Tuesday, 5 January 2021

SAFEGUARDING AND DECISION MAKING

A nurse is caring for a patient with end-stage lung disease. The patient wants to go home on oxygen and be comfortable. The family wants the patient to have a new surgical procedure. The nurse explains the risk and benefits of the surgery to the family and discusses the patient's wishes with the family. The nurse is acting as the patient's:

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Educator

Advocate

Primary care

 

Case manager

Correct answer

Advocate

 

In the role of patient advocate, the nurse would do which of the following?

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Emphasise the need for cost-containment measures when making health care decisions

Override a patient's decision when the patient refuses the recommended treatment

Support a patient's decision, even if it is not the decision desired by the nurse

Foster patient dependence on health care providers for decision making

 

Correct answer

Support a patient's decision, even if it is not the decision desired by the nurse

 

An elderly patient with dementia wants to go home against medical advice. The family wanted the patient to stay for her to undergo the needed surgery. What should be the nurse's course of action?

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Liaise with the patient's family as it is important for them to understand what is happening and what they can do to help

The family should be given the opportunity to talk about their concerns and be updated with information about the cause and management

If a patient with dementia declines care or treatment the nurse should encourage the patient to stay and discuss treatment options thoroughly

The nurse should notify the complex discharge coordinator and security so the patient stays until the doctor is done with consultation

 

Correct answer

If a patient with dementia declines care or treatment the nurse should encourage the patient to stay and discuss treatment options thoroughly

 

An adult you support has dementia with fluctuating mental capacity. They have previously stated a desire to move into a care home, but now, faced with the reality of that decision they want to change their mind. They seem to have forgotten all the reasons they had for wanting to move, and the information you provided that helped the come to this decision. What should you do?

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Talk it through with them again, at a time when you believe they have the mental capacity to make an informed decision

Say nothing to the person, but go ahead with the plans made You are confident they made the right decision when they had the mental capacity to do so It is in their best interests

Tell them it's too late to change their mind, and remind them of their reasons for making the decision

Respect their wishes, and cancel the arrangements made

 

Correct answer

Talk it through with them again, at a time when you believe they have the mental capacity to make an informed decision

 

The best way to describe advocacy?

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Liaise between patient and healthcare team

 

Decide in behalf of patients

Communicate with family in decision making

All of the above

 

What is Advocacy according to NHS Trust?

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It is taking action to help people say what they want, secure their rights, represent their interests and obtain the services they need

 

This is the divulging or provision of access to data

It is the response to the suffering of others that motivates a desire to help

It is a set of rules or a promise that limits access or places restrictions on certain types of information

 

Independent Advocacy is:

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Providing general advice

Making decisions for someone

Care and support work

Agreeing with everything a person says and doing anything a person asks you to do

 

None of the above

Correct answer

None of the above

 

A mentally competent client with end stage liver disease continues to consume alcohol after being informed of the consequences of this action. What action best illustrates the nurse’s role as a client advocate?

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Asking the spouse to take all the alcohol out of the house

 

Accepting the patient’s choice and not intervening

Reminding the client that the action may be an end-of life decision

Refusing to care for the client because of the client’s noncompliance

 

Correct answer

Accepting the patient’s choice and not intervening

 

A nurse demonstrates patient advocacy by becoming involved in which of the following activities?

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Taking a public stand on quality issues and educating the public on "public interest" issues

Teaching in a school of nursing to help decrease the nursing shortage

Engaging in nursing research to justify nursing care delivery

Supporting the status quo when changes are pending

 

Correct answer

Taking a public stand on quality issues and educating the public on "public interest" issues

 

What is meant by an advocate?

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Someone who develops opportunities for the patient

Someone who has the same beliefs as the patient

Someone who does something on behalf of the patient

Someone who has the same values as the patient

 

Correct answer

Someone who does something on behalf of the patient

 

The nurse is functioning as a patient advocate. Which of the following would be the first step the nurse should take when functioning in this role?

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Ensure that the nursing process is complete and includes active participation by the patient and family

Become creative in meeting patient’s needs

 

Empower the patient by providing needed information and support

Help the patient understand the need for preventive health care

Correct answer

Empower the patient by providing needed information and support

 

Safeguarding is the responsibility of:

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Health care assistants

Registered nurses

Doctors

 

All of the above

Correct answer

All of the above

 

In a community hospital, an elderly man approaches you and tells you that his neighbour has been stealing his money, saying "sometimes I give him money to buy groceries but he didn't buy groceries and he kept the money" what is your best course of action for this?

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Raise a safeguarding alert

Just listen but don't do anything

Ignore the old man, he is just having delusions

 

Refer the old man to the community clergy who is giving him spiritual support

Correct answer

Raise a safeguarding alert

 

If you witness or suspect there is a risk to the safety of people in your care and you consider that there is an immediate risk of harm, you should:

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Report your concerns immediately, in writing to the appropriate person

Ask for advice from your professional body if unsure on what actions to take

Protect client confidentiality

Refer to your employer’s whistleblowing policy

 

Keep an accurate record of your concerns and action taken

All of the above

Correct answer

All of the above

 

As you visit your patient during rounds, you notice a thin child who is shy and not mingling with the group who seemed to be visitors of the patient. You offered him food but his mother told you not to mind him as he is not eating much while all of them are eating during that time. As a nurse, what will you do?

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Inform social service desk on suspected case of child neglect

Ignore incident since the child is under the responsibility of the mother

 

Raise the situation to your head nurse and discuss with her what intervention might be done to help the child

Correct answer

Raise the situation to your head nurse and discuss with her what intervention might be done to help the child

 

You believe that an adult you know and support has been a victim of physical abuse that might be considered a criminal offence. What should you do to support the police in an investigation?

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Question the adult thoroughly to get as much information as possible

Take photographs of any signs of abuse or other potential evidence before cleaning up the victim or the crime scene

 

Explain to the victim that you cannot speak to them unless a police officer is present

Make an accurate record of what the person has said to you

Correct answer

Make an accurate record of what the person has said to you

 

If you suspect abuse is happening to someone, and it is not serious enough to involve the police straight away, who should you inform?

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A manager with safeguarding responsibility (if within an organisation) or Adult Social Care directly (if you are a member of the public)

 

No one – it is up to the adult at risk to raise the alert

 

The adult's next of kin

 

Everyone with a caring responsibility for the adult

 

 

Correct answer

A manager with safeguarding responsibility (if within an organisation) or Adult Social Care directly (if you are a member of the public)

 

In the UK, safeguarding is the responsibility of:

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Nurse assistant

Doctor

 

Registered Nurse

All of the above

Correct answer

All of the above

 

In a community setting, an elderly patient reported to you that he gives shopping money to his neighbours but failed to bring groceries on frequent occasions. What is your best response on this situation?

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Confront the neighbour

 

Ignore, maybe he is very old and does not think clearly

Fill up a raising a concern/ safeguarding form, and escalate

Ask patient to report neighbour to police

 

Correct answer

Fill up a raising a concern/ safeguarding form, and escalate

 

You saw a relative of a client has come with her son, who looks very thin, shy and frightened. You serve them food, but the mother of that child says "don't give him, he eats too much". You should:

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Raise your concern with your nurse manager about potential for child abuse and ask for her support

Ignore the mother and ask the relative if the child is abused

 

Ignore the mother's advice and serve food to the child

Ignore the situation as she is the mother and knows better about her child

 

 

Correct answer

Raise your concern with your nurse manager about potential for child abuse and ask for her support

 

Which of the following statements is true?

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Someone is only an abuser if they deliberately intend to cause harm

Abuse only happens to children

 

Only people over 70 can be vulnerable

Abuse can occur unintentionally without the person meaning to cause harm

 

Correct answer

Abuse can occur unintentionally without the person meaning to cause harm

 

Which of the following statements is false?

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Abuse mostly happens in nursing and residential homes

 

Abuse can take place anywhere there is a vulnerable adult

Abuse can take place in a day care centre

Abuse can be carried out by anyone – doctors, nurses, carers and even family members

 

Correct answer

Abuse can take place anywhere there is a vulnerable adult

 

You have noticed that the management wants all residents to be up and about by 8:30 am, so they can be ready for breakfast. Mrs X has refused to get up at 8 am, and she wants to have a bit of a lie in, but one of the carers insisted to wash and dress her, and took her to the dining room. What type of abuse in in place?

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Financial Abuse

 

Psychological Abuse

Sexual Abuse

Institutional Abuse

 

Correct answer

Institutional Abuse

 

During the day, Mrs X was sat on a chair and has a table put in front of her to stop her getting up and walking about. What type of abuse is this?

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Physical Abuse

Psychological Abuse

Emotional Abuse

Discriminatory Abuse

 

Correct answer

Physical Abuse

 

Michael feels very uncomfortable when the carer visiting him always gives him a kiss and holds him tightly when he arrives and leaves his home. What type of abuse is this?

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Emotional Abuse

Psychological Abuse

Discriminatory Abuse

 

Sexual Abuse

 

Correct answer

Sexual Abuse

 

Anna has been told that unless she does what the ward staff tell her, the consultant will stop her family from visiting. What type of abuse is this?

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Psychological Abuse

Discriminatory Abuse

Institutional Abuse

Neglect

 

Correct answer

Psychological Abuse

 

Christine cannot get herself a drink because of her disability. Her carers only give her drinks three times a day so she does not wet herself. What type of abuse is this?

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Physical Abuse

Institutional Abuse

Neglect

Sexual Abuse

 

Correct answer

Neglect

 

Gabriella is 26 year old woman with severe learning disabilities. She is usually happy and outgoing. Her mobility is good, her speech is limited but she is able to be involved if carers take time to use simple language. She lives with her mother, and is being assisted with personal care. Her home care worker has noticed bruising on upper insides of her thighs and arms. The genital area was red and sore. She told the care worker that a male care worker is her friend and he has been cuddling her but she does not like the cuddling because it hurts. What could possibly be the type of abuse Gabriella is experiencing?

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Discriminatory Abuse

Financial Abuse

 

Sexual Abuse

Institutional Abuse

 

Correct answer

Sexual Abuse

 

You were a new nurse in a geriatric ward. The son of one of your patients discussed that he has noticed his mother is not being treated well in the ward, and that she looks very dehydrated and malnourished. How do you deal with the scenario?

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Do not do anything, because it is not much of a concern

 

Discuss the case with a colleague

Report this to your supervisor

Make a decision not to intervene – it will be dealt with by management

 

Correct answer

Report this to your supervisor

 

You are nurse at the community care centre and an elderly complaints to you that his neighbour is stealing money from him. He sends him for shopping and sometimes the neighbour does not shop and keeps the money with him. You will:

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Confront the neighbour when he visits you next time

 

Remain quite and ignore the complaint

Request the elderly to talk to the hospital chaplin for further assisitance

Raise a complaint in the incident report form and investigate the matter and inform the concerned

 

Correct answer

Raise a complaint in the incident report form and investigate the matter and inform the concerned

 

An 86-year-old male with senile dementia has been physically abused and neglected for the past two years by his live in caregiver. He has since moved and is living with his son and daughter-in-law. Which response by the client’s son would cause the nurse great concern?

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"How can we obtain reliable help to assist us in taking care of Dad? We can’t do it alone"

"Dad used to beat us kids all the time I wonder if he remembered that when it happened to him?"

"I’m not sure how to deal with Dad’s constant repetition of words"

 

"I plan to ask my sister and brother to help my wife and me with Dad on the weekends"

 

Correct answer

"Dad used to beat us kids all the time I wonder if he remembered that when it happened to him?"

 

An adult has just returned to the unit from surgery. The nurse transferred him to his bed but did not put up the side rails. The client fell and was injured. What kind of liability does the nurse have?

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None

Negligence

Intentional tort

 

Assault and battery

 

Correct answer

Negligence

 

An elderly client with dementia is cared by his daughter. The daughter locks him in a room to keep him safe when she goes out to work and not considering any other options. As a nurse what is your action?

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Explain this is a restrain Urgently call for a safe guarding and arrange a multi-disciplinary team conference

Do nothing as this is the best way of keeping him safe

 

Call police, social services to remove client immediately and refer to safeguarding

Explain this is a restrain and discuss other possible options

 

Correct answer

Explain this is a restrain Urgently call for a safe guarding and arrange a multi-disciplinary team conference

 

A Chinese woman has been admitted with fracture of wrist. When you are helping her undress, you notice some bruises on her back and abdomen of different ages. You want to talk to her and what is your action

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Ask her husband about the bruises

Ask her son/ daughter to translate

Arrange for interpreter to ask questions in private

Do not carry any assessment and document this is not possible as the client cannot speak English

 

Correct answer

Arrange for interpreter to ask questions in private

 

A nurse is not allowing the client to go to bed without finishing her meal. What is your action as a RN?

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Do nothing as client has to finish her meal which is important for her health

Challenge the situation immediately as this is related to dignity of the patient and raise your concern

Do nothing as patient is not under your care

 

Wait until the situation is over and speak to the client on what she wants to do

 

Correct answer

Challenge the situation immediately as this is related to dignity of the patient and raise your concern

 

In a GP clinic when you assessing a pregnant lady you observe some bruises on her hand. When you asked her about this she remains silent. What is your action?

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Call her husband to know what is happening

 

Tell her that you are concerned of her welfare and you may need to share this information appropriately with the people who offer help

Do nothing as she does not want to speak anything

Call the police

 

 

 

Correct answer

Tell her that you are concerned of her welfare and you may need to share this information appropriately with the people who offer help

 

You just joined in a new hospital. You see a senior nurse beating a child with learning disability. Your role:

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Neglect the situation as you are new to the scenario

 

Intervene at the spot, speak directly to the senior in a non-confronting manner, and report to management in writing

Inform the ward in-charge after the shift

 

Correct answer

Intervene at the spot, speak directly to the senior in a non-confronting manner, and report to management in writing

 

A nurse notices a thin emaciated child among the family members of a patient. The child is weak and withdrawn. When nurse offers some food to child, mother says do not give as he eats too much. Nurses response:

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Mother needs to take care of her child So neglect the situation

Ask family members about child abuse

 

Call the local police for help

Inform the manager about suspected child neglect and seek support

 

Correct answer

Inform the manager about suspected child neglect and seek support

 

The nurse restrains a client in a client in a locked room for 3 hours until the client acknowledge who started a fight in the group room last evening. The nurse’s behaviour constitutes:

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False imprisonment

Duty of care

Standard of care practice

 

Contract of care

 

Correct answer

False imprisonment

 

A client requests you that he wants to go home against medical advice, what should you do?

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Inform the management

Inform the local police

 

Call the security guard

Allow the client to go home as he won't pose any threat to self or others

 

Correct answer

Inform the management

 

A patient with Leukaemia was about to receive a transfusion of blood platelets. The experiences nurse on duty in the ward noticed small clumps visible in the platelet pack and questions whether the transfusion should proceed. What should the nurse do?

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Proceed with platelet transfusion and monitor for signs of rejection

 

Withhold platelet transfusion and document it on the patient’s chart

Ring the blood bank and enquire about the platelet pack received

All of the above

 

Correct answer

Ring the blood bank and enquire about the platelet pack received

 

You walk onto one of the bay on your ward and noticed a colleague wrongly using a hoist in transferring their patient. As a nurse you will:

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Let them continue with their work as you are not in charge of that bay

 

Report the event to the unit manager

Call the manual handling specialist nurse for training

Inform the relatives of the mistake

 

Correct answer

Report the event to the unit manager

 

A patient has just returned from theatre following surgery on their left arm. They have a PCA infusion connected and from the admission, you remember that they have poor dexterity with their right hand. They are currently pain free. What actions would you take?

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Educate the patient's family to push the button when the patient asks for it

 

Encourage them to tell the nursing staff when they leave the ward so that staff can take over

 

Routinely offer the patient a bolus and document this clearly

 

Contact the pain team/anaesthetist to discuss the situation and suggest that the means of delivery are changed

 

The patient has paracetamol qds written up, so this should be adequate pain relief

 

Correct answer

Contact the pain team/anaesthetist to discuss the situation and suggest that the means of delivery are changed

 

One busy day on your shift, a manager told you that all washes should be done by 10am. What would you do?

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Follow the manager and ensure that everything is done on time

Talk to the manager and tell her that the quality of care will be compromised if washes are rushed

Ignore the manager and just continue with what you are doing

 

Provide a written statement of the incident

 

Correct answer

Talk to the manager and tell her that the quality of care will be compromised if washes are rushed

 

The nurse-in-charge or Head nurse wanted to follow a task-oriented model of care. She wanted everything to be done before 10 am. How will you best approach the situation?

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Tell other nurses to follow

 

Inform the patient about the goal

Discuss to her that this has a negative impact on meeting patient care and outcomes

Disregard her method and do it your way

 

Correct answer

Discuss to her that this has a negative impact on meeting patient care and outcomes

 

A patient needs weighing, as he is due to a drug that is calculated on body weight. He is experiences a lot of pain on movement so is reluctant to move, particularly stand up. What would you do?

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Discuss the case with your colleagues and agree to guess his body weight until he agrees to stand and use the chair scales

 

Omit the drugs as it is not safe to give it without this information; inform the doctor and document your actions

 

Offer the patient pain relief and either use bed scales or a hoist with scales built in

 

Document clearly in the patient's notes that a weight cannot be obtained

 

Correct answer

Offer the patient pain relief and either use bed scales or a hoist with scales built in

 

A registered nurse identifies a care assistant not washing hands hand before caring an immunocompromised client. Your response?

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Let her do the procedure Correct her later

Inform to ward in charge

 

Interrupt the procedure, correct her politely, teach her 6 steps of handwashing and make sure she became competent

 

Correct answer

Interrupt the procedure, correct her politely, teach her 6 steps of handwashing and make sure she became competent

 

Mr Cross informed you of how upset he was when you commented on his diabetic foot during your regular home visit. He is considering to see another tissue viability nurse. How will you best respond to him?

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Apologise for the comments made

Tell him of his overreaction

Explain that his condition will make him over-sensitive to a lot of things

 

Apologise and tell him to deal with the event lightly

 

Correct answer

Apologise for the comments made

 

A patient has expressed a value which you do not share and this has upset you. What do you do?

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Refuse to take care of the patient

 

Care for the patient as it is in your professional code to care for a person of different values

Report to the ward manager the difference in values, seek support and see how you can learn from the situation

 

Correct answer

Report to the ward manager the difference in values, seek support and see how you can learn from the situation

 

A doctor is about to apply oxygen therapy to patient via nasal cannula at 2L per minute when he was called on an emergency and he gave the task to you. However you are not trained. What should you do?

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Inform your supervisor that the doctor left you to do

Apply the cannula since you have seen it done before

Do not give because you’re not trained and assessed as competent

Have a friend help you apply it

 

Correct answer

Inform your supervisor that the doctor left you to do

 

The doctor is about to insert an IV cannula when he was called to assist in an emergency. The nurse is not experienced in peripheral cannulation. What should the nurse do?

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Inform the supervisor that the doctor left you to do it

Apply the canula since you have seen it done before

 

Do not give because you’re not trained and assessed as competent

Have a friend help you apply it

 

Correct answer

Inform the supervisor that the doctor left you to do it

 

A patient in your care knocks their head on the bedside locker when reaching down to pick up something they have dropped. What do you do?

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Let the patient’s relatives know so that they don’t make a complaint and write an incident report for yourself so you remember the details in case there are problems in the future

 

Help the patient to a safe comfortable position, commence neurological observations and ask the patient’s doctor to come and review them, checking the injury isn’t serious When this has taken place, write up what happened and any future care in the nursing notes

Discuss the incident with the nurse in charge, and contact your union representative in case you get into trouble

 

Help the patient to a safe comfortable position, take a set of observations and report the incident to the nurse in charge who may call a doctor Complete an incident form At an appropriate time, discuss the incident with the patient and, if they wish, their relatives

 

Correct answer

Help the patient to a safe comfortable position, take a set of observations and report the incident to the nurse in charge who may call a doctor Complete an incident form At an appropriate time, discuss the incident with the patient and, if they wish, their relatives

 

A carer has reported that she has seen a resident fall off his bed. What initial assessment should be done?

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Check the patient’s Early Warning Score along with the Glasgow Coma Scale immediately

 

Ask the patient if he is in pain; if so, administer painkillers immediately

 

Dial 999 and request for an ambulance to take your patient to the hospital

 

Contact the out-of-hours GP and request for a home visit

 

Correct answer

Check the patient’s Early Warning Score along with the Glasgow Coma Scale immediately

 

The nurse sat an older man on the toilet in a six-bed hospital bay. Using her judgement, she recognised that he was at risk of falling and so left the toilet door ajar. In the meantime, the nurse went to make his bed on the other side of the bay. On turning around, she noticed that the patient had fallen onto the toilet floor. What should be her initial intervention?

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Immobilise the patient and conduct a thorough assessment, checking for injuries

Call for help immediately

Press the emergency call button immediately

 

Check the patient for injuries and transfer him to the wheelchair

 

Correct answer

Immobilise the patient and conduct a thorough assessment, checking for injuries

 

Mr Z called for your assistance and wanted you to sit with him for a bit. He has disclosed confidential information about his personal life. Which of the following should you urgently deal with?

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History of gall stones

Presence of pacemaker

Suicidal connotations

 

Loss of appetite due to depression

 

A nurse is not trained to do the procedure of IV cannulation , still she tries to do the procedure. You are the colleague of this nurse. What will be your action?

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You should tell that nurse to not to do this again

You should report the incident to someone in authority

 

You must threaten the nurse, that you will report this to the authority

You should ignore her act

 

Bystander informs you that the patient is in severe pain. Your response:

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Tell him that he would come as soon as possible

Record in the chart and inform doc and in charge

Tell that she would give the next dose of analgesic when it’s time

 

Go instantly to the patient and assess the condition

 

Correct answer

Go instantly to the patient and assess the condition

 

Barbara was screaming in pain later in the day despite the PCA in-situ. You refer back to your nurse in charge for a stronger pain killer. She refused to call the doctor because her pain relief was reassessed earlier. What will you do next?

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Continue to refer back to her until she calls the doctor

Encourage Barbara to continuously use the PCA

Give Barbara some sedatives to keep her calm

Wait until her pain stops

 

Correct answer

Encourage Barbara to continuously use the PCA

 

The nurse needs to validate which of the following statements pertaining to an assigned client?

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The client has a hard, raised, red lesion on his right hand

A weight of 185 lbs is recorded in the chart

 

The client reported an infected toe

The client's blood pressure is 124/70 It was 118/68 yesterday

 

Correct answer

The client reported an infected toe

 

You have admitted a post-caesarian patient on epidural analgesia. Few hours later, the pump alarmed indicating the infusion is about to finish. Upon checking, you noticed there is still about 100 mls of solution left in the bag. You will:

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Adjust the infusion rate

Check the line for the presence of air

Check prescription

Wait until the pump stops

 

Correct answer

Check the line for the presence of air

 

Mr Smith has just been certified dead by the General Practitioner. However, no arrangements have been made by the family. What should you do first?

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Check patient’s records for the next of kin details, and contact them to discuss about funeral services

 

Ring the co-operative and arrange for the undertaker to pick up Mr Smith as soon as possible

Contact the GP and discuss about how to deal with Mr Smith

Contact your manager and enquire about dealing with Mr Smith

 

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 the process. Which of the following would be most helpful to the grieving family during this difficult time?

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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 call other family members for advice

 

Correct answer

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

 

When breaking bad news over phone which of the following statement is appropriate

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I am sorry to tell you that your mother died

I am sorry to tell you that your mother has gone to heaven

I am sorry to tell you that your mother is no more

 

I am sorry to tell you that your mother passed away

 

 

 

Correct answer

I am sorry to tell you that your mother died

 

A nurse from Medical-surgical unit asked to work on the orthopedic unit. The medical-surgical nurse has no orthopedic nursing experience. Which client should be assigned to the medical-surgical nurse?

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A client with a cast for a fractured femur and who has numbness and discoloration of the toes

 

A client with balanced skeletal traction and who needs assistance with morning care

 

A client who had an above-the-knee amputation yesterday and has a temperature of 1014F

 

A client who had a total hip replacement 2 days ago and needs blood glucose monitoring

 

Correct answer

A client who had a total hip replacement 2 days ago and needs blood glucose monitoring

 

An RN from the women's health clinic is temporarily reassigned to a medical-surgical unit. Which of these client assignments would be most appropriate for this nurse?

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A newly diagnosed client with type 2 diabetes mellitus who is learning foot care

A client from a motor vehicle accident with an external fixation device on the leg

A client admitted for a barium swallow after a transient ischemic attack

A newly admitted client with a diagnosis of pancreatic cancer

 

Correct answer

A client from a motor vehicle accident with an external fixation device on the leg

 

Nurses are not using a hoist to transfer patient. They said it was not well maintained. What would you do?

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Make a written report

Complain verbally

Take a picture for evidence

Do nothing

 

Correct answer

Make a written report

 

You were on duty, and you have noticed that the syringe driver is not working properly. What should you do?

0/1

Ask someone to fix it

Report this to your supervisor immediately

Leave this for the senior staff to sort out

 

Recommend a person to repair it

 

Correct answer

Report this to your supervisor immediately

 

You noticed medical equipment not working while you joined a new team and the team members are not using it. Your role?

0/1

During audit raise your concern

Inform in written to management

Inform NMC

Take photograph

 

Correct answer

Inform in written to management

 

A nurse is preparing to deliver a food tray to a client whose religion is Jewish. The nurse checks the food on the tray and notes that the food on the tray and notes that the client has received a roast beef dinner with whole milk as a beverage. Which action will the nurse take?

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Deliver the food tray to the client

Call the dietary department and ask for a new meal tray

Replace the whole milk with fat free milk

Ask the dietary department to replace the roast beef with pork

 

Correct answer

Call the dietary department and ask for a new meal tray

 

A patient with a nutritional deficit and a MUST Score of 2 and above is of high risk. What should be done?

0/1

Refer the patient to the dietician, the Nutritional Support Team and implement local policy

Observe and document dietary intake for three days

Repeat screening weekly or monthly depending on the patient’s food intake during the last 72 hours

 

All of the above

Correct answer

Refer the patient to the dietician, the Nutritional Support Team and implement local policy

 

Mrs Hannigan has been assessed to be on nutritional deficit with a MUST Score of 1, which means that she is on medium risk. One of your interventions is to modify her diet for her to meet her nutritional needs. What should you consider?

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Mrs Hannigan’s meal preferences

Mrs Hannigan’s intake and output records

 

Mrs Hannigan’s x-ray results

A and B

B and C

 

Correct answer

A and B

 

An 82 year old lady was admitted to the hospital for assessment of her respiratory problems. She has been a long term smoker in spite of her daughter advising her to stop. Based on your assessment, she has lost a substantial amount of weight. How will you assess her nutritional status?

0/1

Check her height and weight, so you can determine her BMI, BMI Score and Nutritional Care Plan

 

Use the respiratory and perfusion assessment chart on admission

 

Check if she is struggling to chew and swallow, and make a referral to the Speech and Language Therapist

 

All of the above

 

Correct answer

Check her height and weight, so you can determine her BMI, BMI Score and Nutritional Care Plan

 

An adult patient with Nasogastric Tube died in a medical ward due to aspiration of fluids. Staff nurse on duty believes that she has flushed the tube and believed it is patent. What should not have been done?

0/1

Nothing should be introduced down the tube before gastric placement is confirmed

 

Internal guidewires should not be lubricated before gastric placement is confirmed

 

Auscultate the patient’s stomach as you push some air in, and if you cannot hear anything, flush it

 

It is important to check the position of the tube by measuring the pH value of stomach contents

 

Correct answer

Auscultate the patient’s stomach as you push some air in, and if you cannot hear anything, flush it

 

Nurse caring a confused client not taking fluids, staff on previous shift tried to make him drink but were unsuccessful. Now it is the visitors time, wife is waiting outside What to do?

0/1

Ask the wife to give him fluid, and enquire about his fluid preferences and usual drinking time

 

Tell her to wait and you need some time to make him drink

 

Inform doctor to start iv fluids to prevent dehydration

 

When doing your drug round at midday, you have noticed one of your patient coughing more frequently whilst being assisted by a nursing student at mealtime. What is your initial action at this situation?

0/1

Tell the student to feed the patient slowly to help stop coughing

Ask the student to completely stop feeding

Ask student to allow patient some sips of water to stop coughing

 

Ask student to stop feeding and assess patients swallowing

 

Correct answer

Ask student to stop feeding and assess patients swallowing

 

You are the nurse on Ward C with 14 patients. Your fellow incoming nurses called in sick and cannot come to work on your shift. What will be your best action on this situation?

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Review patient intervention, set priorities, ask the supervisor to hand over extra staff

 

Continue with your shift and delegate some responsibilities to the nursing assistant

 

Fill out an incident form about the staffing condition

 

Ask the colleague to look for someone to cover

Correct answer

Review patient intervention, set priorities, ask the supervisor to hand over extra staff

 

As the nurse on duty, you have noted that there has been an increasing number of cases of pressure sores in your nursing home. Which of the following is the best intervention?

0/1

Collaboration with the Multidisciplinary Team

Patient Advocacy

Reduce fragmentation and costs

 

Identify opportunities and develop policies to improve nursing practice

 

Correct answer

Identify opportunities and develop policies to improve nursing practice

 

One of your health care assistants came to you saying that she could not continue with her rounds due to a bad back. What will you do first?

0/1

Document the incident and report to the manager

Ring for agency staff to cover the shift

Assess your colleague’s back and administer pain killers

Send her home and cover her work yourself to help the team

 

Correct answer

Document the incident and report to the manager

 

The hospice nurse has been working for two weeks without a day off. During this time, she has been present at the deaths of seven of her clients. Which of the following might be beneficial for this nurse?

0/1

Nothing

 

Provide her with an assistant

 

Suggest she take a few days off

 

Assign her to clients that aren't going to die for awhile

 

Correct answer

Suggest she take a few days off

 

A patient with complex, multiple diseases is discharged to a tertiary level care unit what to do?

0/1

Inform the tertiary unit about patient arrival

 

Call for a multidisciplinary meeting with professional who took care of patient to discuss the patient care modalities that everyone accepts

 

Inform to patient relatives about the situation

 

Correct answer

Call for a multidisciplinary meeting with professional who took care of patient to discuss the patient care modalities that everyone accepts

 

You were the nurse on duty and it’s time to take your patient’s vital signs. Upon checking, you noted that the patient was given Digoxin and now has a heart rate of 50 BPM. What will you do with the next dose of Digoxin?

0/1

Omit then document

Omit then double the next dose; document

Administer then document

Administer then recheck VS

 

Correct answer

Omit then document

 

Mr James, a patient in the community phoned you asking for advise as he is experiencing some side effects of the medications he was given. What will be your best action on this situation?

0/1

Call the doctor and wait for advice

Tell the patient to stop taking the drug

 

Attend to the patient and make necessary intervention for the side effect

Ask the patient to call the emergency service/ambulance

 

Correct answer

Attend to the patient and make necessary intervention for the side effect

 

After having done your medication round, you have realised that your patient has experienced the adverse effect of the drug. What will be your initial intervention?

1/1

You must do the physical observations and notify the General practitioner

 

You must ring the General Practitioner and request for a home visit

You must administer medication from the Homely Remedy Pod after having spoken to the General Practitioner

You must observe your patient until the General Practitioner arrives at your nursing home

 

Cherry has been prescribed with Estradiol tablet to be inserted twice a week at night. You entered her bedroom and noticed she is fast asleep. What would you do?

0/1

Try to gently wake her up and insert her vaginal tablets

 

Allow her to get some sleep and try to insert the vaginal tablet on your next turn rounds

 

Speak to her and ask her to spread her legs, so you can insert her vaginal tablet

 

Document that the tablet cannot be administered at all because the patient has refused

 

The MARS says that Benedict is on TID Macrogol. You have notice that the nurses have been writing “A” for refused. What do you do?

0/1

Write “A” on the MARS, because Benedict is expected to refuse it

Offer the Macrogol, and write “A” if the patient refuses it

Check bowel charts and cancel Macrogol on MARS if bowels are fine

Change the prescription to PRN

 

Correct answer

Offer the Macrogol, and write “A” if the patient refuses it

 

Maria has ran out of Cavilon Cream. You have noted that her groins are very red and sore. You can see that David has spare Cavilon tubes after checking the stocks. What will you do?

0/1

Borrow a tube from David’s stock as Maria’s groins are red and sore

Use Canesten for now and apply Cavilon once stock has arrived

 

Request for a repeat prescription from the GP, and have the stock delivered by the chemist

Ring the GP and ask him to see Maria’s groins, then prescribe Cavilon

 

Correct answer

Request for a repeat prescription from the GP, and have the stock delivered by the chemist

 

An antihypertensive medication has been prescribed for a client with hypertension. The client tells the clinic nurse that they would like to take a 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

 

You are about to administer Morphine Sulphate to a paediatric patient. The information written on the control drug book was not clearly written – 15 mg or 0.15 mg. What will you do first?

0/1

Not administer the drug, and wait for the General Practitioner to do his rounds

 

Administer 015 mg, because 15 mg is quite a big dose for a paediatric patient

 

Double check the medication label and the information on the controlled drug book; ring the chemist the verify the dosage

 

Ask a senior staff to read the medication label for you

 

Correct answer

Double check the medication label and the information on the controlled drug book; ring the chemist the verify the dosage

 

Which of the following client should the nurse deal with first

0/1

A client who needs to be suctioned

A client who needs her dressing changed

A client who needs to be medicated for incisional pain

A client who is incontinent and needs to be cleaned

 

Correct answer

A client who needs to be suctioned

 

In a nursing and residential home setting, how will you manage your time and prioritise patients’ needs whilst doing your medication rounds in the morning?

0/1

Start administering medications from the patient nearest to the treatment room

 

Start administering medications to patients who are in the dining room, as this is where most of them are for breakfast

 

Check the list of patients and identify the ones who have Diabetes Mellitus and Parkinson’s disease

All of the above

 

Correct answer

Check the list of patients and identify the ones who have Diabetes Mellitus and Parkinson’s disease

 

There has been a bomb threat at the medical centre. The emergency response team informs the staff that the threat is legitimate and that service users should start being evacuated. Which of the following should you do?

1/1

Ambulatory Patients

 

Bedridden Patients

ITU Patients

Infants

 

The nurse is preparing to make rounds. Which client should be seen first?

0/1

1 year old with hand and foot syndrome

69 year old with congestive heart failure

40 year old resolving pancreatitis

56 year old with Cushing’s disease

 

Correct answer

69 year old with congestive heart failure

 

The client at greatest risk for postoperative wound infection is:

0/1

A 3-month-old infant postoperative from pyloric stenosis repair

A 78-year-old postoperative from inguinal hernia repair

An 18-year-old drug user postoperative from removal of a bullet in the leg

A 32-year-old diabetic postoperative from an appendectomy

 

Correct answer

An 18-year-old drug user postoperative from removal of a bullet in the leg

 

While assisting a client from bed to chair, the nurse observes that the client looks pale and is beginning to perspire heavily. The nurse would then do which of the following activities as a reassessment?

0/1

Help client into the chair but more quickly

 

Document client’s vital signs taken just prior to moving the client

Help client back to bed immediately

Observe clients skin color and take another set of vital signs

 

Correct answer

Observe clients skin color and take another set of vital signs

 

A resident is due for discharge from your nursing home. You have been his keyworker for the last five years, and his family has been appreciative of the care you have provided. One of the relatives has offered you cash in an envelope after saying goodbye. What should you do?

0/1

Say thank you, but refuse the offer politely

Say thank you and accept the offer

Accept the offer, and share it to your colleagues

 

Accept the offer and keep it to yourself

 

Correct answer

Say thank you, but refuse the offer politely

 

One of your patient was pleased with the standard of care you have provided him. As a gesture, he is giving you a £50 voucher to spend. What is your most appropriate action on this situation?

1/1

Accept the voucher and thank him for this gesture

Refuse the voucher and thank him for this gesture

 

Accept the voucher and give it to ward manager

Refuse the voucher and inform the ward manager for his gesture

 

A young adult is being treated for second and third degree burns over 25% of his body and is now ready for discharge. The nurse evaluates his understanding of discharge instructions relating to wound care and is satisfied that he is prepared for home care when he makes which statement?

0/1

“I will need to take sponge baths at home to avoid exposing the wounds to unsterile bath water.”

“If any healed areas break open I should first cover them with a sterile dressing and then report it.”

“I must wear my Jobst elastic garment all day and can only remove it when I’m going to bed.”

“I can expect occasional periods of low-grade fever and can take Tylenol every 4 hours.”

 

Correct answer

“If any healed areas break open I should first cover them with a sterile dressing and then report it.” 

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