Ethical Principles in Nursing Practice, Exams of Laboratory Practices and Management

Download Ethical Principles in Nursing Practice and more Exams Laboratory Practices and Management in PDF only on Docsity! NCLEX-RN Practice Questions with 100% Correct Answers. A client is referred to a surgeon by the general practitioner. After meeting the surgeon, the client decides to find a different surgeon to continue treatment. The nurse supports the client's action, utilizing which ethical principle? 1. Beneficence 2. Veracity 3. Autonomy 4. Privacy - Answer: 3 Rationale: Autonomy is the right of individuals to take action for themselves. Beneficence is an ethical principle to do well and applies when the nurse has a city to help others by doing what is best for them. Veracity refers to truthfulness. Privacy is the nondisclosure of information by the health care team. Cognitive Level: Applying Client Need: Management of Care Integrated Process: Nursing Process: Implementation Content Area: Fundamentals Strategy: The core issue of the question is the ability to interpret which ethical principle is operating in a specific situation. Eliminate beneficence and veracity next because they focus on the obligation of the nurse rather than on a right of the client. A nurse forgets to administer a client's diuretic and the client experiences an episode of pulmonary edema. The charge nurse would consider the medication error to constitute negligence because the situation contains which element? 1. Purposeful failure to perform a health care procedure 2. Unintentional failure to perform a health care procedure 3. Act of substituting a different medication for the one ordered 4. Failure to follow a direct order by a physician - Answer: 2 Rationale: Negligence is the unintentional failure of an individual to perform or not perform an act that a reasonable person would or would not do in the same or similar circumstances. A purposeful failure to perform a procedure would be the opposite of negligence, which is unintentional. Substituting a different medication does not fit the description of the situation in the question. Failure to follow a direct order does not fit the description in the situation in the question. Cognitive Level: Applying Client Need: Management of Care Integrated Process: Nursing Process: Assessment Content Area: Fundamentals Strategy: Two options are opposites, which is a clue that one of them may be correct. Choose unintentional failure to carry out a procedure over purposeful failure because it matches the definition of negligence. Page 1 of 13 A client asks why a diagnostic test has been ordered and the nurse replies, "I'm unsure but will find out for you." When the nurse later returns and provides an explanation, the nurse is acting under which principle? 1. No maleficence 2. Veracity 3. Beneficence 4. Fidelity - Answer: 4 Rationale: Fidelity means being faithful to agreements and promises. This nurse is acting on the client's behalf to obtain needed information and report it back to the client. No maleficence is the duty to do no harm. Veracity refers to telling the truth for example, not lying to a client about a serious prognosis. Beneficence means doing well, such as by implementing actions (e.g. keeping a salt shaker out of sight) that benefit a client (heart condition requiring sodium-restricted diet). Cognitive Level: Understanding Client Need: Management of Care Integrated Process: Nursing Process: Implementation Content Area: Fundamentals Strategy: Use the process of elimination. The correct Answer is the one that matches the description in the stem; that is, the nurse made a promise to a client and kept it, which constitutes fidelity. An individual has a seizure while walking down the street. During the seizure, a nurse from a physician's office is noticed driving past without stopping to assist. The individual sues the nurse for negligence but fails to win a judgment for which reason? 1. The nurse had no duty to the individual. 2. The nurse did what most nurses would do in the same circumstance. 3. The nurse did not cause the client's injuries. 4. The nurse was off-duty at the time. - Answer: 1 Rationale: To be guilty of negligence, the nurse must have a relationship with the client that involves a duty to provide care. The relationship is usually a component of employment. The nurse did not necessarily do what others would do in this situation. Although the nurse did not cause the client's injuries, it does not prevent the nurse from assisting in this situation. Although the nurse was off-duty, the nurse could have assisted if motivated to do so. Cognitive Level: Understanding Client Need: Management of Care Integrated Process: Nursing Process: Implementation Content Area: Fundamentals Strategy: Use the process of elimination and nursing knowledge. The correct Answer is the one that recognizes that the nurse was not in the role of employee at the time of the incident, removing the requirement of acting on the client's behalf. An adult female ambulatory care client receiving an oral anticoagulant is given aspirin for a headache while visiting a neighbor, who is a nurse. The client subsequently has a bleeding episode because of a drug interaction. The legal nurse consultant interprets that which necessary elements of malpractice are missing from this case? Select all that apply. Page 2 of 13 2. Share information about a client with nurses from the unit to which the client may eventually be transferred. 3. Allow the client's family to review the medical record to obtain Answers to their questions. 4. Share information about the client with those involved in planning nursing care. - Answer: 4 Rationale: Client confidentiality is maintained when the nurse shares client information only with those currently involved in the plan of care. Staff should only access information about clients currently assigned to their care and should not access information about other clients on the unit not assigned to them. Client information should not be shared with nurses who are not currently working with the client. Family members would need approval from the client and the health care provider prior to reviewing a medical record. Cognitive Level: Applying Client Need: Management of Care Integrated Process: Communication and Documentation Content Area: Fundamentals Strategy: Select the response that protects the client's information, but allows communication necessary for the delivery of quality care. The nurse working in an acute care environment would utilize which strategies to reduce the risk of malpractice litigation? Select all that apply. 1. Discuss any errors with the client and family in detail. 2. Keep incident reports on file. 3. Maintain expertise in practice. 4. Offer opinions to clients when the situation warrants. 5. Report unsafe staffing levels to supervisor. - Answer: 3, 5 Rationale: Maintaining expertise in practice by keeping up to date in knowledge and skills aids in reducing the risk of malpractice claims by fostering continued competence in practice. Unsafe staffing levels can result in a higher incidence rate of errors, which could later lead to charges of malpractice. Thus, reporting such situations so they can be prevented should be beneficial. Discussing errors in detail with the client and family does not reduce the risk of malpractice claim. Incident reports should be kept on file but do not decrease the risk of malpractice litigation. The nurse should not offer opinions at any time as this not part of therapeutic communication. Cognitive Level: Applying Client Need: Management of Care Integrated Process: Nursing Process: Implementation Content Area: Fundamentals Strategy: Focus on malpractice as the concept being tested. Recall that maintaining expertise is the best way to reduce personal risk and that reporting unsafe staffing situations may help reduce personal risk and that reporting unsafe staffing situations may help reduce general agency risk by preventing omissions or errors due to insufficient numbers of caregivers to do the work required during the shift. The registered nurse (RN) must delegate care of an assigned client to an unlicensed assistive person (UAP) for the shift. Which client would be best to delegate to the UAP? 1. A client who would benefit from talking about the recent death of her husband. 2. A client with a urinary drainage catheter and nasogastric feedings who is on bed rest. Page 5 of 13 3. A client with an osmotic who has persistent problems with leakage. 4. A client who was transferred from the critical care unit 3 days ago is ambulatory - Answer: 4 Rationale: Factors to consider when delegating care include complexity of task, problem- solving innovation required, unpredictability, and level of client interaction. The ambulatory client is best to delegate because this client in likely to be stable with a low level of unpredictability. The client who recently lost her husband would benefit from professional communication with the RN and requires a high level of client interaction. The client receiving enteral feedings and is immobilized represents a more complex client, who is better assigned to a licensed nurse. The client with a leaking osmotic would benefit from problem-solving innovation and is best cared for by the RN. Cognitive Level: Analyzing Client Need: Management of Care Integrated Process: Nursing Process: Planning Content Area: Leadership and Management Strategy: The core issue of the question is basic concepts that are useful when considering delegation to a UAP. Use this knowledge and the process of elimination to make selection. Which task would not be appropriate for the registered nurse (RN) to delegate to a licensed practical nurse (LPN) or unlicensed assistive personnel (UAP)? 1. Instructing the LPN to reinforce teaching of the RN's assigned clients prior to discharge 2. Assigning UAPs to complete vital signs and document and report changes to the RN 3. Asking the UAP to assess and evaluate the client response to IV pain medication 4. Instructing the LPN to remove a dressing from a postoperative client's abdominal would - Answer: Rationale: Cognitive Level: Client Need: Integrated Process: Content Area: Strategy: The charge nurse on the night shift reports that the narcotic count is incorrect. The nurse has spoken to the responsible staff nurse and believes that substance abuse by the nurse is the cause. If substance abuse proves to be the cause of the incorrect count, what is the most appropriate next step? 1. Recount the narcotics with the staff nurse and take disciplinary action 2. Ask the staff nurse to leave the unit and report the incident to the American Nurses Association 3. Complete an incident report and report findings to the pharmacy and nursing administration 4. Submit the findings to the Council on Nursing Practice - Answer: Rationale: Cognitive Level: Client Need: Integrated Process: Page 6 of 13 Content Area: Strategy: A quarterly audit is now due to evaluate implementation of an electronic medical record system on the nursing unit. As the unit representative who supervised the adaptation of this documentation system, how can the nurse best determine if nursing staff have accepted this change? 1. Nursing staff uses the electronic medical record daily in routine documentation 2. Nursing staff verbalizes the need for the electronic record but still hand-write nursing notes into the clients' charts 3. Nursing staff uses the electronic record sporadically to monitor clients' progress 4. Nursing staff likes the electronic record because they believe it saves them time - Answer: Rationale: Cognitive Level: Client Need: Integrated Process: Content Area: Strategy: The nurse on the hospital quality improvement team has been asked to evaluate nursing care on the nurse's assigned unit. After deciding to ask the nursing staff for assistance in this effort, what would be most appropriate for the nurse to initially ask the staff to do? 1. Track the number of supplies used by clients on the unit 2. Document the time spent on direct client care 3. Administer a client and family satisfaction survey 4. Assess clients and report acuity daily - Answer: Rationale: Cognitive Level: Client Need: Integrated Process: Content Area: Strategy: An RN is about to make first rounds after receiving an inter shift report at 3pm. In what order should the RN see the following clients? Place the options in order. All options must be used. 1. A 54-year-old client 4 hours post-cardiac catheterization who has mild discomfort at the access site 2. A client newly diagnosed with diabetes mellitus who needs reinforcement of sick day management guidelines 3. A client who arrived 30 minutes ago from the post anesthesia care unit 4. A client who is ready for discharge but will not have transportation home available until 5pm 5. A client with pneumonia who has received two doses of IV antibiotics and has an oxygen saturation of 93% - Answer: Page 7 of 13 Rationale: Cognitive Level: Client Need: Integrated Process: Content Area: Strategy: A nurse is preparing for the shift, and makes a list of delegated tasks for the unlicensed assistive person (UAP). Which task should the nurse delegate to the UAP? 1. Feeding a client who was admitted with dysphasia from cerebrovascular accident 2. Monitoring drainage from a chest tube on a client with a hem thorax 3. Rechecking vital signs on a client whose blood pressure is 190/102 4. Repositioning a client with severe weakness caused by multiple sclerosis - Answer: Rationale: Cognitive Level: Client Need: Integrated Process: Content Area: Strategy: A registered nurse (RN) who is the charge nurse for the shift is making assignments for the day. Which client should be assigned to the licensed practical nurse (LPN)? 1. A client with sickle-cell anemia requiring pain medications every three hours 2. A three-day postoperative client who will be discharged tomorrow morning 3. A 76-year-old client who will be discharged tomorrow morning 4. A client who received chemotherapy for leukemia and has a hemoglobin of 6.4 grams/ld. - Answer: Rationale: Cognitive Level: Client Need: Integrated Process: Content Area: Strategy: The staff nurse who is in charge of the medical-surgical unit for the shift is receiving four admissions. The emergency department is sending a client with hypertension and an exacerbation of heart failure, and a client who has pneumonia and a history of diabetes mellitus. The post-anesthesia care unit (PACU) is transferring a client who had a total abdominal hysterectomy and a client who underwent hip replacement. If the staff consists of two RNs (one on orientation) and two LPNs, what assignment would be appropriate? 1. The RN on orientation will be assigned the postoperative client who underwent hip replacement 2. The experienced RN will be assigned the postoperative client who underwent hip replacement 3. An LPN will be assigned the client with pneumonia and history of diabetes Page 10 of 13 4. An LPN will be assigned the client with the abdominal hysterectomy - Answer: Rationale: Cognitive Level: Client Need: Integrated Process: Content Area: Strategy: An obstetric nurse is floated to a medical unit to care for a group of acutely ill clients. The charge nurse should assign which group of clients to the float nurse? 1. A client with a three-day-old total knee replacement, a client who is postoperative for colectomy, and a client who is postoperative for hysterectomy 2. An older adult client with dehydration, a client with atrial fibrillation, and a client just admitted with hip fracture 3. A client with an old cerebrovascular accident, a client with a three-day-old hip replacement, and a client with diabetic ketoacidosis 4. An older adult client with pneumonia, a client with an exacerbation of asthma, and a client who has below knee amputation - Answer: Rationale: Cognitive Level: Client Need: Integrated Process: Content Area: Strategy: A nurse plans to delegate some responsibilities of client care to a licensed practical nurse (LPN). Which task should the nurse delegate to the LPN? 1. Assessment of a newly admitted client 2. Admission of a postoperative client 3. Dressing changes for a client with wounds 4. Assist a client with ambulation and AM care - Answer: Rationale: Cognitive Level: Client Need: Integrated Process: Content Area: Strategy: A nurse has delegated a venipuncture to an unlicensed assistant (UA) who has been off orientation for five days. The UA reports, “This client has a large, raised red area where the need was inserted." The nurse's subsequent assessment reveals a hematoma in the venipuncture area. What elements of delegation have been breached? Select all that apply. 1. Task 2. Circumstance 3. Communication Page 11 of 13 4. Supervision 5. Skill - Answer: Rationale: Cognitive Level: Client Need: Integrated Process: Content Area: Strategy: Upon calling the health care provider regarding a client with "heartburn," diaphoresis, and irregular pulse, the nurse receives stat orders for the following: electrocardiogram, cardiac panel, morphine 2 mg IV push, nitroglycerin 0.4 mg sublingual, and aspirin 325 mg p.m. chew and swallow. Which tasks should the nurse delegate? Select all that apply. 1. Administration of medications 2. Reassessment of the client's condition 3. Venipuncture for the cardiac panel 4. Electrocardiogram 5. Oxygen saturation - Answer: Rationale: Cognitive Level: Client Need: Integrated Process: Content Area: Strategy: A registered nurse (RN) working on the medical unit arrives at work 15 minutes late. The nurse is assigned five clients, and an admission is on the way. Place in order of priority how the nurse should complete the following activities at the beginning of the work shift. Place the options in order. All options must be used. 1. Listen to report 2. Check the medication administration record (MAR) 3. Check on the status of all clients 4. Review morning lab results, including glucose monitoring - Answer: Rationale: Cognitive Level: Client Need: Integrated Process: Content Area: Strategy: A nurse is preparing for a busy day on a medical nursing unit. Prioritize the tasks and place the options in order. All options must be used. 1. Irrigate a nasogastric tube on a client who had a colectomy the previous day. 2. Flush a poorly draining urinary catheter on an older adult client. 3. Check vital signs on a 30-year-old client with a BP of 114/68 and a heart rate of 94. Page 12 of 13