Exam 2 Flashcards
(265 cards)
0
Q
Which of the following statements accurately depicts a step in the critical thinking process?
A. The first step when thinking critically is together as much data related to the question as possible
B. nurses who think critically allow emotions to direct their thinking
C. Nurses who use the critical thinking process ultimately must identify alternative decisions and reach a conclusion
D. The critical thinking process is based on intuition and excludes the use of outside resources
A
C. Nurses who use the critical thinking process ultimately must identify alternative decisions and reach a conclusion
1
Q
In which of the following cases is the nursing process applicable?
A. When nurses work with patients who are able to participate in her care
B. when families are clearly supportive and wish to participate in care
C. When patients are totally dependent on the nurse for care
D. In all the Nursing situations listed above
A
D. In all the Nursing situations listed above
3
Q
Which of the following interpersonal skills is displayed by a nurse was attentive and responsive to the healthcare needs of individual patients and ensures the continuity of care when leaving the patient?
A. Establishing caring relationships
B. enjoying the rewards of mutual interchange
C. Developing accountability
D. Developing ethical/legal skills
A
C. Developing accountability
4
Q
Which of the following statements are key descriptors of the nursing process? Select all that apply
A. The nursing process is systematic in that each Nursing activity is part of an order and sequence of activities, depends on the accuracy of the activity that preceded it, and influences the actions that follow it.
B. The nursing process is dynamic, meaning that each step flows into the next step and there’s a great deal of interaction and overlapping among the five steps.
C. The nursing process is interpersonal because the human being is always at the heart of nursing.
D. The nursing process is interpersonal and that a patient is viewed as a “problem to be solved “and nurses interact mechanically to provide the solution
E. The nursing process is outcome oriented in that it is a means to an end, which may not always focus on the outcomes that are patient priorities.
F. The nursing process is universal late applicable in Nursing situations, meaning that health care is provided in an unchanging environment and the nursing process can be used as a tool in any nursing situation
A
A,B,C
5
Q
Which of the following traits help nurses develop the attitudes and dispositions to think critically?
A. Thinking independently
B. being intellectually humble
C. Being curious and persevering
D. All of the above
A
D. All of the above
6
Q
What is the dominant culture in the US? A) Native American B) Anglo-American C) Asian American D) African American
A
B-Anglo-American
6
Q
Which of the following statements describes the use of problem-solving in the nursing process? Select all that apply
A. The trial and error problem-solving method is used extensively in the nursing process
B. The trial and error problem-solving method is recommended as a guide for nursing practice
C. The scientific problem-solving method is closely related to the more general problem-solving process(The nursing process) commonly used by healthcare professionals as they work with patients.
D. Nurse theorists and educators advocate, basing clinical judgments on data alone in an attempt to establish nursing as a science, where they have the respect of other professions
E. Today, yours is it knowledge the positive role of intuitive thinking in clinical decision-making
F. Critical thinking in Nursing can be intuitive or logical or combination of both
A
c, e, f
8
Q
SELECT ALL THAT APPLY
The minority population is more likely to have poor health and die at an earlier age because of…
A) complex interaction among genetic differences
B) environmental factors
C) socioeconomic factors
D) Specific health behaviors (i.e herbs to prevent illness)
E) Government medical practices
A
A-complex interaction among genetic differences
B-environmental factors
C- socioeconomic factors
D- Specific health behaviors (i.e herbs to prevent illness)
8
Q
SELECT ALL THAT APPLY Racial and ethnic minorities often experience poorer access to health care and lower quality of which of the following? A) Preventive B) Immediate C) Primary D) Specialty Care
A
A-Preventive
C-Primary
D-Specialty Care
9
Q
Which of the following accurately describes the role of documenting in the nursing process? Select all that apply
A. The patient record is the chief means of communication among members of the interdisciplinary team
B. If a nurse is accused of negligent care, a nurse his word that he/she faithfully assess the patient’s needs, diagnosed problems, and implemented and evaluated an effective plan of care is his/her best offense
C. Legally speaking, I nursing action not documented is a nursing action not performed
D. It is helpful to practice documentation while learning any given nursing activity
E. The content of the patient report and nursing documentation helps to establish nursing priorities in a practice setting
F. Because data collection is ongoing and responsive to changes in the patient’s condition, it should be documented in the final step of the nursing process
A
a, c, d, e
10
Q
According to the US Census Bureau, approximately \_\_% of the population currently belongs to a racial or ethnic minority group. A) 13% B) 22% C) 33% D) 47%
A
C-33%
12
Q
SELECT ALL THAT APPLY Primary characteristics of a culture include which of the following? A) nationality B) religious beliefs C) personal beliefs D) gender
A
A-nationality
B-religious beliefs
D-gender
12
Q
SELECT ALL THAT APPLY Secondary characteristics of a culture include which of the following? A) immigration status B) socioeconomic status C) age D) political orientation
A
A-Immigration status
B-socioeconomic status
D-political orientation
13
Q
Which of the following cultural healers DOES NOT belong... Chinese and Southeast Asians A) Herbalist B) Fortune Teller C) Spiritualist D) Shaman
A
C-Spiritualist
14
Q
Which of the following cultural healers DOES belong... Asian Indians A) Ayurvedic practitioner B) Fortune Teller C) Spiritualist D) Shaman
A
A-Ayurvedic practitioner
15
Q
Which of the following cultural healers DOES belong... Native American A) Herbalist B) Fortune Teller C) Spiritualist D) Shaman
A
D-Shaman
16
Q
Which of the following cultural healers DOES NOT belong... African American A) Herbalist B) Granny Midwife C) Spiritualist D) Voodoo practitioner
A
A-Herbalist
17
Q
Infertility in women is considered grounds for divorce and rejection in which culture? A) Japanese B) African American C) Chinese D) Arab
A
D-Arab
18
Q
Which culture has religious beliefs AGAINST testing during pregnancy because they "believe that the outcome is God's will"? A) Hispanic B) European C) Filipino D) Chinese
A
C-Filipino
19
Q
SELECT ALL THAT APPLY Which religions prohibit the presence of males, including husbands, from the delivery room? A) Muslims B) Hindus C) Orthodox Jews D) Protestant
A
A-Muslim
B-Hindus
C-Orthodox Jews
20
Q
Which religion refuses autopsy or organ donation because they fear of desecrating the dead and believe one has to be whole to appear in front of the creator? A) Orthodox Jew B) Hindu C) Korean D) Muslim
A
D- Muslim
21
Q
The use of eye contact varies from culture to culture. Which of the following assumptions may be accurate when eye contact is used as nonverbal communication by different cultural groups in the following situations?
a. A native American stares at the floor while talking with the nurse. Assumption: He is embarrassed by the conversation
b. A Hasidic Jewish man listens intently to a male physician, making direct eye contact with him, but refuses to make eye contact with a female nursing student. Assumption: Jewish men consider women inferior to men.
c. A Muslim-Arab woman refuses to make eye contact with her male nurse. Assumption: She is being modest.
d. An African American man rolls his eyes when asked how he copes with stress in the workplace. Assumption: He may feel he has already answered this question and has become impatient.
A
c. A Muslim-Arab woman refuses to make eye contact with her male nurse. Assumption: She is being modest.
22
Q
Which one of the following statements about food accurately reflects foods that are edible for various cultural groups?
a. For some Asians, Hispanics, and Seventh-Day Adventists, religious beliefs prohibit the consumption of pork.
b. Patients following a vegetarian diet generally eat chicken
c. Vietnamese patients will not eat beans.
d. French patient consider corn to be animal feed.
A
d. French patient consider corn to be animal feed.
23
Q
Nursing is a subculture of which of the following larger cultures in our society?
a. Healthcare providers
b. Organizations of nurses
c. Institutions
d. Healthcare systems
A
d. Healthcare systems
24
An African American patient complains of gas after eating a bedtime snack of cheese and crackers. This may be a symptom of which of the following conditions?
a. Lactose intolerance
b. Keloid formation
c. Thalassemia
d. G6PD deficiency
a. Lactose intolerance
25
what is not one of the 6 rights to medication administration?
a. Right medication
b. Right to reuse
c. Right patient
d. Right route
e. Right time
f. Right documentation
b. Right to reuse
26
when would you use the Z-tract method for an injection?
a. To minimize skin irritation by sealing off the medication in muscle tissue
b. When your patient is on the fluffier side to make sure you get into the muscle
c. When you are giving a medication that is not clear
d. To decrease damage to the surrounding tissue
a. To minimize skin irritation by sealing off the medication in muscle tissue
27
Which is not a way to prevent a medication error?
a. Identify each patient using at least two identifiers before administering medications.
b. a. Set up and prepare medications in distraction-free areas
c. take care of yourself, be sure to get a regular amount of sleep and increase calorie intake
d. Verify expiration date of medications during preparation. Do not administer expired medications
c. take care of yourself, be sure to get a regular amount of sleep and increase calorie intake
28
Matching:
1. Medication action a. the passage of medication into
the blood from the site of
medication administration
2. Absorption b. after medications are
metabolized, they exit the body
through the kidneys, liver,
bowel, lungs, and exocrine
glands
3. Distribution c. after a medication is absorbed,
it is distributed within the body to
tissues and organs and ultimately
to its specific site of action
4. Metabolism d. metabolized into a less active or
inactive form that is easier to
excrete
5. Excretion e. varies considerably in the way
they act and their types of action.
Patients do not always respond
in the same way to each
successive does of medication
and sometimes the same
medication can cause very
different responses in the
different patients
1. Medication action e. varies considerably in the way they act and their types of action. Patients do not always respond in the same way to each successive does of medication and sometimes the same medication can cause vary different responses in the different patients
2. Absorption a. the passage of medication into the blood from the site of medication administration
3. Distribution c. after a medication is absorbed, it is distributed within the body to tissues and organs and ultimately to its specific site of action
4. Metabolism d. metabolized into a less active or inactive form that is easier to excrete
5. Excretion c. after medications are metabolized, they exit the body through the kidneys, liver, bowel, lungs, and exocrine glands
29
The nurse is having difficulty reading a physician’s order for a medication. He knows that the physician is very busy and does not like to be called. What is the most appropriate next step for the nurse to take?
a. Call a pharmacist to interpret the order
b. Call the physician to have the order clarified
c. Consult the unit manager to help interpret the order
d. Ask the unit secretary to interpret the physician’s
handwriting
b. Call the physician to have the order clarified
30
The patient has an order for 2 tablespoons of Milk of Magnesia. How much medication does the nurse give her?
a. 2 mL
b. 5 mL
c. 16 mL
d. 30 mL
d. 30 mL
31
A nurse is administering ear-drops to an 8-year-old patient with an ear infection. How does the nurse pull the patient’s ear when administering the medication?
a. Outward
b. Back
c. Upward and back
d. Upward and outward
d. Upward and outward
32
A patient is to receive cephalexin (Keflex) 500 mg PO. The pharmacy has sent 250-mg tablets. How many tablets does the nurse administer?
a. 1/2 tablet
b. 1 tablet
c. 1 1/2 tablets
d. 2 tablets
d. 2 tablets
33
A nurse is administering medications to a 4-year-old patient. After he or she explains which medications are being given, the mother states, “I don’t remember my child having that medication before.” What is the nurse’s next action?
a. Give the medications
b. Identify the patient using two patient identifiers
c. Withhold the medications and verify the medication
orders
d. Provide medication education to the mother to help her better understand her child’s medications.
c. Withhold the medications and verify the medication
| orders
34
A patient is transitioning from the hospital to the home environment. A home care referral is obtained. What is a priority in relation to safe medication administration for the discharge nurse?
a. Set up the follow-up appointments with the physician for the patient.
b. Ensure that someone will provide housekeeping for the patient at home.
c. Ensure that the home care agency is aware of medication and health teaching needs.
d. Make sure that the patient’s family knows how to safely
bathe him or her and provide mouth care.
c. Ensure that the home care agency is aware of medication and health teaching needs.
35
A nursing student takes a patient’s antibiotic to his room. The patient asks the nursing student what it is and why he should take it. Which information does the nursing student include when replying to the patient?
a. Only the patient’s physician can give this information.
b. The student provides the name of the medication and a description of its desired effect.
c. Information about medications is confidential and cannot be shared.
d. He has to speak with his assigned nurse about this.
b. The student provides the name of the medication and a
| description of its desired effect.
36
The nurse is administering a sustained-release capsule to a new patient. The patient insists that he cannot swallow pills. What is the nurse’s next best course of action?
a. Ask the prescriber to change the order
b. Crush the pill with a mortar and pestle
c. Hide the capsule in a piece of solid food
d. Open the capsule and sprinkle it over pudding
a. Ask the prescriber to change the order
37
The nurse takes a medication to a patient, and the patient tells him or her to take it away because she is not going to take it. What is the nurse’s next action?
a. Ask the patient’s reason for refusal
b. Explain that she must take the medication
c. Take the medication away and chart the patient’s refusal
d. Tell the patient that her physician knows what is best for her
a. Ask the patient’s reason for refusal
38
The nurse receives an order to start giving a loop diuretic to a patient to help lower his or her blood pressure. The nurse determines the appropriate route for administering the diuretic according to:
a. Hospital policy.
b. The prescriber’s orders.
c. The type of medication ordered.
d. The patient’s size and muscle mass.
b. The prescriber’s orders.
39
A patient is receiving an intravenous (IV) push medication. If the drug infiltrates into the outer tissues, the nurse:
a. Continues to let the IV run.
b. Applies a warm compress to the infiltrated site.
c. Stops the administration of the medication and follows
agency policy.
d. Should not worry about this because vesicant filtration is not a problem.
c. Stops the administration of the medication and follows
| agency policy.
40
If a patient who is receiving intravenous (IV) fluids develops tenderness, warmth, erythema, and pain at the site, the nurse suspects:
a. Sepsis.
b. Phlebitis.
c. Infiltration.
d. Fluid overload.
b. Phlebitis.
41
After seeing a patient, the physician gives a nursing student a verbal order for a new medication. The nursing student first needs to:
a. Follow ISMP guidelines for safe medication abbreviations.
b. Explain to the physician that the order needs to be given to a registered nurse.
c. Write down the order on the patient’s order sheet and read it back to the physician.
d. Ensure that the six rights of medication administration are followed when giving the medication.
b. Explain to the physician that the order needs to be given to a registered nurse.
42
A nurse accidentally gives a patient a medication at the wrong time. The nurse’s first priority is to:
a. Complete an occurrence report.
b. Notify the health care provider.
c. Inform the charge nurse of the error.
d. Assess the patient for adverse effects.
d. Assess the patient for adverse effects.
43
A patient is taking albuterol through a pressurized metereddose inhaler (pMDI) that contains a total of 200 puffs. The patient takes 2 puffs every 4 hours. How many days will the pMDI last?
___________ days
16 days
44
What are the 5 steps in the cultural competence process?
1) Cultural awareness
2) Cultural knowledge
3) Cultural skills
4) Cultural encounters
5) Cultural desire
45
Definition: an in-depth self-examination of one's own background, recognizing biases, prejudice, and assumptions about other people
Cultural Awareness
46
Definition: Obtaining sufficient comparative knowledge of diverse groups, including their indigenous values, health beliefs, care practices, worldview, and bicultural ecology
Cultural Knowledge
47
Components of Cultural Assessment
```
Family Structure
Ethnic Heritage and Ethnohistory
Bicultural Effects on Health
Social Organization
Religious and Spiritual Beliefs
Foods with Cultural Significance
Communication Patterns
```
48
Leininger's three Nursing decisions to achieve culturally congruent care:
1. Cultural care preservation or maintenance
2. Cultural care accommodation or negotiation
3. Cultural care re-patterning or restructuring
49
A 6-month-old child from Guatemala was adopted by an American family in Indiana. The child's socialization into the American midwestern culture is best described as:
1. Assimilation
2. Acculturation
3. Biculturalism
4. Enculturation
4. Enculturation
50
A 46 year old woman from Bosnia came to the United States 6 years ago. Although she did not celebrate Christmas when she lived in Bosnia, she celebrates Christmas with her family now. This woman has experienced assimilation into the culture of the United States because she:
1. Chose to be bicultural
2. Adapted to and adopted the American culture
3. Had an extremely negative experience with the American culture
4. Gave up part of her ethnic identity in favor of the American culture
2. Adapted to and adopted the American culture
51
To enhance their cultural awareness, nursing students need to make an in-depth self-examination of their own:
1. Motivation and commitment to caring
2. Social, cultural, and biophysical factors
3. Engagement in cross-cultural interactions
4. Background, recognizing personal biases and prejudices
4. Background, recognizing personal biases and prejudices
52
Which of the following is required in the delivery of culturally congruent care?
1. Learning about vast cultures
2. Motivation and commitment to caring
3. Influencing treatment and care of patients
4. Acquiring specific knowledge, skills, and attitudes
4. Acquiring specific knowledge, skills, and attitudes
53
A registered nurse is admitting a patient of French heritage to the hospital. which question asked by the nurse indicates that the nurse is stereotyping the patient?
1. "What are your dietary preferences?"
2. "What time do you typically go to bed?"
3. "Do you bathe and use deodorant more than one time a week?"
4. "do you have any health issues that we should know about?"
3. "Do you bathe and use deodorant more than one time a week?"
54
When a nurse acts on his/her prejudices:
1. Discrimination occurs
2. Delivery of culturally congruent care is ensured
3. Effective intercultural communication develops
4. Sufficient comparative knowledge of diverse groups is obtained
1. Discrimination occurs
55
A nursing student is doing a community health rotation in an inner-city public health department. The student investigates sociodemographic and health data of the people served by the health department, and detects disparities in health outcomes between the rich and poor. This is an example of a(n):
1. Illness attributed to natural and biological forces.
2. Creation of the student's interpretation and descriptions of the data.
3. Influence of socioeconomic factors in morbidity and mortality
4. Combination of naturalistic, religious, and supernatural modalities
3. Influence of socioeconomic factors in morbidity and mortality.
56
Culture strongly influences pain expression and need for pain medication. Howerver, cultural pain is:
1. Not expressed verbally or physically
2. Expressed only to others from a similar culture.
3. Usually more intense than physical pain
4. Suffered by a patient whose valued way of life is disregarded by practitioners.
4. Suffered by a patient whose valued way of life is disregarded by practitioners
57
Which of the following best represents the dominant values in American society on individual autonomy and self-determination?
1. Physician orders
2. Advance directive
3. Durable power of attorney
4. Court-appointed guardian
2. Advance directive
58
The nurse at an outpatient clinic asks a patient who is Chinese American with newly diagnosed hypertension if he is limiting his sodium intake as directed. The patient does not make eye contact with the nurse but nods his head. What should the nurse do next?
1. Ask the patient how much salt he is consuming each day
2. Discuss the health implications of sodium and hypertension
3. Remind the patient that many foods such as soy sauce contain "hidden" sodium
4. Suggest some low-sodium dietary alternatives
1. Ask the patient how much salt he is consuming each day
59
A female Jamaican immigrant has been late to her last two clinic visits, which in turn had to be rescheduled. The best action that the nurse could take to prevent the patient from being late to her next appointment is:
1. Give her a copy of the city bus schedule
2. Call her the day before her appointment as a reminder to be on time.
3. Explore what has prevented her from being at the clinic on time for her appointment
4. Refer her to a clinic that is closer to her home
3. Explore what has prevented her from being at the clinic on time for her appointment.
60
A nursing student is taking postoperative vital signs in the post-anesthesia care unit. She knows that some ethnic groups are more prone to genetic disorders. Which of the following patients is most at risk for developing malignant hypertension?
1. Ashkenazi Jew
2. Chinese American
3. African American
4. Filipino
3. African American
61
During their clinical postcoference meeting, several nursing students were discussing their patients with their instructor. One patient from a middle-class family shared that her patient was homeless. This is an example of caring for a patient from a different:
1. Ethnicity
2. Culture
3. Heritage
4. Religion
2. Culture
62
When interviewing a Native American patient on admission to the hospital emergency department, which questions are appropriate for the nurse to ask? Select all that apply
1. Do you use any folk remedies?
2. Do you have a family physician?
3. Do you use a Shaman?
4. Does your family have a history of alcohol abuse?
1. Do you use any folk remedies?
2. Do you have a family physician?
3. Do you use a Shaman?
63
```
What agency governs all areas of patient information and management of that information?
A. ANA
B. NCQA
C. HIPAA
D. TJC
```
C. HIPAA
64
```
The characteristics for quality documentation and reporting are: (select all that apply)
A. Factual
B. Accurate
C. Complete
D. Computerized
E. Current
F. Organized
```
A. Factual, B. Accurate, C. Complete, E. Current, and F. Organized
65
What is the difference in an emic worldview and an etic worldview?
A. Emic worldview is an insider perspective. Etic worldview is an outsider perspective.
B. Etic worldview is an insider perspective. Emic worldview is an outsider perspective.
A. Emic worldview is an insider perspective. Etic worldview is an outsider perspective.
66
During which of the five steps in the nursing process does the nurse determine whether outcomes of care are achieved?
1. implementation
2. evaluation
3. planning
4. analysis
2. Evaluation
67
When considering the nursing process, the word "observe" is to "assess" as the word "explore" is to
1. Plan
2. analyze
3. evaluate
4. implement
2. Analyze
68
The concept that is the cornerstone of the nursing process is that it:
1. is dynamic rather than static
2. focuses on the role of the nurse
3. moves from simple to complex
4. is based on the patient's medical problem
1. Is dynamic rather than static
69
A nurse is caring for a patient with a urinary elimination problem. Which is the most accurately stated goal? "The patient will:
1. Be taught how to use a bedpan been on bedrest"
2. Experience fewer incontinence episodes at night"
3. Transfer independently and safely to a toilet before discharge"
4. Be assisted to the commode every two hours and whenever necessary"
3. Transfer independently and safely to a toilet before discharge
70
Which of the following statements concerning the nursing process is accurate?
A. The nursing process is nurse oriented.
B The steps of the nursing process are separate entities.
C. The nursing process is nursing practice in action.
D. The nursing process comprises four steps to promote patient well-being.
C. The nursing process is nursing practice in action.
72
Which of the following clients is experiencing an abnormal change in vital signs? A client whose (select all that apply):
1) Blood pressure (BP) was 132/80 mm Hg sitting and is 120/60 mm Hg upon standing
2) Rectal temperature is 97.9°F in the morning and 99.2°F in the evening
3) Heart rate was 76 before eating and is 60 after eating
4) Respiratory rate was 14 when standing and is 22 after walking
1) Blood pressure (BP) was 132/80 mm Hg sitting and is 120/60 mm Hg upon standing
3) Heart rate was 76 before eating and is 60 after eating
73
```
Which of the following is the meaning of PRN?
A. When advice
B. Immediately
C. When necessary
D. Now
```
C. When necessary
74
One (1) tsp is equals to how many drops?
A. 15
B. 60
C. 10
D. 30
B. 60
75
The nurse must verify the client’s identity before administration of medication. Which of the following is the safest way to identify the client?
A. Ask the client his name
B. Check the client’s identification band
C. State the client’s name aloud and have the client repeat it
D. Check the room number
B. Check the client’s identification band
76
The nurse prepares to administer buccal medication. The medicine should be placed…
A. On the client’s skin
B. Between the client’s cheeks and gums
C. Under the client’s tongue
D. On the client’s conjunctiva
B. Between the client’s cheeks and gums
77
A client complains of difficulty of swallowing, when the nurse try to administer capsule medication. Which of the following measures the nurse should do?
A. Dissolve the capsule in a glass of water
B. Break the capsule and give the content with an applesauce
C. Check the availability of a liquid preparation
D. Crash the capsule and place it under the tongue
C. Check the availability of a liquid preparation
78
The nurse is ordered to administer ampicillin capsule TID p.o. The nurse should give the medication…
A. Three times a day orally
B. Three times a day after meals
C. Two time a day by mouth
D. Two times a day before meals
A. Three times a day orally
79
The nurse prepare IM injection that is irritating to the subcutaneous tissue. Which of the following is the best action in order to prevent tracking of the medication
A. Use a small gauge needle
B. Apply ice on the injection site
C. Administer at a 45° angle
D. Use the Z-track technique
D. Use the Z-track technique
80
Which of the following is the name assigned to a drug by the manufacturer that first develops it?
a. Trade name
b. Official name
c. Chemical name
d. Generic name
d. Generic name
81
Most drugs are excreted through which of the following organs?
a. Kidneys
b. Lungs
c. Intestines
d. Skin
a. Kidneys
82
Which of the following acts designated the United States Pharmacopeia and the National Formulary as official standards of drugs and empowered the federal government to enforce these standards?
a. Federal Food, Drug, and Cosmetic Act
b. Food and Drug Administration
c. Pure Food and Drug Act
d. Comprehensive Drug Abuse Prevention and Control Act
c. Pure Food and Drug Act
83
Which of the following statements about patient medications is accurate?
a. Safe practice dictates that a nurse follows written or verbal orders.
b. In most settings, student nurses are permitted to accept verbal orders from a physician
c. When a patient is admitted to a hospital, all drugs that the physician may have ordered while the patient was at home are continued.
d. Upon admittance to a hospital, all patient medications from home should be sent home with the family or placed in safe-keeping
d. Upon admittance to a hospital, all patient medications from home should be sent home with the family or placed in safe-keeping
84
Which of the following types of medication orders would a physician prescribe for "as needed" pain medication?
a. Standing order
b. PRN order
c. Single order
d. Stat order
b. PRN order
85
A nurse suspects a drug he/she administered to a patient is in error. Who is legally responsible for the error?
a. Nurse
b. Physician
c. Hospital
d. Pharmacist
a. Nurse
86
Which of the following measurement systems uses a grain as the basic unit of weight?
a. Metric
b. Apothecary
c. Household
d. Decimal
b. Apothecary
87
If a nurse is preparing medication for a patient and is called away to an emergency, which of the following should he/she do?
a. Have another nurse guard the preparations
b. Put the medication back in the containers
c. Have another nurse finish preparing and administering the medications
d. Lock the medications in a room and finish them when he/she returns
d. Lock the medications in a room and finish them when he/she returns
88
Before administering a drug to a patient, the nurse should identify the patient by doing which of the following?
a. Call the patient by name
b. Check the patient's ID bracelet
c. Check the patient's record
d. Check the patient's name with family of significant others
b. Check the patient's ID bracelet
89
Which means of drug administration would be used in an emergency to achieve rapid absorption and quicker results?
a. Injection
b. Oral
c. Patch
d. Inhalation
a. Injection
90
Which of the following sites is recommended for adults as a safe site for the majority of intramuscular injections?
a. Vastus lateralis site
b. Deltoid muscle site
c. Ventrogluteal site
d. Dorsogluteal site
c. Ventrogluteal site
91
Mrs. Harris is a 78-year old woman admitted to your unit after experiencing symptoms of stroke. When administering the medication prescribed for her, the nurse should be aware that this patient has an increased possibility of drug toxicity due to which of the following age-related factors?
a. Decreased adipose tissue and increased total body fluid in proportion to total body mass.
b. Increased number of protein-binding sites
c. Increased kidney function, resulting in excessive filtration and excretion
d. Decline in liver function and production of enzymes needed for drug metabolism
d. Decline in liver function and production of enzymes needed for drug metabolism
92
To convert 0.8 grams to milligrams, the nurse should do which of the following?
a. Move the decimal point 2 places to the right
b. Move the decimal point 3 places to the right
c. Move the decimal point 2 places to the left
d. Move the decimal point 3 places to the left
b. Move the decimal point 3 places to the right
93
Mr. Downs is given a dose of gentamicin and has an immediate reaction of hypotension, bronchospasms, and rapid, thready pulse. Which of the following would be the drugs of choice for this situation?
a. Antibiotic, antihistamines, and Isuprel
b. Bronchodilators, antihistamines, and vasodilatros
c. Epinephrine, antihistamines, and bronchodilators
d. Antihistamines, vasodilators, and bronchoconstrictors
c. Epinephrine, antihistamines, and bronchodilators
94
An oral medication has been ordered for Mr. Moran, who has a nasogastric tube in place. Which of the following nursing activities would increase the safety of medications administration?
a. Check the tube placement before administration
b. Have Mr. Moran swallow the pills around the tube
c. Flush the tube with 30 to 40mL saline before medication administration
d. Bring the liquids to room temp before administration
a. Check the tube placement before administration
95
Mrs. Banks has an order for Choloromycetin, 500mg every 6 hours. The drug comes in 250-mg capsules. Which of the following nursing activities would increase the safety of medication administration?
1. 1 tab
2. 2 tabs
3. 3 tabs
4. 4 tabs
b. 2 tabs
96
When giving an intramuscular injection using the Z-track technique, the nurse should use which of the following techniques?
a. Use a needle at least 1 inch long
b. Apply pressure to the injection site
c. Inject the medication quickly, and steadily withdraw the needle.
d. Don not massage the site because it could cause irritation.
d. Don not massage the site because it could cause irritation.
97
Which of the following statements accurately describe the influence of specific factors on the absorption of a drug? (Select all that apply)
a. Injected medications are usually absorbed more rapidly than oral medications
b. Liquid preparations have to be dissolved in the gastrointestinal fluids
c. The unionized form of drugs is absorbed more readily
d. Acidic drugs are well absorbed in the stomach
e. Food in the stomach always delays the absorption of medications
f. A trough level is the point when a drug is at its highest concentration
a, c, d
98
Which of the following statements accurately describe an adverse drug effect? (select all that apply)
a. A drug allergy is always manifested immediately after the patient receives the medication
b. An anaphylactic reaction is a life-threatening immediate reaction to a drug that results in respiratory distress, sudden sever bronchospasm, and cardiovascular collapse.
c. Drug tolerance occurs when the body cannot metabolize one dose of a drug before another dose is administered
d. A cumulative effect occurs when the body becomes accustomed to a particular drug over a period of time
e. An idiosyncratic effect is any abnormal or peculiar response to a drug that may manifest itself by over response, under response, or a response different from the expected outcome.
f. An antagonistic effect occurs when the combined effect of two or more drugs acting simultaneously produces an effect that is less than that of each drug alone
b, e, f,
99
Which of the following is a type of order that a physician might write? (select all that apply)
a. A standing order to be carried out as specified until canceled by another order
b. A prn order for pain medication
c. A single order to be carried out only once at a specified time
d. A stat order to be carried out at a predetermined later date
e. A double order to increase the dosage of the medication being administered
f. A gloating order to administer medication as needed
a, b, c
100
Which of the following factors should a nurse consider when administering medications to an older adult? (select all that apply)
a. An increased number of protein-binding sites
b. An increased difficulty with the penetration of fat-soluble drugs
c. Altered peripheral venous tone
d. A decline in liver function
e. A decline in enzyme production needed for drug metabolism
f. An increased gastric emptying time
d, e
101
Which of the following actions would a nurse be expected to perform when instilling eyedrops correctly? (select all that apply)
a. Wash hands and put on gloves
b. Clean the eyelids and eyelashes of any drainage with cotton balls soaked in clean water.
c. Tilt the patient's head back slightly if sitting or place the head on a pillow if lying down
d. Have the patient look up and focus on something on the ceiling
e. Place the thumb near the margin of the lower eyelid and exert pressure upward over the bony prominence of the cheek
f. Squeeze the container and allow the prescribed number of drops to fall into the cornea
a, c, d
102
Which of the following actions would a nurse be expected to perform when instilling eardrops correctly? (select all that apply)
a. Make sure the solution to be instilled is at room temperature
b. Clean the external ear with cotton balls moistened with normal saline solution
c. Place the patient on the affected side in bed
d. Draw up the amount of solution needed in the dropper and return any excess medication to the stock bottle
e. Straighten the auditory canal by pulling the cartilaginous portion of the pinna up and back in an adult and down and back in an infant or child under 3 years
f. Hold the dropper in the ear with its tip above the auditory canal
b, e, f
103
Which of the following actions would a nurse be expected to perform when administering a subcutaneous injection correctly? (select all that apply)
a. If using the outer aspect of the upper arm, place the patient's arm over the chest with the outer area exposed
b. Remove the needle cap with the dominant hand, pulling it straight off
c. Grasp and bunch the area surrounding the injection site or spread the skin at the site
d. Inject the needle quickly at an angle of 45 to 90 degrees
e. If blood appears when aspirating, withdraw the needle and reinject it at another site
f. After removing the needle, massage the area gently with the alcohol swab unless it is a subcutaneous heparin or insulin injection site
c, d, f
104
Which of the following are components of a medication order? (select all that apply)
a. The full name of the patient
b. The date and sometimes the time when the order is written
c. Preferably the brand name of the drug to be administered
d. The dosage of the drug, stated in either the apothecary or metric system
e. The rout by which the drug is to be administered, only if there is more than one route possible
f. The signature of the nurse carrying out the order
a, b, d
105
Order: gentamicin 60mg. On hand: gentamicin 80 mg/2mL. Give patient:
1.5 mL
106
Order: Mestinon 30 mg. On hand: Mestinon 60mg/tab. Give patient:
0.5 tabs
107
Order: amitriptyline 75mg. On hand: amitriptyline 25 mg/tab. Give patient:
3 tabs
108
Order: phenylbutazone 250mg. On hand: phenylbutazone 500mg/tab. Give patient:
0.5 tab
109
Order: Pro-Banthine 15mg On hand: Pro-Banthine 5 mg/tab. Give patient
3 tabs
110
List three categories for drug classification
a. body systems
b. the symptom relieved by the drug
c. the clinical indication for the drug
111
Explain the process by which drugs alter cell physiology.
| Drug-receptor interactions:
The drug interacts with one or more cellular structures to alter cell function
112
Explain the process by which drugs alter cell physiology.
| Drug-enzyme interactions:
The drug combines with enzymes to achieve the desired effect
113
How do developmental stages of patients affect drug action
A child's dose of medication is smaller than adults dose
114
How does weight affect drug dosing?
drug doses for children should be calculated on weight or body surface area. Doses for adults are based on a reference adult
115
How does sex/gender affect drug action
hormonal fluctuation can affect drug action
116
How do psychological factor affect drug action?
Patients may attain the same effect with a placebo as with an active drug
117
How do genetic factor affect drug action?
Patients may require smaller/larger doses of a drug because they metabolize at a different rate. Herbal remedies may interfere with or counteract the action of the prescribed medication
118
How does liver pathology affect drug action?
Liver disease may affect drug action by slowing the metabolism down
119
How does food in the stomach affect drug action?
The presence of food in the stomach generally delays the absorption of oral medications
120
What are some example of situations in which you would question a medical order?
The nurse knows that the patient is allergic to the drug
The nurse has difficulty reading the order
The nurse knows the drug will be harmful to the patient
The nurse know the drug will interact adversely with another prescribed medication
121
What are the three check of administering medication?
The medication label should be checked
1. when the nurse reaches for the container
2. after retrieval from the drawer and compared with the MAR or CMAR, or compared with the CMAR immediately before pouring from a mulitdose container
3. Before giving the unit does medication to the patient
122
What are the 5 rights of administer medication?
1. Right medication
2. Right patient
3. Right dosage
4. Right route
5. Right time
123
Your patient tells you she refuses to take the medication prescribed for her because it tastes "disgusting". List three techniques you could use to mask the taste.
1. crush the medication or add it to food
2. allow the patient to suck on a piece of ice to numb the taste buds
c. give the medication with generous amounts of water
124
How does route of administration affect the type of equipment a nurse would use for an injection?
a longer needle is needed for an intramuscular injection than for an intradermal or subcutaneous injection
125
How does viscosity of the solution affect the type of equipment needed for an injection?
some medications are more viscous than others and require a large-lumen needle to be injected
126
Explain how quantity of the solution would affect the type of equipment a nurse would choose for an injection.
the larger the amount of medication to be injected the greater the capacity of the syringe
127
Explain how body size would affect the type of equipment a nurse would choose for an injection
An obese person requires a longer needle to reach muscle tissue than a thin person
128
Explain how type of medication would affect the type of equipment a nurse would choose for an injection
there are special syringes for certain uses (ie. insulin)
129
What steps should be followed when a medication error occurs?
1. check the patient's condition immediately, observe for adverse effects
2. notify the nurse manager and the physician to discuss possible courses of action based on the patient's condition
3. write a description of the error on the patient's medical record, including remedial steps that were taken
4. complete a special form for reporting errors, as dictated by agency policy
130
When a nurse is able to recognize that an ethical moment has occurred with a patient, he/she is experiencing which of the following ethical abilities?
a. Ethical responsiveness
b. Ethical reasoning
c. Ethical sensibility
d. Ethical valuing
c. Ethical sensibility
131
A nurse who is caring for a new mother realizes that the woman is not prepared to go home with her newborn after a hospital stay of only 24 hours, but hospital policy dictates that the mother be discharged. This nurse may be face with which of the following problems?
a. Ethical uncertainty
b. Ethical distress
c. Ethical dilemma
d. Ethical dissatisfaction
b. Ethical distress
132
Which of the following principles applies to utilitarian action guiding theory?
a. The rightness or wrongness of an action depends on the consequences the action produces
b. An action is right or wrong independent of the consequences it produces.
c. An action is right or wrong depending on the process used to arrive at the action
d. The rightness or wrongness of an action is not dependent on the process used to arrive at the action
a. The rightness or wrongness of an action depends on the consequences the action produces
133
Which of the following guidelines was developed by the American Hospital Association to enumerate the rights and responsibilities of patients while receiving hospital care?
a. Code of Ethics
b. Patient Bill of Rights
c. Biomedical ethics
d. Hospital patient advocacy
b. Patient Bill of Rights
134
Which of the following elements of ethical agency could be described as the cultivated dispositions that allow one to act as one believes one ought to act?
a. Ethical sensibility
b. Ethical responsiveness
c. Ethical character
d. Ethical valuing
c.Ethical character
135
When a nurse provides the information and support that patients and their families need to make the decision that is right for them, he/she is practicing which of the following principles of bioethics?
a. Autonomy
b. Nonmaleficence
c. Justice
d. Fidelity
a. Autonomy
136
Nurses who value patient advocacy follow which of the following guidelines?
a. They value their loyalty to an employing institution or to a colleague over their commitment to their patient.
b. They give priority to the good of the individual patient rather than to the good of society in general
c. They choose the claims of the patient's well-being over the claims of the patient's autonomy
d. They make decisions for patients who are uninformed concerning their rights and opportunities
b. They give priority to the good of the individual patient rather than to the good of society in general
137
Which of the following statements reflect the mode of value transmission known as laissez-faire? (select all that apply)
a. A boy says a prayer before meals that he learned from his patients.
b. A boy is taken for ice cream to celebrate his good report card.
c. A teenage boy explores the religions of his friends in hopes of developing his own faith
d. A boy is taught how to behave in public by his schoolteacher
e. A teenage girl is punished for staying out too late with her friends.
f. A teenage girl tries alcohol at a party with her friends
c, f
138
Which of the following actions best describe the use of the professional value of autonomy? (select all that apply)
a. A nurse stays later than his/her shift to continue caring for a patient in critical condition
b. A nurse researches a new procedure that would benefit his/her patient
c. A nurse keeps her promise to call a patient's doctor regarding pain relief
d. A nurse reads the Patient Bill of Rights to a visually impaired patient
e. A nurse collaborate with other healthcare team members to ensure the best possible treatment for his patient.
f. A novice nurse seeks the help of a nurse experienced nurse to insert a catheter in a patient
d, e
139
Which of the following actions best describe the use of the professional value of altruism? (select all that apply)
a. A nurse demonstrates an understanding of the culture of his/her patient
b. A nurse becomes a mentor to a student nurse working on her floor
c. A nurse is accountable for the care provided to a mentally challenged patient
d. A nurse lobbies for universal access to healthcare
e. A nurse respects the right of a Native American to call in a shaman for a consultation
f. A nurse protects the privacy of a patient with AIDS
a, b, e
140
Which of the following actions best describes the use of the professional value of human dignity? (select all that apply)
a. A nurse plans nursing care together with his/her patient
b. A nurse provides honest information to a patient about his/her illness
c. A nurse provides privacy for an elderly patient
d. A nurse reports an error made by an incompetent coworker
e. A nurse plans individualized nursing care for his/her patients
f. A nurse refuses to discuss a patient with a curious friend
c, e, f
141
Which of the following statements accurately represent the basic principles of ethics? (select all that apply)
a. The term "ethics" generally refers to personal or communal standards of right or wrong
b. The ability to be ethical begins in childhood and develops gradually
c. An action that is legal or customary is ethically right
d. Ethics is a systematic inquiry into the principles of right and wrong conduct, of virtue and vice, and of good and evil, as they relate to conduct
e. A commitment to developing one's ability to act ethically is known as one's ethical agency
f. Most nurses are born with a natural ability to behave in an ethically professional way
b,d,e
142
Definition: Two (or more) clear moral principles apply, but they support mutually inconsistent course of action
Ethical dilemma
143
A process of discovery allowing a person to discover what choices to make when alternatives are presented and to identify whether these choices are rationally made or the result of previous conditioning
Values clarification
144
A personal belief about worth that acts as a standard to guide one's behavior
Value
145
Personal or communal standards of right and wrong
Morals
146
Ethical problem in which the person knows the right thing to do, but institutional constraints make it nearly impossible to pursue the right actions
Ethical distress
147
A commitment to developing one's ability to act ethically
Ethical agency
148
A systematic inquiry into the principles of right and wrong conduct, of virtue and vice, and of good and evil, as the relate to conduct
Ethics
149
The protection and support of another's rights
Advocacy
150
A body of law that has evolved from accumulated judiciary decisions is known as which of the following?
a. Statutory law
b. Administrative law
c. Common law
d. Constitutional law
c. Common law
151
A nurse who misrepresents the outcome of a procedure or treatment may have committed which of the following torts?
a. Slander
b. Fraud
c. Libel
d. Assault
b. Fraud
152
```
Which of the following is the process in which specialty knowledge, experience, and clinical judgement are validated by many U.S. professional organizations?
a. Certification
b. Accreditation
c. Licensure
d Litigation
```
a. Certification
153
Which of the following is the primary reason for filling out an incident report?
a. To document everyday occurrences
b. To document the need for disciplinary action
c. To improve quality of care
d. To initiate litigation
c. To improve quality of care
154
The Good Samaritan laws would protect which of the following actions performed by a healthcare practitioner?
a. Any emergency care where consent is given
b. Negligent acts performed in an emergency situation
c. Medical advice given to a neighbor regarding her child's rash
d. Emergency care for a choking victim in a restaurant
d. Emergency care for a choking victim in a restaurant
155
Protection of employees from discrimination based on race, color, religion, sex, and national origin is provided under which of the following government agencies?
a. OSHA
b. EEOC
c. HUD
d. NAACP
b. EEOC
156
When a nurse has met all the criteria necessary for recognition by the ANA, he/she is said to have undergone which of the following processes?
a. Licensure
b. Accreditation
c. Certification
d. Registration
c. Certification
157
A nurse who comments to her coworkers at lunch that her patient with a sexually transmitted disease has been sexually active in the community may be guilty of which of the following torts?
a. Slander
b. Libel
c. Fraud
d. Assault
a. Slander
158
What is the process by which an educational program is evaluated and recognized as having met certain predetermined criteria?
a. Licensure
b. Registration
c. Accreditation
d. Certification
c. Accreditation
159
Which of the following actions would be recommended for a nurse who is named as a defendant?
a. Discuss the case with the plaintiff to ensure understanding of each others positions
b. If a mistake was made on a chart, change it to read appropriately
c. Be prepared to tell your side to the press, if necessary
d. Do not volunteer any information on the witness stand
d. Do not volunteer any information on the witness stand
160
Which of the following are sources of laws at the federal and state level? (select all that apply)
a. Constitutions
b. Mandates
c. Criminal law
d. Common law
e. Statutes
f. Administrative law
a, d, e, f
161
________ law is law in which the government is involved directly.
Public
162
A state's _______ protects the public by broadly defining the legal scope of nursing practice.
Nurse Practice Act
163
________ is a specialized form of credentialing based on laws passed by a state legislature.
Licensure
164
When a nurse documents the fall of an elderly patient, he or she is filing an ________ report.
incident
165
Which of the following is a nurse's best defense against allegations of negligence by a patient or patient's surrogate?
a. Nursing team
b. Flow sheet
c. MAR
d. Patient record
d. Patient record
166
Which of the following statements regrading the patient record is accurate?
a. A patient's chart may be shared only with close family members
b. Student nurses are not granted access to patient records
c. The patient record is generally the responsibility of one caregiver
d. Most patient records are microfilmed and stored in computers
d. Most patient records are microfilmed and stored in computers
167
In which of the following systems would a nurse organize data according to the SOAP format?
a. Source-oriented method
b. PIE charting method
c. Problem-oriented method
d. Focus charting method
c. Problem-oriented method
168
Abnormal status can be seen immediately with narrative easily retrieved in which of the following documentation formats?
a. Charting by exception
b. PIE
c. Narrative notes
d. SOAP notes
a. Charting by exception
169
Which of the following is a key component to facilitate data and outcome comparisons by using uniform definitions to create a common language among multiple healthcare data users?
a. Kardex care plan
b. Minimum data sets
c. Computer-based records
d. Critical/collaborative pathways
b. Minimum data sets
170
You are finding it difficult to plan and implement care for Mr. Rivers and decide to have a nursing care conference. Which of the following best defines this action?
a. You consult with someone in order to exchange ideas or seek information, advice, or instructions
b. You meet with nurses or other healthcare professionals to discuss some aspect of patient care
c. You and other nurses visit similar patients individually at each patient's bedside in order to plan nursing care
d. You send or direct someone for action in a specific nursing care problem
b. You meet with nurses or other healthcare professionals to discuss some aspect of patient care
171
The usual format for _____ charting is the unexpected event, the cause of the event, actions taken in response to the event, and discharge planning if appropriate.
Variance
172
________ is the protection and support of another's rights
Advocacy
173
_______ are a key component to facilitate data and outcome comparisons. They are specific categories of information that use uniform definitions to create a common language among multiple healthcare data users.
Minimum data sets
174
A nurse who communicates oral, written, or audio taped patient data to the nurse replacing him/her on the next shift is giving a ______ report.
change-of-shift report
175
An _______ is a tool used by healthcare agencies to document the occurrence of anything out of the ordinary that results in, or has the potential to result in , harm to a patient, employee, or visitor
Incident report
176
The nurse records the database obtained from the nursing history and physical assessment
Initial nursing assessment
177
The nurse documents a patient's diagnosis of AIDS, expected outcomes, and specific nursing interventions
Plan of nursing care
178
The nurse documents the case management plan for a patient population with a designated diagnosis, which includes expected outcomes, interventions to be performed, and the sequence and timing of these interventions
Critical/collaborative pathways
179
The nurse uses this form to record a patient's pulse, respiratory rate, blood pressure, body temperature, weight, and bowel movements
Graphic records
180
Powder or gel form of an active drug enclosed in a gelatinous container
Capsule
181
A _____ is a compilation of a patient's health information.
Patient record
182
Medication mixed with alcohol, oil, or soap, which is rubbed on the skin
Liniment
183
Finely divided, undissolved particles in a liquid medium; should be shaken before use
Suspension
184
Medication in a clear liquid containing water, alcohol, sweeteners, and flavoring
Elixir
185
An easily melted medication preparation in a firm base, such as gelatin, that is inserted into the body
Suppository
186
Drug particles in a solution for topical use
Lotion
187
Mixture of a powdered drug with a cohesive material;p may be round or oval
Pill
188
A drug dissolved in another substance
Solution
189
Single drug or mixture of finely ground drugs
Powder
190
Medication combined with water and sugar solution
Syrup
191
Tablet or pill that prevents stomach irritation
Enteric coated
192
Name the injection: Muscle tissue
Intramuscular injection
193
Name the injection: Vein
Intravenous injection
194
Name the injection: heart tissue
Intracardial injection
195
Name the injection: Artery
Intra-arterial injection
196
Name the injection: Subcutaneous tissue
Subcutaneous injection
197
Name the injection: Bone
Intraosseous injection
198
Name the injection: Corium
Intradermal injection
199
Name the injection: Peritoneal cavity
Intraperitoneal injection
200
Definition: A continuous process characterized by open-mindedness, continual inquiry, and perseverance, combined with a willingness to look at each unique patient situation and determine which identified assumptions are true and relevant.
Critical thinking
201
Definition: recognizing that an issue exists, analyzing information, evaluating information, and making conclusions
Critical thinking
202
Definition: Able to act on ones own
Autonomous
203
Some attitudes for critical thinking are:
```
Confidence
Independence
Fairness
Responsibility
Accountability
Risk Taking
Discipline
Perseverance
Creativity
Curiosity
Integrity
Humility
```
204
Nurses critically think so that a patient receives the ______ ______ ______.
best care possible (or best nursing care)
205
small, solid dose of medication; compressed or molded; may be any size or shape, or enteric coated
Tablet
206
Definition: knowledge based on research or clinical expertise
Evidence-based knowledge
207
Critical thinking skills (6):
```
Interpretation
Analysis
Inference
Evaluation
Explanation
Self-regulation
```
208
Involves being order in data collection, looking for patters to categorize data, and clarifying any data you are uncertain about
Interpretation (Critical thinking skill)
209
Being open-minded as you look at information about a patient. Not making careless assumptions.
Analysis (Critical thinking skill)
210
Looking at the meaning and significance of findings. Realizing relationships between findings.
Inference (Critical thinking skills)
211
Looking at all situations objectively. Using criteria to determine results of nursing actions based. Reflecting on your own behaviors.
Evaluation (Critical thinking skill)
212
Supporting your findings and conclusions. Using knowledge and experience to choose strategies to use in the care of patients.
Explanation (Critical thinking skill)
213
Reflecting on your experiences. Identifying the ways you can improve your own performance.
Self-regulation (Critical thinking skill)
214
Concepts of a critical thinker (7):
```
Truth Seeking
Open-mindedness
Analyticity
Systematicity
Self-confidence
Inquisitiveness
Maturity
```
215
The three levels on critical thinking:
Level 1- Basic
Level 2- Complex
Level 3- Commitment
216
At the ________ level of critical thinking a learner trusts that experts have the right answers for every problem. Thinking is concrete and based on a set of rules or principles.
Basic
217
At the __________ level of critical thinking, thinkers begin to separate themselves from experts. They analyze and examine choices more independently.
Complex
218
At the _______ level of critical thinking, a person anticipates when to make choices without assistance from others and accepts accountability for decisions made.
Commitment
219
What are the five components of critical thinking?
```
Specific Knowledge Base
Experience
Competencies (the Nursing Process)
Attitudes
Standards
```
220
The process of obtaining information when a problem arrises and using it, plus what you already know to find a solution.
Problem Solving
221
________ _________ is a product of critical thinking that focuses on problem resolution.
Decision making
222
________ ________ is the analytical process for determining a patient's health problems.
Diagnostic reasoning
223
Diagnostic reasoning includes:
Seeing the _______ of a patient's solution
Observing _________ and _______
Making ________ quickly
Seeing the context of a patient's solution
Observing patterns and themes
Making decisions quickly
224
Definition: Process of drawing conclusions from related pieces of evidence and previous experience with the evidence. Part of diagnostic reasoning.
Inference
225
_________ decision making is a problem-solving activity that focuses on defining a problem and selecting appropriate action. In this process, the nurse identifies a patient's problem and selects a nursing intervention.
Clinical.
226
Clinical decision making skills separate professional nurses from __________ ___________.
Technical Personnel.
227
Critical thinking attitude application: Learning how to introduce yourself to a patient, speaking with conviction when you begin a treatment or procedure. Not leading a patient to think you are unable to perform care safely. Always being prepared before performing a nursing Activity. Encouraging a patient to ask questions.
Confidence
228
Critical thinking attitude application: Reading nursing literature (especially when there are different views on the same subject), talking with other nurses and sharing ideas about nursing interventions.
Thinking Independently
229
Critical thinking attitude application: Listening to both sides in any discussion.
Fairness
230
Critical thinking attitude application: If your knowledge causes you to question a health care provider's order, do so. Be willing to recommend alternative approaches to nursing care when colleagues are having little success with patients.
Risk Taking
231
Critical thinking attitude application: Be thorough in whatever you do. Use known scientific and practice-based criteria for activities such as assessment and evaluation. Take time to be thorough and manage your time effectively.
Discipline
232
Critical thinking attitude application: Be cautious of an easy answer. If co-workers give you information about a patient and some fact seems to be missing, clarify the information or talk to the patient directly.
Perseverance
233
Critical thinking attitude application: Look for different approaches if interventions are not working for a patient. For example, a patient in pain may need a different positioning or distraction technique.
Creativity
234
Critical thinking attitude application: Always ask why. A clinical sign or symptom often indicates a variety of problems. Explore and learn more about the patient so as to make appropriate clinical judgement.
Curiousity
235
Critical thinking attitude application: Recognize when your options conflict with those of a patient review your position, and decide how to best proceed to reach outcomes that will satisfy everyone. Do not compromise nursing standards or honesty in delivering nursing care.
Integrity
236
Nurses need to:
Seek ___________
________ quickly
make sound __________ _________
Seek knowledge
Act quickly
Make sound clinical decisions
238
Critical thinking attitude application: Recognize when you need more information to make a decision. When you are new to a clinical devision, ask for an orientation to the area.
Humility
239
_________ standards:
- Guidelines for rational thought
- Clear, precise, specific, accurate, relevant, plausible, consistent, logical, deep, broad, complete, significant, adequate, fair
Intellectual
240
_________ standards:
- Refers to ethical criteria for nursing judgements, evidence-based criteria used for evaluation, and criteria for professional responsibility.
- Uses critical thinking for the good of individuals or groups
Professional
241
Three ways to develop critical thinking skills
__________ journaling
Meeting with ________
Concept _________
Reflective journaling
Meeting with Colleagues
Concept Mapping
242
The nurse sits down to talk with a patient who lost her sister 2 weeks ago. The patient reports she is unable to sleep, feels very fatigued during the day, and is having trouble at work. The nurse asks her to clarify the type of trouble. The patient explains she can't concentrate or even solve simple problems. The nurse records the results of the assessment, describing the patient as having ineffective coping. This is an example of:
1. Diagnostic reasoning
2. Competency
3. Inference
4. Problem solving
1. Diagnostic reasoning
243
A patient on a surgical unit develops sudden shortness of breath and a drop in blood pressure. The staff respond, but the patient dies 30 minutes later. The manager on the nursing unit calls the staff involved in the emergency response together. The staff discusses what ocured over the 30-minute time frame, the actions taken, and whether other steps should have been implemented. The nurses in this situation are:
1. Problem solving
2. Showing humility
3. Conducting reflective practice
4. Exercising responsibility
3. Conducting reflective practice
244
A nurse has worked on an oncology unit for 3 years. One patient has become visibly weaker and states, "I feel funny." The nurse knows how patients often have behavior changes before developing sepsis when they have cancer. The nurse asks the patient questions to assess thinking skills and notices the patient shivering. The nurse goes to the phone, calls the physician, and begins the conversation by saying, "I believe that your patient is developing sepsis. I want to report symptoms I'm seeing." What examples of critical thinking concepts does the nurse show? (Select all that apply)
1. Experience
2. Ethical
3. Analyticity
4. Self-confidence
5. Risk-taking
3. Analyticity
| 4. Self-confidence
245
Critical thinking attitude application: Ask for help if you are uncertain how to perform a nursing skill. Refer to a policy and procedure manual to review steps of a skill.
Responsibility and Authority
246
A nurse who is working on a surgical unit is caring for four different patients. Patient A will be discharged home and is in need of instruction about wound care. Patients B and C have returned from the operating room within an hour of each other, and both require vital signs and monitoring of their IV lines. Patient D is resting following a visit by physical therapy. Which of the following activities by the nurse represent(s) use of clinical decision making for groups of patients?
1. Consider how to involve patient A in deciding whether to involve the family caregiver in the wound care instruction
2. Think about past experience with patients who develop postoperative complications
3. Decide which activities can be combined for patients B and C
4. Carefully gather any assessment information and identify patient problems.
1. Consider how to involve patient A in deciding whether to involve the family caregiver in wound care instruction
3. Decide which activities can be combined for patient B and C
247
The surgical unit has initiated the use of a pain-rating scale to assess patients' pain severity during their postoperative recovery. The RN looks at the pain flow sheet to see the pain scores recorded for a patient over the last 24 hours. Use of the pain scale is an example of which intellectual standard?
1. Deep
2. Relevant
3. Consistent
4. Significant
3. Consistent
248
During a home health visit the nurse prepares to instruct a patient in how to perform ROM exercises for an injured shoulder. The nurse verifies that the patient took an analgesic 30 minutes before arrival at the patient's home. After discussing the purpose for the exercises and demonstrating each one, the nurse has the patient perform them. After two attempts with only the second of three exercises, the patient stops and says, "This hurts too much. I don't see why I have to do this so may times." The nurse applies the critical thinking attitude of integrity in which of the following actions?
1. "I understand your reluctance, but the exercises are necessary for you to regain function in your shoulder. Let's go a bit more slowly and try to relax"
2. "I see that you're uncomfortable. I'll call your doctor and decide on the next step."
3. "Show me exactly where your pain is and rate it for me on a scale of 0 to 10."
4. "Is anything else bothering you? Other than the pain, is there any other reason you might not want to do the exercises?"
1. "I understand your reluctance, but the exercises are necessary for you to regain function in your shoulder. Let's go a bit more slowly and try to relax."
249
While assessing a patient, the nurse observes that the patient's IV line is not infusing at the ordered rate. The nurse assesses the patient for pain at the IV site, checks the flow regulator on the tubing, looks ot see if the patient is lying on the tubing, checks the point of connection between the tubing and the IV catheter, and then checks the condition of the site where the intravenous catheter enters the patient's skin. After the nurse readjusts the flow rate, the infusion begins at the correct rate. This is an example of:
1. Inference
2. Diagnostic reasoning
3. Competency
4. Problem solving
4. Problem solving
250
Which critical thinking competencies are specific to nursing?
1. Scientific method
2. Clinical decision making
3. Decision making
4. Diagnostic reasoning and inference
5. Problem solving
6. Nursing process as a competency
2. Clinical decision making
4. Diagnostic reasoning and inference
6. Nursing process as a competency
251
The nurse cared for a 14 yo. with renal failure who died near the end of the work shift. The health care team tried for 45 minutes to resuscitate the child with no success. The family was devastated by the loss, and, when the nurse tried to talk with them, the mother said, "You can't make me feel better; you don't know what it's like to lose a child." Which of the following examples of journal entries might best help the nurse reflect and think about this clinical experience? (Select all that apply)
1. Data entry of time of day, who was present, and condition of the child.
2. Description of the efforts to restore the child's blood pressure, what was used, and questions about the child's response
3. The meaning the experience had for the nurse with respect to her understanding of dealing with a patient's death
4. A description of what the nurse said to the mother, the mother's response, and how the nurse might approach the situation differently in the future.
2. Description of the efforts to restore the child's blood pressure, what was used, and questions about the child's response
3. The meaning the experience had for the nurse with respect to her understanding of dealing with a patient's death
4. A description of what the nurse said to the mother, the mother's response, and how the nurse might approach the situation differently.
252
Which of the following is an accurately written documentation of the effectiveness of a patient's pain management?
a. Mr. Gray is receiving sufficient relief from pain medication
b. Mr. Gray appears comfortable and is resting adequately
c. Mr. Gray reports that on a scale of 1 to 10, the pain he is experiencing is a 3
d. Mr. Gray appears to have a low tolerance for pain and complains frequently about the intensity of his pain
c. Mr. Gray reports that on a scale of 1 to 10, the pain he is experiencing is a 3
252
Which of the following guidelines for charting patient information is accurate?
a. Nursing interventions should be charted chronologically on consecutive lines
b. If a mistake is made on a chart, correcting fluid should be used to change the mistake
c. Charting should be done in pencil to facilitate correction of mistakes
d. If a procedure is repeated frequently, it is proper to use dittos to decrease recording time
a. Nursing interventions should be charted chronologically on consecutive lines
253
A nurse has been working on a surgical unit for 3 weeks. A patient requires a Foley catheter to be inserted, so the nurse reads the procedure manual for the institution to review how to insert it. The level of critical thinking the nurse is using is:
1. Commitment
2. Scientific method
3. Basic critical thinking
4. Complex critical thinking
3. Basic critical thinking
254
Which of the following are potential documentation errors that increase the risk for legal problems? (select all that apply)
a. The content reflects patient needs
b. The content includes descriptions of situations that are out of the ordinary
c. The content is not in accordance with professional or healthcare organization standards
d. There are lines between the entries
e. The documentation is not countersigned
f. Dates and times of entries are omitted
c, d, f
256
A patient had hip surgery 16 hours ago. During the previous shift the patient had 40mL of drainage in the surgical drainage collection device for an 8-hour period. The nurse refers to the written plan of care, noting that the health care provider is to be notified when drainage in the device exceeds 100mL for the day. On entering the room, the nurse looks at the device and carefully notes the amount of drainage currently in it. This is an example of:
1. Planning
2. Evaluation
3. Intervention
4. Diagnosis
2. Evaluation
257
According to HIPPA, patients have the right to do which of the following with their health record? (select all that apply)
a. See their health record
b. Copy their health record
c. Destroy their health record
d. Change their health record
e. Update their health record
f. Request a restriction on all uses and disclosures
a, b, e
257
Which of the following are incidental disclosures of patient health information that are permitted by HIPAA? (select all that apply)
a. The use of sign-in sheets that contain information about the reason for the patient visit
b. The possibility of a confidential conversation being overheard, provided that the surroundings are appropriate and voices are kept down
c. The unlimited use of white boards
d. X-ray light boards that can be seen by passersby, provided that patient x-rays are not left unattended on them
e. Calling out names in the waiting room, provided that the reason for the patient visit is not mentioned
f. Leaving detailed appointment reminder messages on a patient's voice mail
b, d, e
259
Which of the following actions would a nurse be expected to perform when instilling eyedrops correctly? (select all that apply)
a. Wash hands and put on gloves
b. Clean the eyelids and eyelashes of any drainage with cotton balls soaked in clean water
c. Tilt the patient's head back slightly if sitting or place the head on a pillow if lying down
d. Have the patient look up and focus on something on the ceiling
e. Place the thumb near the margin of the lower eyelid and exert pressure upward over the bony prominence of the cheek
f. Squeeze the container and allow the prescribed number of drops to fall into the cornea
a, c, d
260
Which of the following are key principles of the Beauchamp/Childress principle-based approach to bioethics? (select all that apply)
a. Autonomy
b. Nonmaleficence
c. Human dignity
d. Beneficence
e. Altruism
f. Justice
a, b, d, f
260
Which of the following factors should a nurse consider when administering medications to an older adult? (select all that apply)
a. An increased number of protein-binding sites
b. An increased difficulty with the penetration of fat-soluable drugs
c. Altered peripheral venous tone
d. A decline in liver function
e. A decline in enzyme production needed for drug metabolism
f. An increased gastric emptying time
d, e
260
Which of the following actions would a nurse be expected to perform when instilling eardrops correctly? (select all that apply)
a. Make sure the solution to be instilled is at room temperature
b. Clean the external ear with cotton balls moistened with normal saline solution
c. Place the patient on the affected side in bed.
d. Draw up the amount of solution needed in the dropper and return any excess medication to the stock bottle
e. Straighten the auditory canal by pulling the cartilaginous portion of the pinna up and back in an adult and down and back in an infant or child under 3 years
f. Hold the dropper in the ear with its tip above the auditory canal
b, e, f
262
The nurse asks a patient how she feels about her impending surgery for breast cancer. Before the discussion the nurse reviewed the description of loss and grief and therapeutic communication principles in his textbook. The critical thinking component involved in the nurse's review of the literature is:
1. Experience
2. Problem solving
3. Knowledge application
4. Clinical decision making
3. Knowledge application
263
Which of the following is unique to the commitment level of critical thinking?
1. Weighs benefits and risks when making a decision
2. Analyzes and examines choices more independently
3. Concrete thinking
4. Anticipates when to make choices without others' assistance
4. Anticipates when to make choices without others' assistance
264
In which of the following examples is the nurse not applying critical thinking skills in practice?
1. The nurse considers personal experience in performing IV line insertion and ways to improve performance
2. The nurses uses a fall risk inventory scale to determine a patient's fall risk
3. the nurse observes a change in a patient's behavior and considers which problem is likely developing
4. The nurse explains the procedure for giving a tube feeding to a second nurse who has floated to the unit to assist with care.
4. The nurse explains the procedure for giving a tube feeding to a second nurse who has floated to the unit to assist with care
265
A practitioner asks the nurse to witness an informed consent. Which patient does the nurse identify is unable to give an informed consent for surgery?
1. 16 yo boy who is married
2. 35 yo woman who is depressed
3. 50 yo woman who does not speak English
4. 65 yo man who has received a narcotic for pain
4. 65 yo man who has received a narcotic for pain.
(Narcotics depress the central nervous system, including decision-making abilities. This person is considered functionally incompetent)
