Online Practice Test 4

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Site Title: Kozier & Erb's Fundamentals of Nursing Book Title: Kozier & Erb's Fundamentals of Nursing Location on Site: Chapter 4 > NCLEX® Review Date/Time Submitted: July 4, 2012 at 2:43 PM (UTC/GMT)

Summary of Results 47% Correct of 15 Scored items: 7 Correct:  47% 8 Incorrect:  53% More information about scoring

1.		While preparing medications, the nurse notes an unusually large dose of medication for a client. Which action would be most appropriate? Your Answer: Calling the prescribing physician
		Objective: Identify ways in which nurses and nursing students can minimize their chances of liability. Rationale: Clarification from sources other than the prescribing physician is unacceptable. Asking another nurse to administer the medication will still put the client in jeopardy; giving it as ordered is negligent if a problem arises; and notifying the supervisor is an unnecessary additional step in the process of contacting the physician. Nursing Process: Planning Client Need: Safe, Effective Care Environment Cognitive Level: Analysis Strategy: Decide what is the best action for client and situation
2.		Albeit the responsibility to explain procedures, their risks and benefits to the client is that of the physician's, in some cases, this could be witnessed by the nurse. Which client is legally allowed to give informed consent?  Your Answer: A client who cannot read
		Objective: Describe the purpose and essential elements of informed consent. Rationale: If a client cannot read, the consent must be read to the client, followed by documentation of the client's understanding. A client who is unconscious or sedated is not considered functionally competent, and cannot give consent. A 14-year-old is a minor, and parental consent must be obtained. Nursing Process: Assessment Client Need: Safe, Effective Care Environment Cognitive Level: Application Strategy: Decide what is the best action for client and situation.
3.		A nurse is involved in a research project on the unit involving evaluation of client care. What would be the best resource for gathering information on external standards of care? Your Answer: Nurse practice acts
		Objective: Describe ways nurse practice acts, standards of care, and agency policies and procedures affect the scope of nursing practice. Rationale: External standards of care include nurse practice acts, professional organizations, nursing specialty/practice organizations, and federal organizations and guidelines. Internal standards of care include nurse's job descriptions, education, and expertise, as well as individual institutional policies and procedures. Nursing Process: Assessment Client Need: Safe, Effective Care Environment Cognitive Level: Analysis Strategy: Understand contemporary nursing practice.
4.		In which situation would the nurse understand that implied consent is given? Your Answer: A client is nearing delivery, attended by a nurse midwife. Correct Answer: The nurse prepares to insert a nasogastric tube into a client.
		Objective: Describe the purpose and essential elements of informed consent. Rationale: Oral or implied consent is given with most nursing interventions, such as insertion of a nasogastric tube or giving medications. The other answers carry increased risks to the client, and generally require written consent. Nursing Process: Planning Client Need: Safe, Effective Care Environment Cognitive Level: Application Strategy: Understand contemporary nursing practice.
5.		A nurse has been in the peer assistance program voluntarily after being charged with drug abuse on the nursing unit. Which statement is true about this nurse's ability to practice? Your Answer: The nurse may no longer practice nursing under state law. Correct Answer: The nurse may only work day shift, with no overtime.
		Objective: Discuss the impaired nurse and available diversion or peer assistance programs. Rationale: In many states, impaired nurses who voluntarily enter diversion programs do not have their nursing license revoked if they follow treatment requirements. Treatment includes but is not limited to working day shift only, without overtime. The nurse may only work a general nursing unit, and must agree to random drug screening, and not to administer narcotics. Nursing Process: Evaluation Client Need: Safe, Effective Care Environment Cognitive Level: Application Strategy: Understand contemporary nursing practice.
6.		Which situation is an example of an unintentional tort? Your Answer: Administering a medication that causes client harm
		Objective: Compare and contrast intentional torts (assault/battery, false imprisonment, invasion of privacy, defamation) and unintentional torts (negligence, malpractice). Rationale: Unintentional torts may occur in a health care setting, and involve situations where the nurse did not intend any harm to the client but harm ensued. Administering a medication that caused harm is unforeseen and unintentional. Forcible restraint is considered false imprisonment; telling another nurse the client is gay is invasion of privacy; and documenting the word "incompetent" is libel. All these are intentional torts. Nursing Process: Evaluation Client Need: Safe, Effective Care Environment Cognitive Level: Application Strategy: Understand contemporary nursing practice.
7.		The client responds when the nurse calls the client by name. After giving the client a medication, the nurse realizes that it is the wrong client. The physician is notified, and the nurse documents no adverse reactions to the medication. What should the nurse understand about the possibility of being sued for malpractice? Your Answer: The nurse can be sued, because the action was below the standard of practice. Correct Answer: There is no validity to a lawsuit for malpractice, because the client did not sustain harm or injury from the action.
		Objective: List information that needs to be included in an incident report. Rationale: The client must demonstrate some type of harm or injury as a result of a wrongful act. In this case, no adverse reactions were documented. Notifying the physician does not absolve the nurse of wrongdoing if the client is harmed. The nurse's action may have been below the standard of practice, but again, no harm was done to the client, so a lawsuit would not be successful. It doesn't matter that the client responded to the name the nurse called out. The nurse should always have the client state his name, and check the client's armband to verify identify. Nursing Process: Evaluation Client Need: Safe, Effective Care Environment Cognitive Level: Application Strategy: Decide what is the best action for client and situation.
8.		When giving a report to the oncoming shift, which action by the nurse could be considered an invasion of the client's privacy? Your Answer: Allowing a photographer to take a sleeping client's photograph
		Objective: Describe the four specific areas if HIPAA and their impact on nursing practice. Rationale: Giving information, or making statements, that are not relevant to the client's care can be considered invasion of privacy. Any photographs require a signed consent prior. Asking a client about a nursing student's participating in their care allows the client to give consent. It is important that the oncoming nurse know that the client has active herpes. Telling a visitor a client's room number is not an invasion of privacy, unless the client has requested this information be withheld. Nursing Process: Evaluation Client Need: Safe, Effective Care Environment Cognitive Level: Application Strategy: Decide what is the best action for client and situation.
9.		A nurse is interviewing for a position at a major hospital. Which information regarding liability insurance should the nurse keep in mind when asking questions about hospital versus private liability insurance? Your Answer: Private liability insurance covers the nurse in all situations, inside and outside the hospital. Correct Answer: Nurses can be countersued by the hospital if they are found negligent and the hospital has to pay.
		Objective: Describe the purpose of professional liability insurance. Rationale: Because of the increase in the number of malpractice lawsuits against health professionals, nurses are advised to carry their own liability insurance. Hospitals have countersued nurses when they have been found negligent and the hospital was required to pay. The hospital policy may-but does not always-cover all nurses, such as those in "walk-in" clinics. Hospitals are not required to carry liability insurance for their employees. Private insurance does not cover nurses in all situations; the insurance must be specific to the area in which the nurse is working. Nursing Process: Planning Client Need: Safe, Effective Care Environment Cognitive Level: Application Strategy: Understand contemporary nursing practice.
10.		A client climbs over the side rails and falls after the nurse has instructed the client to remain in bed. What information should the nurse leave out of an incident report? Your Answer: That the client received a sedative one hour prior to the incident Correct Answer: That the client disregarded the nurse's instructions on not getting out of bed
		Objective: List information that needs to be included in an incident report. Rationale: Included in an incident report should be the client identifying information; date, time, and place of incident; facts of the incident; what the client states happened; identification of all witnesses; any equipment or medication by name and dosage. Placing blame should be avoided. It would not be necessary to state that the client disregarded the nurse's instructions. Nursing Process: Implementation Client Need: Safe, Effective Care Environment Cognitive Level: Analysis Strategy: Decide what is the best action for client and situation.
11.		A nurse has been convicted of theft after the head nurse discovered the narcotics count inaccurate on a number of occasions. The hospital must report the nurse's conviction to which data base: Your Answer: Health Professionals Data Collection Bank Correct Answer: Healthcare Integrity and Protection Data Bank
		Objective: Differentiate crimes from torts and give examples in nursing. Rationale: Healthcare Integrity and Protection Data Bank (HIPDB) was created for the reporting of civil judgments or criminal convictions related to health care and licensure or certification actions. Another data bank, the National Practitioner Data Bank (NPDB), was established to identify incompetent and unprofessional health care practitioners. Nursing Process: Assessment Client Need: Safe, Effective Care Environment Cognitive Level: Comprehension Strategy: Use nursing knowledge and process of elimination.
12.		A majority of disciplinary actions by the state boards of nursing pertain to: Your Answer: Negligence Correct Answer: Impaired nurses
		Objective: Recognize the nurse's legal responsibilities with selected aspects of nursing practice. Rationale: According to a national survey, 67% of disciplinary actions are related to chemical dependency. Nursing Process: Assessment Client Need: Safe, Effective Care Environment Cognitive Level: Comprehension Strategy: Use knowledge of contemporary nursing practice.
13.		A consulting surgeon explained the risks and benefits of an experimental surgery. The client signs the consent form with a witness that attests to the signature. The client dies during the surgery. The family, despondent after the death wants to litigate the hospital, physician and nursing staff. The nurse knows:  Your Answer: Nurse's notes should have documented the procedure of the informed consent and if the form was signed voluntarily.
		Nurse's notes should reflect whether the procedure was fully explained to the client and whether the client stated an understanding of the procedure and potential complications. Objective: Describe the purpose and essential elements of informed consent. Rationale: Informed consent is an agreement by a client to accept a course of treatment or a procedure after being provided complete information, including the benefits and risks of treatments, alternatives to the treatment, and prognosis if not treated by a health care provider. Nursing Process: Assessment Client Need: Safe, Effective Care Environment Cognitive Level: Comprehension Strategy: Use knowledge of nursing practice and process of elimination.
14.		The day shift nurse receives report for a critically ill client who has pneumonia and is on a ventilator. The departing nurse shares the vital signs with the day nurse and reports that the temperature and blood pressure are within normal limits. When the day shift nurse performs an assessment, the client's temperature is 104.8° F. After checking the previous shift's vital signs, the nurse notes that the last time the temperature was taken was at midnight. It was now 8 am and the patient begins to seize. The nurse on duty knows:  Your Answer: Causation occurred
		Harm occurred as a direct result of the failure to follow the standard of care. Objective: Discriminate between negligence and malpractice. Rationale: Negligence is misconduct or practice that is below the standard expected of an ordinary, reasonable, and prudent person. Malpractice is professional negligence that occurred while the person was performing as a professional. Nursing Process: Assessment Client Need: Safe, Effective Care Environment Cognitive Level: Analysis Strategy: Use knowledge of contemporary nursing practice and standards of professional practice.
15.		Which law is the first nationwide legislation to protect privacy for health information? Your Answer: Code of Ethics Correct Answer: Health Insurance Portability Act
		Objective: Describe the four specific areas of HIPAA and their impact on nursing practice. Rationale: HIPAA is an acronym for the Health Insurance Portability & Accountability Act of 1996. HIPAA is the first nationwide legislation to protect privacy for health information. Nursing Process: Assessment Client Need: Safe, Effective Care Environment Cognitive Level: Comprehension Strategy: Use knowledge of contemporary health care and legal system.