurse manager understands that the most important problem-solving step is:

Accurate identification of the problem.

30.7. A clinic nurse has observed another nurse deviating from agency policy in performing wound care. The best approach for the clinic nurse to take is to:

Assess the risk to the client and the agency before proceeding.

31.8. The clinic nurse understands that problem solving is best defined as:

Identifying the gap between “what is” and “what should be.”

32.9. The risk manager wants to evaluate the reasons for an increased number of falls on the rehab unit. The risk manager devises a fishbone diagram. A fishbone diagram is a useful tool to:

Identify the root causes of problems.

33.10. An outpatient surgery manager is evaluating infusion pumps for the operating room. The manager should:

Use a decision-making tool to evaluate brands.

34.11. Select the statement that best defines the difference between problem solving and decision making:

Decision making is a goal-directed effort, problem solving is focused on solving an immediate problem.

35.12. Sue, a nurse manager, has a staff nurse that has been absent a great deal for the past three months. A whistleblower gives some information to Sue indicating that the staff nurse will be resigning and returning to school. Because of this, Sue decides to do which of the following?

Do nothing.

36.13. The maintenance department wishes to have the nursing lounge renovated, so the lounge will be more “user-friendly.” The department asks the nursing staff to make a wish list of everything that they would like to see in the new lounge. This process is an example of which part of the decision-making process?

Assessment/Data collection

37.14. A good nursing decision maker is one who:

Uses various models to guide the process based on the circumstances of the situation.38.15. From the information supplied in this chapter, which statements best defines critical thinking? Critical thinking is a:

High-level cognitive process that includes creativity, problem solving, and decision making.

39.16. Decision making is described by the nursing educator as the process one uses to:

Choose between alternatives.

40.17. Justin is a nurse manager in a rehabilitation unit in a small urban center. There is a high turnover rate among rehab-assistants because of the heavy work assignments. Justin decides to hire new staff in the order that applications are received until all vacant positions are filled. Which of the following decision-making models did Justin use in making his decision?

Satisficing model

41.18. Which of the following decision-making solutions should Justin (Question 17) consider to have a more efficient department?

Consider all the options listed.

42.19. When confronted with the controversy and the apparent poor morale of the evening staff, the unit manager decided the staff needed to take some time off. He scheduled holidays for the staff without consulting them. A couple of the staff nurses approached the manager and indicated that the problem was not scheduling, but rather the team leader and her patient assignments. What was the unit manager’s first missed step in problem solving?

Incorrect problem identification

43.20. John Smith, one of three managers at BSG Labs, drafted a policy that would allow his department to do more testing in his lab. This policy included the times for regular collection as well as a new process for emergency laboratory testing. The policy and procedures were never followed. The reason was that:

The policy made decisions for other departments in the company.

44.21. High-quality decisions are most likely to be made in nursing situations when:

Group size is neither too small nor too large.

45.22. Knowing when to have the entire team participate in the decision-making process or when to have only the team leader make the decisions depends upon the situation and the desired outcomes. The autocratic process is used in which of the following situations?

The task and the outcome are relatively simple.

46.23. Jane, an experienced head nurse, is given the task of completing the summer vacation schedule for the pediatric unit. She is fully aware of the hospital’s restrictions on time off and the number of staff on vacation at any given time, as well as its issues regarding seniority. She weighs the options of allowing staff choice, such as it takes more time but gives employees options. However, if choice is allowed, this could cause arguments. Which of the following is the best alternative?

Post a blank schedule, and ask staff members to fill in their times by a given date.

47.24. When decision making, critical thinking, and problem solving are considered, which of the following statements are accurate and valid points?

The nursing decision maker who is successful recognizes that only those with similar experiences should be involved in decision making.

48.1. In a busy rehabilitation unit, the team manager decided that the best way to reward the staff was to give them a monetary bonus rather than time off. The staff was very concerned about the decision and went to the administration with a number of complaints. Critical thinking is a process that entails a number of steps. What steps did the manager omit? She should have (select all that apply):

Identified the assumptions that were underpinning the issues.

Considered the context of the present problem or situation.

Gathered data before making her decision and evaluated all possible outcomes.

49.MULTIPLE CHOICE

1. According to Leininger, “cultural imposition” is a major concern in nursing because nurses have a tendency to impose their values, beliefs, and practices on those of other cultures. The discussion topic most likely to be without cultural imposition would be:Wound management.