Test Bank for Foundations and Adult Health Nursing 9th Edition Cooper Chapter 1 - 58 Updated 2023-24

Test Bank for Foundations and Adult Health Nursing 9th Edition Cooper Chapter 1 - 58 Updated 2023-24 Tables Of Contents Chapter01:The Evolution of Nursing Chapter02:Legal and Ethical Aspects of Nursing Chapter03:Documentation Chapter04:Communication Chapter 05:Nursing Process and Critical Thinking Chapter06:Cultural and Ethnic Considerations Chapter07:Asepsisand Infection Control Chapter 08: Body Mechanics and Patient Mobility Chapter09:Hygiene and Care of the Patient’s Environment Chapter10:Safety Chapter11:Admission,Transfer,andDischarge Chapter12:Vital Signs Chapter13:Physical Assessment Chapter14:Oxygenation Chapter15:Elimination and GastricIntubation Chapter16:Care of Patients Experiencing Urgent Alterations in Health Chapter17:Dosage Calculation and Medication Administration Chapter18:Fluids and Electrolytes Chapter 19: Nutritional Concepts and Related Therapies Chapter 20: Complementary and Alternative Therapies Chapter 21: Pain Management, Comfort, Rest, and Sleep Chapter 22:Surgical Wound Care Chapter 23: Specimen Collection and Diagnostic Testing Chapter24: Lifespan Development Chapter25:Loss,Grief,Dying,andDeath Chapter26:Health Promotion and Pregnancy Chapter27: Labor and Delivery Chapter28:Care of the Mother and Newborn Chapter29:Care of the High RiskMother,Newborn,and Family with Special Needs Chapter30:Health Promotion for the Infant,Child,and Adolescent Chapter31:Basic Pediatric Nursing Care Chapter32:Care of the Child with a Physical and Mental or Cognitive Disorder Chapter33:Health Promotion and Care of the Older Adult Chapter34:Concepts of Mental Health Chapter35:Careof the Patient with a Psychiatric Disorder Chapter36:Care of the Patient with an Addictive Personality Chapter37:Home Health Nursing Chapter38:Long-Term Care Chapter39:Rehabilitation Nursing Chapter40:Hospice Care Chapter 41: Introduction to Anatomy and Physiology Chapter42:Care of the Surgical Patient Chapter43:Care of the Patient with an Integumentary Disorder Chapter44:Care of the Patient With a Musculoskeletal Disorder Chapter45:Care of the Patient With a Gastrointestinal Disorder Chapter46:Care of the Patient With a Gallbladder, Liver, BiliaryTract, or Exocrine Pancreatic Disorder Chapter47:CareofthePatientWithaBloodorLymphaticDisorder Chapter48:CareofthePatientWithaCardiovascularoraPeripheralVascularDisorder Chapter49:Care of the Patient With a Respiratory Disorder Chapter 50: Care of the Patient With a Urinary Disorder Chapter51:Care of the Patient With an Endocrine Disorder Chapter52:Care of the Patient With a Reproductive Disorder Chapter53:Care of the Patient With a Visual or Auditory Disorder Chapter54:Care of the Patient With a Neurologic Disorder Chapter 55: Care of the Patient With an Immune Disorder Chapter56:Care of the Patient With HIV/AIDS Chapter57:Care of the Patient With Cancer Chapter58:Professional Roles and Leadership 1 Chapter01:TheEvolutionofNursing Cooper:FoundationsandAdultHealthNursing,9thEdition MULTIPLECHOICE 1. Whatisanursingprogramconsideredwhencertifiedbyastateagency? a. Accredited b. Approved c. Provisional d. Exemplified ANS:B Approved means certified by a state agency for having met minimum standards; accredited means certified by the NLN for havingmetmorecomplexstandards.Provisionalandexemplifiedarenottermsusedinregardtonursingprogramcertification. DIF:Cognitive Level: Knowledge REF:p. 10 OBJ:5 TOP:Nursing programs KEY:NursingProcessStep:N/A MSC:NCLEX: N/A 2. Whichofthefollowingmustthenurserecognizeregardingthehealthcaredeliverysystem? a. Itincludesallstates. b. Itaffectstheillnessofpatients. c. Insurancecompaniesarenotinvolved. d. Themajorgoalistoachieveoptimallevelsofhealthcare. ANS:D The nurse must recognize that in the health care delivery system, the major goal is to achieve optimal levels of healthcare. Thehealth care system consists of a network of agencies, facilities, and providers involved with health care in a specifiedgeographicarea. Insurance companies do have involvement in the health care system. The illness of patients is not necessarily affected by thehealth care system. DIF:Cognitive Level: Comprehension REF:p. 12 OBJ:7 TOP:Health care systems KEY:NursingProcessStep:N/A MSC:NCLEX: N/A 3. Whatisrequiredbythehealthcareteamtoidentifytheneedsofapatientandtodesigncaretomeetthoseneeds? a. TheKardex b. Thehealthcareprovider’sordersheet c. Anindividualizedcareplan d. Thenurse’snotes ANS:C An individualized care plan involves all health care workers and outlines care to meet the needs of the individual patient. TheKardex, health care provider’s order sheet, and nurse’s notes do not identify the needs of the patient nor are they designed to assistall members of the health care team to meet those needs. DIF:CognitiveLevel:Comprehension REF:p.13 OBJ:8 |9 TOP:Careplan KEY:NursingProcessStep:Planning MSC:NCLEX:N/A 4. Patientcareemphasisonwellness,ratherthanillness,beginsasaresultof: a. increasededucationconcerningcausesofillness. b. improvedinsurancepayments. c. decentralizedcarecenters. d. increasednumberofhealthcaregivers. ANS:A The acute awareness of preventive medicine has resulted in today’s emphasis on education about issues such as smoking, heartdisease, drug and alcohol abuse, weight control, and mental health and wellness promotion activities. This preventive education hasresulted in an emphasis on wellness, rather than illness. Improved insurance payments, decentralized care centers, and increasednumbers of health care givers did not influence an emphasis on wellness. DIF:CognitiveLevel:Comprehension REF:p.12 OBJ:4 |8 TOP:Wellness KEY:NursingProcessStep: N/A MSC:NCLEX:N/A 5. Whatisthemosteffectiveprocesstoensurethatthecareplanismeetingtheneedsofthepatient? a. Documentation b. Communication c. Evaluation d. Planning ANS:B Communication is the primary essential component among the health care team to evaluate and modify the care plan.Documentation, evaluation, and planning are not primary essential components to ensure the care plan is meeting the needs of thepatient. DIF:Cognitive Level: Comprehension REF:p. 17 OBJ:8 TOP:Communication KEY:NursingProcessStep:N/A MSC:NCLEX: N/A 6. Howdoesaninterdisciplinaryapproachtopatienttreatmentenhancecare? a. Byimprovingefficiencyofcare b. Byreducingthenumberofcaregivers c. Bypreventingthefragmentationofpatientcare d. Byshorteninghospitalstay ANS:C An interdisciplinary approach prevents fragmentation of care. An interdisciplinary approach does not improve the efficiency ofcare, reduce the number of caregivers, or shorten hospital stay. DIF:Cognitive Level: ComprehensionREF:p. 16 OBJ:8|9 TOP:Interdisciplinary approach KEY:NursingProcessStep:N/A MSC:NCLEX: N/A 7. HowmayanewlylicensedLPN/LVNpractice? a. Independentlyinahospitalsetting b. WithanexperiencedLPN/LVN c. UnderthesupervisionofahealthcareproviderorRN d. Asasolehealthcareproviderinaclinicsetting ANS:C AnLPN/LVNpracticesunderthesupervisionofahealthcareprovider,dentist,OD,orRN. DIF:Cognitive Level: Knowledge REF:p. 11 OBJ:11 TOP:Vocational nursing KEY:NursingProcessStep:N/A MSC:NCLEX: N/A 8. Whose influence on nursing practice in the 19th century was related to improvement of patient environment as a method ofhealthpromotion? a. ClaraBarton b. LindaRichards c. DorotheaDix d. FlorenceNightingale ANS:D The influence of Florence Nightingale was highly significant in the 19th century as she fought for sanitary conditions,fresh air, andgeneralimprovementinthepatientenvironment.ClaraBartondevelopedtheAmericanRedCrossin1881.LindaRichardsis known as the first trained nurse in America, was responsible for the development of the first nursing and hospital records, and iscredited with the development of our present-day documentation system. Dorothea Dix was the pioneer crusader for elevation ofstandards of care for the mentally ill and superintendent of female nurses of the Union Army. DIF:Cognitive Level: Knowledge REF:p. 17 OBJ:2|4 TOP:Nursing leaders KEY:NursingProcessStep:N/A MSC:NCLEX: N/A 9. WhatdocumentidentifiestherolesandresponsibilitiesoftheLPN/LVN? a. NLNAccreditationStandards b. NursePracticeAct c. NAPNECode d. AmericanNurses’AssociationCode ANS:B The LPN/LVN functions under the Nurse Practice Act. NLN Accreditation Standards, the NAPNE Code, and the AmericanNurses’ Association Code do not identify the roles and responsibilities of the LPN/LVN. DIF:Cognitive Level: Knowledge REF:p. 12 | p. 14 OBJ:11 TOP:Roles and responsibilities KEY:NursingProcessStep:N/A MSC:NCLEX: N/A 10. Whatisacost-effectivedeliveryofcareusedbymanyhospitalsthatallowstheLPN/LVNtoworkwiththeRNtomeettheneeds of patients? a. Focusednursing b. Teamnursing c. Casemanagement d. Primarynursing ANS:C Case management is a cost-effective method of care. Focused nursing, team nursing, and primary nursing are not costeffectivemethods of delivering care that allow the LPN/LVN to work with the RN to meet patient needs. DIF:Cognitive Level: ComprehensionREF:p. 15 OBJ:7|9 TOP:Patient care delivery systems KEY:NursingProcessStep:N/A MSC:NCLEX: N/A 3 11. What is the title of the American Hospital Association’s 1972 document that outlines the patient’s expectations to be treated withdignity and compassion? a. CodeofEthics b. Patient’sBillofRights c. OBRA d. Advancedirectives ANS:B PatientexpectationsareoutlinedbythePatient’sBillofRights.PatientexpectationsarenotoutlinedintheCodeofEthics,OBRA, or advance directives. DIF:Cognitive Level: Knowledge REF:p. 16 OBJ:4|8 TOP:Patient’s rights KEY:NursingProcessStep:N/A MSC:NCLEX: N/A 12. Therelationshipsamongnursing,patients,health,andtheenvironmentarethebasisfor: a. careplans. b. nursingmodels. c. healthcareprovider’sorders. d. evaluationofpatientcare. ANS:B Nursing models are theories based on the relationship between nursing, patients, health, and environment. Care plans, health careprovider’s orders, and evaluation of patient care are not based on the relationships among nursing, patients, health, andenvironment. DIF:Cognitive Level: Comprehension REF:p. 17 OBJ:1 TOP:Nursing models KEY:NursingProcessStep:N/A MSC:NCLEX: N/A 13. Whatsystemreducesthenumberofemployeesbutstillprovidesqualitycareforpatients? a. Teamnursing b. Cross-training c. Useofcriticalpathways d. Casemanagement ANS:B Cross-training reduces the number of employees but does not alter the quality of patient care. Team nursing, use of criticalpathways,andcasemanagementdonotreducethenumberofemployeeswhilecontinuingtoprovidequalitycareforpatients. DIF:CognitiveLevel:Comprehension REF:p.15 OBJ:8 TOP:Patientcare KEY:NursingProcessStep: N/A MSC:NCLEX:N/A 14. WhatisthepurposeoflicensinglawsforLPN/LVNs? a. TolimitthenumberofLPN/LVNs b. Preventionofmalpractice c. Protectionofthepublicfromunqualifiedpeople d. Toincreaserevenueforthestateboardofnursing ANS:C The purpose of licensing laws for LPN/LVNs is to protect the public from unqualified health care providers. Licensing laws’purposeisnottolimitthenumberofLPNs/LVNs,preventmalpractice,orincreaserevenueforthestateboardofnursing. DIF:Cognitive Level: Comprehension REF:p. 11 OBJ:4 | 9 | 10TOP:Licensure KEY:Nursing Process Step: N/A MSC:NCLEX:N/A 15. WhatpremiseisMaslow’shierarchyofneedsbasedon? a. Allneedsareequallyimportant. b. Basicneedsmustbemetbeforethenextlevelofneedscanbemet. c. Self-actualizationisaprimaryneed. d. Individualsprioritizeneedsthesameway. ANS:B Maslow’s hierarchy of needs is based on the premise that basic needs must be met first. It is not based on all needs being equallyimportantorthatindividualsprioritizeneedsthesameway.Self-actualizationisnotaprimaryneedaccordingtoMaslow. DIF:Cognitive Level: Comprehension REF:p. 12 | p. 13 OBJ:8 TOP:Maslow’s Hierarchy of Needs KEY:NursingProcessStep:N/A MSC:NCLEX: N/A 16. Whatmustthenurserealizewhenassessingphysicalandsocialenvironmentalfactorsaffectinghealthandillness? a. Theyaffectoneanother. b. Theycauseillness. c. Theycausepatientstoreactsimilarly. d. Theycanbeseparated. ANS:A Physical and social factors affect each other, cannot be separated, and cause each patient to react in a unique manner.They do notnecessarily cause illness or cause patients to react similarly, and they cannot be separated. DIF:CognitiveLevel:Comprehension REF:p.14 OBJ:4 |8 TOP:Environmental factors KEY:NursingProcessStep:Assessment MSC:NCLEX: Health Promotion and Maintenance 17. Whatorganization,establishedduringWorldWarII,providednursingeducationandtraining? a. Nightingaleschool b. CadetNurseCorps c. Publichealthdepartment d. FrontierNursingService ANS:B The Cadet Nurse Corps was established during World War II to provide nursing education and training. The Nightingale school, public health department, and Frontier Nursing Service are not organizations established during World War II to provide nursing education and training. DIF:Cognitive Level: Knowledge REF:p. 5 OBJ:1|4 TOP:Nursing education KEY:NursingProcessStep:N/A MSC:NCLEX: N/A 18. WhatisamoderneducationaladvancementprogramfortheLPN/LVNtoenterRNeducation? a. Repetition b. Exclusion c. Articulation d. Coexistence ANS:C Most states have some type of articulation program in which the LPN/LVN can achieve advanced standing in an RN program withouthavingtoenrollintheentirecurriculum.Repetition,exclusion,andcoexistencedonotrefertoeducationaladvancement. DIF:Cognitive Level: Knowledge REF:p. 10 OBJ:1|9 TOP:Nursing education KEY:NursingProcessStep:N/A MSC:NCLEX: N/A 19. WheredidFlorenceNightingale’soriginalnursingeducationtakeplace? a. SaintThomas b. KingsCollegeHospital c. CrimeanHospital d. KaiserswerthSchool ANS:D Florence Nightingale trained at Kaiserswerth School. Florence Nightingale’s original training was not at Saint Thomas, KingsCollege Hospital, or Crimean Hospital. DIF:Cognitive Level: Knowledge REF:p. 2 OBJ:2 TOP:Nursing programs KEY:NursingProcessStep:N/A MSC:NCLEX: N/A 20. What system of comprehensive patient care considers the physical, emotional, and social environment and spiritual needsof aperson? a. Interdependentcare b. Holistichealthcare c. Illnesspreventioncare d. Healthpromotioncare ANS:B Holistichealthcareencompassesthephysical,emotional,social,andspiritualaspectsofthepatient. DIF:CognitiveLevel:Comprehension REF:p.12 OBJ:8 TOP:Healthcare KEY:NursingProcessStep:N/A MSC:NCLEX:N/A 21. WhatofficialagencyexistsexclusivelyforLPN/LVNmembershipandpromotesstandardsfortheLPN/LVN? a. NFLPN b. ANA c. NLN d. NAPNES ANS:A TheNFLPNexistssolelyfortheLPN/LVN.TheotheroptionshavemembershipthatincludesRNsandthelaypublic. DIF:Cognitive Level: Knowledge REF:p. 10 OBJ:5|6|9 TOP:Nursing organizations KEY:Nursing Process Step: N/A MSC:NCLEX: N/A 22. Whatscoredoesthegraduatepracticalnurserequiretobeissuedalicenseuponcompletionofthecomputerizedexamination? a. 70%orbetter b. Thisisdefinedandsetbyeachstate c. Designatedas“pass” d. Withinthe75thpercentile ANS:C Currently graduates of an approved vocational school are eligible to take the licensing examination and be awarded a license with ascore of “pass” that is recognized by all states. DIF:Cognitive Level: Knowledge REF:p. 12 OBJ:3 TOP:Licensure examination KEY:NursingProcessStep:N/A MSC:NCLEX: N/A 23. Whatdocument,publishedin1965bytheANA,clearlydefinedtwolevelsofnursingpractice? a. Licensingstandards b. Positionpaper c. Smith-HughesAct d. Nursepracticeact ANS:B The ANA’s position paper of 1965 defined two levels of nursing: registered nurse and technical nurse. Licensing standards, theSmith-HughesAct,andthenursepracticeactwerenotdocumentsdefiningtwolevelsofnursingpracticepublishedin1965. DIF:Cognitive Level: Knowledge REF:p. 11 OBJ:3|4|9 TOP:Position paper KEY:Nursing Process Step: N/A MSC:NCLEX: N/A 24. Whatisthewellness/illnesscontinuumdefinedas? a. Aconceptthatneverchanges b. Therangeofaperson’stotalhealth c. Acontinuuminfluencedonlybyone’sphysicalcondition d. Anideathatfocusesstrictlyonanindividual’ssocialwell-being ANS:B The wellness/illness continuum is defined as the range of a person’s total health. This continuum is ever changing, andit is influenced by the individual’s physical condition, mental condition, and social well-being. DIF:Cognitive Level: Comprehension REF:p. 12 OBJ:8 TOP:Wellness/illness continuum KEY:NursingProcessStep:N/A MSC:NCLEX: N/A 25. AccordingtoMaslow’shierarchyofneeds,whatisanindividual’smostbasicneed? a. Safetyandsecurity b. Love/belongingness c. Physiologic d. Self-actualization e. Esteem ANS:C Abraham Maslow believed that an individual’s behavior is formed by the individual’s attempts to meet essential human needs,whichheidentifiedasphysiologic,safetyandsecurity,loveandbelongingness,andesteemandself-actualization. DIF:Cognitive Level: Comprehension REF:p. 12 | p. 13 OBJ:8 TOP:Maslow’s Hierarchy of Needs KEY:NursingProcessStep:N/A MSC:NCLEX: N/A MULTIPLERESPONSE 1. Florence Nightingale established a nursing school at Saint Thomas Hospital in London. What was it characterized by?(Select allthat apply.) a. Allowingallapplicantswhoappliedtobeenrolled b. Offeringformalandpracticaleducationalexperiences c. Keepingrecordsofstudents’progress d. Focusingonsanitationandhygiene e. Retainingaregistryofallgraduates ANS:B,C,D, E The nursing school established by Florence Nightingale rigorously screened its applicants. The curriculum, which included bothformal education and practical experiences, was focused on hygiene and sanitation. The school kept records of the students’progress during their school years, and also kept a registry of the graduates. DIF:CognitiveLevel:Comprehension REF:p.3 OBJ:1 |2 TOP:School established by Florence Nightingale KEY:NursingProcessStep:N/A MSC:NCLEX: N/A COMPLETION 1. Primitivemedicalinterventionswerebasedonthebeliefthatillnesswascausedbythepresenceof spirits. ANS: evil Illness was thought to be caused by the inhabitation of the body by evil spirits. Medical interventions were designed todrive out theevil spirits by introducing good spirits. DIF:Cognitive Level: Comprehension REF:p. 1 OBJ:1 TOP:Primitive health care KEY:NursingProcessStep:N/A MSC:NCLEX: N/A 2. During early civilization men performed witchcraft and rituals to induce the bad spirits to leave the bodyof the ailing person. ANS: medicine Medicine men performed witchcraft and rituals to induce the bad spirits to leave the body of the ailing person during earlycivilization. DIF:Cognitive Level: Knowledge REF:p. 2 OBJ:1 TOP:Primitive health care KEY:NursingProcessStep:N/A MSC:NCLEX: N/A 3. The National Council of State Boards of Nursing (NCSBN) performs a job analysis every years to determine the scope of practice of LPN/LVNs. ANS: 3 three The National Council of State Boards of Nursing performs a job analysis every 3 years to measure the scope of practice forLPN/LVNs. DIF:Cognitive Level: Knowledge REF:p. 18 OBJ:6|9 TOP:National Council analysis KEY:NursingProcessStep:N/A MSC:NCLEX: N/A 4. Graduatesofthefirstschoolfortrainingthepracticalnursewerereferredtoas nurses. ANS: attendant ThefirstschoolfortrainingthepracticalnursestartedinBrooklyn,NewYork,in1892andwasconductedundertheauspicesof theYoungWomen’sChristianAssociation(YWCA).TheBallardSchool,asitwasknown,wasapproximately3monthsin duration and trained its students to care for the chronically ill, invalids, children, and the elderly. The main emphasis was on homecare and included cooking, nutrition, basic science, and basic procedures. Graduates of this program were referred to asattendantnurses. DIF:Cognitive Level: Knowledge REF:p. 9 OBJ:1 TOP:Attendant nurses KEY:NursingProcessStep:N/A MSC:NCLEX: N/A 5. In1949,theNationalFederationofLicensedPracticalNurses(NFLPN)wasfoundedbyLillian . ANS: Kuster In 1949, the National Federation of Licensed Practical Nurses (NFLPN) was founded by Lillian Kuster. This association isthe officialmembershiporganizationforlicensedpracticalnurses/licensedvocationalnurses(LPN/LVNs),andmembershipislimited to LPNs and LVNs. DIF:CognitiveLevel:Knowledge REF:p.10 OBJ:2 TOP:National Federation of Licensed Practical Nurses KEY:NursingProcessStep:N/A MSC:NCLEX: N/A Chapter02:LegalandEthicalAspectsofNursing Cooper:FoundationsandAdultHealthNursing,9thEdition MULTIPLECHOICE 1. When a nurse becomes involved in a legal action, the first step to occur is that a document is filed in an appropriate court. What isthis document called? a. Deposition b. Appeal c. Complaint d. Summons ANS:C A document called a complaint is filed in an appropriate court as the first step in litigation. A deposition is when witnesses arerequiredtoundergoquestioningbytheattorneys.Anappealisarequestforareviewofadecisionbyahighercourt.Asummonsis a court order that notifies the defendant of the legal action. DIF:CognitiveLevel:Knowledge REF:p.24 OBJ:1 TOP:Legal KEY:NursingProcessStep:N/A MSC:NCLEX:N/A 2. The nurse caring for a patient in the acute care setting assumes responsibility for a patient’s care. What is this legally bindingsituation? a. Nurse-patientrelationship b. Accountability c. Advocacy d. Standardofcare ANS:A When the nurse assumes responsibility for a patient’s care, the nurse-patient relationship is formed. This is a legallybinding “contract” for which the nurse must take responsibility. Accountability is being responsible for one’s own actions. An advocate isone who defends or pleads a cause or issue on behalf of another. Standards of care define acts whose performance is required,permitted, or prohibited. DIF:CognitiveLevel:Comprehension REF:p.24 OBJ:3 TOP:Legal KEY:NursingProcessStep:N/A MSC:NCLEX:N/A 3. Whataretheuniversalguidelinesthatdefineappropriatemeasuresforallnursinginterventions? a. Scopeofpractice b. Advocacy c. Standardofcare d. Prudentpractice ANS:C Standardsofcaredefineactionsthatarepermittedorprohibitedinmostnursinginterventions.Thesestandardsareacceptedas legal guidelines for appropriateness of performance. The laws that formally define and limit the scope of nursing practice are callednurse practice acts. An advocate is one who defends or pleads a cause or issue on behalf of another. Prudent is a term that refers tocareful and/or wise practice. DIF:CognitiveLevel:Knowledge REF:p.22 OBJ:4 TOP:Legal KEY:NursingProcessStep:N/A MSC:NCLEX:N/A 4. An LPN/LVN is asked by the RN to administer an IV chemotherapeutic agent to a patient in the acute care setting. What lawshould this nurse refer to before initiating this intervention? a. Standardsofcare b. Regulationofpractice c. AmericanNurses’AssociationCode d. Nursepracticeact ANS:D It is the nurse’s responsibility to know the nurse practice act in his or her state. Standards of care, regulation of practice, and theAmerican Nurses’ code are not laws that the nurse should refer to before initiating this treatment. DIF:CognitiveLevel:Application REF:p.26 OBJ:5 TOP:Legal KEY:NursingProcessStep:N/A MSC:NCLEX:N/A 5. Anursefailstoirrigateafeedingtubeasordered,resultinginharmtothepatient.Thisnursecouldbefoundguiltyof: a. malpractice. b. harmtothepatient. c. negligence. d. failuretofollowthenursepracticeact. ANS:A The nurse can be held liable for malpractice for acts of omission. Failure to meet a legal duty, thus causing harm to another, ismalpractice. The nurse practice act has general guidelines that can support the charge of malpractice. DIF:CognitiveLevel:Application REF:p.24 OBJ:2 TOP:Legal KEY:NursingProcessStep:N/A MSC:NCLEX:N/A 6. Patients have expectations regarding the health care services they receive. To protect these expectations, which of thefollowing has become law? a. AmericanHospitalAssociation’sPatient’sBillofRights b. Self-DeterminationAct c. AmericanHospitalAssociation’sStandardsofCare d. TheJointCommission’srightsandresponsibilitiesofpatients ANS:A Patients have expectations regarding the health care services they receive. In 1972, the American Hospital Association (AHA)developed the Patient’s Bill of Rights. The Self-Determination Act, American Hospital Association’s Standards of Care, and TheJoint Commission’s rights and responsibilities do not address patients’ expectations regarding health care. DIF:CognitiveLevel:Comprehension REF:p.27 OBJ:3 |4 TOP:Legal KEY:NursingProcessStep:N/A MSC:NCLEX:N/A 7. Thenurseispreparingthepatientforathoracentesis.Whatmustbecompletedbeforetheproceduremaybeperformed? a. Physicalassessment b. Interview c. Informedconsent d. Surgicalchecklist ANS:C The doctrine of informed consent refers to full disclosure of the facts the patient needs to make an intelligent (informed) decisionbefore any invasive treatment or procedure is performed. A physical assessment, interview, and surgical checklist are not requiredbefore this procedure. DIF:CognitiveLevel:Application REF:p.27 OBJ:8 TOP:Legal KEY:NursingProcessStep:N/A MSC:NCLEX:N/A 8. Whenanurseprotectstheinformationinapatient’srecord,whatethicalresponsibilityisthenursefulfilling? a. Privacy b. Disclosure c. Confidentiality d. Absolutesecrecy ANS:C Thenursehasanethicalandlegaldutytoprotectinformationaboutapatientandpreserveconfidentiality.Somedisclosuresare legalandanticipated,andmaynotbesubjecttotherulesofconfidentiality.Noneoftheinformationinachartisconsideredsecret. DIF:Cognitive Level: Comprehension REF:pp. 29-30 OBJ:9 TOP:Confidentiality KEY:NursingProcessStep:N/A MSC:NCLEX: N/A 9. An older adult is admitted to the hospital with numerous bodily bruises, and the nurse suspects elder abuse. What is thebestnursing action? a. Coverthebruiseswithbandages. b. Takephotographsofthebruises. c. Askthepatientifanyonehashither. d. Reportthebruisestothechargenurse. ANS:D The law stipulates that the health care professional is required to report certain information to the appropriate authorities. Thereport should be given to a supervisor or directly to the police, according to agency policy. When acting in good faithto reportmandated information (e.g., certain communicable diseases or gunshot wounds), the health care professional is protectedfromliability. DIF:CognitiveLevel:Application REF:p.31 OBJ:9 TOP:Elderabuse KEY:NursingProcessStep:N/A MSC:NCLEX:N/A 10. Whatisthebestwayforanursetoavoidalawsuit? a. Carrymalpracticeinsurance. b. Spendtimewiththepatient. c. Providecompassionate,competentcare. d. Answerallcalllightsquickly. ANS:C The best defense against a lawsuit is to provide compassionate and competent nursing care. Carrying malpractice insurance is prudent, but it will not avoid a lawsuit. Spending time with patients and answering call lights quickly will not necessarily help avoid a lawsuit. DIF:Cognitive Level: Comprehension REF:p. 29 OBJ:8 TOP:Avoiding a lawsuit KEY:NursingProcessStep:N/A MSC:NCLEX: N/A 11. The nurse is caring for a patient with a do-not-resuscitate (DNR) order. Although the nurse may disagree with this order, what ishis or her legal obligation? a. Toquestionthehealthcareprovider b. Toseekadvicefromthefamily c. Todiscussitwiththepatient d. Tofollowtheorder ANS:D When a DNR order is written in the chart, the nurse has a duty to follow the order. Questioning the health care provider, seekingadvice from the family, and discussing it with the patient are not legal obligations of the nurse. DIF:CognitiveLevel:Application REF:p.37 OBJ:10 |14 TOP:Legal KEY:NursingProcessStep:N/A MSC:NCLEX:N/A 12. The nurse has strong moral convictions that abortions are wrong. When assigned to assist with an abortion, what is the mostappropriate action for the nurse to take? a. Askforanotherassignment. b. Leavework. c. Transfertoanotherfloor. d. Protesttothesupervisor. ANS:A Thenurseshouldnotabandonthepatient,butaskforanotherassignment. DIF:CognitiveLevel:Application REF:p.37 OBJ:9 |16 TOP:Ethics KEY:NursingProcessStep: N/A MSC:NCLEX:N/A 13. The new LPN/LVN is concerned regarding what should or should not be done for patients. What resource will best provide thisinformation? a. Nursepracticeact b. Standardsofcare c. Scopeofnursingpractice d. Professionalorganizations ANS:B Standards of care define what should or should not be done for patients. The nurse practice act, scope of nursing practice, andprofessionalorganizationsdonotprovidethebestinformation astowhatshouldorshouldnotbedoneforpatients. DIF:Cognitive Level: Comprehension REF:p. 24 OBJ:5 TOP:Standards of care KEY:NursingProcessStep:N/A MSC:NCLEX: N/A 14. Whatroleisthenursewhodiligentlyworksfortheprotectionofpatients’interestsplaying? a. Caregiver b. Healthcareadministrator c. Advocate d. Healthcareevaluator ANS:C A nurse accepts the role of advocate when, in addition to general care, the nurse protects the patient’s interests. Caregiver, healthcareadministrator,andhealthcareevaluatorarenottermsforthenursewhodiligentlyworksfortheprotectionofpatients. DIF:CognitiveLevel:Comprehension REF:p.25 OBJ:9 |12 TOP:Advocate KEY:NursingProcessStep:N/A MSC:NCLEX:N/A 15. When asked to perform a procedure that the nurse has never done before, what should the nurse do to legally protect himself orherself? a. Goaheadanddoit. b. Refusetoperformit,citinglackofknowledge. c. Discussitwiththechargenurse,askingfordirection. d. Askanothernursewhohasperformedtheprocedure. ANS:C The nurse cannot use ignorance as an excuse for nonperformance. The nurse should ask for direction from the charge nurse,explaining she has never performed the procedure independently. DIF:CognitiveLevel:Application REF:p.26 OBJ:8 TOP:Legal KEY:NursingProcessStep:N/A MSC:NCLEX:N/A 16. The nurse is assisting a patient to clarify values by encouraging the expression of feelings and thoughts related to thesituation.What is the most appropriate action for the nurse? a. Comparevalueswiththoseofthepatient. b. Makeajudgment. c. Withholdanopinion. d. Giveadvice. ANS:C Thenursecanassistthepatientinvaluesclarificationwithoutgivinganopinion. DIF:Cognitive Level: Application REF:p. 35 OBJ:3|8 TOP:Values clarification KEY:NursingProcessStep:N/A MSC:NCLEX: N/A e 17. Whatfundamentalprinciplemustthenursefirstobservewhenconfrontedwithanethicaldecision? a. Autonomy b. Beneficence c. Respectforpeople d. Nonmaleficence ANS:C The first fundamental principle is respect for people. Autonomy, beneficence, and nonmaleficence are not the first fundamentalprinciples to observe when confronted with an ethical decision. DIF:CognitiveLevel:Comprehension REF:p.36 OBJ:13 |15 TOP:Ethics KEY:NursingProcessStep: N/A MSC:NCLEX:N/A 18. A nurse working on an acute care medical surgical unit is aware that his or her first duty is to the patient’s health, safety, andwell-being. Given this knowledge, which of the following is most necessary for the nurse to report? a. Unethicalbehaviorofotherstaffmembers b. Aworkerwhoarriveslate c. Favoritismshownbynursingadministration d. Argumentsamongthestaff ANS:A A member of the nursing profession must report behavior that does not meet established standards. Unethical behavior involvesfailing to perform the duties of a competent caring nurse. DIF:Cognitive Level: Application REF:p. 36 OBJ:13 TOP:Unethical behavior KEY:NursingProcessStep:N/A MSC:NCLEX: N/A 19. A nurse is considering purchasing malpractice insurance. What should the nurse be aware of regarding malpractice insuranceprovided by the hospital? a. Onlyoffersprotectionwhileonduty. b. Islimitedintheamountofcoverage. c. Isdifficulttorenew. d. Canbeterminatedatanytime. ANS:A Mostinstitutionalinsuranceonlyprovidesliabilitycoverageifthenurseisondutyatthatfacility. DIF:Cognitive Level: Comprehension REF:p. 32 OBJ:2 TOP:Malpractice insurance KEY:NursingProcessStep:N/A MSC:NCLEX: N/A 20. WhichisanursingcareerrorthatviolatestheHealthInsurancePortabilityandAccountabilityAct(HIPAA)? a. Administeringastrongerdoseofdrugthanwasordered b. Refusingtogiveapatient’sdaughterinformationoverthephone c. Informingthepatient’smedicalpowerofattorneyofamedicationchange d. Leavingacopyofthepatient’shistoryandphysicalinthephotocopier ANS:D Leaving the document in the photocopier could expose it to the public. Inappropriate drug administration is possible malpractice.Sharing information with the power of attorney is legal. Refusing to give a patient’s daughter information over the phone isappropriate practice. DIF:Cognitive Level: Comprehension REF:p. 27 OBJ:7 TOP:Health Insurance Portability and Accountability Act (HIPAA)KEY:Nursing Process Step: N/A MSC:NCLEX: N/A 21. Whichofthefollowingcouldcauseanursetobecitedformalpractice? a. Refusingtogive60mgofmorphineasordered b. Givingprochlorperazine(Compazine)toapatientallergictophenothiazines c. Dragginganinjuredmotoristoffthehighwayandcausingfurtherinjury d. Informingavisitoraboutapatient’scondition ANS:B Standards of care dictate that a nurse must be aware of all the properties of drugs administered. Prochlorperazine (Compazine) is aphenothiazine. Providing confidential information or refusing to give an excessively large narcotic dose is not consideredmalpractice. Good Samaritan laws generally protect a person giving aid to an injured motorist. DIF:CognitiveLevel:Application REF:p.26 OBJ:2 TOP:Malpractice KEY:NursingProcessStep: N/A MSC:NCLEX:N/A 22. Alumbarpuncturewasperformedonapatientwithoutasignedinformedconsentform.Thispatientmightsuefor: a. punitivedamages. b. civilbattery. c. assault. d. nothing;noviolationhasoccurred. ANS:B Civil battery charges can be brought against someone performing an invasive procedure without the patient’s informed consentlegally documented. This patient could not sue for punitive damages or an assault. DIF:Cognitive Level: ComprehensionREF:p. 27 OBJ:6|8 TOP:Informed consent KEY:NursingProcessStep:N/A MSC:NCLEX: N/A 23. A health care provider instructs the nurse to bladder train a patient. The nurse clamps the patient’s indwelling urinarycatheter butforgets to unclamp it. The patient develops a urinary tract infection. What do the nurse’s actions exemplify? a. Malpractice b. Battery c. Assault d. Neglectofduty ANS:A A nurse is liable for acts of commission (doing an act) and omission (not doing an act) performed in the course of theirprofessionalduty.Achargeofmalpracticeislikelywhenadutyexists,thereisabreachofthatduty,andharmhasoccurredtothepatient. DIF:CognitiveLevel:Application REF:p.25 OBJ:2 TOP:Malpractice KEY:NursingProcessStep: N/A MSC:NCLEX:N/A 24. Whatistrueaboutnursepracticeacts? a. Theyinformallydefinethescopeofnursingpractice. b. Theyprovideforunlimitedscopeofnursingpractice. c. Onlysomestateshaveadoptedanursepracticeact. d. Thenursemustknowthenursepracticeactwithinhisorherstate. ANS:D The laws formally defining and limiting the scope of nursing practice are called nurse practice acts. All state, provincial, andterritorial legislatures in the United States and Canada have adopted nurse practice acts, although the specifics they contain oftenvary. It is the nurse’s responsibility to know the nurse practice act that is in effect for her geographic region. DIF:Cognitive Level: Comprehension REF:p. 26 OBJ:5 TOP:Nurse practice acts KEY:NursingProcessStep:N/A MSC:NCLEX: N/A MULTIPLERESPONSE 1. Howcanthemedicalrecordbeusedinlitigation?(Selectallthatapply.) a. Publicrecord b. Proofofadherencetostandards c. Evidenceofomissionofcare d. Documentationoftimelapses e. Evidencebyonlytheplaintiff ANS:A,B,C, D The information when used in court becomes a public record. The information can be used as proof of adherence to standards,omission of care, and documentation of time lapses. Both plaintiff and defendant can use the document. DIF:Cognitive Level: ComprehensionREF:p. 24 OBJ:1|4 TOP:LegalpropertiesofmedicalrecordKEY:NursingProcessStep:N/A MSC:NCLEX: N/A 2. Duringalunchbreak,anemergencydepartment(ED)nursetruthfullytellsanothernurseabouttheconditionofapatientwhocame to the ED last night. What is the ED nurse guilty of?(Select all that apply.) a. HIPAAviolation b. Slander c. Libel d. Invasionofprivacy e. Defamation ANS:A,D The disclosure is an invasion of privacy and a violation of HIPAA. Because the information is true and verbal, it cannotbeconsidered slander or libel. DIF:Cognitive Level: Application REF:p. 30 OBJ:7 TOP:Disclosure of information KEY:NursingProcessStep:N/A MSC:NCLEX: N/A 3. A nurse failed to monitor a patient’s respiratory status after medicating the patient with a narcotic analgesic. The patient’srespiratory status worsened, requiring intubation. The patient’s family claimed the nurse committed malpractice. What must bepresent for the nurse to be held liable? (Select all that apply.) a. Anurse-patientrelationshipexists. b. Thenursefailedtoperforminareasonablemanner. c. Therewasharmtothepatient. d. Thenursewasprudentinherperformance. e. Thenursedidnotcausethepatientharm. f. Dutydoesnotexist. ANS:A,B,C For the court to uphold the charge of malpractice, and to find the nurse liable, the following elements must be present:duty exists,there is a breach of duty, and harm must have occurred. DIF:CognitiveLevel:Application REF:p.24 OBJ:2 TOP:Malpractice KEY:NursingProcessStep: N/A MSC:NCLEX:N/A COMPLETION 1. Personal beliefs about the worth of an object, idea, custom, or attitude that influence a person’s behavior in a given situation arereferred to as . ANS: values Values are personal beliefs about the worth of an object, an idea, a custom, or an attitude. Values vary among people and cultures;they develop over time and undergo change in response to changing circumstances and necessity. Each of us adopts a valuesystemthatwillgovernwhatwefeelisrightorwrong(orgoodandbad)andwillinfluenceourbehaviorinagivensituation. DIF:CognitiveLevel:Knowledge REF:p.34 OBJ:11|12 TOP:Values KEY:NursingProcessStep:N/A MSC:NCLEX:N/A 2. Actswhoseperformanceisrequired,permitted,orprohibitedaredefinedby ofcare. ANS: standards Standardsofcaredefineactswhoseperformanceisrequired,permitted,orprohibited. DIF:Cognitive Level: Knowledge REF:p. 26 OBJ:4 TOP:Standards of care KEY:NursingProcessStep:N/A MSC:NCLEX: N/A Chapter03:Documentation Cooper:FoundationsandAdultHealthNursing,9thEdition MULTIPLECHOICE 1. Whatdoesdocumentationoftypeofcare,timeofcare,andsignatureofthepersonprove? a. Thepersonwhosignedthedocumentationdidalltheworknoted. b. Nolitigationcanbebroughtagainstthepersonwhosigned. c. Interventionswereimplementedtomeetthepatient’sneeds. d. Thepatient’sresponsetotheinterventionwaspositive. ANS:C Documenting type of care, time of care, and signature of the person results in recording the interventions that are implemented to meet the patient’s needs. Many charting entries include health care provider’s visits, presence of family, or interventions by other departments. Patient response to some interventions is not always positive. DIF:CognitiveLevel:Comprehension REF:p.40 OBJ:1 TOP:Documentation KEY:NursingProcessStep:Implementation MSC:NCLEX: N/A 2. Whyisdocumentationespeciallysignificantinmanagedcare? a. Thehospitalneedstoshowthatemployeescareforpatients. b. Institutionsarereimbursedonlyforpatientcarethatisdocumented. c. Patientsmightbringlawsuitsifcarewasnotgiven. d. Documentsmaybecomepartofalawsuit. ANS:B Costreimbursementratesbygovernmentplans(Medicare,Medicaid)arebasedontheprospectivepaymentsystemof diagnosis-related groups (DRGs): a system that classifies patients by age, diagnosis, surgical procedure, and other information withhundredsofdifferentcategoriestopredicttheuseofhospitalresources,includinglengthofstay,resultinginafixedpayment amount. DIF:Cognitive Level: Comprehension REF:p. 41 OBJ:1 TOP:Documentation KEY:NursingProcessStep:N/A MSC:NCLEX: N/A 3. The nurse charts only additional treatments done, changes in patient condition, and new concerns. What is this system of documentation? a. SOAP b. Block c. CBE d. Focus ANS:C Charting additional treatments done, changes in a patient’s condition, and new concerns during the shift is charting by exception (CBE). DIF:Cognitive Level: Comprehension REF:pp. 47-48 OBJ:1|5|7 TOP:Documentation KEY:Nursing Process Step: N/A MSC:NCLEX: N/A 4. Whatformexplainsthelapsewheneventsarenotconsistentwithfacilityornationalstandardsofexpectedcare? a. Subjectivedata b. Focuschart c. Incidentreport d. Nursingassessment ANS:C An incident report is completed when patient care was not consistent with facility or national standards. The form explains theevent, time, extent of injury, and who was notified. DIF:Cognitive Level: Knowledge REF:p. 49 OBJ:1|7 TOP:Documentation KEY:NursingProcessStep:N/A MSC:NCLEX: N/A 5. The staff from all disciplines is developing integrated care plans for a projected length of stay for patients of a specific case type.This is known as a: a. nursingorder. b. Kardex. c. nursingcareplan. d. criticalpathway. ANS:D Critical pathways allow staff from all disciplines to develop integrated care plans for a projected length of stay for patients of aspecific case type. DIF:CognitiveLevel:Knowledge REF:p.41 OBJ:8 TOP:Documentation KEY:NursingProcessStep:Implementation MSC:NCLEX: N/A 6. Whatmakeshomehealthcaredocumentationunique? a. Somechartingisretainedatthehospital. b. Thehealthcareprovider’sofficeneedsseparatecharting. c. Differenthealthcareprovidersneedaccess. d. Thehealthcareprovideristhepivotalpersoninthecharting. ANS:C Home health care documentation has unique problems because of the need for different health care workers to access the medicalrecord. DIF:Cognitive Level: Comprehension REF:p. 55 OBJ:9 TOP:Documentation KEY:NursingProcessStep:N/A MSC:NCLEX: N/A 7. Whatregulatesstandardsforlong-termcaredocumentation? a. OBRA b. TitleXXII c. Patientproblems d. Thecareplan ANS:A OBRA (Omnibus Budget Reconciliation Act) was a significant Medicare and Medicaid legislation for long-term health caredocumentation. DIF:Cognitive Level: Knowledge REF:p. 55 OBJ:10 TOP:Documentation KEY:NursingProcessStep:N/A MSC:NCLEX: N/A 8. Whatisthenurserequiredtodotoadheretotheconceptofconfidentialityforthepatient’smedicalrecord? a. Provideinformationonlytoanothernurse. b. Provideinformationonlytoanattorney. c. Shareinformationonlywiththefamily. d. Haveaclinicalreasonforreadingtherecord. ANS:D Thenurseshouldnotreadthepatient’smedicalrecordunlessthereisaclinicalreasonfordoingso. DIF:Cognitive Level: Comprehension REF:p. 56 OBJ:4 TOP:Confidentiality KEY:NursingProcessStep:N/A MSC:NCLEX: N/A 9. Documentation is necessary for the evaluation of patient care. Which of the following phases of the nursing process is necessary forthe evaluation of patient care? a. Assessment b. Planning c. Implementation d. Evaluation ANS:C Documentationispartoftheimplementationphaseofthenursingprocess. DIF:Cognitive Level: ComprehensionREF:p. 40 OBJ:1|4 TOP:Documentation KEY:NursingProcessStep:N/A MSC:NCLEX: N/A 10. Whatdoesthenurseuseasabasisfordocumentationinfocuscharting? a. Problemlist b. Nursingorders c. Patientproblems d. Evaluation ANS:C Infocuscharting,insteadofusingtheproblemlist,modifiedpatientproblemsareusedasanindexfornursingdocumentation. DIF:Cognitive Level: Knowledge REF:p. 47 OBJ:7 TOP:Documentation KEY:NursingProcessStep:N/A MSC:NCLEX: N/A 11. WhatisthepurposeofQA(qualityassurance)? a. Toscreenemploymentapplications b. Toevaluatecareresultsagainstacceptedstandards c. Toconductin-servicesfor“qualitydocumentation” d. Toreportdeviationfromstandardstothestatehealthdepartment ANS:B QAisanin-housedepartmentthatevaluatescareservicesandresultsagainstacceptedstandards. DIF:Cognitive Level: Comprehension REF:p. 41 OBJ:1 TOP:Documentation KEY:NursingProcessStep:N/A MSC:NCLEX: N/A 12. Whatistheprocessusedtoappraisethepracticeofanindividualnurseknownas? a. Qualityassurance b. Incidentreporting c. OBRA d. Peerreview ANS:D Peerreviewisanin-housedepartmentstudythatmayappraisethenursingpracticeofindividualnurses. DIF:CognitiveLevel:Knowledge REF:p.41 OBJ:4 TOP:Peerreview KEY:NursingProcessStep: N/A MSC:NCLEX:N/A 13. WhatisthedocumentationformatthatusestheacronymSOAPE? a. Problem-oriented b. Focused c. Traditional d. Crisis ANS:A Theproblem-orientedmedicalrecordusestheacronymSOAPEtoformatandforfocuschartingonalistofpatientproblems. DIF:CognitiveLevel:Comprehension REF:p.46 OBJ:7 TOP:Problem-oriented medical record (POMR) KEY:NursingProcessStep:N/A MSC:NCLEX: N/A 14. Whoisthelegalownerofthepatient’smedicalrecord? a. Patient b. Healthcareprovider c. Institution d. State ANS:C Ownershipofamedicalrecordbelongstotheinstitutioninthecaseofahospitalizedpatient,orthehealthcareproviderinthecase of private office visits. DIF:CognitiveLevel:Knowledge REF:p.56 OBJ:4 TOP:Legal ownership KEY:NursingProcessStep:Implementation MSC:NCLEX: Psychosocial Integrity 15. When using electronic (or computerized) documentation, which process should the nurse use to ensure that no one alters theinformation the nurse has entered? a. Chartingincode b. Loggingoff c. Chartinginprivacy d. Signingonwithapassword ANS:B Logging off closes the computer file that was opened with the nurse’s password. Any other data entry will require that person tosign on with their password. DIF:Cognitive Level: Comprehension REF:p. 57 OBJ:2 TOP:Computer documentation KEY:NursingProcessStep:N/A MSC:NCLEX: N/A 16. What is the system that classifies patients by age, diagnosis, and surgical procedure, and produces 300 different categories used forpredicting the use of hospital resources? a. Qualityassurance b. Resourceassessment c. Qualityimprovement d. Diagnosis-relatedgroups ANS:D Cost reimbursement rates under government plans are based on diagnosis-related groups (DRGs), which is a system that classifiespatients by age, diagnosis, and surgical procedure, producing 300 different categories used in predicting the use of hospitalresources, including length of stay. DIF:Cognitive Level: Knowledge REF:pp. 41-42 OBJ:5 TOP:Diagnostic-related groups KEY:NursingProcessStep:N/A MSC:NCLEX: N/A 17. A nurse is using the data, action, response, education (DARE) system of charting, and is completing the data portion. What data arethe nurse’s focus? a. Planning b. Assessment c. Implementation d. Patientteaching ANS:B DARE is the acronym for four different aspects of charting using the focus format. Data (D) is both subjective and objective and isequivalenttotheassessmentstepofthenursingprocess.Action(A)isacombinationofplanningandimplementation.Response (R)ofthepatientisthesameasevaluationofeffectiveness.Somefacilitiesincludeeducation/patientteaching(E). DIF:CognitiveLevel:Comprehension REF:p.47 OBJ:7 TOP:Charting KEY:NursingProcessStep: AssessmentMSC:NCLEX:N/A 18. A new patient is being admitted to a long-term care facility. Who has primary responsibility for each patient’s initialadmissionnursinghistory,physicalassessment,anddevelopmentofthecareplanbasedonthepatientproblemidentified? a. Healthcareprovider b. Registerednurse c. Unlicensedassistivepersonnel d. Licensedpracticalnurse/licensedvocationalnurse ANS:B The registered nurse (RN) has primary responsibility for each patient’s initial admission nursing history, physical assessment, anddevelopment of the care plan based on the patient problem identified. DIF:Cognitive Level: Comprehension REF:p. 43 OBJ:4|10 TOP:Scope of practice KEY:Nursing Process Step: N/A MSC:NCLEX: N/A 19. Whichofthefollowingwillthenurseimplementwhenanerrorismadewhendocumentinginapatient’schart? a. Scratchouttheerror. b. Applycorrectionfluid. c. Erasetheerrorcompletely. d. Drawasinglelinethroughtheerror. ANS:D A nurse should not erase, apply correction fluid, or scratch out errors made while recording in a patient’s chart. Instead, the nurseshould draw a single line through the error, write the word “error” above it, and sign her name or initials. DIF:Cognitive Level: Application REF:p. 45 OBJ:6 TOP:Documentation KEY:NursingProcessStep:N/A MSC:NCLEX: N/A 20. Whatshouldthenursebesuretodowhendocumentinginapatient’schart? a. Includespeculation. b. Chartconsecutively. c. Leaveblankspaces. d. Includeretaliatorycomments. ANS:B Anurseshouldnotwriteretaliatoryorcriticalcommentsaboutapatientorcarebyotherhealthcareprofessionals.Thenurse should not leave blank spaces in the nurse’s notes. The nurse should be certain the entry is factual and not speculate or guess. Thenurse should chart consecutively, line by line. DIF:Cognitive Level: Application REF:p. 45 OBJ:6 TOP:Documentation KEY:NursingProcessStep:N/A MSC:NCLEX: N/A 21. A nurse is receiving a telephone order from a health care provider. The nurse uses a safety measure of preventing errors that is recognized by The Joint Commission as one method of meeting National Patient Safety Goals. What is the second step of this method? a. Readback b. Background c. Recommendation d. Situation e. Assessment ANS:B SBAR (Situation, Background, Assessment, and Recommendation) is a method of communication among health care workers and apart of documentation (Kaiser Permanente, 2007). SBAR is considered a safety measure in preventing errors from poorcommunication during “hand-off” or “handover” interactions, the communication that occurs from one shift to the next orwhen anurse phones a health care provider with information about a patient. An additional “R” is added. The additional “R” (SBARR)represents “read back” when the nurse reads back the order for clarification. DIF:CognitiveLevel:Application REF:p.43 OBJ:3 TOP:SBARR KEY:NursingProcessStep:N/A MSC:NCLEX:N/A MULTIPLERESPONSE 1. Whatarecategoriesofinadequatedocumentationthatmayleadtoamalpracticeclaim?(Selectallthatapply.) a. Incorrectlyrecordingthetimeofanevent b. Failingtorecordverbalorders c. Chartingeventsinadvance d. Documentinganincorrectdate e. Markingoutandinitialingchartingerrors ANS:A,B,C, D Markingoutwithasinglelineandinitialingisanacceptablemethodtoindicateachartingerror. DIF:Cognitive Level: Application REF:p. 45 OBJ:4 TOP:Inadequate documentation KEY:NursingProcessStep:N/A MSC:NCLEX: N/A 2. Whataresomeproblemsassociatedwithelectronic(orcomputerized)charting?(Selectallthatapply.) a. Security b. Expenseoftrainingstaff c. Legibility d. Easyretrieval e. Newterminology ANS:A,B,E Security, expensive staff training, and learning new terminology are all problems of electronic charting. Legibility andeasyretrieval are advantages. DIF:Cognitive Level: Comprehension REF:pp. 42-43 OBJ:1 TOP:Computer charting KEY:NursingProcessStep:N/A MSC:NCLEX: N/A 3. Whatarethebasicpurposesofwrittenpatientrecords?(Selectallthatapply.) a. Teaching b. Legalrecordofcare c. Writtencommunication d. Researchanddatacollection e. Permanentrecordforaccountability f. Temporaryrecordofhospitalization ANS:A,B,C, D,E There are five basic purposes for written patient records: (1) written communication, (2) permanent record for accountability, (3)legal record of care, (4) teaching, and (5) research and data collection. DIF:Cognitive Level: Comprehension REF:p. 41 OBJ:1 TOP:Medical record KEY:NursingProcessStep:N/A MSC:NCLEX: N/A 4. Whatshouldamedicalrecordprovideforallhealthcareproviders?(Selectallthatapply.) a. Caregiventothepatient b. Careplannedforthepatient c. Apatient’snursingproblems d. Apatient’smedicalproblems e. Detailsaboutanyincidentreports f. Thepatient’sresponsetotreatment ANS:A,B,C, D,F A medical record should furnish all health care providers with a concise, accurate, written picture of a patient’s medical andnursing problems, care planned and given, and the patient’s response to treatments. DIF:Cognitive Level: Comprehension REF:p. 43 OBJ:1 TOP:Medical record KEY:NursingProcessStep:N/A MSC:NCLEX: N/A COMPLETION 1. Thebestdefenseagainstmalpracticeclaimsassociatedwithnursingcareisaccurate . ANS: documentation Accuratedocumentationcanguardagainstmalpracticeclaimsbecauseitshoulddescribewhen,what,andhoweventsoccurred. DIF:Cognitive Level: Comprehension REF:p. 41 | p. 42 OBJ:4 TOP:Documentation KEY:NursingProcessStep:N/A MSC:NCLEX: N/A 2. Twenty-four-hourchartingisdesignedtoestablish levelstohelpdeterminestaffingneeds. ANS: acuity Patientacuity,whichisreflectedin24-hourchartingcompilation,candictatestaffingneeds. DIF:Cognitive Level: Comprehension REF:p. 49 OBJ:7 TOP:24-hour charting KEY:NursingProcessStep:N/A MSC:NCLEX: N/A 3. Documentation using the DARE format (Data, Action, Response, Education) includes elements of the charting system. ANS: focused FocusedchartingusestheacronymDAREtodirectandformalizecharting. DIF:Cognitive Level: Comprehension REF:p. 47 OBJ:7 TOP:Focused charting KEY:NursingProcessStep:N/A MSC:NCLEX: N/A 4. Ahealthcareauditthatevaluatesservicesprovidedandtheresultsachievedcomparedwithacceptedstandardsisknownas . ANS: quality assurance quality assessment quality improvement Quality assurance/assessment/improvement is an audit in health care that evaluates services provided and the results achievedcompared with accepted standards. DIF:Cognitive Level: Knowledge REF:p. 41 OBJ:1 TOP:Quality assurance KEY:NursingProcessStep:N/A MSC:NCLEX: N/A Chapter04:Communication Cooper:FoundationsandAdultHealthNursing,9thEdition MULTIPLECHOICE 1. Although the patient denies pain, the nurse observes the patient breathing rapidly with clenched fists and facial grimacing. What isthe nurse’s best response to these observations? a. “Iamgladyouarefeelingbetterandhavenodiscomfort.” b. “Wheredoyouhurt?” c. “WhatyouaresayingandwhatIamobservingdon’tseemtomatch.” d. “Itmakesmeuncomfortablewhenyouarenothonestwithme.” ANS:C Thenonverbalcommunicationshouldbeclarifiedtopreventmiscommunication. DIF:CognitiveLevel:Application REF:p.69 OBJ:2 |3 TOP:Communication KEY:NursingProcessStep:Assessment MSC:NCLEX: Physiological Integrity 2. The nurse considers the feelings and needs of a patient by stating, “I know you are concerned about your surgery tomorrow. Howcan I help you?” What type of communication is this? a. Intrusive b. Aggressive c. Closed d. Assertive ANS:D Assertivecommunicationtakesapatient’sfeelingsandneedsintoaccount,yethonorsthepatient’srightsasanindividual. DIF:CognitiveLevel:Comprehension REF:p.63 OBJ:4 TOP:Communication KEY:NursingProcessStep:Implementation MSC:NCLEX: Psychosocial Integrity 3. Whatdoestherapeuticcommunicationaccomplish? a. Facilitatestheformationofapositivenurse-patientrelationship. b. Manipulatesthepatient. c. Assignsthepatientapassiverole. d. Requiresthepatienttoacceptwhatthenursesays. ANS:A Apositivenurse-patientrelationshipisfacilitatedbytherapeuticcommunication. DIF:Cognitive Level: Comprehension REF:p. 64 OBJ:10 TOP:Communication KEY:NursingProcessStep:N/A MSC:NCLEX: N/A 4. Thenurseissittinginachairnearthepatient’sbed,leaningforwardtohearwhatthepatientissaying,anddoesnotinterrupt.What is the nurse demonstrating? a. Support b. Caring c. Activelistening d. Interest ANS:C When demonstrating active listening, the nurse must give his or her full attention and make an effort to understand boththe verbaland nonverbal message. DIF:CognitiveLevel:Comprehension REF:p.65 OBJ:5 TOP:Communication KEY:NursingProcessStep:Implementation MSC:NCLEX: Psychosocial Integrity 5. What therapeutic communication technique requires a great deal of skill and is not used as frequently as other communicationtechniques? a. Touch b. Silence c. Listening d. Summarizing ANS:B Silence is an extremely effective therapeutic communication skill that is frequently underused because the nurse feelsuncomfortable applying it. DIF:Cognitive Level: Comprehension REF:p. 65 OBJ:5 TOP:Communication KEY:NursingProcessStep:N/A MSC:NCLEX: N/A 6. A patient does not speak English; therefore, the nurse cannot use words to provide comfort during a painful procedure. What isanother intervention that may provide comfort to this patient? a. Silence b. Listening c. Touch d. Restating ANS:C Holdingthehandofanon–English-speakingpatientiseffectiveandcomforting. DIF:CognitiveLevel:Application REF:p.76 OBJ:9 TOP:Communication KEY:NursingProcessStep:Implementation MSC:NCLEX: Psychosocial Integrity 7. A patient states, “I do cocaine when I feel things are out of my control.” The nurse responds by asking, “What else doescocaine dofor you?” What communication skill does this exemplify? a. Summarization b. Restating c. Showingacceptance d. Statingobservations ANS:C Acceptanceisthewillingnesstolistenandrespondtowhatthepatientissayingwithoutpassingjudgment. DIF:CognitiveLevel:Application REF:p.66 OBJ:5 TOP:Communication KEY:NursingProcessStep:Implementation MSC:NCLEX: Psychosocial Integrity 8. A patient states, “I’m really strung out about this pregnancy.” The nurse responds by asking, “What about this pregnancyworriesyou?” What communication technique is this? a. Closedinquiry b. Restating c. Open-endedquestion d. Minimalencouraging ANS:C Open-endedquestionsconveyinterestanddonotrequireaspecificresponse. DIF:CognitiveLevel:Application REF:p.68 OBJ:5 TOP:Communication KEY:NursingProcessStep:Implementation MSC:NCLEX: Psychosocial Integrity 9. Agrievingyoungwidowcriesout,“Whywasmyhusbandkilled?Whywasn’titme?”Whatisthenurse’sbestresponse? a. Stating“Youneedtobestrongforyourchildren.” b. Silentlyplacingherhandonthewidow’sarm. c. Askingifthereisanyonethewidowneedstohavenotified. d. Stating“Youarefeelingoverwhelmedaboutyourhusband’sdeath.” ANS:B Theabilitytolistenandassistthosewhoarenewlygrievingthroughtheuseofsilenceandaquietpresenceisveryeffective. Stating “You need to be strong for your children” is a cliché. Asking if there is anyone the widow needs to have notified and stating“You are feeling overwhelmed about your husband’s death” are not therapeutic in this immediate grieving time. DIF:CognitiveLevel:Application REF:p.73 OBJ:5 TOP:Communication KEY:NursingProcessStep:Implementation MSC:NCLEX: Psychosocial Integrity 10. A nurse is assessing a patient with a patient problem of impaired verbal communication. What is the lowest number of definingcharacteristics for this diagnosis? a. One b. Two c. Three d. Four ANS:A Ifoneormoreofthedefiningcharacteristicsispresent,apatientproblemofimpairedverbalcommunicationcanbedetermined. DIF:CognitiveLevel:Comprehension REF:p.74 OBJ:9 TOP:Communication KEY:NursingProcessStep:Assessment MSC:NCLEX: Psychosocial Integrity 11. Whatcommunicationtechniqueshouldthenurseusewhencommunicatingwithanunresponsivepatient? a. Avoidspeakingdirectlytothepatient. b. Assumeverbalstimuliareheard. c. Speakinaloudvoice. d. Usesimplewords. ANS:B A person interacting with an unresponsive patient should assume all sounds and verbal stimuli have the potential of being heard bythe patient. DIF:CognitiveLevel:Application REF:p.76 OBJ:10 TOP:Communication KEY:NursingProcessStep:Implementation MSC:NCLEX: Psychosocial Integrity 12. Thepatientstates,“Iamupsetaboutallthislabwork.”Thenurseresponds“You’reupset?”Thisresponseisanexampleof: a. Anopen-endedquestion b. Reflecting c. Restating d. Paraphrasing ANS:C Restatingisoneofthemosteffectivemethodsoftherapeuticcommunicationtoencouragethepatienttooffermoreinformation. DIF:CognitiveLevel:Application REF:p.69 OBJ:5 TOP:Communication KEY:NursingProcessStep:Implementation MSC:NCLEX: Psychosocial Integrity 13. Whatisoneofthemaincharacteristicsoftherapeuticcommunication? a. Itallowsthepatientapassiverole. b. Itusesonlyverbalcommunication. c. Itinvolvesthepatientasaperson. d. Itisdirective. ANS:C Therapeuticcommunicationactivelyinvolvesthepatientinallareasofthenursingprocess. DIF:Cognitive Level: Comprehension REF:p. 64 OBJ:1 TOP:Communication KEY:NursingProcessStep:N/A MSC:NCLEX: N/A 14. Anurseactivelyavoidstheuseofone-waycommunication.Whatisthemajorproblemwithone-waycommunication? a. Thereceiverisincontrol. b. Feedbackisprovidedtothesender. c. Participationisnotequal. d. Thecommunicationisunstructured. ANS:C One-waycommunicationisseldomeffectivebecausethesenderisincontrolandgetsverylittlefeedbackfromthereceiver. DIF:CognitiveLevel:Comprehension REF:p.61 OBJ:7 TOP:Communication KEY:NursingProcessStep:Implementation MSC:NCLEX: Psychosocial Integrity 15. A nurse must violate the personal space of a patient to perform an invasive procedure. How can the nurse reduce the discomfort ofthe patient? a. Byapproachingtheinteractioninaprofessionalmanner b. Bydistractingthepatientwithjokesandhumor c. Byaskinganothernursetobepresentatthebedside d. Byassuringthepatientthatallpeopledislikeinvasionofpersonalspace ANS:A Theintimatezonecancauseuneasinessforbothpatientandnurse;therefore,approachtheinteractioninaprofessionalmanner. DIF:CognitiveLevel:Application REF:p.70 OBJ:6 TOP:Communication KEY:NursingProcessStep:Implementation MSC:NCLEX: Psychosocial Integrity 16. Whatwouldbethebestmethodforaliterate,English-speakingpatientonaventilatortocommunicatehisorherneeds? a. Eyeblinkingfor“yes”and“no” b. Magicslateorpaperandpencil c. Computer d. Messageboardorcards ANS:B Writing devices are preferred as they do not limit the patient’s messages compared to a message board or cards. Eye blinks aretiring and time-consuming. Computers require space and the ability to type. DIF:CognitiveLevel:Application REF:p.76 OBJ:10 TOP:Communication KEY:NursingProcessStep:Implementation MSC:NCLEX: Psychosocial Integrity 17. Apatientroughlyasksthenursetobringhimsomeicecream.Whatwouldbeconsideredanassertiveresponsebythenurse? a. “Youarehungryandwantasnack.” b. “Icandothatin10minuteswhenIfinishmyrounds.” c. “MaybeIcangetoneoftheaidestobringyousomethinginawhile.” d. “Call the nurses’ station and ask them to have the kitchen bring whatever you want.” ANS:B Assertivenessisthemosteffectivestyleofcommunicationtoberesponsivetothepatientandsetlimits. DIF:CognitiveLevel:Application REF:p.63 OBJ:4 TOP:Communication KEY:NursingProcessStep:Implementation MSC:NCLEX: Psychosocial Integrity 18. A nurse tells a patient, “This PM you are going for an abdominal A&P, an H&H, as well as an IV pyelogram. Please sign theseconsent forms.” What may this use of medical jargon cause? a. Understanding b. Speedincommunication c. Misinterpretation d. Clarityinthemessage ANS:C Jargon is terminology unique to people in a special type of work and is not understood by everyone. Although jargon doesspeedcommunicationandiscleartothosewhoknowit,itmaybemisinterpretedandnotunderstoodbyallpeople. DIF:CognitiveLevel:Comprehension REF:p.61 OBJ:7 TOP:Communication KEY:NursingProcessStep:Implementation MSC:NCLEX: Psychosocial Integrity 19. Duringacompleteassessment,whichtypeofquestioningisnotusuallyconducivetofosteringcommunication? a. Open-ended b. Focused c. Closed d. Clarifying ANS:C Closedquestionsaretypesofquestionsthatthenursemaychoosetousethatarenotusuallyconducivetofosteringcommunication. DIF:CognitiveLevel:Comprehension REF:p.67 OBJ:7 TOP:Communication KEY:NursingProcessStep:Implementation MSC:NCLEX: Psychosocial Integrity 20. A patient states, “My husband has told me how he feels about my having a mastectomy.” The nurse nods and says, “Go on.”This isan example of: a. clarifying. b. restating. c. focusing. d. minimalencouraging. ANS:D Thenurseusesminimalencouragementtoleadthepatienttoprovidemoreinformation. DIF:CognitiveLevel:Application REF:p.66 OBJ:5 TOP:Communication KEY:NursingProcessStep:Implementation MSC:NCLEX: Psychosocial Integrity 21. Anurseiscommunicatingwithanolderadult.Howmightthenurseenhancecommunication? a. Speakinarapidmannertoaccommodatethepatient’sshortattentionspan. b. Speakinalowervoicetonetoaccommodatehearingloss. c. Speakinasimplemannerasifspeakingtoachild. d. Speakinaloudvoicedirectlyatearlevel. ANS:B Older adults lose their ability to hear higher frequency sound. Speaking in a lower tone enhances communication. Speaking overlyloudandasiftoachildmaybeirritatinganddemeaning.Rapidspeechmaybedifficultforolderadultstounderstand. DIF:Cognitive Level: Application REF:p. 73 OBJ:6 TOP:Physiologic factors affecting communication KEY:NursingProcessStep:Implementation MSC:NCLEX: Psychosocial Integrity 22. Whatdoesmaintainingeyecontactfor2to6secondsduringcommunicationwithapatientdo? a. Keepsthenurse’sattentionontheconversation b. Counteractsshynessinthepatient c. Indicatescontinuousfocusedattention d. Assessesifthepatientisinvolvedintheconversation ANS:C Maintaining eye contact for 2 to 6 seconds involves the person in what is being said, is indicative of continued interest, andconveys to the patient an accepting attitude. DIF:CognitiveLevel:Comprehension REF:p.62 OBJ:2 TOP:Communication KEY:NursingProcessStep:Implementation MSC:NCLEX: Psychosocial Integrity 23. The nurse recognizes that a patient experiencing stress feels vulnerable. What would be the most appropriate way for thenurse tointervene? a. Usetechnicallanguage. b. Directtheconversation. c. Modifycommunicationmethods. d. Offerallt