Question 1

The licensed practical nurse (LPN) with 20 years of experience approaches the new graduate registered nurse (RN) during orientation. The LPN states, "The only difference between you and me is the size of our paychecks." What would be the best response for the new graduate RN to make initially?

Accepted Answer

Team building involves recognizing that everyone has personal strengths and specific skill sets that together can be used to provide quality client care. The new graduate should recognize the contributions of the LPN and give respect to the LPN rather than initially be confrontational. Emphasizing common goals, such as safe, quality client care, is usually more effective than debating personnel qualifications. (Option A) The LPN knows that the RN is the manager. This response might have been appropriate if the LPN had refused a direct delegation or showed some other disregard of the RN's team management. The RN should focus on the value the RN has for the LPN. (Option B) The LPN knows that the RN has more education. The real need is not to clarify educational preparation. The RN must focus on the common good rather than argue. The LPN could be making this statement due to feeling threatened, disrespected, or underappreciated. Demonstrating respect and willingness to use the LPN's strengths is more effective in team building. (Option C) The LPN knows that they have different scopes of practice. This response might have been appropriate if the RN had found the LPN doing something outside of the LPN's legal scope of practice. The RN needs to focus on the common good rather than reemphasize the obvious. Educational objective: When initially confronted by other team members about qualifications or experience, the RN should emphasize the common goal of working toward safe, quality client care.

Question 2

The charge nurse on the orthopedic unit has 4 semiprivate room beds available.  Which room should the nurse assign to a client being transferred from the post anesthesia recovery unit following a total knee replacement?

Accepted Answer

A client who is postoperative total knee replacement is at risk for infection. No postoperative client should be assigned to a room with a client who has an actual infection or the potential for infection. This client should be assigned to room 4 as the client with the cast has the lowest potential risk for infection (Option D). (Option A) This client has erythema at the pin sites; this can be a sign of infection, a complication of skeletal traction. (Option B) This client has cellulitis, a bacterial infection of the skin, and osteomyelitis, an infection of the bone. (Option C) This client has a fasciotomy wound, which is usually kept open for several days to relieve the pressure in the myofascial compartment. This client is a potential source of infection and is susceptible to infection as well. Educational objective: A client who is postoperative total knee replacement is at increased risk for infection. This client should not be assigned to a room with a client who has an actual (eg, cellulitis, osteomyelitis) or potential (eg, skeletal traction, fasciotomy) infection.

Question 3

The nurse is caring for a client with chronic pain who just had surgery and is receiving patient-controlled analgesia (PCA) morphine.  The client is in severe pain, with a rating of 10/10, despite receiving the maximum ordered dose.  The nurse calls the health care provider, saying that the client is still having pain and recommending a higher PCA dose.  Which nursing role is being implemented in this situation?

Accepted Answer

The role of the nurse as advocate is to protect the rights of the client, including the right to adequate pain control. The nurse acting as advocate speaks up for clients when they cannot easily speak for themselves. (Option B) In the role of caregiver, the nurse promotes healing and well-being by helping the client and family set and achieve goals through the nursing process. (Option C) In the role of educator, the nurse helps the client and family learn about topics relevant to their health. (Option D) In the role of manager, the nurse coordinates the care of the client among different members of the interdisciplinary team and across care settings. Educational objective: An important nursing role is client advocacy, which involves speaking up for clients to protect their rights and improve their health outcomes and experiences.

Question 4

The nurse is caring for a client who is participating in a research study (randomized controlled trial) of a new medication.  Which statement indicates that the client has an appropriate understanding of the study and reason for participation?

Accepted Answer

Research with human subjects is reviewed by institutional research boards to ensure ethical principles are followed. The research participant cannot be deceived and must participate voluntarily knowing the risks and purpose of the study; confidentiality must be maintained. Clients in research studies often have altruistic motives. They know they may achieve no personal gain, but others could benefit from their participation. (Option A) A basic tenet of any research study is that the client has the right to autonomy and to withdraw at any time. (Option C) All clients should receive safe, quality care whether they participate in the study or not. Due to randomization, the client has no guarantee of receiving a medication that is more effective rather than the placebo. This misconception should be clarified. (Option D) Clients should not be coerced in any way, including withdrawal of approval or affection. The client may have misperceived the HCP's potential response, but this stated reason for participation needs further exploration. Educational objective: Quantitative research studies involving humans must use ethical principles, including that the client cannot be coerced into participation and has the right to withdraw at any time.

Question 5

A client is being discharged with plans to return home alone. The client cannot get up from a chair without help and is very unsteady when standing, even with a walker. The nurse expresses concern, but the primary health care provider is adamant that the client be discharged today. Which team member would be most appropriate to assist the nurse in advocating for this client?

Accepted Answer

The case manager and social worker on the interdisciplinary team have expertise in discharge planning and health care finance. They can assess the adequacy of the discharge setting and support systems, arrange for resources at home, or discharge to an alternate setting, such as a rehabilitation facility. They can also help advocate for safe, effective discharge planning. (Option A) The clinical psychologist's role is to assess the client's psychological issues and assist with counseling and coping strategies. (Option B) The occupational therapist promotes development of the client's fine motor skills and ability to carry out activities of daily living. (Option C) Although the role of the physical therapist is to assist the client with mobility issues, the nurse needs someone who can advocate for this client and assist with appropriate discharge arrangements to promote safety. Educational objective: The nurse concerned about client safety at discharge should advocate for the client. Other interdisciplinary team members, such as the case manager or social worker, should be brought in to advocate for the client and explore alternate discharge resources or settings.

Question 6

A young Spanish-speaking client is experiencing a spontaneous abortion (miscarriage). Which illustrates the best use of an interpreter to explain the situation to the client? Select all that apply.

Accepted Answer

Clients from many cultures will be more responsive if the interpreter is the same gender, especially when the condition is highly personal or sensitive (Option B). The nurse should maintain good eye contact when communicating with the client. The interpreter should translate the client's words literally. Communication is with the client, not the interpreter. The nurse should use basic English rather than medical terms, speak slowly, and pause after 1-2 sentences to allow for translation (Option C). Providing simple instructions about upcoming actions in the order they will occur will be easier for the client to understand. For example, the nurse can indicate that there will be surgery and then a follow-up visit as opposed to, "You'll follow up with the health care provider after your procedure" (Option E). (Option A) The nurse should obtain feedback to be certain that the client understands. This feedback should extend beyond nodding as some people nod to indicate that they are listening or nod in agreement to "save face" even though they do not understand. It is better to use a tactic such as having the client repeat back information (which is then translated into English). (Option D) Using a fee-based agency or language line is preferred if an appropriate bilingual employee is not available. The client may not want the friend/relative to know about this personal situation, or the person may not be able to adequately translate medical concepts and/or understand client rights. Educational objective: When an interpreter is needed, the nurse should attempt to use a trained, proficient, same-sex individual rather than a family member or personal friend. The nurse should speak slowly and directly to the client, not the interpreter; provide information in the sequence it will occur; and obtain feedback of comprehension beyond merely nodding.

Question 7

A charge nurse suspects that the unlicensed assistive personnel (UAP) is falsifying the documentation of clients' capillary glucose results rather than performing the test. What is the best action by the charge nurse to handle this situation?

Accepted Answer

The best initial result is to assess and validate the charge nurse's perception. Doing the test and comparing results randomly/intermittently will give data to prove/disprove this concern. (Option A) It could cause concern to involve a client when there may be an issue about inadequate provider care. The nurse should handle it independently. (Option B) It is good to reinforce policies in general announcements to the entire staff, especially if wide-spread compliance is a concern. However, there is only one person that is suspected of not adhering in this case. Speaking out is often a general step taken, but the intended individuals usually don't hear the information. In addition, this is information that the staff has known/heard before. (Option C) The normal discipline process is a verbal warning, a written warning, suspension, and termination. To initiate the process, there has to be evidence of wrong doing. However, it is only a suspicion at this point. Educational objective: When deliberate inaccurate documentation is suspected, gather evidence before confronting the staff member. One way of doing this is by checking the data personally and comparing it to what has been documented.

Question 8

Which client event would be considered an adverse event and would require completion of an incident/event/irregular occurrence/variance report? Select all that apply.

Accepted Answer

Adverse event is an injury to a client caused by medical management rather than a client's underlying condition. It may or may not be preventable. The Institute of Medicine (2000) recognizes 4 types of errors. They are: Diagnostic (delay in diagnosis, failure to employ indicated tests, failure to act on results of monitoring) Treatment (error in performance of procedure, treatment, dose; avoidable delay) Preventive (failure to provide prophylactic treatment, inadequate follow-up/monitoring of treatment) Other (failure of communication, equipment failure, system failure) Option D is a fall, although the mechanism probably results in a lesser chance of serious injury. The risk fall assessment should be adjusted. Option E is an avoidable delay in application of a test, which will affect timely diagnosis. The nurse should advocate for a more timely completion of the test. Option B is a failure to provide appropriate treatment and has a direct correlation for worsening cellulitis. (Option A) Failure to complete an ideal nursing care plan is not an adverse event. Hospitals have policies that allow medications to be given within a range (usually 30-60 minutes) of the due time. It could be an issue if the treatment was significantly out of the time range or omitted completely. (Option C) The client's seizure is most likely related to an underlying condition rather than a medical management error. Educational objective: Adverse events cause injury that is related to medical management, not the client's underlying condition. Identified areas are diagnostic, treatment, preventive or failure of communication, and equipment or other systems. Adverse events include falls, unreasonable delay in diagnostic tests, and failure to provide a prescribed treatment.

Question 9

The charge nurse on the cardiac floor is orienting a new graduate nurse. The charge nurse describes various roles of the interdisciplinary team. In which situations would the nurse "case manager" be consulted? Select all that apply.

Accepted Answer

Case management involves assessing, planning, facilitating, and advocating for client health services to accomplish cost-effective quality client outcomes. This is done through communication and use of available resources. A professional nurse often serves in the case manager role. The case manager in the hospital setting assesses client needs, decreases fragmentation of care (Option B), helps to coordinate care and communication between HCPs (Option A), makes referrals, ensures quality standards are being met, and arranges for home health or placement after discharge (Option D). (Option C) Case managers typically do not provide direct client care. Medication reconciliation should be done between the primary nurse directly caring for the client and the HCP. (Option E) Case managers often make daily rounds to the nursing department to review documentation in the client's chart but do not necessarily visit the client personally. Educational objective: The nurse providing direct client care should be familiar with the nurse case manager role as part of the interdisciplinary team. The goal of the nurse case manager is to facilitate provision of quality care across a continuum, decrease fragmentation of care across various settings, and contain costs.

Question 10

The health care provider (HCP) explains the risks and benefits of a procedure to the client through an interpreter.  The HCP leaves after asking the nurse to witness the client's signature on the consent.  The interpreter and client now have a lengthy discussion in the foreign language.  The nurse should take which action at this time?

Accepted Answer

An interpreter's job is to literally translate the words/concepts spoken (as much as possible). The role does not include personally editorializing or embellishing with advice beyond what the health care provider (HCP) said. It is important to find out if there was any discussion related to the procedure or if the follow-up conversation was about other topics (eg, social). The nurse needs to obtain feedback to be certain that the client understands about the procedure and had no additional questions that the interpreter personally answered. The nurse can ask the client additional questions using this interpreter or use a different interpreter/a language line. After the nurse is satisfied that no additional information was provided and the client understands what the client is signing, the nurse (as the hospital employee) should then witness the signature. The nurse should indicate that an interpreter was used in the process. (Option B) Gestures/pantomime may be adequate for basic actions, such as obtaining a blood pressure. In this case, there is specific information that must be clear and should be communicated with interpretation. Federal law requires accommodations for people with limited English proficiency. The Joint Commission indicates that clients' rights include translation. (Option C) Clarifying the content of the conversation is the priority. The nurse (as an employee of the hospital) should be the witness whenever the signature is obtained. However, the name and the contact information of the interpreter should be documented. (Option D) The consent should not be signed until it is clearly established that no additional information/advice was given by or asked of the interpreter after the HCP left. Educational objective: An interpreter should only provide literal translation of the words spoken by the HCP, not adding any personal advice/information. The nurse should clarify if there is any question about the accuracy or content of the translation and ensure the client's concerns have been addressed prior to obtaining the signature on the consent.

Question 11

The nurse enters a client's room just as the unlicensed assistive personnel (UAP) is completing a bath and placing thigh-high anti-embolism stockings on the client.  Which situation would cause the nurse to intervene?

Accepted Answer

11ecbb05_cbb1_a44b_b433_13b19c8084a5_MD0009_00 Anti-embolism stockings are part of venous thromboembolism (VTE) prophylaxis in hospitalized clients. Anti-embolism stockings improve blood circulation in the leg veins by applying graduated compression. When fitted properly and worn consistently, the stockings decrease VTE risk. The stockings should not be rolled down, folded down, cut, or altered in any way. If stockings are not fitted and worn correctly, venous return can actually be impeded. (Option A) Anti-embolism stockings should be applied before ambulating while the client is in bed; this maximizes the compression effects of the stockings and promotes venous return. The UAP has performed this correctly. (Option B) Wrinkles should be smoothed out to avoid impeding venous return. The UAP has performed this correctly. (Option C) The toe opening should be located on the plantar side of the foot/under the toes. The UAP has performed this correctly. Educational objective: Anti-embolism stockings are worn by clients as part of VTE prophylaxis. It is important that the nurse verifies the stockings are correctly fitted and worn appropriately. Incorrect size and fit or alterations to the stockings can impede venous return.

Question 12

During the shift report, the night charge nurse tells the day charge nurse that the night unlicensed assistive personnel (UAP) is totally incompetent. What is the best response for the day charge nurse to give?

Accepted Answer

Incompetency is a concern for client safety and quality care. The nurse manager is responsible for hiring/firing and setting up additional training times or experiences for staff. The situation should be discussed with the person who has 24/7 responsibility for the unit so that an appropriate response can be given to the night nurse's perceptions (Option D). (Option A) The night nurse can provide task-specific instructions/training, but incompetence implies a global dysfunction beyond minor, on-the-job, intermittent instructions. In addition, other factors could be involved that may be influencing the UAP's behavior, such as personal issues or impairment from substance abuse. It is best to discuss this situation with a higher authority to determine the best approach. (Option B) This response is something the night nurse knows. The need is to decide the next action. The scope of this problem is probably beyond the night nurse's responsibility and authority. (Option C) This response may be true. However, the bottom line is finding out if the UAP's performance is of adequate quality and safe for clients. The amount of effort that the caregiver is expending is not the bottom line. Educational objective: When a caregiver's performance is below the standard of care needed to provide safe and quality care to clients, the appropriate authority should be notified so that the situation can be handled.

Question 13

The nurse is caring for a 5-year-old client who is dehydrated and malnourished, and suspects that the client may be neglected.  Which information most strongly supports the nurse's suspicion of child neglect?

Accepted Answer

Child neglect occurs when a caregiver purposely withholds or does not adequately provide necessary resources to fulfill the basic needs of a child (eg, adequate nutrition, security, hygiene). Supervisory neglect, leaving children without adequate guardianship to ensure safety, is one form of child neglect (Option D). Children age <12 lack formal operational reasoning and cannot anticipate safety risks or respond appropriately to emergencies, and should therefore not be left to supervise other children. It is a priority for the nurse to intervene, as this is an unsafe situation for the young children. The nurse, or social services, should report the situation to an appropriate government child protective service and/or law enforcement. (Option A) Potential job loss indicates that the parent may be overwhelmed. The nurse should alert a social worker about the situation at a later time to discuss potential assistance. (Option B) Transitioning to the role of a single parent can present mental and financial stressors, possibly requiring assistance from a social worker. However, this does not require immediate intervention. (Option C) A parent stealing food may warrant calling the police or security, but the children's safety is a priority requiring immediate action. Educational objective: Supervisory neglect (eg, leaving a young child to supervise other children) is a type of child neglect and represents an immediate risk to the safety of younger children. The nurse should ensure that the children are safe and report the child neglect incident to social services, the appropriate child protective service, and/or law enforcement.

Question 14

Which statements involve acceptable use of an abbreviation, symbol, or dose designation in documentation? Select all that apply.

Accepted Answer

The Joint Commission (2004) and Institute for Safe Medication Practices prohibit error-prone or "dangerous" abbreviations, descriptions of symptoms, and dose designations in medical documentation. "Cm" (centimeters) and "II" (2) (eg, decubitus staging) are acceptable abbreviations/notations (Option A). The abbreviations "ac" (before meals), "pc" (after meals), and "c/o" (complains of) are acceptable (Option D). "QID" (4 times a day) is acceptable. Abbreviations that are not acceptable include "qd" (daily) and "q1d" (daily), which can be mistaken for "qid" (4 times a day), and "qod" (every other day), which can be mistaken for "qd" (daily) (Option E). (Option B) A trailing zero after the decimal point is not acceptable as it could be interpreted as 40 instead of 4 if the decimal point is not noted. The use of "u" for unit is not acceptable as it can be mistaken for the number 0 or 4 (eg, 4u seen as 40). "SSRI" (sliding-scale regular insulin) is not acceptable to indicate insulin as it can be mistaken for selective serotonin reuptake inhibitor. "Mg" for milligrams is acceptable. (Option C) A zero must precede the decimal dose. If the decimal point is missed, ".5" could be mistaken for 5 mg. Educational objective: Acceptable abbreviations include "ac," "pc," "QID," and "cm." Unacceptable abbreviations include "qd," "q1d," and "qod"; "SSRI" for insulin; and "u" for units. There must be a zero before a decimal dose and no trailing zero after a decimal point.

Question 15

The nurse reads a journal article about a study using a new pain management protocol for clients with terminal cancer. What should the nurse first consider in determining whether the protocol is appropriate to implement on the unit?

Accepted Answer

When evaluating research for practice changes, the nurse must first determine if there is reasonable similarity between the nurse's unit population and the study population to expect equivocal results. This should be the initial consideration to ensure that the research is appropriate for a given setting. For instance, if the nurse cares for pediatric clients with acute pain, the protocol for adult clients with terminal cancer might not translate effectively or safely to those clients. Other aspects of the study to evaluate include whether all clinically relevant outcomes were addressed, if the benefits outweigh any potential harm or costs, and if the protocol resulted in improved care. (Option A) An institutional review board (IRB) is a committee that reviews research before it is conducted to ensure that is it ethical. Legally, any study of human subjects needs IRB approval to provide protection from unnecessary risk. Peer-reviewed journals usually require a statement of IRB approval before accepting an article for publication. However, the IRB process does not determine whether the findings are relevant for a particular setting. (Option C) The educational credentials of a researcher may be relevant, especially if a non-health care professional has conducted a health care study. However, the integrity of the research process and findings is more important than the holding of any particular degree. (Option D) Financial support can be considered, particularly when research finds favorably for a drug or product that is manufactured or supported by a sponsor of the study. Although it is essential for a financial relationship to be disclosed, that alone does not negate the usefulness of the study. Educational objective: When seeking to apply research findings in practice, the nurse should consider the similarities between the research study population and the client population.

Question 16

The nurse is discharging a client with emphysema who is on continuous oxygen.  The case manager alerts the nurse that the home oxygen will not be delivered until 2 hours later.  What action should the nurse take?

Accepted Answer

The nurse (with the case manager) needs to assure that the client has the essential equipment/supplies for a smooth discharge into the home environment. The safest option is to delay discharge until that can be accomplished. (Option A) It is not appropriate to ask the client to go without the oxygen as it would mean not following the client's prescription. The client could arrive home and then require oxygen due to additional exertion. (Option C) The issue is not the client's need or the prescription but the logistics of implementation. There is no need to involve the HCP as the solution is within the nurse's abilities and control. (Option D) If the nurse sends the hospital oxygen tank home with the client, the question of how it will be returned remains. It is safer and more reasonable to delay the discharge. Educational objective: A client should not be allowed to leave until essential home supplies and equipment have been made available for a safe discharge.

Question 17

Which are appropriate examples of cost-effective care? Select all that apply.

Accepted Answer

Removing a dressing that has been on the client's skin is not a sterile procedure (unlike applying a new dressing, when sterile technique is commonly used). The gloves need to be removed and changed prior to application of a new dressing. There is no need to use the more expensive sterile gloves. The sterile glove wrapper is inside a paper package and is sterile. It can be used as a small sterile field if properly opened, with the other aspects of asepsis/sterile field observed (eg, do not get it wet, do not reach over it). (Option C) Once supplies have been in a client's room, they are "contaminated" and cannot be returned to a central source or used on other clients. They can be sent home with the client for the client's own use. (Option D) Tourniquets should be for single client use. They should not be shared as there is a risk of cross-infection, even if contamination is not visible. (Option E) Pour bottles and IV bags with sterile solutions have no preservative and must be changed every 24 hours after being accessed. After 24 hours following opening a bottle of sterile saline, the solution is considered contaminated and must be discarded, even if there is still unused solution in the container. Educational objective: Use clean, rather than sterile, gloves when removing contaminated dressings. The inside of a sterile glove wrapper is sterile. Do not return items in clients' rooms to central supplies, discard sterile solution after 24 hours, and do not reuse tourniquets between clients.

Question 18

The charge nurse on the medical surgical unit must assign a room for an immediate post-operative nephrectomy client. Which room assignment is the best option for this client?

Accepted Answer

The best option is room 4 with the client who has severe epistaxis and decreased platelet count (normal 150,000-400,000/mm³ [150-400 x 10⁹/L]) as this does not place the immediate post-operative client at increased risk for infection. (Options A, B, and C) The clients in these rooms place the postoperative client at increased risk for infection: Room 1: A client with diabetes mellitus and advanced chronic kidney disease may have infectious complications due to increased susceptibility to infection resulting from an altered immune response and decreased leukocyte function due to hyperglycemia. In addition, hemodialysis increases the risk for infection due to invasive lines and catheters. Room 2: A low CD4⁺ cell count (<500/mm³ [0.5 x 10⁹/L], normal is 500-1,200/mm³ [0.5-1.2 x 10⁹/L]) in a client with chronic HIV infection indicates disease progression. It can also indicate progression of asymptomatic early infections to more advanced symptomatic infections. Room 3: The client with cellulitis and an increased white blood cell count (>11,000/mm³ [11.0 x 10⁹/L]) has an infection. Educational objective: An immediate post-operative client should not be assigned a bed in a room with a client who is contagious or potentially infected as this poses an increased risk for infection.

Question 19

Which client does the nurse assess first after receiving morning report?

Accepted Answer

The nurse assesses the client who reports burning at the PCA IV site first. The analgesia runs through a special PCA administration set that is attached to the PCA pump. It is attached to a running IV line, which is on its own infusion pump, to flush the PCA drug through the IV line each time a dose is administered. If the IV line infiltrates the subcutaneous tissue or the catheter becomes occluded, the PCA drug can back up into the primary tubing each time a dose is administered, resulting in inadequate pain control. In addition, burning can indicate phlebitis, which causes vessel wall injury and can lead to thrombophlebitis (Option A). (Option B) The nurse will perform abdominal and pain assessments and will check the function and patency of the suction. However, this client was admitted yesterday, is stable, and does not need to be assessed first. (Option C) An irregular heart rhythm is to be expected in a client with atrial fibrillation, and a heart rate of 94/min is within the normal range (eg, 60-100/min). This client is stable and does not need to be assessed first. (Option D) Incontinence of stool in a client with dementia and C difficile is not uncommon. To provide for immediate client comfort, the nurse can delegate the task of bathing the client to the unlicensed assistive personnel. This client does not need to be assessed first. Educational objective: To prioritize care, the nurse first identifies the type of problem, associated complications, and desired outcomes. The nurse then decides which client problems and needs are most urgent and require immediate action and which can be delayed.

Question 20

Which client should the charge nurse assign to the room closest to the nurses' station?

Accepted Answer

The client with dementia and gastroenteritis presents the greatest safety risk, which includes potential for falls and fluid and electrolyte imbalance. This client should be assigned to the room closest to the nurses' station as a confused client requires frequent checks and this allows the staff to respond quickly if necessary. (Option A) The nurse will instruct the client who is deaf on the proper use of the call system. Staff should be instructed to answer this client's call light immediately. Notes to communicate that there was an immediate response to this client's call should be posted at the nurses' station as well. (Option C) Meeting the needs of a client in airborne isolation safely is not dependent on proximity of the client's room to the nurse's station. The staff should assess the client with the same frequency even if the client is in the room furthest from the nurses' station. (Option D) The client requiring frequent intravenous pain medication can rest best in a quiet location that is further away from the nurse's station. Proximity to the nurses' station does not affect the frequency of pain assessment, administration, and assessment of response to analgesia. Educational objective: When assigning rooms, the nurse should consider infection control, physical location, acuity level, and individual client safety needs. Cognitive impairment and fluid and electrolyte disturbances pose the greatest risks to a client's safety.

Exam 5: Leadership & Management

The licensed practical nurse (LPN) with 20 years of experience approaches the new graduate registered nurse (RN) during orientation. The LPN states, "The only difference between you and me is the size of our paychecks." What would be the best response for the new graduate RN to make initially?

The charge nurse on the orthopedic unit has 4 semiprivate room beds available. Which room should the nurse assign to a client being transferred from the post anesthesia recovery unit following a total knee replacement?

The nurse is caring for a client who is participating in a research study (randomized controlled trial) of a new medication. Which statement indicates that the client has an appropriate understanding of the study and reason for participation?

A young Spanish-speaking client is experiencing a spontaneous abortion (miscarriage) . Which illustrates the best use of an interpreter to explain the situation to the client? Select all that apply.

A charge nurse suspects that the unlicensed assistive personnel (UAP) is falsifying the documentation of clients' capillary glucose results rather than performing the test. What is the best action by the charge nurse to handle this situation?

Which client event would be considered an adverse event and would require completion of an incident/event/irregular occurrence/variance report? Select all that apply.

The charge nurse on the cardiac floor is orienting a new graduate nurse. The charge nurse describes various roles of the interdisciplinary team. In which situations would the nurse "case manager" be consulted? Select all that apply.

The nurse enters a client's room just as the unlicensed assistive personnel (UAP) is completing a bath and placing thigh-high anti-embolism stockings on the client. Which situation would cause the nurse to intervene?

During the shift report, the night charge nurse tells the day charge nurse that the night unlicensed assistive personnel (UAP) is totally incompetent. What is the best response for the day charge nurse to give?

The nurse is caring for a 5-year-old client who is dehydrated and malnourished, and suspects that the client may be neglected. Which information most strongly supports the nurse's suspicion of child neglect?

Which statements involve acceptable use of an abbreviation, symbol, or dose designation in documentation? Select all that apply.

The nurse reads a journal article about a study using a new pain management protocol for clients with terminal cancer. What should the nurse first consider in determining whether the protocol is appropriate to implement on the unit?

The nurse is discharging a client with emphysema who is on continuous oxygen. The case manager alerts the nurse that the home oxygen will not be delivered until 2 hours later. What action should the nurse take?

Which are appropriate examples of cost-effective care? Select all that apply.

The charge nurse on the medical surgical unit must assign a room for an immediate post-operative nephrectomy client. Which room assignment is the best option for this client?

Which client does the nurse assess first after receiving morning report?

Which client should the charge nurse assign to the room closest to the nurses' station?