Chapter 01: Nursing and the Health Care System
1. Florence Nightingale’s contributions to nursing practice and education:
a. are historically important but have no validity for nursing today.
b. were neither recognized nor appreciated in her own time.
c. were a major factor in reducing the death rate in the Crimean War.
d. were limited only to the care of severe traumatic wounds.
2. Early nursing education and care in the United States:
a. were directed at community health.
b. provided independence for women through education and employment.
c. were an educational model based in institutions of higher learning.
d. have continued to be entirely focused on hospital nursing.
3. In order to fulfill the common goals defined by nursing theorists (promote wellness, prevent illness, facilitate coping, and restore health), the LPN must take on the roles of:
a. caregiver, educator, and collaborator.
b. nursing assistant, delegator, and environmental specialist.
c. medication dispenser, collaborator, and transporter.
d. dietitian, manager, and housekeeper.
4. Although nursing theories differ in their attempts to define nursing, all of them base their beliefs on common concepts concerning:
a. self-actualization, fundamental needs, and belonging.
b. stress reduction, self-care, and a systems model.
c. curative care, restorative care, and terminal care.
d. human relationships, the environment, and health.
5. Standards of care for the nursing practice of the LPN are established by the:
a. Boards of Nursing Examiners in each state.
b. National Council of States Boards of Nursing (NCSBN).
c. American Nurses Association (ANA).
d. National Federation of Licensed Practical Nurses.
6. The LPN demonstrates an evidence-based practice by:
a. using a drug manual to check compatibility of drugs.
b. using scientific information to guide decision making.
c. using medical history of a patient to direct nursing interventions.
d. basing nursing care on advice from an experienced nurse.
7. Lillian Wald and Mary Brewster established the Henry Street Settlement Service in New York in 1893 in order to:
a. offer a shelter to injured war veterans.
b. found a nursing apprenticeship.
c. provide health care to poor persons living in tenements.
d. offer better housing to low-income families.
8. An educational pathway for an LPN refers to an LPN:
a. learning on the job and being promoted to a higher level of responsibility.
b. moving from a maternity unit to a more complicated surgical unit.
c. obtaining additional education to move from one level of nursing to another.
d. learning that advancement requires consistent work and commitment.
9. When diagnosis-related groups (DRGs) were established by Medicare in 1983, the purpose was to:
a. put patients with the same diagnosis on the same unit.
b. attempt to contain the costs of health care.
c. increase availability of medical care to the elderly.
d. identify a patient’s condition more quickly.
10. The advent of diagnosis-related groups (DRGs) required that nurses working in health care agencies:
a. record supportive documentation to confirm a patient’s need for care in order to qualify for reimbursement.
b. use the DRG rather than their own observations for patient assessment.
c. be aware of the specific drugs related to the diagnosis.
d. acquire cross-training to make staffing more flexible.
Chapter 02: Concepts of Health, Illness, Stress, and Health Promotion
1. The nurse is aware that any description of health would include the concept that:
a. health is the absence of illness, and illness is the presence of chronic disease.
b. culture, education, and socioeconomic status influence one’s definition of health or illness.
c. illness is a biologic malfunction, and health is biologic soundness.
d. lifestyle factors are the major determinant of health or illness.
2. The nurse takes into consideration that the patient with an admitting diagnosis of type 2 diabetes mellitus and influenza is described as having:
a. two chronic illnesses.
b. two acute illnesses.
c. one chronic and one acute illness.
d. one acute and one infectious illness.
3. The nurse explains that an idiopathic disease is one that:
a. is caused by inherited characteristics.
b. develops suddenly, related to new viruses.
c. results from injury during labor or delivery.
d. has an unknown cause.
4. The nurse assesses a terminal illness in a:
a. 76 year old admitted to a nursing home with Alzheimer’s disease who is pacing and asking to go home.
b. 43 year old with Lou Gehrig’s disease who is refusing food and fluid.
c. 2 year old child who burned her esophagus by drinking drain cleaner and who is being fed by a tube.
d. 52 year old diagnosed with lung cancer who had part of one lung removed and has a closed chest drainage device in place.
5. The nurse clarifies to a patient who now has an abscess following a ruptured appendix that the abscess is considered to be:
a. a secondary illness.
b. a life threatening complication.
c. an expected event following any surgery.
d. a disorder easily treated with antibiotics.
6. The nurse uses a diagram to demonstrate how Dunn’s theory of health and illness can be compared with a:
a. plant that grows from a seed, blossoms, wilts, and dies.
b. continuum, with peak wellness and death at opposite ends; the person moves back and forth in a dynamic state of change.
c. ladder; from birth to death the individual moves progressively downward a ladder to eventual death.
d. state of mind dependent on the individual perception of their own health or illness.
7. A patient has been advised by the physician to take medication for high cholesterol and to change eating habits after discharge home. The home health nurse discovered that the patient refused to follow the medical and nutritional directions. The nurse’s best initial response to this situation is to:
a. emphasize to the patient how important it is to follow the doctor’s advice.
b. determine whether any cultural, socioeconomic, or religious values conflict, thus interfering with the patient’s compliance.
c. explain that without diet and medication the condition will worsen and serious problems will develop.
d. inform the physician that the patient is unable to understand the instructions.
8. A nurse practicing a holistic approach to nursing care must:
a. recognize that a change in one aspect of the person’s life can alter the whole of that person’s life.
b. take responsibility for health care decisions.
c. promote state of the art technology.
d. discourage the use of more natural remedies and alternative methods of health care.
9. According to Maslow’s hierarchy, physiological needs are those that:
a. nurture intimacy.
b. foster independence.
c. encourage social interaction.
d. are essential to human life.
10. The factors involved in assessing the importance the patient attaches to the relief of a particular deficit include:
a. needs that the nurse must assess to prioritize care, because they may be different from person to person.
b. ordering needs according to Maslow’s hierarchy, with lower level needs being least compelling.
c. needs based on a hierarchy in which higher level needs are more prominent and demand attention before lower level needs.
d. needs that are usually not known to the patient and that must be determined by the nurse.
Chapter 03: Legal and Ethical Aspects of Nursing
1. A student nurse who is not yet licensed:
a. may not perform nursing actions until he or she has passed the licensing examination.
b. is not responsible for his or her actions as a student under the state licensing law.
c. may perform nursing actions only under the supervision of a licensed nurse.
d. must apply for a temporary student nurse permit to practice as a student.
2. During an employment interview, the interviewer asks the nurse applicant about HIV status. The nurse applicant can legally respond:
a. “No,” even though he or she has a positive HIV test.
b. “I don’t know, but I would be willing to be tested.”
c. “I don’t know, and I refuse to be tested.”
d. “You do not have a right to ask me that question.”
3. An example of a violation of criminal law by a nurse is:
a. taking a controlled substance from agency supply for personal use.
b. accidentally administering a drug to the wrong patient, who then has a serious reaction.
c. advising a patient to sue the doctor for a supposed mistake the doctor made.
d. writing a letter to the newspaper outlining questionable or unsafe hospital practices.
4. The LPN (LVN) assigns part of the care for her patients to a nursing assistant. The LPN is legally required to perform which of the following for the residents assigned to the assistant?
a. Toilet the residents every 2 hours and as needed.
b. Feed breakfast to one of the residents who needs assistance.
c. Give medications to the residents at the prescribed times.
d. Transport the residents to the physical therapy department.
5. If a nurse is reported to a state board of nursing for repeatedly making medication errors, it is most likely that:
a. the nurse will immediately have his or her license revoked.
b. the nurse will have to take the licensing examination again.
c. a course in legal aspects of nursing care will be required.
d. there will be a hearing to determine whether the charges are true.
6. A nurse co-worker arrives at work 30 minutes late, smelling strongly of alcohol. The fellow nurses’ legal course of action is to:
a. have the nurse lie down in the nurses’ lounge and sleep while others do the work.
b. state that, if this happens again, it will be reported.
c. report the condition of the nurse to the nursing supervisor.
d. offer a breath mint and instruct the nurse co-worker to work.
7. When a student nurse performs a nursing skill, it is expected that the student:
a. perform the skill as quickly as the licensed nurse.
b. achieve the same result as the licensed nurse.
c. not be held to the same standard as the licensed nurse.
d. always be directly supervised by an instructor.
8. If a nurse receives unwelcome sexual advances from a nursing supervisor, the first step the nurse should take is to:
a. send an anonymous letter to the nursing administration to alert them to the situation.
b. tell the nursing supervisor that she is uncomfortable with the sexual advances and ask the supervisor to refrain from this behavior.
c. report the nursing supervisor to the state board for nursing.
d. resign and seek employment in a more comfortable environment.
9. A person who has been brought to the emergency room after being struck by a car insists on leaving, although the doctor has advised him to be hospitalized overnight. The nurse caring for this patient should:
a. have him sign a Leave Against Medical Advice (AMA) form.
b. tell him that he cannot leave until the doctor releases him.
c. immediately begin the process of involuntary committal.
d. contact the person’s health care proxy to assist in the decision-making process.
10. The information in a patient’s chart may legally be:
a. copied by students for use in school reports or case studies.
b. provided to lawyers or insurers without the patient’s permission.
c. shared with other health care providers at the patient’s request.
d. withheld from the patient, because it is the property of the doctor or agency.
Chapter 04: Nursing Process and Critical Thinking
1. The nurse who uses the nursing process will:
a. help reduce the obvious signs of discomfort.
b. help the patient adhere to the physician’s treatment protocol.
c. approach the patient’s disorder in a step-by-step method.
d. make all significant nursing care decisions involving patient care.
2. A nurse will arrive at a nursing diagnosis through the nursing process step of:
3. In the collaborative process of delivering care based on the nursing process, the responsibility of the LPN/LVN is to:
a. collect data of health status.
b. select a nursing diagnosis.
c. organize data to help the RN evaluate patient progress.
d. prioritize nursing diagnoses for more effective care.
4. The participants of the planning stage of the nursing process during which the health goals are defined include the:
b. health team led by the RN.
c. health team, the patient, and the patient’s family.
d. health team as directed by the physician.
5. When a resident in the nursing home complains of constipation, the nurse performs a digital rectal examination and finds a hard fecal mass. This is an example of:
b. nursing diagnosis.
6. The nurse completing morning assessments on a patient who is sitting up in bed is told by the patient, “I’m having trouble breathing—I can’t seem to get enough air.” The best nursing response is to:
a. notify the doctor as soon as he or she comes in later in the morning.
b. finish the vital signs for the assigned patients, and then notify the charge nurse.
c. reassure the patient, if his blood pressure and pulse are normal.
d. notify the charge nurse immediately of the patient’s statement.
7. The order in which the nursing process is approached is:
a. planning, assessment, implementation, nursing diagnosis, evaluation.
b. nursing diagnosis, evaluation, assessment, implementation, planning.
c. assessment, nursing diagnosis, planning, implementation, evaluation.
d. evaluation, nursing diagnosis, planning, implementation, assessment.
8. Once the nursing plan has been initiated, the nursing care plan will:
a. stay in place until all nursing goals have been met.
b. change as the patient’s condition changes.
c. remain on the patient record to show progress.
d. be given to the patient for final approval.
9. When a patient states, “I can’t walk very well,” the first problem-solving step would be to:
a. consider alternatives such as a wheelchair or walker.
b. find out what the problem is, such as weakness or poor balance.
c. choose the alternative with the best chance of success.
d. consider the outcomes of the choices, such as danger of falling with a walker.
10. A student nurse can begin to develop critical thinking skills by means of:
a. working with a more experienced nurse.
b. questioning every statement made by instructors to be sure of its correctness.
c. memorizing class notes for tests and studying all night for big tests.
d. listening attentively and focusing on the speaker’s words and meaning.
Chapter 05: Assessment, Nursing Diagnosis, and Planning
1. When the patient complains of nausea and dizziness, the nurse recognizes these complaints as _______ data.
2. The major goal of the admission interview (usually performed by the RN) is to:
a. establish rapport.
b. help the patient understand the objectives of care.
c. identify the patient’s major complaints.
d. initiate nursing care plan forms.
3. An example of a structured format for gathering data that aids in forming a database is:
a. North American Nursing Diagnosis Association–International (NANDA-I).
b. Maslow’s hierarchy.
c. following the information in the history and physical.
d. Gordon’s 11 Health Patterns.
4. During the assessment phase of the nursing process, the nurse
a. develops a care plan to meet the patient’s nursing needs.
b. begins to formulate plans for providing nursing intervention.
c. establishes a nursing diagnosis for the nursing care plan.
d. gathers, organizes, and documents data in a logical database.
5. After the admission assessment is completed, on subsequent shifts or days, the nurse:
a. does not assess the patient again unless the condition changes.
b. refers only to the admission assessment during the hospitalization.
c. performs a complete physical examination every day.
d. assesses the patient briefly in the first hour of the shift.
6. The nurse performing an admission interview on an elderly person should:
a. rush through the interview to avoid tiring the patient.
b. direct questions to the family rather than the patient.
c. allow more time for a response to questions.
d. prompt the patient to speed recall.
7. A nursing diagnosis consists of:
a. the physician’s medical diagnosis listed as the nursing diagnosis.
b. diagnostic labels formulated by the North American Nursing Diagnosis Association–International (NANDA-I).
c. the patient’s explanation of his or her “chief complaint” or “current complaint.”
d. the results of the nursing assessment without consideration of doctor’s orders.
8. An elderly patient with a medical diagnosis of chronic lung disease has developed pneumonia. She is coughing frequently and expectorating thick, sticky secretions. She is very short of breath, even with oxygen running, and she is exhausted and says she “can’t breathe.” Based on this information, an appropriately worded nursing diagnosis for this patient is
a. Airway clearance, ineffective, related to lung secretions as evidenced by cough and shortness of breath.
b. Pneumonia, cough, and shortness of breath related to chronic lung disease.
c. Difficulty breathing not relieved by oxygen and evidenced by shortness of breath.
d. Cough and shortness of breath caused by pneumonia, chronic lung disease, advanced age, and exhaustion.
9. If a patient has several nursing diagnoses, the nurse will first:
a. consult with the doctor regarding which diagnosis is most important.
b. devise nursing interventions for the most quickly solved problems.
c. prioritize the nursing problems according to Maslow’s hierarchy of needs.
d. review the patient’s medical prescriptions and other drugs being taken.
10. A patient has a nursing diagnosis of Imbalanced nutrition: less than body requirements, related to mental impairment and decreased intake, as evidenced by increasing confusion and weight loss of more than 30-pounds over the last 6 months. An appropriate short-term goal for this patient is to:
a. eat 50% of six small meals each day by the end of 1 week.
b. demonstrate progressive weight gain over 6 months.
c. eat all of the meals prepared during admission.
d. verbalize understanding of caloric needs and intention to eat.
Chapter 06: Implementation and Evaluation
1. The nurse is aware that one of the time-flexible tasks to be accomplished would be:
a. administering daily insulin 30 minutes before breakfast.
b. taking the patient’s vital signs once a day.
c. weighing the patient before breakfast.
d. monitoring a critical patient’s vital signs every 15 minutes.
2. Prior to the nurse implementing a nursing procedure for a patient, the nurse should initially:
a. question the rationale for the procedure.
b. perform a physical assessment of the patient.
c. check the agency manual for the procedure.
d. mentally review the procedure.
3. At the 7:00 AM change-of-shift report, the nurse receives the report that patient A had a sleepless night related to pain and just fell asleep after an increased pain medication administration one-half hour ago. Patient B, who is scheduled for surgery at 8:30 AM, is also sleeping. How would an organized nurse plan the early morning activities?
a. Wake patient A for breakfast.
b. Perform time-flexible tasks that can be done while both patients sleep.
c. Prep patient B now; allow patient A to sleep.
d. Assign a nursing assistant to wake and help feed patient A.
4. Preparing a patient for a diagnostic test, and telling the patient what to expect during and after the test, is considered:
a. an independent nursing action.
b. the doctor’s responsibility.
c. a dependent nursing action that requires the doctor’s authorization.
d. an interdependent nursing action.
5. The nurse explains that a multidisciplinary step-by-step approach to patient care is:
a. documented in the nursing care plan in the patient’s chart.
b. not used often since managed care became part of health care.
c. referred to as a clinical pathway and is used instead of a nursing care plan.
d. more expensive than the traditional separation of health care services.
6. The nurse documents interventions periodically during the shift in nurses’ notes primarily to:
a. validate the number of non-licensed personnel who interact with the patient.
b. indicate that the nursing care plan has been implemented.
c. briefly summarize activities during the shift.
d. confirm that the nursing diagnoses in the care plan are appropriate.
7. The nurse compares actual nursing outcomes to the expected nursing outcomes in order to:
a. prepare the patient to be discharged from the facility.
b. determine if the patient’s health problems have been treated.
c. calculate charges for nursing services during the patient’s hospital stay.
d. determine if progress is made or to determine if revisions are needed.
8. The general rule is that the initial care plan for a patient is:
a. developed by an RN in an acute care setting.
b. used as the basis of care throughout a hospital stay without alteration.
c. completed on the day of admission.
d. developed by the physician and incorporated into the nursing care.
9. The nurse is aware that the nursing audit is a valuable process used to:
a. determine whether a particular patient received the care indicated in the nursing care plan.
b. evaluate whether nursing care for a group of patients meets the standards of care in that facility.
c. determine the cost of nursing care in the hospital in order to set rates for daily care.
d. identify careless or negligent nursing care to protect the facility from lawsuits.
10. The nurse evaluates that the patient has met the outcome of feeding himself independently. The nurse should:
a. inactivate the nursing diagnosis from the care plan.
b. notify the physician that the patient can now feed himself.
c. document the ability to self-feed and mark the nursing diagnosis as resolved.
d. inform the RN to document the self-feeding and to cancel the nursing diagnosis.
Chapter 07: Documentation of Nursing Care
1. The nurse with a patient who complains of severe pain documents every 15 minutes about the steps taken to try to relieve the pain (without success). The nurse also documents the time and content of two calls made to the patient’s physician requesting that the physician examine the patient for unexpected complications. This documentation by the nurse is likely to:
a. cause the physician to come to the attention of the hospital administration.
b. be questioned by the nurse’s supervisor for time inefficiency.
c. be used against the nurse if a lawsuit results, because it proves the nurse was not able to relieve the pain.
d. justify insurance reimbursement for an extended duration of hospitalization for the patient.
2. A patient who is very angry and is leaving the hospital against medical advice (AMA) demands to have the medical chart to take, because it is her personal property. An appropriate response would be:
a. “Certainly. This hospital doesn’t need to keep it if you are leaving and will not be returning here.”
b. “You are entitled to the information in your chart, but the chart is the property of the hospital. I will see about having a copy made for you.”
c. “The information in your chart is confidential, and you cannot leave this facility with it.”
d. “Because you are leaving against the medical advice of your physician, you may not have the chart.”
3. A student nurse is assigned to a clinical unit on which one of the patients is a nationally known celebrity. The student reads the chart to find out why the celebrity is being treated. The student who is not the assigned caregiver is:
a. motivated to learn about the health problem of this patient and is appropriately seeking knowledge during his clinical experience.
b. doing appropriate research about nursing care as long as information is not divulged.
c. violating the confidentiality of the patient’s record.
d. neglecting the assigned patient load and should read the unassigned patient’s chart only after his assigned work is completed.
4. A patient with a nursing diagnosis of Skin integrity, impaired, related to surgery as evidenced by disruption of skin surface has the following nursing documentation: “Incision clean, dry, intact. No pain or tenderness. Instructed to keep area dry, may wear light dressing to protect from clothing. Verbalizes understanding of wound care and ability to manage at home. Wound healing without complication.” This documentation is:
a. an example of charting by exception.
b. evidence of the use of the nursing process.
c. using the problem-oriented medical record (POMR) format.
d. usually entered on a flow sheet for treatments and vital signs.
5. Which nursing assessment is an example of brevity and clarity while meeting legal guidelines?
a. “4 cm reddened area over sacrum. Skin intact, warm, and dry.”
b. “Taking fluids poorly, but more than yesterday.”
c. “Apparently comfortable all night. Offers no complaints of pain.”
d. “Patient says she is still slightly nauseated, would like to try some toast and tea.”
6. A nurse enters a notation in a patient’s chart but then discovers that the notation was made in the wrong chart. The nurse correctly:
a. draws a single line through the notation so that it is still readable and writes “mistaken entry,” his signature, and the date and time.
b. removes the page on which the error is written and rewrites the other correct notes.
c. blacks out the note to protect the confidentiality of the patient about whom it was written and writes in the margin “wrong patient,” his signature, and the date and time.
d. whites out the wrong entry and writes the note in the chart of the correct patient.
7. A resident in a skilled nursing facility for a short-term rehabilitation following a hip replacement says to the nurse, “I don’t want to have you draw any more blood for those useless tests.” When the nurse fails to convince the patient to have the blood drawn, the most appropriate documentation would be:
a. “Refuses to have blood drawn. Doctor notified.”
b. “Refuses to have blood drawn; says tests are ‘useless.’ Doctor notified.”
c. “Doctor notified of failure to draw ordered blood work.”
d. “Blood not drawn because tests are no longer desired by patient.”
8. A clinic nurse is documenting in a patient chart about the pain that brought the patient to seek medical attention. The best description is:
a. “Abdominal pain, unrelieved by antacids. Had spaghetti, salad, coffee, and ice cream cake for lunch.”
b. “Severe pain around umbilicus, unable to sleep because of pain. Started approximately 2 hours after lunch.”
c. “Pain at level of 7 to 8. Nothing has relieved or lessened pain, it just keeps getting worse.”
d. “Peri-umbilical sharp pain at pain level of 7 to 8 for last 3 hours, started 2 hours after lunch. No relief from antacids.”
9. In a chart for a patient who has had an allergic reaction to a drug and an associated nursing diagnosis of Skin integrity, impaired, related to allergic reaction as evidenced by rash and hives, the nurse charts “Subjective: denies itching. Happy with improvement in skin. Objective: rash fading on face, chest, and back; no hives visible on skin. Skin warm, dry, and intact. Assessment: skin integrity improving. Plan: check rash daily until discharge.” This type of charting is an example of:
a. charting by exception.
b. narrative style.
c. a problem-oriented medical record (POMR).
d. the case management system.
10. In an agency that uses specific protocols (Standard Procedures) and charting by exception, an advantage compared with using traditional (narrative or problem-oriented) charting is that charting by exception:
a. is well suited to defending nursing actions in court.
b. contains important data certain to be noted in the narrative sections.
c. allows staff to learn the system quickly and easily.
d. highlights abnormal data and patient trends.
Chapter 08: Communication and the Nurse-Patient Relationship
1. The nurse can best ensure that communication is understood by:
a. speaking slowly and clearly in the patient’s native language.
b. asking the family members whether the patient understands.
c. obtaining feedback from the patient that indicates accurate comprehension.
d. checking for signs of hearing loss or aphasia before communicating.
2. The nurse recognizes a verbal response when the patient:
a. nods her head when asked whether she wants juice.
b. writes the answer to a question asked by the nurse.
c. begins sobbing uncontrollably when asked about her daughter.
d. is moaning and restless and appears to be in pain.
3. The nurse recognizes the patient who demonstrates communication congruency when the patient:
a. smiles and laughs while speaking of feeling lonely and depressed.
b. wrings her hands and paces around the room while denying that she is upset.
c. is tearful and slow in speech when talking about her husband’s death.
d. states she is comfortable while she frowns and her teeth are clenched.
4. A Hispanic patient approaches the Asian nurse and, standing very close, touches the nurse’s shoulder during their conversation. The nurse begins to step back to 18 to 24 inches, while smiling and nodding to the patient. This situation is most likely an example of:
a. the nurse’s need to maintain a professional role rather than a social role.
b. a patient’s attempt to keep the nurse’s attention.
c. a nurse’s need to establish a more appropriate location for conversation.
d. a difference in culturally learned personal space of the nurse and the patient.
5. A nurse says to a patient, “I am going to take your TPR, and then I’ll check to see whether you can have a PRN analgesic.” In considering factors that affect communication, the nurse has:
a. used terminology to clearly inform the patient of what she is doing.
b. given information that is unnecessary for the patient to know.
c. used medical jargon, which might not be understood by the patient.
d. taken into consideration the patient’s need to know what is happening.
6. A nurse using active listening techniques would:
a. use nonverbal cues such as leaning forward, focusing on the speaker’s face, and slightly nodding to indicate that the message has been heard.
b. avoid the use of eye contact to allow the patient to express herself without feeling stared at or demeaned.
c. anticipate what the speaker is trying to say and help the patient express herself when she has difficulty with finishing a sentence.
d. ask probing questions to direct the conversation and obtain the information needed as efficiently as possible.
7. When the patient says, “I don’t want to go home,” the nurse’s best therapeutic verbal response would be:
a. “I’m sure everything will be fine once you get home.”
b. “You don’t want to go home?”
c. “Doesn’t your family want you to come home?”
d. “I felt like that when I had surgery last year.”
8. To begin talking with a newly admitted patient about pain management, the nurse would most appropriately state:
a. “You look pretty comfortable. Are you having any pain?”
b. “Tell me about the pain you’ve been having.”
c. “Is this pain the same as the pain you had yesterday?”
d. “Don’t worry; this pain won’t last forever.”
9. When a patient begins crying during a conversation with the nurse about the patient’s upcoming surgery for possible malignancy, the nurse’s most therapeutic response would be:
a. “Your surgeon is excellent, and I know he’ll do a great job.”
b. “Oh, dear, your gown is way too big, let me get you another one.”
c. “Don’t cry; think about something else and you’ll feel better.”
d. “Here is a tissue. I’d like to sit here for a while if you want to talk.”
10. To enhance the establishment of rapport with a patient, the nurse should:
a. identify himself by name and title each time he introduces himself.
b. share his own personal experiences so that the patient gets to know him as a friend.
c. act in a trustworthy and reliable manner; respect the individuality of the patient.
d. share information with the patient about other patients and why they are hospitalized.
Chapter 09: Patient Teaching for Health Promotion
1. Before beginning to teach a patient to give himself insulin, the nurse asks, “Have you ever known anyone who gave himself insulin injections?” This question is primarily designed to:
a. assess the patient’s learning needs.
b. stimulate the patient to focus on the teaching goal.
c. reduce the patient’s anxiety relative to insulin injection.
d. reduce the amount of information the nurse has to provide.
2. The nurse uses a syringe and vial of insulin to show how to draw up the correct dose while she explains the procedure to the patient. To best promote learning, her next step should be to:
a. give the patient written materials to study and learn the procedure.
b. have the patient explain the procedure to the nurse to assess understanding.
c. give the patient a day to allow him to process and absorb the information.
d. have the patient practice the procedure with the nurse helping.
3. In teaching an 82-year-old patient to perform a dressing change to be done at home after discharge, the nurse would adjust the teaching session to:
a. include another person in the instruction because an 82-year-old person will be unable to master the technique.
b. slow the pace and frequently ask questions to assess comprehension.
c. speed through the details because age and experience will shorten learning time.
d. provide written material and diagrams alone.
4. An 80-year-old patient is to be taught the process of colostomy irrigation and reattachment of the colostomy bag. The nurse’s initial assessment prior to instruction should address the patient’s:
a. understanding of the process of irrigation.
b. familiarity with the irrigation materials.
c. manual dexterity.
d. motivation to learn.
5. The nurse can assess her patient’s ability to read and comprehend written instructions by doing which of the following?
a. Asking the patient, “Did you graduate from high school?”
b. Giving the patient a printed instruction sheet and saying, “Some people have difficulty with written instructions. Others find them helpful. Would these be helpful to you?”
c. Asking the patient, “Are you able to read?”
d. Giving the patient some printed materials and saying, “After you have read this, I’ll ask you some questions about what’s in them, to see if you’ve learned it.”
6. A patient being assessed for pre-operative learning needs says his mother had the same surgery by the same surgeon 3 years ago. The nurse should design the teaching plan to:
a. do a brief review of the preoperative teaching, because the patient is already familiar with the procedure.
b. teach thoroughly as the procedure may have changed.
c. simply give the patient a written list of preoperative instructions.
d. explore with the patient what he knows about the proposed surgery and add or correct where necessary.
7. The nurse is aware that the knowledge deficit of a postpartum patient with her first child that can be safely addressed by the community nurse after discharge is:
a. weaning the child from breast-feeding.
b. care of the patient’s surgical incision.
c. feeding the baby by breast or bottle.
d. recognizing signs or symptoms of infection.
8. The nurse evaluates the effectiveness of teaching relative to how to use an eye shield after eye surgery is to:
a. have the patient tell the nurse what he is going to do.
b. have the patient demonstrate that he can secure the eye shield.
c. ask the patient if he has any questions related to the use of the shield.
d. call the patient at home in 3 days and ask if he has been wearing the shield.
9. The nurse will choose the best time to continue postoperative teaching regarding wound care and dressings, which would be:
a. immediately after the patient has been medicated for pain.
b. just before the patient is discharged, so the information is current.
c. when the patient is comfortable and receptive to the teaching.
d. the last thing in the evening, after visitors have left, before bedtime.
10. A nurse plans to teach a 4-year-old about what to expect after his broken arm has been casted by:
a. bringing a doll and casting materials to the room, showing the casting materials and actually casting the doll’s arm, and explaining the purpose of the cast.
b. telling the child that while he is asleep, the doctor will take off his arm and wrap it up.
c. breaking up the teaching sessions into two separate 5-minute sessions.
d. being treated as an adult because this approach helps the child to feel “grown up.”
Chapter 10: Delegation, Leadership, and Management
1. Leadership is best defined as a process that:
a. motivates people to accomplish set goals.
b. provides a framework for health care delivery systems.
c. guides staff to use resources to meet patient needs.
d. uses advanced management training.
2. The best description of an autocratic leader is a leader who:
a. is permissive.
b. has confidence in the staff.
c. tightly controls team members.
d. accepts all responsibility for the team.
3. A laissez-faire leader would be most likely to:
a. consult staff members.
b. tightly control team members.
c. allow team members to function independently.
d. set goals that are task oriented.
4. A team leader with effective communication skills would:
a. make precise authoritarian assignments to team members.
b. give specific information in a tactful, friendly manner.
c. maintain eye contact when giving directions.
d. limit time for feedback and complaints.
5. The most effective communication from a nurse leader to a team member that is most likely to have a positive outcome would be:
a. “Jane, be sure to get those vital signs recorded on time today.”
b. “Jane, I need those vital signs before breakfast.”
c. “Jane, please give me a list of those vital signs before breakfast.”
d. “Jane, breakfast trays are being served. You need to get those vital signs.”
6. Prior to addressing a situation, the nurse is aware that an effective leader must _____ the problem.
b. identify persons to address
c. know the legal implications of
d. look to alternatives to address
7. The nurse is aware that the best way to evaluate an unlicensed assistive personnel’s (UAP’s) ability to perform a skill or task is to:
a. obtain verbal confirmation from another nurse that the nursing assistant is proficient.
b. review documentation that the nursing assistant is competent in skills.
c. observe the nursing assistant performing the skill or task.
d. demonstrate the skill to the nursing assistant before his demonstration.
8. The nurse’s most appropriate selection of a task to be delegated to an unlicensed assistive personnel (UAP) would be:
a. assessing circulation in the toes of a patient in a cast.
b. changing a patient’s wound dressing.
c. taking the blood pressure of a patient who has just returned from surgery.
d. toileting a patient on a bladder-training regimen.
9. The nurse is aware that when a task is delegated to an unlicensed assistive personnel (UAP), the nurse is:
a. no longer responsible to that patient.
b. responsible to communicate outcome to appropriate senior staff.
c. responsible for overall patient care.
d. liable for all adverse outcomes.
10. The nurse recognizes that one of the responsibilities of a charge nurse as opposed to the team leader is that the charge nurse is responsible for:
a. evaluating members of the health care team.
b. evaluating unlicensed assistive personnel.
c. making rounds and assessing all patients on the unit.
d. collaborating with physicians and other health team members.
AND MUCH MORE