Management exam2 PART 3

Question 1

78. A floor in a hospital is having issues with nurses not properly calibrating glucometers. What is the most effective way to educate the nursing staff on the importance of glucometer calibration?
    a. Send out staff wide email.
    b. Put a flyer on the bulletin in the break room.
    c. Send a message to the staff on Facebook.
    d. Hold a mandatory inservice on how and why glucometers need to be calibrated.

Answer 1

D. Hold a mandatory inservice on how and why glucometers need to be calibrated.

Question 2

79. When a nurse manager is checking charts for appropriate documentation, which of the following documentations regarding the administration of a medication is recorded accurately according to the Joint Commission?
    a. Coumadin 5 mg QOD for 7 days
    b. Heparin 5,000 units Sub-Q daily
    c. MgSO4 1.0 g for hypertension
    d. Calcium 600 mg po qd

Answer 2

B. Heparin 5,000 Units Sub-Q daily

Question 3

80. A nurse is planning to teach a 75 year old adult how to change a surgical dressing before being discharged from the hospital. What strategy should the nurse use that takes in to consideration the patient’s developmental level?
    a. Incorporate repetition into the teaching plan.
    b. Obtain a return demonstration of the procedure.
    c. Include a family member in the teaching session.
    d. Build on the patient’s past positive learning experiences.

Answer 3

A. Incorporated repetition into the teaching plan.

Question 4

81. A charge nurse in a nursing home identifies that the weights of residents assigned to a particular nursing assistant are exactly the same as the week before. The nurse is concerned that the nursing assistant is not weighing residents and is falsifying the weights. What should the nurse do first?
    a. Confront the nursing assistant responsible for taking the weight
    b. Report the problem regarding the nursing assistant to the nursing supervisor
    c. Reweigh the residents assigned to the nursing assistant who had duplicate weights for both weeks.
    d. Assign the nursing assistant to take the weight of another resident and observe is the weight is actually taken.

Answer 4

C. Reweigh the residents assigned to the nursing assistant who had duplicate weights for both weeks.

Question 5

82. A charge nurse is assessing the physical status of several patients. Which patient problem should be the nurses greatest concern?
    a. Tenting of skin
    b. Difficulty breathing
    c. Erythema over the greater trochanter
    d. Body weight inadequate in relation to height

Answer 5

B. Difficulty breathing

Question 6

83. A registered nurse arrives at work and is told to report (float) to the ICU for the day because the ICU is understaffed and needs additional nurses to care for the clients. The nurse has never worked in the ICU. The nurse should take what action first?
    a. Call the hospital lawyer
    b. Refuse to float to the ICU
    c. Call the nursing supervisor
    d. Report to the ICU and identify tasks that can be performed safely.

Answer 6

D. Report to the ICU and identify tasks that can be performed safely

Question 7

84. A patient was admitted to the hospital with active tuberculosis. A RN is in charge of assigning this patient’s room. Which room would be the most appropriate room for the patent with tuberculosis?
    a. A regular private room
    b. With a patient with pneumonia
    c. A negative-pressure room
    d. With a patient with a broken leg

Answer 7

C. a negative-pressure room

Question 8

85. A charge nurse walks by a patient’s room where a nursing assistant just walked out of. The bed side rails are all down and the bed is not in the lowest positon. What should the charge nurse do regarding the nursing assistant?
    a. Ignore it.
    b. Talk to the nursing assistant in front of the nursing staff about the incident
    c. Take aside the nursing assistant and discuss the safety regarding the side rails and the level of the bed.
    d. Yell at the nursing assistant for not doing their job properly.

Answer 8

C. Take aside the nursing assistant and discuss the safety regarding the side rails and the level of the bed.

Question 9

86. Following a shift report on an oncology unit, a nurse determines that which client should be assessed first?
    a. A client with breast cancer who has an order for ondasetron (Zofran) 8mg intravenously 30 minutes prior to chemotherapy
    b. A client just admitted with a temperature of 101F, diaphoresis, and an absolute neutrophil count of 98/mm3
    c. A client with breast cancer who is scheduled for external beam radiation in 15 minutes
    d. A client with stomatitis associated with tonsilar cancer who receives gastrostomy tube feedings

Answer 9

B. A client just admitted with a temperature of 101F, Diaphoresis, and an absolute neutrophil count of 98/mm3

Question 10

87. When making room assignments for an RN caring for an HIV patient, which patient should be assigned to another nurse?
    a. A patient with arterial fibrillation
    b. A patient with metastatic lung cancer
    c. A patient who recently underwent an ORIF that morning
    d. A patient diagnosed with the flu

Answer 10

D. A patient diagnosed with the flu

Question 11

88. A nurse was recently caught diverting narcotics. In evaluating the effectiveness of the floor director’s intervention, the nurse correctly states:
    a) Next time, I won’t get caught
    b) I will only take medications that isn’t life-altering to my patients
    c) I will no longer steal patients’ medications and will take any disciplinary actions required
    d) I will only steal from unconscious patients, they will never know

Answer 11

C. I will no longer steal patient’s medications and will take any disciplinary actions required

Question 12

89. A nurse is caring for a patient from Spain who experienced a hypertensive crisis while on vacation in the United States. The patient knows only a few words of English. What is the most important when planning a teaching session about nutrients that are high in sodium?
    a. Providing a professional interpreter fluent in Spanish
    b. Securing written materials in Spanish from the internet
    c. Using the technique of demonstration when teaching information
    d. Showing pictures of foods that should be avoided to lower blood pressure

Answer 12

A. providing a professional interpreter fluent in spanish

Question 13

90. A client is scheduled for surgery and the surgeon has explained the procedure and is about to obtain informed consent. Which statement by the client would indicate to the nurse that the client needs more information before giving informed consent to the procedure?
    a. “If you don’t have this surgery, then the tumor will grow.”
    b. “You said you will remove the tumor but will not be removing the entire breast.”
    c. “I know my surgeon explained it, but I still don’t know why surgery is needed.”
    d. “I’ll have some pain after the surgery, but it should get better with that tumor gone.”

Answer 13

C. “I know my surgeon explained it, but I still don’t know why surgery is needed.”

Question 14

91. The nurse is caring for a client who was involuntarily hospitalized and is scheduled for electroconvulsive therapy. The nurse notes that an informed consent has not been obtained for the procedure. Based on this information, what is the nurse’s best determination?
    a. The informed consent does not need to be obtained.
    b. The informed consent should be obtained from the family.
    c. The informed consent needs to be obtained from the client.
    d. The health care provider will provide the informed consent.

Answer 14

C. The informed consent needs to be obtained from the client.

Question 15

92. The nurse manager discovers that the last dose of intravenous antibiotics that was supposed to be administered to a client was missed. Which of the following should the nurse manager do?
    a. Document the event in the client’s medical record only and give the nurse a written reprimand for the incident.
    b. File an incident report, and document the event in the client’s medical record. Speak with the patient’s primary nurse about why the medication was missed to prevent further errors.
    c. Document in the client’s medical record that an incident report was filed. Commend the primary nurse on documenting that the missed medication was given so that they won’t get in trouble about it later.
    d. File an incident report, but don’t document the event the client’s medical record so that if an adverse event occurs the papers will look better in court. Collaborate with the primary nurse to make sure everyone has the same story.

Answer 15

B. File an incident report, and document the event in the client’s medical record. Speak with the patient’s primary nurse about why the medication was missed to prevent further errors.

Question 16

93. A nurse manager has been notified to obtain a bed for a client. Of the following clients, which one would the nurse anticipate being able to discharge?
    a. A client who had a myocardial infarction (MI) 2 days ago. His vital signs are: BP – 150/94, pulse – 84 and irregular, respiratory rate of 28, minimal chest pain
    b. A client who underwent an abdominal aortic aneurysm resection. His vital signs are: BP – 130/88, pulse – 88, respiratory rate of 22, temperature of 101* F. He is beginning oral intake without problems
    c. A client who has subdural hematoma. He is lethargic, BP – 150/90, pulse of 60, respiratory rate of 28, and temperature of 99* F.
    d. A client who had abdominal exploratory surgery for a bowel obstruction 4 days ago. He has bowel sounds, is taking fluids orally, has an abdominal Penrose drain, and is continuing to experience abdominal pain.

Answer 16

D. A client who had abdominal exploratory surgery for a bowel obstruction 4 days ago. He has bowel sounds, is taking fluids orally, has an abdominal Penrose drain, and is continuing to experience abdominal pain.

Question 17

94. A client who is on reverse isolation for immunosuppression is two rooms away from a client that is on isolation for an MRSA infection. Which assignment should the nurse manager make?
    a. Assign both patients to the same nurse so they don’t have to walk so far.
    b. Assign both patients to the same nurse to keep all the isolation patients with a “dirty” nurse.
    c. Assign clients to different nurses because an immunosuppressed client will require a higher level of care and should be placed on 1 to 1 nursing care.
    d. Assign clients to different nurses because a nurse should not have clients that are immunosuppressed and clients with active communicable infections

Answer 17

D. Assign clients to different nurses because a nurse should not have clients that are immunosuppressed and clients with active communicable infections.

Question 18

95. The nurse manager has just received report from the previous shift. Which of the following clients should the nurse see first?
    a. A 35 year old admitted 3 hours ago with a gunshot wound; 1.5cm area of dark drainage noted on the dressing.
    b. A 43 year old who had a mastectomy 2 days ago; 23mL of sero-sanguinous fluid noted in the Jackson-Pratt drain
    c. A 59 year old with a collapsed lung due to an accident; no drainage noted in the previous 8 hours.
    d. A 62 year old who had an abdominal-perineal resection 3 days ago; client complains of chills.

Answer 18

D. A 62 year old who had an abdominal-perineal resection 3 days ago; client complains of chills.

Question 19

96. A nursing team consists of an RN, an LPN, and a UAP. The nurse manager should assign which of the following clients to the RN due to their change in condition?
    a. A 72 year old client with diabetes who has had a stasis ulcer for the last 3 days, the orders now say that the dressing should be changed BID as opposed to daily
    b. A 42 year old client with dehydration that is having their IV fluids discontinued and is expected to be discharged later that day with no anticipated medication or regimen changes
    c. A 55 year old client with brain cancer that was alert and oriented yesterday that is now confused, combative, and hypertensive.
    d. A 23 year old client with a fracture of the right lower leg that is asking to use the urinal standing.

Answer 19

B. A 42 year old client with dehydration that is having their IV fluids discontinued and is expected to be discharged later that day with no anticipated medication or regimen changes.

Question 20

97. A patient’s primary nurse has come to the nurse manager to ask about an ethical dilemma. A 20 year-old patient with leukemia has consented to a blood transfusion against the wishes of his family, who are all Jehovah’s Witnesses. The nurse manager knows that according to the ethical principle of autonomy that the nurse should…
    a. Hold the blood transfusion until the family can come to an agreement to prevent undue stress on the patient.
    b. Give the blood transfusion because the client has the right to make decisions for themselves.
    c. Refuse to take any action until the family accepts the clients wishes
    d. Give the blood transfusion, but tell the family it is a medication and not blood.

Answer 20

B. Give the blood transfusion because the client has the right to make decisions for themselves.

Question 21

98. A mother brings her child to the emergency department after her husband beat the child. She’s afraid to return home. The nurse can refer the mother to several social service agencies. Which agency would be most important?
    a. Women’s shelter
    b. Welfare bureau
    c. Children’s protective services
    d. Homeless shelter

Answer 21

A. Women’s shelter

Question 22

99. The community health nurse is working with disaster relief personnel after a hurricane that ruined many homes in the local community. The nurse is working to find housing for the survivors and organizing counseling services. Which prevention level does the nurse’s action represent?
    a. Primary
    b. Secondary
    c. Tertiary
    d. Quaternary

Answer 22

C. Tertiary

Question 23

100. A client is brought to the emergency department by EMS after being hit by a car. The name of the client is unknown, and the client has sustained a severe head injury and multiple fractures and is unconscious. An emergency craniotomy is required. Regarding informed consent for the procedure, which is the best action?
     a. Obtain a court order for the procedure.
     b. Ask the EMS to sign the informed consent.
     c. Transport the victim to the OR for surgery.
     d. Call the police to identify the client and locate the family.

Answer 23

C. Transport the victim to the OR for surgery.

Question 24

101. As the manager, what would you do first if a nurse is suspected of diversion of medication?
     a. Contact ASBN & request an investigation
     b. Confront the suspected nurse to clarify
     c. Question other RNs that work closely with the suspected nurse
     d. Interview the nurse in the same room with those who reported the diversion

Answer 24

B. confront the suspected nurse to clarify.

Question 25

102. A 45 year old male patient is admitted to the floor after a scheduled wound debridement. There are orders to change the surgical dressing for the first time in 24 hours. As a manager, who would you delegate this task to? a. Only the surgeon can remove the dressing b. The RN c. The LPN d. The UAP

Answer 25

B. The RN

Question 26

103. A patient is being referred to a rehab facility after a total knee arthroplasty. Which of the following documents must be included in the referral? Select all that apply. a. Medical record b. Referral form c. Physician order for transfer d. Care notes

Answer 26

A,B,C

Question 27

104. Which of the following room assignments is considered unsafe? a. A nurse caring for patient A with chickenpox and patient B with AIDS b. A nurse caring for patient A with a total knee arthoplasty and patient B who is receiving external radiation c. A nurse caring for patient A with appendicitis and patient B with sepsis d. A nurse caring for patient A who is post-op CABG and patient B who is post-op CEA

Answer 27

A. A nurse caring for patient A with chickenpox and patient B with AIDS

Question 28

105. A patient is newly admitted to your unit with signs and symptoms of that are suggestive of Hepatitis A. What hepatitis A related history should the nurse know to gather? a. Recent travel history. b. History of injected drug use c. Vaccination history d. All of the above

Answer 28

D. all of the above

Question 29

106. A nurse from an oncology unit is reassigned to an OB unit due to unexpected staffing issues. The oncology nurse feels unprepared to care for OB patients. What would be the best decision for her to make? a. Accept the assignment even though she feels unprepared b. Ask the OB unit nurses to teach her as she goes along during the day c. Refuse the assignment to her manager because she does not feel adequately trained and ask for an alternate assignment d. Ask other oncology staff members their opinions on the assignment before she accepts or refuses

Answer 29

C. Refuse the assignment to her manager because she does not feel adequately trained and ask for an alternate assignment.

Question 30

107. A client scheduled for a small bowel obstruction repair states, “You were here when the doctor had me sign the consent form for my procedure. I thought I understood most of it but I’m still unsure about some things.” Which is the best response by the RN? a. “You should have listened more closely.” b. “You sound as if you would like to ask more questions.” c. “I will get you a pamphlet” d. “That often happens when this procedure is explained to patients.”

Answer 30

B. "You sound as if you would like to ask more questions."

Question 31

108. A patient with DNR-DNI physicians orders experiences respiratory arrest. A competent RN understands intubation is the only effective way of establishing a patient air way. Which of the following actions should be taken first? a. Administer life saving medications. b. Assess the client for signs of death. c. Open the airway and give two breaths. d. Summon the emergency response team

Answer 31

B. Assess the client for signs of death.

Question 32

109. An RN in caring for a terminally ill patient who says “Sometimes I just want it all to end”. The RN should examine the client’s medical record for which of the following documents: a. Advance directives b. Power of attorney c. DNR orders d. Living will

Answer 32

A. Advance directives

Question 33

110. A competent RN knows information technology has advanced in development and use in all aspects of patient care because of the following: a. Information technology improves patient care through comprehensive evaluation of the safety, effectiveness, and cost benefits b. Information technology plays a major role in reducing health care costs c. Information technology assists nurses in delivering care in remote areas d. Information technology helps nurses understand, apply, and disseminate the principles of health care technology

Answer 33

A. Information technology improves patient care through comprehensive evaluation of the safety, effectiveness, and cost benefits.

Question 34

111. A nursing preceptor knows the minimal informatics competencies a new orienting nurse should possess are the following: a. Implementing policies to protect patient confidentiality and privacy b. Maintain information security c. Record data relevant to nursing care d. All of the above

Answer 34

D. all of the above

Question 35

112. A competent RN understands HIPPA when he or she notes the following statements is true: a. The RN must request the client’s permission to share medical records with an insurance company b. The RN discusses the client’s information over lunch in a hospital cafeteria with a coworker c. The RN keeps a list of patient names at the front desk in clear view so that physicians can efficiently locate patients d. The RN gives information regarding the patient’s status over the phone without a password to a concerned friend or family member

Answer 35

A. The RN must request the client's permission to share medical records with an insurance company.

Question 36

113. You are a manager on a nursing unit and a staff member (RN) approaches you with concerns about caring for a patient with Ebola that was assigned to her. She appears anxious. As a manager, which action by the manager would be appropriate? a. Assign this patient to a different RN who is experienced and shows competency in infection control. b. Explain to the RN that this patient was assigned to her and the staffing assignments cannot be changed. c. Explain to the RN that she is qualified to care for this patient and she should accept this responsibility. d. Punish the RN for expressing these feelings to her

Answer 36

A. Assign the patient to a different RN who is experienced and shows competency in infection control.

Question 37

114. A nurse working in the emergency department of a hospital is interviewing an extremely agitated patient who keeps standing up, pacing, and sitting down. The RN asks the charge nurse what the most appropriate response would be to this patient? a. “Please sit down so that we can discuss your concerns.” b. “Your behavior is inappropriate and you have to try to control it.” c. “Let’s go to a quiet room because your anxiety may be contagious.” d. “Come with me for a walk and you can describe what is bothering you.”

Answer 37

D. "Come with me for a walk and you can describe what is bothering you."

Question 38

115. You are a nurse manger for the emergency department. What triage color would you assign to a patient that is alert and oriented with a suspected simple fracture? a. Red b. Yellow c. Green d. Blue

Answer 38

B. Yellow

Question 39

116. You are a nursing manager in the emergency department. There has been a multi vehicle car accident. When triaging patients, place the patients in order from highest priority to lowest priority. 1. Child with a simple fracture of the arm complaining of arm pain 2. Confused female with bright red blood pulsating from a leg wound 3. Sobbing child with several minor lacerations on the face, arms, and legs 4. Male with closed head wound and multiple compound fractures of the arms and legs. a. 2, 4, 1, 3 b. 3,4, 2,1 c. 4,2, 3, 1 d. 2,1,4,3

Answer 39

A. 2,4,1,3

Question 40

117. A newly hired Licensed practical nurse (LPN) asks you, the nurse manager, what SBAR stands for. What is the most appropriate response: a. Subjective, background, assessment, restrictions b. Situation, basic knowledge, assessment, recent history c. Situation, background, assessment, recommendation d. Subjective, baseline vital signs, assessment, recommendation

Answer 40

C. situation, background, assessment, recommendation

Question 41

118. A nursing manger recognizes anxiety in his/her staff member when he/she sees the following: a. Avoiding responsibilities b. Acting impatient toward other staff members c. Avoiding eye contact d. All of the above

Answer 41

D. all of the above

Question 42

119. A nurse is caring for a client who is being prepared for surgery. The client hands the nurse information about advance directives and states, “Here, I don’t need this. I am too young to worry about life-sustaining measures and what I want done for me.” Which of the following actions should the nurse take? a. Return the papers to the admitting department with a note stating that the client does not wish to address the issue at this time. b. Explain to the client that you never know what can happen during surgery and that he should fill the papers out “just in case.” c. Contact a client representative to talk with the client and offer additional information about the purpose of advance directives. d. Inform the client that surgery cannot be conducted unless he completes the advance directives forms.

Answer 42

C. contact a client representative to talk with the client and offer additional information about the purpose of advance directives.

Question 43

120. Which of the following is appropriate when using an interpreter to communicate with a client and his family? (Select all that apply.) a. Talk to the interpreter about the family while the family is in the room. b. Ask the family one question at a time. c. Look at the interpreter when asking the family questions. d. Use lay terms if possible. e. Do not interrupt the interpreter and the family as they talk.

Answer 43

B, D, E

Question 44

121. A 68 year old male is admitted to an adult psychiatric unit. He has a cell phone, wedding ring, and wallet on him. What should the admitting nurse do with these belongings? a. Allow the patient to keep the items b. Ask the family member to take the items with her c. Take the belongings to the nurse’s station d. Label the items in a bag with patient name and date of birth and put them in the safe

Answer 44

B. Ask the family member to take the items with her

Question 45

122. A 22 year old female arrives to the ED via ambulance after being shot in the left forearm by a neighborhood gang. After primary care by the EMTs, she is now refusing care. After assessment she has been determined to be of no immediate harm to herself or others. Which of the following actions by the nurse would be inappropriate? a. Encourage the patient to accept medical help b. Adhere to the patient’s wishes because we cannot treat her without her consent c. Tell the patient that you have notified the police of the gunshot wound d. Call the doctor to admit the patient to the hospital and under a 72 hour hold

Answer 45

D. call the doctor to admit the patient to the hospital and under a 72 hour hold

Question 46

123. A 45 year old female weighing 350lbs and left-sided weakness is 12 hours post-op TKA and incontinent. She calls the nurse’s station needing a bed change. A tech starts collecting supplies to do a bed bath by herself. What action should the charge nurse take? a. Stop the tech and advise her to request the help of another tech and the patient’s primary nurse b. Praise the tech for being on top of things c. Stop the tech and inform her that this patient needs the RN give her a bed bath due to her knowledge of post-op TKA procedures d. Tell the patient that if she can’t call before this happens again then the RN is going to insert an indwelling Foley catheter.

Answer 46

A. Stop the tech and advise her to request the help of another tech and the patient's primary nurse.