Row A
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.
C
By improving sanitation, nutrition ventilation, and handwashing techniques, Florence Nightingale’s nurses dramatically reduced the death rate from injuries in the Crimean War.
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.
D
Idiopathic disease is defined as disease whose cause is unknown.
A patient states, “I am not obese. My entire family is large.” The nurse assesses that the patient is using the defense mechanism of:
a. sublimation.
b. projection.
c. denial.
d. displacement.
C
Denial is a defense mechanism that allows a person to live as though an unwanted piece of information or reality does not exist. There is a persistent refusal to be swayed by the evidence.
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.
C
Toileting, feeding, and transporting residents or patients are tasks that can be legally assigned to a nurse’s aide. Administering medications is a nursing act that can be performed only by a licensed nurse or by a student nurse under the supervision of a licensed nurse.
Ethics and law are different from each other in that ethics:
a. bear a penalty if violated.
b. are voluntary.
c. rarely change.
d. can always direct all decisions.
B
Ethics are voluntary and are based on values. Ethics may change as parameters of health care change. There is no penalty for violation.
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.
A
In order for the LPN to apply the common goals of nursing, he or she must assume the roles of caregiver, educator, collaborator, manager, and advocate.
A patient has been advised by the primary care provider 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 primary care provider that the patient is unable to understand the instructions.
B
The patient may have cultural, socioeconomic, or religious values that cause conflicts that prevent her from following the doctor’s instructions.
The nurse encourages a patient to participate in health maintenance by maintaining an ideal body weight as a method of:
a. primary prevention.
b. secondary prevention.
c. tertiary prevention.
d. simple prevention.
A
Primary prevention avoids or delays occurrence of a specific disease or disorder.
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.
A
A person has the right to refuse medical care, and agencies use the Leave AMA to document the medical advice given and the patient’s informed choice to leave against that advice.
Which of the following could place the nurse in a serious legal situation?
a. A nurse posts a poem about the qualities of a compassionate nurse on his or her social media page.
b. A nurse’s mother shares a “selfie” of her daughter (a nurse) and a celebrity patient she is caring for on her social media page.
c. A nurse posts a request for prayer for strength after a difficult day at work.
d. A nurse posts a video of fellow nurse’s lip syncing and dancing to a popular song, “We are Strong.”
B
Legal and Ethical Considerations
Social Media and HIPAA
Social media use has increased greatly since the implementation of HIPAA. Health care agencies and institutions have had to become more diligent in protecting personal health information (PHI) as a result. It is imperative that no PHI be disseminated, either intentionally or unintentionally, over social media. Posting of pictures, discussions (even those that do not use patient or hospital names), and images of X-rays all violate HIPAA and place the nurse in a serious legal situation. It is generally best to separate one’s personal and professional life when dealing with social media. The National Council of State Boards of Nursing (2018) provides guidelines and suggestions for nurses in dealing with social media and nursing practice.
Nursing interventions are best defined as activities that:
a. are taken to improve the patient’s health.
b. involve researching methods to maintain asepsis.
c. include the family in nursing care.
d. review guidelines for handling infectious wastes.
A
Interventions are actions taken to improve, maintain, or restore health.
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.
A
A person’s concern relative to a needs deficit must be assessed by the nurse to meet the needs of each patient. Needs are viewed differently from one person to the next.
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. are held to the same standards as a licensed nurse.
d. must apply for a temporary student nurse permit to practice as a student.
C
Student nurses are held to the same standards as a licensed nurse. This means that although a student nurse may not perform a task as quickly or as smoothly as the licensed nurse would, the student is expected to perform it as effectively. In other words, she must achieve the same outcome without harm to the patient. The student is legally responsible for her own actions or inaction, and many schools require the student to carry malpractice insurance.
A nurse remarks to several people that “Dr. X must be getting senile because she makes so many mistakes.” If that remark results in some of Dr. X’s patients changing to another doctor, Dr. X would have grounds to sue the nurse for:
a. slander.
b. libel.
c. invasion of privacy.
d. negligence.
A
A person who makes untrue, malicious, or harmful remarks that damage a person’s reputation and cause injury (loss of business) is guilty of defamation and slander. Libel is defamation that is written.
A 48-year-old man refuses to take a medication ordered for the control of his blood pressure. The nurse’s most effective response would be:
a. “Your doctor expects you to be compliant.”
b. “You have the right to refuse. This medication keeps your blood pressure under control.”
c. “Fine. I will document that you are refusing this drug.”
d. “Are you aware that you could have a stroke?”
B
Patients have the right to refuse medication, but it is the nurse’s responsibility to explain the reason for the particular drug.
A state’s Nurse Practice Act is designed to protect the:
a. physician.
b. nurse.
c. public.
d. hospital.
C
Nurse Practice Acts are designed to protect the public.
The nurse believes that patient teaching of how to give insulin and monitor blood glucose levels will improve the level of the patient’s:
a. physiological well-being.
b. security, by providing psychological comfort.
c. self-esteem, by promoting independence and learning.
d. self-actualization, by seeking knowledge and truth.
C
Patient education activities that are to be used after discharge enhance independence and promote self-esteem.
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.”
D
In employment practice, it is illegal to discriminate against people with certain diseases or conditions. Asking a question about health status, especially HIV or AIDS infection, is illegal.
A licensed nurse is liable for charges of malpractice when she:
a. does not show up for work and fails to call to notify the agency.
b. clocks in for another nurse to prevent that nurse from having pay docked.
c. falsifies data, causing the patient to suffer problems resulting in death.
d. assists in performing CPR that is unsuccessful, and the patient dies.
C
Malpractice is professional negligence or, in this case, doing (falsifying) something the reasonable and prudent nurse would not do. It is the proximate cause of the patient injury. This is a case of causation.
Characteristics of primary nursing include: (Select all that apply.)
a. elimination of fragmentation of care between shifts.
b. evolved in the mid-1950s.
c. planning and direction performed by one nurse.
d. ancillary workers used to increase productivity.
e. the care plan covering the entire day.
f. associate nurses taking over care and planning when the primary nurse is off duty.
ACDEF
Primary care reduces fragmentation of care between shifts. Care is planned by one nurse to cover a 24-hour period using ancillary workers to increase the productivity. An associate nurse may take on direction of care in the absence of the primary nurse.
Which of the following is considered a positive aspect of the Affordable Care Act?
a. A 38-year-old mother is penalized on her taxes for not purchasing health insurance.
b. A 42-year-old laborer who has chronic kidney disease is denied insurance coverage.
c. Jamie, age 24, cannot continue insurance coverage on his parent’s insurance since he has graduated from college.
d. Maria, age 60, is able to obtain health insurance at a rate that is manageable on her income.
D.
The Patient Protection and Affordable Care Act (the “Affordable Care Act,”) was signed into law in 2010 as was meant to be phased in over several years. It created health insurance exchanges, expanded eligibility for Medicaid, allowed young adults to remain on their parents’ insurance through age 26, and stopped insurance providers from denying coverage for pre-existing conditions. Uninsured people were required to purchase health insurance and were penalized on their income taxes if they did not. Since the Republican administration came to power in 2017, however, many aspects of the Affordable Care Act have either been defunded or repealed. For example, the penalty for not purchasing insurance has been removed, the enrollment period has been cut in half, and “navigators” (people employed to help those looking into buying insurance) have had their funding cut. Fortunately, enrollment hasn’t declined significantly so far, although the current administration has a goal to repeal and replace the Affordable Care Act. As coverage under the Affordable Care Act expanded, the national uninsured rate initially fell from 16% to 11% of people under age 65 (people over age 65 generally have universal coverage by Medicare), although with the weakening of the Affordable Care Act the uninsured rate has gone back up to nearly 16% (Collins 2018).
The nurse assesses successful adaptation in a post stroke patient when the patient:
a. learns to walk and maintain balance with the aid of a walker.
b. consistently takes antihypertensive drugs.
c. attempts to get out of bed unassisted.
d. refuses assistance with feeding.
A
Adaptation is a readjustment in habits to limitations and disabilities. Learning to walk and maintain balance with the aid of a walker is an example of this.
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.
A
Theft of a controlled substance is a federal crime and consequently a crime against society.
A postoperative patient in the intensive care unit (ICU) is so confused and agitated that staff have not been able to safely care for him. He has pulled out his central line once, and he slides to the bottom of the bed, where he attempts to climb out, pulling and disrupting the various tubes and monitors. The nurse’s best course of action is to:
a. place him in a protective vest device.
b. use a sheet to tie him in a chair at the nurses’ station.
c. request that the doctor write an order for a protective device and/or medication.
d. call a family member to stay with the patient.
C
A protective device may not be used (except in an emergency) without a doctor’s order, and it is used only when other less restrictive means do not provide safety for the patient.
Which defines the holistic approach to caring for the sick and promoting wellness? (Select all that apply.)
a. The nurse’s focus is specific to the disease or injury.
b. The nurse realizes that each person has a responsibility for his or her own health.
c. Health care providers are required to intervene on behalf of all persons to ensure that health goals are met.
d. Providers combine traditional methods of health care with relaxation techniques for pain management.
e. A change in one aspect of a person’s life may or may not alter the person as a whole.
BCDE
The holistic approach to medicine treats the patient as a whole and may use a mix of traditional medicine and alternative medicine. Any change in one aspect of the whole may change the entire whole.