Tuesday, 5 January 2021

NURSING CARE AND RESPONSIBILITIES

The nursing process involves the following:

0/1

Assessment, diagnosis, planning, intervention and evaluation

Assessment, differentiation, planning, intervention, evaluation

Assessment, planning, intervention, evaluation

Assessment, planning, referring, evaluation

 

Correct answer

Assessment, diagnosis, planning, intervention and evaluation

 

What are the steps of the nursing process?

0/1

Assessing, diagnosing, planning, implementing, and evaluating

Assessing, planning, implementing, evaluating, documenting

Assessing, observing, diagnosing, planning, evaluating

Assessing, reacting, implementing, planning, evaluating

 

Correct answer

Assessing, diagnosing, planning, implementing, and evaluating

 

When do you see problems or potential problems?

0/1

Assessment

Planning

 

Implementation

Evaluation

Correct answer

Assessment

 

A walk-in client enters into the clinic with a chief complaint of abdominal pain and diarrhea. The nurse takes the client's vital sign thereafter. What phrase of nursing process is being implemented here by the nurse?

0/1

Assessment

Diagnosis

Planning

Implementation

 

Correct answer

Assessment

 

Constipation needs to be sort out during:

0/1

Planning

Assessment

Implementation

Evaluation

 

Correct answer

Assessment

 

At what stage of the nursing process does the revision of the care plan occur?

0/1

Assessment

 

Planning

Implementation

Evaluation

Correct answer

Evaluation

 

When do you plan a discharge?

0/1

24 hours within admission

72 hours within admission

48 hours within admission

12 hours within admission

 

Correct answer

24 hours within admission

 

Hospital discharge planning for a patient should start:

0/1

When the patient is medically fit

 

On the admission assessment

When transport is available

 

Correct answer

On the admission assessment

 

Which statement is not correct about the nursing process?

0/1

An organised, systematic and deliberate approach to nursing with the aim of improving standards in nursing care

 

It uses a systematic, holistic, problem solving approach in partnership with the patient and their family

 

It is a form of documentation

 

It requires collection of objective data

 

Correct answer

It requires collection of objective data

 

What is comprehensive nursing assessment?

0/1

It provides the foundation for care that enables individuals to gain greater control over their lives and enhance their health status

 

An in-depth assessment of the patient’s health status, physical examination, risk factors, psychological and social aspects of the patient’s health that usually takes place on admission or transfer to a hospital or healthcare agency

 

An assessment of a specific condition, problem, identified risks or assessment of care; for example, continence assessment, nutritional assessment, neurological assessment following a head injury, assessment for day care, outpatient consultation for a specific condition

 

It is a continuous assessment of the patient’s health status accompanied by monitoring and observation of specific problems identified

 

Correct answer

An in-depth assessment of the patient’s health status, physical examination, risk factors, psychological and social aspects of the patient’s health that usually takes place on admission or transfer to a hospital or healthcare agency

 

Nursing process is best illustrated as:

1/1

Patient with medical diagnosis

Task oriented care

Individualised approach to care

 

All of the above

 

Which of the following descriptors is most appropriate to use when stating the "problem" part of a nursing diagnosis?

0/1

Grimacing

Anxiety

Oxygenation saturation 93%

 

Output 500 mL in 8 hours

 

Correct answer

Anxiety

 

To prepare a client for discharge home from an acute care facility, a nurse knows that the planning process must begin at what point?

0/1

The night before discharge

 

Upon admission to the hospital

Prior to discharge

When the client indicates the readiness for discharge planning and teaching

 

Correct answer

Upon admission to the hospital

 

Making sure that people are involved in and central to their care is now recognised as a key component of developing high quality health care. This is because it is hoped that putting people at the centre of their care will:

0/1

·        Help people get the care they wanted when they are enrolled in the NHS

·        Help improve the quality of the services available

·        Help people be more active in looking for health care providers themselves

·        Help reduce some of the pressures on providing social services

 

Correct answer

Help improve the quality of the services available

 

As a nurse, you make sure that the patient and public safety is protected. Thus, you work within the limits of your competence, exercising your professional 'duty of candour' and raising concerns immediately whenever you come across situations that put patients or public safety at risk. Which is the least effective way to protect a patient's safety?

0/1

·        Support the exchange of information at all levels without fear and against authority gradients - is known to be associated with constant awareness to the possibility of hazard or harm

 

·        Support for continual learning, growth and adaptation even under stress by valuing relevant knowledge, skills and observations even at the lowest levels of hierarchy

 

·        Support the willingness and capacity to look beyond first impressions, labels and old beliefs - organisations must remain closely in touch with activities and facts on the ground in the daily operations

 

·        Support the openness culture that encourages clear lines to report concerns and reinforces the attitudes that prevent safeguarding concerns from scrutiny where staff at all levels feel confident that they can voice their concerns without fear of victimization

 

Correct answer

Support the openness culture that encourages clear lines to report concerns and reinforces the attitudes that prevent safeguarding concerns from scrutiny where staff at all levels feel confident that they can voice their concerns without fear of victimisation

 

The nurse wants to involve a patient in a programme of care geared towards the patient to quit smoking. The nurse should make use of which of the following in communicating to or involving patient in the plan of care:

0/1

National nursing database

Ehealth services

 

Nicotine replacement therapy

Core care plans

 

Correct answer

Core care plans

 

One of the principal responsibilities of a nurse is to educate patients, however, time and work-related constraints can interfere with the provision of patient education. Which of the following is most crucial and can influence the patient's ability to retain pre-operative information?

0/1

Timing of the education

Educational level of the patient and family

The information is appropriate for the patient's understanding

 All of the options above

 

Correct answer

Timing of the education

 

Who should be responsible in proper disposal of sharps

0/1

Healthcare assistant

Doctor

 Registered Nurse

The professional who used the sharp

 

Correct answer

The professional who used the sharp

 

Who is responsible in disposing sharps?

0/1

Registered nurse

 

Nurse assistant

Whoever used the sharps

Whoever collects the garbage

 

Correct answer

Whoever used the sharps

 

How can risks be reduced in the healthcare setting?

1/1

·        By adopting a culture of openness and transparency and exploring the root causes of patient safety incidents

 

·        Healthcare will always involve risks so incidents will always occur; we need to accept this

 

·        Healthcare professionals should be encouraged to fill in incident forms; this will create a culture of ‘no blame’

 

·        By setting targets which measure quality

 

All but one describes holistic care:

1/1

v A system of comprehensive or total patient care that considers the physical, emotional, social, economic, and spiritual needs of the person; his or her response to illness; and the effect of the illness on the ability to meet self-care needs

 

v It embraces all nursing practice that has enhancement of healing the whole person from birth to death as it’s goals

 

v An all nursing practice that has healing the person as its goal

 

v It involves understanding the individual as a unitary whole in mutual process with the environment

 

Adam, 46 years old is of Jewish descent. As his nurse, how will you plan his dietary needs?

0/1

Assume he strictly needs Jewish food

 

Ask relatives to bring food from kosher market

Ask a rabbi to help you plan

Ask the patient about his diet preferences

 

Correct answer

Ask the patient about his diet preferences

 

Patient-centred care is best defined as:

0/1

Care is focused on the doctor

 

Care is focused on the health team

Care is focused on the patient

Care is focused on the environment

 

Correct answer

Care is focused on the patient

 

Which of the following is not a component of end of life care?

0/1

Resuscitation and defibrillation

Reduce pain

Maintain dignity

 

Provide family support

 

Correct answer

Resuscitation and defibrillation

 

Mr. James, 72 years old, is a registered blind admitted on your ward due to dehydration. He is encouraged to drink and eat to recover. How will you best manage this plan of care?

1/1

·        Ask the patient the assistance he needs

 

·        Delegate someone to feed him

·        Ask the relatives to assist in feeding him

·        Look for volunteer to assist with his needs

 

The rehabilitation nurse wishes to make the following entry into a client's plan of care: "Client will reestablish a pattern of daily bowel movements without straining within two months." The nurse would write this statement under which section of the plan of care?

0/1

·        Long-term goals

·        Short-term goals

·        Nursing orders

·        Nursing diagnosis/problem list

 

Correct answer

Long-term goals

 

After instructing the client on crutch walking technique, the nurse should evaluate the client's understanding by using which of the following methods?

0/1

Have client explain produce to the family

 Achievement of 90 on written test

Explanation

Return demonstration

 

Correct answer

Return demonstration

 

A nurse should be able to show awareness of his/her role in health promotion and supporting a healthy lifestyle. Whilst providing health education to a group of patients with cancer about management of their non-healing wounds, it is important for one to:

0/1

Consider individual wound management priorities

Review the patient’s treatment plan

Determine the locations of the wounds

Verify the types of cancer

 

Correct answer

Consider individual wound management priorities

 

It is important to read the label on every IV bag because:

0/1

Different IV solutions are packaged similarly

 

The label contains the expiration date of the IV fluid

A and B

A only

 

Correct answer

A and B

 

Julie, 50 years old, was admitted to the hospital with gastrointestinal bleed presumed to be oesophageal varices. It has been recommended that she needs to be transfused with blood; however, due to her religious and personal beliefs, she needed volume expanding agents. Unfortunately, she died a few hours after admission. Before dying, she said that it was God’s will, which she believed was right. Which of the following statements is false?

0/1

·        Health professionals should be aware of imposing one’s world view upon others and strive to be more receptive and sensitive to the needs of others

 

·        Individual choice, consent and the right to refuse treatment is important

 

·        It is important for all health professionals to do any means to keep a patient alive regardless of traditions and beliefs

 

·        None of the Above

 

Correct answer

It is important for all health professionals to do any means to keep a patient alive regardless of traditions and beliefs

 

Pauleena, 57 years old, suffered from a very dense left sided Cerebrovascular Accident / Stroke. She was unconscious and unresponsive for several days with IV fluids for hydration. Since her recovery from stroke, she has been prescribed to commence enteral feeding through a fine bore nasogastric tube, in which she signed her consent in front of her who have always been supportive of her decisions. However, she tends to pull out her NGT when she is by herself in her room. She died of malnutrition after a few days. Which of the following statements is true?

0/1

·        Nurses should have the empathy to listen to more than just the spoken word

 

·        Nurses should practice in accordance to Pauleena’s best interest while providing support to the family and listening to their concerns and wishes

 

·        Pauleena needs to be supported with questions related to mortality and meaning of life Therapautic communication is also essential

 

·        All of the above

 

 

Correct answer

All of the above

 

Which of the following sets of needs should be included in your service user’s person centred care plan?

0/1

·        Social, spiritual and academic needs

 

·        Medical, psychological and financial needs

 

·        Physical, medical, social, psychological and spiritual needs

 

·        A and B only

 

·        All of the above

 

Correct answer

Physical, medical, social, psychological and spiritual needs

 

What is likely to be true of a nurse's duties when she acts as a case manager providing community-based nursing services to a specific group of individuals?

0/1

·        The nurse will care for clients at the center, in their homes, and in the hospital

 

·        The nurse sees only clients who come to the office

 

·        The nurse works independently of other health care professionals

 

·        The nurse will not continue client care if it involves long-term needs

 

Correct answer

The nurse will care for clients at the center, in their homes, and in the hospital

 

A client is to be discharged home from a hospital using crutches or a wheelchair. The client lives alone with three cats. Which assessment parameter is most important on the initial home visit?

0/1

·        Whether the client will be able to keep medical appointments

 

·        Whether the client desires spiritual counseling

 

·        Whether the home has stairs and/or throw rugs

 

·        Whether the client has financial resources for payment

 

Correct answer

Whether the home has stairs and/or throw rugs

 

To provide effective feedback to a client, the nurse will focus on:

0/1

·        The present and not the past

·        Making inferences of the behaviors observed

·        Providing solutions to the client

·        The client

 

Correct answer

The present and not the past

 

Which of the following actions jeopardise the professional boundaries between patient and nurse

0/1

·        Focusing on social relationship outside working environment

 

·        Focusing on needs of patient related to illness

 

·        Focusing on withholding value opinions related to the decisions

 

Correct answer

Focusing on social relationship outside working environment

 

In using social media like Facebook, these are the best way to adhere to your Code of Conduct as a nurse, except?

1/1

·        Never have relationship with previous patient

·        Never post pictures concerning your practice

·        Never tell you are a nurse

 

·        Always rely solely in your FBs privacy setting

 

The worst advice you can give a student nurse with regards to the use of social networking sites like Facebook?

1/1

·        Do not identify yourself as a nurse

 

·        Do not engage in a personal discussion or relationship with a patient or former patient

·        Do not post a picture of a patient's child even if they allow you to

·        You can rely on the sites privacy settings

 

As an RN in charge you are worried about a nurse's act of being very active on social media site, that it affect the professionalism. Which one of these is the worst advice you can give her?

1/1

·        Do not reveal your profession of being a Nurse on social site

 

·        Do not post any pictures of client's even if they have given you permission

·        Do not involve in any conversions with client's or their relatives through a social site

·        Keep your profile private

 

Nurses assume responsibility on patient with cane. Which of the following is the nurse’s topmost priority in caring for a patient with cane?

0/1

·        Mobility

·        Safety

·        Nutrition

 

·        Rest periods

 

Correct answer

Safety

 

In the context of assessing risks prior to moving and handling, what does T-I-L-E stand for?

0/1

·        Task – individual – lift – environment

·        Task – intervene – load – environment

·        Task – intervene – load – equipment

 

·        Task – individual – load – environment

 

Correct answer

Task – individual – load – environment

 

Barbara, a 75-year old patient from a nursing home was admitted on your ward because of fractured neck of femur after a trip. She will require an open-reduction and internal fixation (ORIF) procedure to correct the injury. Which of the following statements will help her understand the procedure?

0/1

·        You are going to have an ORIF done to correct your fracture

 

·        Some metal screws and pins will be attached to your hip to help with the healing of your broken bone

 

·        The operation will require a metal fixator implanted to your femur and adjacent bones to keep it secured

 

·        The ORIF procedure will be done under general anaesthesia by an orthopaedic surgeon

 

Correct answer

Some metal screws and pins will be attached to your hip to help with the healing of your broken bone

 

Lisa, a working mother of 3, has approached you during a recent attendance of her daughter in Accident and Emergency because of an acute asthma attack about smoking cessation. What is your most appropriate response to her?

1/1

·        Smoking cessation will help prevent further asthma attack

 

·        Referral can be made to the local NHS Stop Smoking Service

 

·        Discuss with her the NICE recommendations on smoking cessation

 

·        It is not common for people like her to stop smoking

 

A nurse finds it very difficult to understand the needs of a child with learning disability. She goes to other nurses and professionals to seek help. How you interpret this action

0/1

·        The nurse is short of self confidence

 

·        A nurse, who is well aware of her limitations sought help from others She worked within her competency

 

·        She doesn’t have the kind of courage a nurse should have

 

Correct answer

A nurse, who is well aware of her limitations sought help from others She worked within her competency

 

Monica is going to receive blood transfusion. How frequently should we do her observation?

0/1

Temperature and pulse before the blood transfusion begins, then every hour, and at the end of bag/unit

 

Temperature, pulse, blood pressure and respiration before the blood transfusion begins, then after 15 min, then as indicated in local guidelines, and finally at the end of bag/unit

 

Temperature, pulse, blood pressure and respiration and urinalysis before the blood transfusion, then at end of bag

 

Pulse, blood pressure and respiration every hour, and at the end of the bag

 

Correct answer

Temperature, pulse, blood pressure and respiration before the blood transfusion begins, then after 15 min, then as indicated in local guidelines, and finally at the end of bag/unit

 

During blood transfusion, a patient develops pyrexia, and loin pain. Nurse interprets the situation as

0/1

·        Common reaction to transfusion

·        Adverse reaction to blood transfusion

·        Patient has septicaemia

 

Correct answer

Adverse reaction to blood transfusion

 

A nurse explains to a student that the nursing process is a dynamic process. Which of the following actions by the nurse best demonstrates this concept during the work shift?

1/1

·        Nurse and client agree upon health care goals for the client

·        Nurse reviews the client's history on the medical record

·        Nurse explains to the client the purpose of each administered medication

·        Nurse rapidly reset priorities for client care based on a change in the client's condition

 

 

Nursing care should be:

0/1

·        Task oriented

·        Caring medical and surgical patient

 

·        Patient oriented, individualistic care

·        All

 

Correct answer

Patient oriented, individualistic care

 

How the nurse assesses the quality of care given?

0/1

·        Reflective process

·        Clinical bench marking

·        Peer and patient response

 

·        All the above

 

Correct answer

All the above

 

A patient doesn't take a tablet which is prescribed by the doctor. Which action by the nurse would be most appropriate?

0/1

·        Report the incident to senior nurse or ward in charge

 

·        Inform the pharmacist

 

·        Do nothing and respect the patients choice

 

·        Routinely document this in the medicine chart and also record it in the nurses notes

 

Correct answer

Routinely document this in the medicine chart and also record it in the nurses notes

 

After the death of a 46-year-old male client, the nurse approaches the family to discuss organ donation options. The family consents to organ donation and the nurse begins to process. Which of the following would be most helpful to the grieving family during this difficult time?

1/1

Calling the client, a donor

Provide care to the deceased client in a careful and loving way

 

Encourage the family to make a quick decision

Tell them that there is no time to all other family members for advice

 

While providing care to a terminally ill client, the nurse has asked questions about death. Which of the following would be beneficial to support the client’s spiritual needs?

0/1

·        Nothing

 

·        Ask if they want to die

·        Ask if they want anything special before they die

·        Provide support, compassion, and love

 

Correct answer

Provide support, compassion, and love

 

Under the Yellow Card Scheme you must report the following except:

0/1

·        Faulty brakes on a wheelchair

·        Suspected side effects to blood factor, except immunoglobulin products

·        Counterfeit or fake medicines or medical devices

 

Correct answer

Suspected side effects to blood factor, except immunoglobulin products

 

Mrs X informs the nurse that she has lost her job due to excessive absences related to her wound. The nurse should:

1/1

·        Encourage the patient to express her feelings about the job loss

 

·        Contact social services to assist the patient with accessing available resources

·        Evaluate Mrs X’s understanding of her wound management

·        Explain to Mrs X that she can no longer be seen at the clinic without a job

 

Margaret has been diagnosed with Hepatic Adenoma. Her results are as follows – benign tumor as shown on triphasic CT Scan and alpha feto proteins within normal range. She is asymptomatic and does not appear jaundice, but she appears to be very anxious. As a nurse, what will you initially do?

0/1

·        Sit down with Margaret and discuss about her fears; use therapeutic communication to alleviate anxiety

 

·        Refer her to a psychiatrist for treatment

 

·        Discuss invasive procedure with patient, and show her videos of the operation

 

·        Take her to the surgeon’s clinic and discuss about consent for invasive procedure

 

Correct answer

Sit down with Margaret and discuss about her fears; use therapeutic communication to alleviate anxiety

 

One of your residents has been transferred from the hospital to your nursing home after having been admitted for a week due to a chest infection. On transfer, you have noted that he had several dressings on his thighs, which he has not had before. What should you do?

0/1

·        If the dressings are intact, document it on the nursing notes and indicate that the dressings need to be changed after 48 hours

 

·        Change the dressings if they look soiled and document this on the wound assessment form

 

·        Remove the dressings whether they are intact or not, assess the wounds, document this on the wound assessment form and redress the wounds

 

·        All of the above

 

Correct answer

Remove the dressings whether they are intact or not, assess the wounds, document this on the wound assessment form and redress the wounds

 

During your medical rounds, you have noted that Mrs X was upset. She has verbalised that she misses her family very much, and that no one has been to visit lately. What would likely be your initial intervention?

1/1

·        Contact Mrs X’s family and encourage them to visit her during the weekend

 

·        Sit next to Mrs X and listen attentively Allow her to talk about things that cause her anxiety

 

·        Collaborate with the GP for a care plan review and request for antidepressants to be prescribed

 

·        All of the above

 

·        None of the above

 

On admission of a service user, you have done an informal risk assessment for pressure sores, and you have noted that the patient is currently not at risk. What will be your next step?

0/1

·        Include the Repositioning Chart on your patient’s daily notes, and instruct your carers/HCA’s to turn your patient every two hours

 

·        Alert the General Practitioner about your patient’s condition

 

·        Reassess your patient on a regular basis and document your observations

 

·        Modify your patient’s diet to maintain intact skin integrity

 

Correct answer

Reassess your patient on a regular basis and document your observations

 

You were on your rounds with one of the carers. You were turning a patient from his left to his right side. What would you do?

0/1

·        Both of you can stay on one side of the bed as you turn your patient

 

·        You go on the opposite side of the bed and use the bed sheet to turn your patient

 

·        You keep the bed as low as possible because the patient might fall

 

·        You go on the opposite side and grab the slide sheet to use

 

Correct answer

You go on the opposite side and grab the slide sheet to use

 

The nurse is preparing to move an adult who has right sided paralysis from the bed into a wheel chair. Which statement describes the best action for the nurse to take?

0/1

·        Position the wheel chair on the left side of the bed

·        Keep the head of the bed elevated 10 degree

·        Protect the client’s left arm with a sling during the transfer

·        Bend at the waist while helping the client into a standing position

 

Correct answer

Position the wheel chair on the left side of the bed

 

A client with a right arm cast for fractured humerus states, “I haven’t been able to straighten the fingers on the right hand since this morning.” What action should the nurse take?

0/1

·        Assess neurovascular status to the hand

·        Ask the client to massage the fingers

 

·        Encourage the client to take the prescribed analgesic

·        Elevate the arm on a pillow to reduce oedema

 

Correct answer

Assess neurovascular status to the hand

 

As a nurse you are responsible for looking after patient’s nutritional needs and to maintain good weight during hospitalization. How would you achieve this?

1/1

·        Providing all clients with liquid nutritional supplements

·        Assessing all patients using MUST screening tool and by taking patients preferences into consideration

·        Checking daily weigh and documenting

·        Assessing nutritional status, client preferences and needs, making individual food choices available, checking daily weight and documentation

 

 

One of your young patient displayed an overt sexual behaviour directly to you. How will you best respond to this?

0/1

·        Talk to the patient about the situation, to re- establish and maintain professional boundaries and relationship

 

·        Ignore the behaviour as this is part of the development process

 

·        Report the patient to their relatives

 

·        Inform line manager of the incident

 

Correct answer

Talk to the patient about the situation, to re- establish and maintain professional boundaries and relationship

 

The patient under a nurse's care is showing sexual behaviours toward him/her, what should the nurse do?

0/1

·        File an incident report, do not care for the patient anymore

 

·        Write the patient's behaviour on the patient's chart

 

·        This is normal as the patient is sick, later as the medication kicks off it will soon be over

·        Talk to the patient about the behaviour, attempt to re-establish professional relationship, talk to the line manager

 

Correct answer

Talk to the patient about the behaviour, attempt to re-establish professional relationship, talk to the line manager

 

Post surgery, the doctor tells the patient that treatment is not working. The doctor instructed the nurse to stay with the patient until the nurse specialist arrive. What should the nurse do?

1/1

·        Document outcomes in the patient's chart

·        Sit silently with patient until nurse specialist arrives

·        Ask the patient if he wants to discuss what the doctor said

 

·        Do not leave the patient unattended and try to answer his questions

 

A registered nurse is new to the diagnosis of her patient. What is the best response of the nurse?

0/1

·        The nurse should come early for her shift and spend more time to care for the patient

 

·        The nurse should spend an hour in library, learn about the new diagnosis and then take care of the patient

 

·        The nurse should clarify her doubts with her senior on duty and with the doctors about the diagnosis and plan nursing care accordingly

 

·        The nurse should request the other staff to continue with the shift as she lacks knowledge about the diagnosis

 

Correct answer

The nurse should clarify her doubts with her senior on duty and with the doctors about the diagnosis and plan nursing care accordingly

 

A client diagnosed of cancer visits the OPD and after consulting the doctor breaks down in the corridor and begins to cry. What would the nurses best action?

0/1

·        Ignore the client and let her cry in the hallway

 

·        Inform the client about the preparing to come forth next appointment for further discussion on the treatment planned

 

·        Take her to a room and try to understand her worries and do the needful and assist her with further information if required

 

·        Explain her about the list of cancer treatments to survive

 

Correct answer

Take her to a room and try to understand her worries and do the needful and assist her with further information if required

 

A patient has sexual interest in you. What would you do?

0/1

·        Just avoid it, because the problem can be the manifestation of the underlying disorder, and it will be resolved by its own as he recovers

 

·        Never attend that patient

 

·        Try to re-establish the therapeutic communication and relationship with patient and inform the manager for support

 

·        Inform police

 

Correct answer

Try to re-establish the therapeutic communication and relationship with patient and inform the manager for support

 

A client is diagnosed with cancer and is told by surgery followed by chemotherapy will be necessary, the client states to the nurse, "I have read a lot about complementary therapies. Do you think I should try it?". The nurse responds by making which most appropriate statement?

0/1

·        It is a tendency to view one's own ways as best

 

·        You need to ask your physician about it

 

·        I would try anything that I could if I had cancer

 

·        There are many different forms of complementary therapies, let's talk about these therapies

 

Correct answer

There are many different forms of complementary therapies, let's talk about these therapies

 

An antihypertensive medication has been prescribed for a client with hypertension. The client tells the clinic nurse that they would like to take an herbal substance to help lower their blood pressure. The nurse should take which action?

0/1

·        Tell the client that herbal substances are not safe and should never be used

 

·        Teach the client how to take their BP so that it can be monitored closely

 

·        Encourage the client to discuss the use of an herbal substance with the health care provider

 

·        Tell the client that if they take the herbal substance they will need to have their BP checked frequently

 

Correct answer

Encourage the client to discuss the use of an herbal substance with the health care provider

 

Mrs. A is posted for CT scan. Patient is afraid cancer will reveal during her scan. She asks "why is this test". What will be your response as a nurse?

0/1

·        Tell her that you will arrange a meeting with a doctor after the procedure

 

·        Give a health education on cancer prevention

 

·        Ignore her question and take her for the procedure

 

·        Understand her feelings and tell the patient that it is normal procedure

 

Correct answer

Understand her feelings and tell the patient that it is normal procedure

 

A patient with a Bipolar Disorder makes a sexually inappropriate comment to the nurse. One should take which of the following actions?

0/1

·        Ignore the comment because the client has a mental health disorder and cannot help it

 

·        Report the comment to the nurse manager

 

·        Ignore the comment, but tell the incoming nurse to be aware of the client’s propensity to make inappropriate comments

 

·        Tell the client that is it inappropriate for clients to speak to any nurse that way

 

Correct answer

Tell the client that is it inappropriate for clients to speak to any nurse that way

 

Betty has been assessed to be very confused and with impaired mobility. She wants to go to the dining room for her meal, but she wants a cardigan before doing so. What will you do?

0/1

·        Give her wet wipes for her hands before dinner

·        Disregard the cardigan and take her to the dining room

 

·        Ask her what she means by a cardigan

 

·        Make her comfortable in a wheelchair, and cover her legs with a blanket

 

Correct answer

Ask her what she means by a cardigan

 

You were assisting Mrs X with personal care and hygiene. She has been assessed to have mental capacity. In her wardrobe, you have seen a dress that is quite difficult to wear and a pair of trousers, which is quite easy to put on. You are trying to make a decision which one to put on her. Which of the following is a person centred intervention?

0/1

·        Ask her what she prefers; show her the clothes and let her choose

 

·        Let Mrs X wear her trousers

 

·        Explain to her that the dress is so difficult to put on

 

·        Tell her that the trousers will make her more comfortable if she chooses it

 

Correct answer

Ask her what she prefers; show her the clothes and let her choose

 

One of your residents in the nursing home has requested for a glass of whiskey before she goes to bed. What would you do?

0/1

·        Refuse to give it / ignore the request

 

·        Explain that the whiskey will cause her harm

 

·        Give her a shot of whiskey, as requested

 

·        Give her a glass of apple juice and tell her it is whiskey

 

 

Correct answer

Give her a shot of whiskey, as requested

 

A client, who has had visitors the last two evenings during the unit's regular evening visitors hours, 6:00 p.m. to 8:00 p.m., asks, "What time can I have visitors this evening?" Which of the following would be the best response to this question?

0/1

·        "Don't you remember what time you visitor have been coming?"

 

·        You are worried about visiting hours

 

·        You want to know when you can have visitors?

 

·        Visiting hours are from 6:00 pm to 8:00 pm

 

Correct answer

Visiting hours are from 6:00 pm to 8:00 pm

 

A critically ill client asks the nurse to help him die. Which of the following would be an appropriate response for the nurse to give this client?

0/1

·        "Tell me why you feel death is your only option"

·        "How would you like to do this?"

·        "Everyone dies sooner or later"

 

·        "Assisted suicide is illegal in this country"

Correct answer

"Tell me why you feel death is your only option"

 

The 4-year-old son of a deceased male is asking questions about his father. Which of the following activities would be beneficial for this young child to participate in?

0/1

·        Nothing because he is too young to understand death

 

·        Tell him his father has gone away, never to return

 

·        Tell him his father is sleeping

 

·        Explain that his father has died and give him the option of attending the funeral

 

Correct answer

Explain that his father has died and give him the option of attending the funeral

 

A young woman has suffered fractured pelvis in an accident, she has been hospitalized for 3 days, when she tells her primary nurse that she has something to tell her but she doesnot want the nurse to tell anyone. She says that she had tried to donate blood and tested positive for HIV. What is best action of the nurse to take?

0/1

·        Document this information on the patient’s chart

 

·        Tell the patient’s physician

 

·        Inform the healthcare team who will come in contact with the patient

 

·        Encourage the patient to disclose this information to her physician

 

Correct answer

Encourage the patient to disclose this information to her physician

 

The nurse is admitting a client, on initial assessment the nurse tries to inquire the patient if he has been taking alternative therapies and OTC drugs but the client becomes angry and refuses to answer saying the nurse is doing so because he belongs to an ethnic minority group, what is the nurse’s best response?

0/1

·        The nurse will stop asking questions as it is upsetting to the patient

·        Wait and give some time for the client to get adjusted to modern ways of hospitalization

 

·        The nurse will politely explain to the patient about alternative therapies such as St Johns Wort which interact with drugs

 

·        The nurse will assign another nurse to ask questions

 

Correct answer

The nurse will politely explain to the patient about alternative therapies such as St Johns Wort which interact with drugs

 

Which is the most appropriate phrase to communicate?

0/1

·        "I'm sorry, your mother died"

·        "I'm sorry, your mother gone to heaven"

 

·        "I'm sorry, your mother is no longer with us"

·        "I'm sorry, your mother passed away"

 

Correct answer

"I'm sorry, your mother died"

 

One of your patient has challenged your recent practice of administering a subcutaneous low-molecular weight heparin (LMWH) without disinfecting the injection site. The guidelines for nursing procedures do not recommend this method. Which of the following response will support your action?

1/1

·        "We were taught during our training not to do so as it is not based on evidence"

 

·        "Our guidelines, which are based on current evidence, recommends a non-disinfection method of subcutaneous injection"

 

·        "I am glad you called my attention I will disinfect your injection site next time to ensure your safety and peace of mind"

 

·        "Disinfecting the site for subcutaneous injection is a thing of the past We are in an evidence-based practice now"

 

A nurse is caring for clients in the mental health clinic. A women comes to the clinic complaining of insomnia and anorexia. The patient tearfully tells the nurse that she was laid off from a job that she had held for 15 years. Which of the following responses, if made by the nurse, is most appropriate?

0/1

·        "Did your company give you a severance package?"

 

·        "Focus on the fact that you have a healthy, happy family"

 

·        "Losing a job is common nowadays"

 

·        "Tell me what happened"

 

Correct answer

"Tell me what happened"

 

When do we need to document?

0/1

·        As soon as possible after an event has happened to provide current up to date information about the care and condition of the patient or client

 

·        Every hour

 

·        When there are significant changes to the patient’s condition

 

·        At the end of the shift

 

Correct answer

As soon as possible after an event has happened to provide current up to date information about the care and condition of the patient or client

 

In a patient with hourly monitoring, when does a nurse formally document the monitoring?

0/1

·        Every hour

 

·        When there are significant changes to the patient’s condition

·        At the end of the shift

 

·        Mid of shift

 

Correct answer

Every hour

 

NMC defines record keeping as all of the following except:

0/1

·        Helping to improve advocacy

 

·        Showing how decisions related to patient care were made

 

·        Supporting effective clinical judgements and decisions

 

·        Helping in identifying risks, and enabling early detection of complication

 

Correct answer

Helping to improve advocacy

 

You are transcribing the patient's medications to the discharge letter. What should you ensure before the letter is sent?

1/1

·        The next of kin's details are included in the letter

·        The letter is checked by a registered practitioner for accuracy

·        It cannot be sent because transcription is not allowed in any circumstances

·        The letter is signed off by the nurse-in-charge

 

 

A nurse documented on the wrong chart. What should the nurse do?

0/1

·        Immediately inform the nurse in charge and tell her to cross it all off

·        Throw away the page

 

·        Write line above the writing; put your name, job title, date, and time

·        Ignore the incident

 

 

 

Correct answer

Write line above the writing; put your name, job title, date, and time

 

When is the time to take the vital signs of the patients? Select which does not apply:

0/1

·        At least once every 12 hours, unless specified otherwise by senior staff

 

·        When they are admitted or initially assessed

 

·        On transfer to a ward setting from critical care or transfer from one ward to

 

·        Every four hours

 

Correct answer

Every four hours

 

All should be seen in a good documentation except:

0/1

·        Legible handwriting

 

·        Name and signature, position, date and time

 

·        Abbreviations, jargon, meaningless phrases, irrelevant speculation and offensive subjective statements

 

·        A correct, consistent, and factual data

 

Correct answer

Abbreviations, jargon, meaningless phrases, irrelevant speculation and offensive subjective statements

 

Taking a nursing history prior to the physical examination allows a nurse to establish a rapport with the patient and family. Elements of the history include all of the following except:

0/1

·        The client’s health status

·        The course of the present illness

 

·        Social history

 

·        Cultural beliefs and practices

 

Correct answer

The client’s health status

 

Adequate record keeping for a medical device should provide evidence of:

0/1

·        A unique identifier for the device, where appropriate

 

·        A full history, including date of purchase and where appropriate when it was put into use, deployed or installed

 

·        Any specific legal requirements and whether these have been met

·        Proper installation and where it was deployed

 

·        Schedule and details of maintenance and repairs

·        The end-of-life date, if specified

 

·        All of the above

 

 

Correct answer

All of the above

 

A registered nurse had a very busy day as her patient was sick, got intubated and had other life saving procedures. She documented all the events and by the end of the shift recognized that she had documented in other patient's record. What is best response of the nurse?

0/1

She should continue documenting in the same file as the medical document cannot be corrected

She should tear the page from the file and start documenting in the correct record

 

She should put a straight cut over her documentation and write as wrong, sign it with her NMC code, date and time

 

She should write as wrong documentation in a bracket and continue

 

Correct answer

She should put a straight cut over her documentation and write as wrong, sign it with her NMC code, date and time

 

A patient in one of your bays has called for staff. She needed assistance with “spending a penny”. What will you do?

0/1

·        Ask her if she wants a hot or cold drink, and give her one as requested

·        Assist her to walk to the vending machine, and let her choose what she wants to buy

·        Assist her to walk to the toilet, and provide her with some privacy

·        Help her find her purse, and ask her what time she will be ready to go out

 

Correct answer

Assist her to walk to the toilet, and provide her with some privacy

 

You are working in a nursing home (morning shift), and one of your residents is still in the hospital. Nothing has been documented since admission. What would you do?

0/1

·        Ring the family and find out what happened to the resident

·        Speak to your manager and tell her about it

·        Ring the ward and request for an update from the nurse on duty

·        Document that the resident is still in the hospital

 

Correct answer

Speak to your manager and tell her about it

 

After the handover, you noticed that the outgoing nurse documented an intervention on a wrong patient chart. What should you do to correct it, maintain safety and continuation of care?

0/1

·        Discard the paper/ document

 

·        Cross the wrong entry with a line, indicated it is an error, write the date, time, name and signature, document the care correctly

 

·        Leave it, never alter patient record

 

·        Inform the nurse manager, let her draw a line on the entry and place her name and signature

 

The nurse suspects that a client is withholding health-related information out of fear of discovery and possible legal problems. The nurse formulates nursing diagnoses for the client carefully, being concerned about a diagnostic error resulting from which of the following?

0/1

·        Incomplete data

·        Generalise from experience

·        Identifying with the client

·        Lack of clinical experience

 

After finding the patient, which statement would be most appropriate for the nurse to document on a datix/incident form?

0/1

·        "The patient climbed over the side rails and fell out of bed"

·        "The use of restraints would have prevented the fall"

 

·        "Upon entering the room, the patient was found lying on the floor"

·        "The use of a sedative would have helped keep the patient in bed"

 

Correct answer

"Upon entering the room, the patient was found lying on the floor"

 

A nurse documents vital signs without actually performing the task. Which action should the charge nurse take after discussing the situation with the nurse?

0/1

·        Charge the nurse with malpractice

·        Document the incident

·        Notify the board of nursing

 

·        Terminate employment

 

Correct answer

Document the incident

 

The nurse has made an error in documenting client care. Which appropriate action should the nurse take?

0/1

·        Draw a line through error, initial, date and document correct information

 

·        Document a late addendum to the nursing note in the client’s chart

 

·        Tear the documented note out of the chart

 

·        Delete the error by using whiteout

 

Correct answer

Draw a line through error, initial, date and document correct information

 

Which of the following items of subjective client data would be documented in the medical record by the nurse?

0/1

·        Client's face is pale

·        Cervical lymph nodes are palpable

·        Nursing assistant reports client refused lunch

·        Client feel nauseated

 

Correct answer

Client feel nauseated

 

Annie is on Cefalexin QID. You were working on a night shift and have noticed that the previous nurse has not signed for the last two doses. What should you do?

0/1

Document the incident and speak to your Manager

 

Check the rota, find out when he is back and leave a note on the MARS for him to sign

 

Find out what the whistle blowing policy is about

 

Ask the qualified nurse to sign it on handover if it is definitely been administered

 

Correct answer

Document the incident and speak to your Manager

 

Providing patient centred nursing care is an expectation for all nurses. For a patient with pyrexia, which of the following is the ritual nursing intervention?

0/1

·        Administer antipyretics

 

·        Remove heavy blankets

·        Direct fan therapy

·        Indirect fan therapy

 

Correct answer

Direct fan therapy

 

You are taking the rectal temperature of an elderly patient when it is registered moderate hypothermia of 34 degrees Celcius. What should be the most appropriate action by the nurse?

1/1

·        Programme the reheating device to increase temperature as fast as possible

·        Programme the reheating device to register the temperature to 36 degrees

·        Programme the reheating device to increase temperature 2 degrees per hour

·        Programme the reheating device to register the temperature to increase at 0.5 to 1 degree per hour

 

 

When do you consider using clean gloves acceptable as methods for preventing infection?

0/1

·        Dressing a necrotic wound

 

·        Assessing IV insertion site

·        Obtaining urine sample

·        Accessing a central venous device

 

Correct answer

Accessing a central venous device

 

To address individual and family responses to health problems, theory-based nursing practice is important for designing and implementing nursing interventions. Dorothea Orem identified a theory of nursing practice. Which of the following statements best exemplify Orem's theory?

0/1

·        Promotes nursing care that increases a patient's self-care abilities

 

·        Helps nurses provide culture-specific care that assists patients to achieve and maintain health

 

·        Assists nurses to identify behaviours associated with various stages of coping with death and dying

 

·        Facilities identification of a child's stage of development so that appropriate nursing care is planned

 

Correct answer

Promotes nursing care that increases a patient's self-care abilities

 

Which nursing action is associated with Faye Glenn Abdellah's Patient-Centred Approach to Nursing?

1/1

·        The nurse identifies that although the patient has a serious chronic illness, the patient states that he feels healthy because he can meet the responsibilities required of him as a husband and a father

 

·        The nurse collects data about a patient and organises it into overt and covert problems as addressing the covert problems may solve the overt problems as well

 

·        The nurse plots a patient's health status in the quadrant of poor health with a very unfavourable environment

 

·        The nurse determines that the patient's need for oxygen is the priority with reference to the 21 nursing problems

 

Which statement by a nurse meets Virginia Henderson's Principles and Practice of Nursing?

0/1

·        I see that you have applied makeup today for the first time since your surgery.

 

·        I am your nurse for the next 12 hours. You can use your call bell to page me when you need assistance.

 

·        Your wife can visit everyday between 10 in the morning and 8 at night.

 

·        A physical therapist will be in today to complete an evaluation so we can start planning your care.

 

Correct answer

I am your nurse for the next 12 hours. You can use your call bell to page me when you need assistance.

 

A nurse is caring for an older adult newly admitted to the hospital. The nurse understands the importance of organising data and then prioritising needs based on Roper-Logan-Tierney Model for Nursing. Based on the collected data, which nursing action addresses the basic assumptions related to this theory?

0/1

·        Encourage the patient to increase oral fluid intake

 

·        Seek an order for oxygen via nasal cannula

·        Activate the bed alarm on the patient's bed

·        Take vital signs every four hours

 

Correct answer

Seek an order for oxygen via nasal cannula

 

The nurse is conducting a patient-centred interview on a teenager who conveys that she is not getting relief from shortness of breatheven if she uses the prescribed inhaler. The nurse then decides to ask the patient to demonstrate how she uses the inhaler and what she does when she gets no relief. On the basis of Gordon's Functional Health Patterns, which pattern is the nurse assessing?

0/1

·        Health perception-health management pattern

·        Value-belief pattern

 

·        Cognitive-perceptual pattern

·        Coping-stress tolerance pattern

 

Correct answer

Health perception-health management pattern

 

The nurse reviewed the patient's clinical record and assessed the patient. Which statement by the patient indicates the conflict of ego integrity versus despair according to Erik Erikson's Theory of Development?

1/1

·        I really don't trust any of my doctors and their treatment plan.

·        I don't care what the doctor says, I will do it my war or no way.

·        I hope that in my next lifetime I get the chance to become a doctor.

 

·        I feel that I will never get better because nothing ever goes well for me.

 

Which statement is accurate in relation to the concepts of health and wellness indicated in the presented theoretical framework?

0/1

·        Implies that people are unhealthy if they are unable to fulfill their roles in society

 

·        Promotes meeting basic-level needs first and then progressing to higher level needs

 

·        Supports teaching about how to alter internal and external factors to facilitate adaptations

 

·        Facilitates prediction of whether patients will likely improve in health or experience a decline based on level of support

 

Correct answer

Facilitates prediction of whether patients will likely improve in health or experience a decline based on level of support

 

A nurse is evaluating patient outcomes associated with learning about hypertension and self-care. Which outcome indicates success in the utilisation of the role-modeling theory?

0/1

·        Patient explains how to interpret the serving size on a food label to calculate the caloric value of the nutrient

 

·        Patient is able to identify five foods high in salt that should be avoided when receiving a low sodium diet

 

·        Patient is able to assess that his blood pressure is within normal limits after accurately obtaining a blood pressure reading using a sphygmomanometer

 

·        Patient adheres to a weight-reduction diet, as evidenced by a weekly 2-lb weight loss

 

 

 

 

Correct answer

Patient is able to assess that his blood pressure is within normal limits after accurately obtaining a blood pressure reading using a sphygmomanometer

 

Which is an example of an independent nursing intervention?

0/1

·        Administering enema

·        Changing a soiled dressing

 

·        Delegating the giving of bath to an unregistered practitioner

·        Assisting a patient with a transfer from a bed to a chair

 

Correct answer

Assisting a patient with a transfer from a bed to a chair 

No comments:

Post a comment