LeMone & Burke's Medical-Surgical Nursing, 7e (Bauldoff/Gubrud/Carno)

Chapter 1 Medical-Surgical Nursing in the 21st Century

1) A patient is instructed on the role of diet, exercise, and medication to control type 2 diabetes mellitus. Which core competency for healthcare professionals is the nurse implementing?

1. Quality improvement

2. Evidence-based practice

3. Patient-centered care

4. Teamwork and collaboration

Page Ref: 5

Cognitive Level: Applying

Client Need & Sub: Safe and Effective Care Environment: Management of Care

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Communicate information effectively; listen openly and cooperatively | Nursing/Integrated Concepts: Nursing Process: Implementation/Teaching/Learning

Learning Outcome: 1.1 Describe the core competencies for healthcare professionals: Patient-centered care, interprofessional teams, evidence-based practice, quality improvement, safety, and health information technology.

MNL Learning Outcome: 1. Demonstrate use of the core competencies for healthcare professionals in nursing practice.

2) The nurse is planning to utilize the core competency use informatics when providing patient care. Which action should the nurse perform when using this core competency?

1. Change the sharps container in a patient's room.

2. Document the effectiveness of pain medication for a patient.

3. Discuss the effectiveness of bedside physical therapy with the therapist.

4. Search through a database of articles to find current research on wound care.

Page Ref: 5

Cognitive Level: Applying

Client Need & Sub: Safe and Effective Care Environment: Management of Care

Standards: QSEN Competencies: VI.B.2. Apply technology and information management tools to support safe processes of care | AACN Essentials Competencies: IV.1. Demonstrate skills in using patient care technologies, information systems, and communication devices that support safe nursing practice | NLN Competencies: Knowledge and Science: Practice-Know-How: Retrieve research findings and other sources of information | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 1.1 Describe the core competencies for healthcare professionals: Patient-centered care, interprofessional teams, evidence-based practice, quality improvement, safety, and health information technology.

MNL Learning Outcome: 1. Demonstrate use of the core competencies for healthcare professionals in nursing practice.

3) The nurse plans to implement evidence-based practice when providing patient care. Which activity should the nurse perform? Select all that apply.

1. Participate in education and research activities when possible.

2. Integrate research findings with clinical care to maximize patient outcomes.

3. Serve on the committee to create critical pathways for patient care.

4. Reinforce hand hygiene techniques with unlicensed assistive personnel.

5. Contact Environmental Services to report a malfunctioning infusion pump.

Page Ref: 5

Cognitive Level: Applying

Client Need & Sub: Safe and Effective Care Environment: Management of Care

Standards: QSEN Competencies: III.B.6. Participate in structuring the work environment to facilitate integration of new evidence into standards of practice | AACN Essentials Competencies: III.2. Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science; Knowledge: What is evidence-based practice (EBP)? Informatics? | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 1.1 Describe the core competencies for healthcare professionals: Patient-centered care, interprofessional teams, evidence-based practice, quality improvement, safety, and health information technology.

MNL Learning Outcome: 1. Demonstrate use of the core competencies for healthcare professionals in nursing practice.

4) The nurse is planning to meet with several community members during a health fair. Which nursing activity exemplifies the core competency patient-centered care?

1. Provide smoking cessation classes and literature.

2. Increase the hours for the healthcare providers to see patients.

3. Attend a continuing education program on clean water initiatives.

4. Evaluate the effectiveness of weight reduction strategies.

Page Ref: 5

Cognitive Level: Applying

Client Need & Sub: Safe and Effective Care Environment: Management of Care

Standards: QSEN Competencies: I.B.3. Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care | NLN Competencies: Context and Environment; Knowledge; Environmental health; health promotion/disease prevention (e.g., transmission of disease, disease patterns, epidemiological principles); chronic disease management; healthcare systems; transcultural approaches to health; family dynamics | Nursing/Integrated Concepts: Nursing Process: Planning/Teaching/Learning

Learning Outcome: 1.1 Describe the core competencies for healthcare professionals: Patient-centered care, interprofessional teams, evidence-based practice, quality improvement, safety, and health information technology.

MNL Learning Outcome: 1. Demonstrate use of the core competencies for healthcare professionals in nursing practice.

5) The nurse is instructing a patient on weight reduction and smoking cessation. Which code of nursing practice is the nurse implementing?

1. International Council of Nurses Code of Ethics for Nurses

2. American Nurses Association Standards of Professional Practice

3. American Nurses Association Code of Ethics for Nurses

4. State Board of Nursing Code

Page Ref: 12-13

Cognitive Level: Applying

Client Need & Sub: Safe and Effective Care Environment: Management of Care

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: VII.4. Use behavioral change techniques to promote health and manage illness | NLN Competencies: Context and Environment; Knowledge; Environmental health; health promotion/disease prevention | Nursing/Integrated Concepts: Nursing Process: Implementation/Teaching/Learning

Learning Outcome: 1.3 Explain the importance of nursing and interprofessional codes of ethics, standards of practice, and legal and ethical issues as guidelines for clinical nursing practice.

MNL Learning Outcome: 3. Integrate nursing and interprofessional codes of ethics, standards of practice, and legal and ethical guidelines in clinical practice.

6) The nurse is providing patient care within the American Nurses Association Standards of Professional Performance. Which activity is the nurse implementing?

1. Integrating research findings into practice

2. Implementing a patient's plan of care

3. Evaluating patient progress toward identified outcomes

4. Analyzing assessment data to determine issues

Page Ref: 13

Cognitive Level: Applying

Client Need & Sub: Safe and Effective Care Environment: Management of Care

Standards: QSEN Competencies: III.B.6. Participate in structuring the work environment to facilitate integration of new evidence into standards of practice | AACN Essentials Competencies: III.2. Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science; Knowledge; What is evidence-based practice (EBP)? Informatics? | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 1.3 Explain the importance of nursing and interprofessional codes of ethics, standards of practice, and legal and ethical issues as guidelines for clinical nursing practice.

MNL Learning Outcome: 3. Integrate nursing and interprofessional codes of ethics, standards of practice, and legal and ethical guidelines in clinical practice.

7) The nurse prescribes strategies and alternatives to assist a patient achieve expected outcomes. Within which American Nurses Association standard is the nurse practicing?

1. Planning

2. Assessment

3. Diagnosis

4. Implementation

Page Ref: 13

Cognitive Level: Applying

Client Need & Sub: Safe and Effective Care Environment: Management of Care

Standards: QSEN Competencies: I.B.3. Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essentials Competencies: IX.3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Context and Environment; Practice-Know-How; Apply professional standards | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 1.3 Explain the importance of nursing and interprofessional codes of ethics, standards of practice, and legal and ethical issues as guidelines for clinical nursing practice.

MNL Learning Outcome: 3. Integrate nursing and interprofessional codes of ethics, standards of practice, and legal and ethical guidelines in clinical practice.

8) A patient with a terminal illness is concerned about pain control. If the International Council of Nurses Code of Ethics for Nurses is followed, what should the nurse plan for the patient?

1. Measures to alleviate suffering

2. Modified activities of daily living

3. Enforcement of strict bed rest

4. Dietary interventions to maximize strength

Page Ref: 12

Cognitive Level: Applying

Client Need & Sub: Safe and Effective Care Environment: Management of Care

Standards: QSEN Competencies: I.B.7. Initiate effective treatments to relieve pain and suffering in light of patient values, preferences and expressed needs | AACN Essentials Competencies: IX.6. Implement patient and family care around resolution of end-of-life and palliative care issues, such as symptom management, support of rituals, and respect for patient and family preferences | NLN Competencies: Knowledge and Science; Practice-Know-How; Translate research into practice in order to promote quality and improve practices | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 1.3 Explain the importance of nursing and interprofessional codes of ethics, standards of practice, and legal and ethical issues as guidelines for clinical nursing practice.

MNL Learning Outcome: 3. Integrate nursing and interprofessional codes of ethics, standards of practice, and legal and ethical guidelines in clinical practice.

9) A patient is angry after waiting over an hour for pain medication. What should the nurse respond to the patient that demonstrates clinical reasoning?

1. "I understand your anger and am sorry for the delay. I have your pain medication now."

2. "I had other patients who needed my attention first, so I did a few things before getting the pain medication."

3. "I needed to find out what your medication is and if you can have more when you asked."

4. "It seems that you always ask for pain medication when I am trying to do other things."

Page Ref: 6

Cognitive Level: Applying

Client Need & Sub: Safe and Effective Care Environment: Management of Care

Standards: QSEN Competencies: I.B.7. Initiate effective treatments to relieve pain and suffering in light of patient values, preferences and expressed needs | AACN Essentials Competencies: IX.6. Implement patient and family care around resolution of end-of-life and palliative care issues, such as symptom management, support of rituals, and respect for patient and family preferences | NLN Competencies: Knowledge and Science; Practice-Know-How; Translate research into practice in order to promote quality and improve practices | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 1.2 Apply the attitudes, mental habits, and skills necessary for clinical reasoning when using the nursing process in patient care.

MNL Learning Outcome: 2. Recognize the skills necessary for clinical reasoning when using the nursing process in patient care.

10) The nurse is identifying nursing diagnoses appropriate for a patient's plan of care. What should the nurse use to determine these diagnoses?

1. Diagnostic reasoning

2. Communication techniques

3. Identified outcome criteria

4. Established priorities

Page Ref: 8

Cognitive Level: Applying

Client Need & Sub: Safe and Effective Care Environment: Management of Care

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: III.6. Integrate evidence, clinical judgment, interprofessional perspectives, and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Knowledge and Science; Practice-Know-How; Translate research into practice in order to promote quality and improve practices | Nursing/Integrated Concepts: Nursing Process: Diagnosis

Learning Outcome: 1.2 Apply the attitudes, mental habits, and skills necessary for clinical reasoning when using the nursing process in patient care.

MNL Learning Outcome: 2. Recognize the skills necessary for clinical reasoning when using the nursing process in patient care.

11) The nurse plans and implements care for a patient based on nursing knowledge and skills. In which role is the nurse functioning?

1. Caregiver

2. Advocate

3. Educator

4. Leader

Page Ref: 14

Cognitive Level: Applying

Client Need & Sub: Safe and Effective Care Environment: Management of Care

Standards: QSEN Competencies: II.B.4. Function competently within own scope of practice as a member of the healthcare team | AACN Essentials Competencies: VI.2. Use inter- and intraprofessional communication and collaborative skills to deliver evidence-based, patient-centered care | NLN Competencies: Knowledge and Science; Practice-Know-How; Translate research into practice in order to promote quality and improve practices | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 1.4 Explain the activities and characteristics of the nurse as caregiver, educator, advocate, leader and manager, and researcher.

MNL Learning Outcome: 4. Consider the various role of the nurse as in medical-surgical nursing practice.

12) A patient has questions about a required surgical procedure. When performing as a patient advocate, what should the nurse do?

1. Contact the healthcare provider and ask that the procedure be explained to the patient.

2. Explain the procedure to the patient.

3. Document that the patient does not understand the proposed surgical procedure.

4. Instruct the patient in alternatives to the surgical procedure.

Page Ref: 16

Cognitive Level: Applying

Client Need & Sub: Safe and Effective Care Environment: Management of Care

Standards: QSEN Competencies: I.B.2. Communicate patient values, preferences, and expressed needs to other members of healthcare team | AACN Essentials Competencies: VI.2. Use inter- and intraprofessional communication and collaborative skills to deliver evidence-based, patient-centered care | NLN Competencies: Knowledge and Science; Practice-Know-How; Translate research into practice in order to promote quality and improve practices | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 1.4 Explain the activities and characteristics of the nurse as caregiver, educator, advocate, leader and manager, and researcher.

MNL Learning Outcome: 4. Consider the various role of the nurse as in medical-surgical nursing practice.

13) The nurse teaches a patient newly diagnosed with type 2 diabetes mellitus about the importance of an annual dilated-retina eye examination and annual urine tests to measure protein levels. Within which role is the nurse functioning?

1. Educator

2. Researcher

3. Advocate

4. Leader

Page Ref: 15

Cognitive Level: Applying

Client Need & Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention

Standards: QSEN Competencies: I.B.15. Communicate care provided and needed at each transition in care | AACN Essentials Competencies: IX.7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Learn continuously, learn cooperatively | Nursing/Integrated Concepts: Nursing Process: Implementation/Teaching/Learning

Learning Outcome: 1.4 Explain the activities and characteristics of the nurse as caregiver, educator, advocate, leader and manager, and researcher.

MNL Learning Outcome: 4. Consider the various role of the nurse as in medical-surgical nursing practice.

14) The nurse is providing care within the primary nursing delivery model. Which leadership activities should the nurse perform within this model? Select all that apply.

1. Communicate with patients, families, and other care providers.

2. Serve as the team leader by making assignments and being responsible for all care provided.

3. Make referrals and manage the quality of care to include timeliness and cost.

4. Manage a caseload of patients and the health team members providing care to the patients.

5. Create patient discharge plans.

Page Ref: 17

Cognitive Level: Applying

Client Need & Sub: Safe and Effective Care Environment: Management of Care

Standards: QSEN Competencies: I.B.15. Communicate care provided and needed at each transition in care | AACN Essentials Competencies: I.4. Use written, verbal, non-verbal and emerging technology methods to communicate effectively | NLN Competencies: Quality and Safety; Practice-Know-How; Communicate effectively with different individuals (team members, other care providers, patients, families, etc.) so as to minimize risks associated with handoffs among providers and across transitions in care. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 1.4 Explain the activities and characteristics of the nurse as caregiver, educator, advocate, leader and manager, and researcher.

MNL Learning Outcome: 4. Consider the various role of the nurse as in medical-surgical nursing practice.

15) The nurse is using a specific process to plan smoking cessation activities for a patient. What is this nurse most likely using to plan the care for this patient?

1. Nursing process

2. Critical pathways

3. Evidence-based practice

4. Variance analysis

Page Ref: 6-7

Cognitive Level: Applying

Client Need & Sub: Safe and Effective Care Environment: Management of Care

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: III.6. Integrate evidence, clinical judgment, interprofessional perspectives, and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Knowledge and Science; Practice-Know-How; Translate research into practice in order to promote quality and improve practices | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 1.2 Apply the attitudes, mental habits, and skills necessary for clinical reasoning when using the nursing process in patient care.

MNL Learning Outcome: 2. Recognize the skills necessary for clinical reasoning when using the nursing process in patient care.

16) The nurse working on a quality improvement study wants to evaluate a patient care process. What should the nurse use to evaluate this process?

1. Nursing process

2. Critical pathway

3. Variance analysis

4. Evidence-based practice

Page Ref: 20

Cognitive Level: Applying

Client Need & Sub: Safe and Effective Care Environment: Management of Care

Standards: QSEN Competencies: IV.A.1. Describe strategies for learning about the outcomes of care in the setting in which one is engaged in clinical practice | AACN Essentials Competencies: II.1. Apply leadership concepts, skills, and decision making in the provision of high-quality nursing care; healthcare team coordination; and the oversight and accountability for care delivery in a variety of settings | NLN Competencies: Knowledge and Science; Knowledge; Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 1.4 Explain the activities and characteristics of the nurse as caregiver, educator, advocate, leader and manager, and researcher.

MNL Learning Outcome: 4. Consider the various role of the nurse as in medical-surgical nursing practice.

17) The nurse is reviewing the outcome of care that was provided to a patient. Which nursing process step is the nurse implementing?

1. Evaluation

2. Assessment

3. Implementation

4. Planning

Page Ref: 11-12

Cognitive Level: Applying

Client Need & Sub: Safe and Effective Care Environment: Management of Care

Standards: QSEN Competencies: I.C.10. Value active partnership with patients or designated surrogates in planning, implementation, and evaluation of care | AACN Essentials Competencies: IX.9. Monitor client outcomes to evaluate the effectiveness of psychobiological interventions | NLN Competencies: Knowledge and Science; Practice-Know-How; Translate research into practice in order to promote quality and improve practices | Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 1.2 Apply the attitudes, mental habits, and skills necessary for clinical reasoning when using the nursing process in patient care.

MNL Learning Outcome: 2. Recognize the skills necessary for clinical reasoning when using the nursing process in patient care.

18) A patient says, "I have pain in my leg when I stand too long." As which type of data should the nurse categorize this information?

1. Subjective

2. Evaluative

3. Qualitative

4. Objective

Page Ref: 8

Cognitive Level: Applying

Client Need & Sub: Safe and Effective Care Environment: Management of Care

Standards: QSEN Competencies: I.B.1. Elicit patient values, preferences, and expressed needs as part of clinical interview; implementation of care plan; and evaluation of care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Practice-Know-How; Read and interpret data; apply health promotion/disease prevention strategies | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 1.2 Apply the attitudes, mental habits, and skills necessary for clinical reasoning when using the nursing process in patient care.

MNL Learning Outcome: 2. Recognize the skills necessary for clinical reasoning when using the nursing process in patient care.

19) While providing care, the nurse stops to assess a new patient problem. What type of assessment is the nurse conducting?

1. Focused

2. Initial

3. Objective

4. Subjective

Page Ref: 8

Cognitive Level: Applying

Client Need & Sub: Safe and Effective Care Environment: Management of Care

Standards: QSEN Competencies: I.B.1. Elicit patient values, preferences, and expressed needs as part of clinical interview; implementation of care plan, and evaluation of care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Practice-Know-How; Read and interpret data; apply health promotion/disease prevention strategies | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 1.2 Apply the attitudes, mental habits, and skills necessary for clinical reasoning when using the nursing process in patient care.

MNL Learning Outcome: 2. Recognize the skills necessary for clinical reasoning when using the nursing process in patient care.

20) At the completion of an assessment, the nurse chooses a nursing diagnosis that best defines the patient's health problems. Which type of clinical judgment should the nurse use at this time?

1. Diagnostic reasoning

2. Evidence-based practice

3. Critical pathway

4. Nursing process

Page Ref: 8

Cognitive Level: Applying

Client Need & Sub: Safe and Effective Care Environment: Management of Care

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: III.6. Integrate evidence, clinical judgment, interprofessional perspectives, and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Knowledge and Science; Practice-Know-How; Translate research into practice in order to promote quality and improve practices | Nursing/Integrated Concepts: Nursing Process: Diagnosis

Learning Outcome: 1.2 Apply the attitudes, mental habits, and skills necessary for clinical reasoning when using the nursing process in patient care.

MNL Learning Outcome: 2. Recognize the skills necessary for clinical reasoning when using the nursing process in patient care.

21) The nurse is creating outcome criteria for identified nursing diagnoses for a patient. What characteristics should the nurse include when creating the criteria?

1. Patient-specific, time-specific, and measurable

2. Constructed as nursing goals

3. Structured as statements

4. Focus on psychomotor actions

Page Ref: 8-9

Cognitive Level: Applying

Client Need & Sub: Safe and Effective Care Environment: Management of Care

Standards: QSEN Competencies: I.A.8. Describe the limits and boundaries of therapeutic patient-centered care | AACN Essentials Competencies: III.6. Integrate evidence, clinical judgment, interprofessional perspectives, and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Quality and Safety; Practice-Know-How; Contribute to assessment of outcome achievement | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 1.2 Apply the attitudes, mental habits, and skills necessary for clinical reasoning when using the nursing process in patient care.

MNL Learning Outcome: 2. Recognize the skills necessary for clinical reasoning when using the nursing process in patient care.

22) The nurse is implementing a plan of care for a patient. After providing care, what should the nurse do as the final step in the process?

1. Document

2. Reassess the patient

3. Measure vital signs

4. Provide report to the charge nurse

Page Ref: 11

Cognitive Level: Applying

Client Need & Sub: Safe and Effective Care Environment: Management of Care

Standards: QSEN Competencies: VI.B.4. Document and plan patient care in an electronic health record | AACN Essentials Competencies: IV.4. Understand the use of CIS (clinical information systems) systems to document interventions related to achieving nurse sensitive outcomes | NLN Competencies: Knowledge and Science; Practice-Know-How; Document via electronic health records; use software applications related to nursing practice | Nursing/Integrated Concepts: Nursing Process: Implementation/Communication and Documentation

Learning Outcome: 1.2 Apply the attitudes, mental habits, and skills necessary for clinical reasoning when using the nursing process in patient care.

MNL Learning Outcome: 2. Recognize the skills necessary for clinical reasoning when using the nursing process in patient care.

23) A patient care issue has been raised about the actions taken by a nurse who provided care to a patient whose healthcare decisions were considered controversial. What should the nurse manager consult to protect the patient and evaluate the care in question?

1. Nursing Code of Ethics

2. Hospital quality improvement guidelines

3. Nurse Practice Act

4. Critical pathway

Page Ref: 12

Cognitive Level: Applying

Client Need & Sub: Safe and Effective Care Environment: Management of Care

Standards: QSEN Competencies: I.A.7. Explore ethical and legal implications of patient-centered care | AACN Essentials Competencies: VIII.12. Act to prevent unsafe, illegal, or unethical care practices | NLN Competencies: Context and Environment; Knowledge; Code of Ethics; regulatory and professional standards | Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 1.3 Explain the importance of nursing and interprofessional codes of ethics, standards of practice, and legal and ethical issues as guidelines for clinical nursing practice.

MNL Learning Outcome: 3. Integrate nursing and interprofessional codes of ethics, standards of practice, and legal and ethical guidelines in clinical practice.

24) The nurse is preparing a patient to go home. Which skill should the nurse use when preparing this patient?

1. Familiarity with adult learning principles

2. Ability to follow written orders

3. Ability to use critical thinking

4. Ability to support patient decision making

Page Ref: 16

Cognitive Level: Applying

Client Need & Sub: Safe and Effective Care Environment: Management of Care

Standards: QSEN Competencies: I.B.3. Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essentials Competencies: IX.7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Learn continuously, learn cooperatively | Nursing/Integrated Concepts: Nursing Process: Implementation/Teaching/Learning

Learning Outcome: 1.4 Explain the activities and characteristics of the nurse as caregiver, educator, advocate, leader and manager, and researcher.

MNL Learning Outcome: 4. Consider the various role of the nurse as in medical-surgical nursing practice.

25) The nurse is preparing to provide patient care information to a group of unlicensed assistive personnel. Which type of care delivery system is this nurse most likely using to provide patient care?

1. Team nursing

2. Functional nursing

3. Primary nursing

4. Case management

Page Ref: 17

Cognitive Level: Applying

Client Need & Sub: Safe and Effective Care Environment: Management of Care

Standards: QSEN Competencies: II.B.5. Assume role of team member or leader based on the situation | AACN Essentials Competencies: VI.1. Compare/contrast the roles and perspectives of the nursing profession with other care professionals on the healthcare team (i.e., scope of discipline, education, and licensure requirements) | NLN Competencies: Teamwork; Knowledge; Scope of practice, roles, and responsibilities of healthcare team members, including overlaps | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 1.4 Explain the activities and characteristics of the nurse as caregiver, educator, advocate, leader and manager, and researcher.

MNL Learning Outcome: 4. Consider the various role of the nurse as in medical-surgical nursing practice.

26) A nurse has delegated the collection of vital signs, including blood pressure readings, to two unlicensed assistive personnel. What is the nurse's responsibility for the delegated care?

1. The nurse is accountable for the care that was delegated.

2. The nurse is not responsible for these vital signs.

3. The nurse is not accountable for these vital signs.

4. The nurse is responsible for re-measuring all the vital signs.

Page Ref: 17

Cognitive Level: Applying

Client Need & Sub: Safe and Effective Care Environment: Management of Care

Standards: QSEN Competencies: II.B.5. Assume role of team member or leader based on the situation | AACN Essentials Competencies: VI.1. Compare/contrast the roles and perspectives of the nursing profession with other care professionals on the healthcare team (i.e., scope of discipline, education, and licensure requirements) | NLN Competencies: Teamwork; Knowledge; Scope of practice, roles, and responsibilities of healthcare team members, including overlaps | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 1.4 Explain the activities and characteristics of the nurse as caregiver, educator, advocate, leader and manager, and researcher.

MNL Learning Outcome: 4. Consider the various role of the nurse as in medical-surgical nursing practice.

27) The nurse manager completes chart audits for a specific group of patients. What should the manager do with this information?

1. Create an action plan to address any negative findings.

2. Share it with the hospital administrator.

3. Submit it to the agency's accrediting body.

4. Place it in a file to compare with the next set of audits.

Page Ref: 5

Cognitive Level: Applying

Client Need & Sub: Safe and Effective Care Environment: Management of Care

Standards: QSEN Competencies: IV.B.5. Use quality measures to understand performance | AACN Essentials Competencies: II.10. Use improvement methods, based on data from the outcomes of care processes, to design and test changes to continuously improve the quality and safety of healthcare | NLN Competencies: Knowledge and Science; Practice; Translate research into practice in order to promote quality and improve practices | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 1.1 Describe the core competencies for healthcare professionals: Patient-centered care, interprofessional teams, evidence-based practice, quality improvement, safety, and health information technology.

MNL Learning Outcome: 1. Demonstrate use of the core competencies for healthcare professionals in nursing practice.

28) The nurse reviews the role of advocacy with a group of new graduate nurse employees. Which statement by a graduate nurse indicates the need for further education?

1. "Patient advocates have the authority to make decisions for the patient."

2. "Being a patient advocate entails making efforts to improve patient outcomes."

3. "Providing education to the patient and family is a key way to be a positive patient advocate."

4. "Communicating patient needs to the members of the healthcare team is a role of the patient advocate."

Page Ref: 16

Cognitive Level: Analyzing

Client Need & Sub: Safe and Effective Care Environment: Management of Care

Standards: QSEN Competencies: I.B.2. Communicate patient values, preferences, and expressed needs to other members of healthcare team | AACN Essentials Competencies: VI.2. Use inter- and intraprofessional communication and collaborative skills to deliver evidence-based, patient-centered care | NLN Competencies: Knowledge and Science; Practice-Know-How; Translate research into practice in order to promote quality and improve practices | Nursing/Integrated Concepts: Nursing Process: Evaluation/Teaching/Learning

Learning Outcome: 1.4 Explain the activities and characteristics of the nurse as caregiver, educator, advocate, leader and manager, and researcher.

MNL Learning Outcome: 4. Consider the various role of the nurse as in medical-surgical nursing practice.

29) The director of nursing is reviewing situations that require attention. Which situation is an ethical dilemma that might need to be analyzed by the hospital Ethics Committee?

1. A 20-year-old male patient with an opportunistic disease is HIV positive and does not want to share this information with sexual partners.

2. The nurse-patient ratio is 5:1 on a medical-surgical care area.

3. A nurse inexperienced with electrocardiogram interpretation was assigned to the telemetry unit to provide care.

4. Nursing staff provide medication to patients after doses are dropped on the floor.

Page Ref: 13-14

Cognitive Level: Analyzing

Client Need & Sub: Safe and Effective Care Environment: Management of Care

Standards: QSEN Competencies: I.A.7. Explore ethical and legal implications of patient-centered care | AACN Essentials Competencies: VIII.12. Act to prevent unsafe, illegal or unethical care practices | NLN Competencies: Context and Environment; Knowledge; Code of Ethics; regulatory and professional standards | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 1.3 Explain the importance of nursing and interprofessional codes of ethics, standards of practice, and legal and ethical issues as guidelines for clinical nursing practice.

MNL Learning Outcome: 3. Integrate nursing and interprofessional codes of ethics, standards of practice, and legal and ethical guidelines in clinical practice.

30) The nurse accepts tickets to a sporting event from a patient in exchange for free home care for 1 week. Which standards did the nurse violate? Select all that apply.

1. HIPAA

2. ANA standards

3. Professional boundaries

4. State nurse practice acts

5. Standards pertinent to specific hospital protocols

Page Ref: 13

Cognitive Level: Analyzing

Client Need & Sub: Safe and Effective Care Environment: Management of Care

Standards: QSEN Competencies: I.A.7. Explore ethical and legal implications of patient-centered care | AACN Essentials Competencies: VIII.1. Demonstrate the professional standards of moral, ethical, and legal conduct | NLN Competencies: Context and Environment; Knowledge; Code of Ethics; regulatory and professional standards | Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 1.3 Explain the importance of nursing and interprofessional codes of ethics, standards of practice, and legal and ethical issues as guidelines for clinical nursing practice.

MNL Learning Outcome: 3. Integrate nursing and interprofessional codes of ethics, standards of practice, and legal and ethical guidelines in clinical practice.

31) A seasoned nurse does not want to assist nursing students during clinical rotations and often obstructs the students' learning process. Which standard is this nurse violating?

1. ICN Code of Ethics

2. ANA Standards of Professional Performance

3. ANA Code of Ethics

4. State practice acts

Page Ref: 13

Cognitive Level: Analyzing

Client Need & Sub: Safe and Effective Care Environment: Management of Care

Standards: QSEN Competencies: II.C.6. Value teamwork and the relationships upon which it is based | AACN Essentials Competencies: VIII.1. Demonstrate the professional standards of moral, ethical, and legal conduct | NLN Competencies: Context and Environment; Knowledge; Code of Ethics; regulatory and professional standards | Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 1.3 Explain the importance of nursing and interprofessional codes of ethics, standards of practice, and legal and ethical issues as guidelines for clinical nursing practice.

MNL Learning Outcome: 3. Integrate nursing and interprofessional codes of ethics, standards of practice, and legal and ethical guidelines in clinical practice.

32) The nurse attends interprofessional meetings to discuss the plan of care for a trauma patient who has been transferred to the medical-surgical unit. In what role is this nurse functioning?

1. Caregiver

2. Team leader

3. Delegate

4. Advocate

Page Ref: 16

Cognitive Level: Applying

Client Need & Sub: Safe and Effective Care Environment: Management of Care

Standards: QSEN Competencies: I.B.2. Communicate patient values, preferences, and expressed needs to other members of healthcare team | AACN Essentials Competencies: VI.2. Use inter- and intraprofessional communication and collaborative skills to deliver evidence-based, patient-centered care | NLN Competencies: Knowledge and Science; Practice-Know-How; Translate research into practice in order to promote quality and improve practices | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 1.4 Explain the activities and characteristics of the nurse as caregiver, educator, advocate, leader and manager, and researcher.

MNL Learning Outcome: 4. Consider the various role of the nurse as in medical-surgical nursing practice.

33) The director of nursing is planning an initiative to improve the quality and safety of patient care. After reviewing the Triple Aim approach, which action should the director recommend? Select all that apply.

1. Improve the patient care experience.

2. Maximize positive outcomes.

3. Reduce the per capita costs of healthcare.

4. Implement evidence-based practice.

5. Support nursing continuing education plans.

Page Ref: 17

Cognitive Level: Applying

Client Need & Sub: Safe and Effective Care Environment: Management of Care

Standards: QSEN Competencies: IV.B.5. Use quality measures to understand performance | AACN Essentials Competencies: II.11. Employ principles of quality improvement, healthcare policy, and cost-effectiveness to assist in the development and initiation of effective plans for the microsystem and/or system-wide practice improvements that will improve the quality of healthcare delivery | NLN Competencies: Quality and Safety; Knowledge; Current best practices | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 1.4 Explain the activities and characteristics of the nurse as caregiver, educator, advocate, leader and manager, and researcher.

MNL Learning Outcome: 4. Consider the various role of the nurse as in medical-surgical nursing practice.

34) The nurse would like to do a research project that focuses on vending machine choices that patients prefer. What should the nurse question before proceeding with this research study?

1. Is the research valid?

2. Will this promote patient independence?

3. Is this a project that would add value to the hospital experience?

4. Does this research contribute to patient care?

Page Ref: 20

Cognitive Level: Applying

Client Need & Sub: Safe and Effective Care Environment: Management of Care

Standards: QSEN Competencies: III.B.1. Participate effectively in appropriate data collection and other research activities | AACN Essentials Competencies: III.2. Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science; Knowledge; Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 1.4 Explain the activities and characteristics of the nurse as caregiver, educator, advocate, leader and manager, and researcher.

MNL Learning Outcome: 4. Consider the various role of the nurse as in medical-surgical nursing practice.

35) The nurse is identifying nursing diagnoses for a patient's care. In which order should the nurse complete this process? Place in order the steps of the process.

Choice 1. Draw conclusions about the present health status.

Choice 2. Determine etiologies and categorize problems.

Choice 3. Cluster cues and identify data gaps.

Choice 4. Verify the problem or diagnoses.

Choice 5. Recognize significant cues.

Page Ref: 9

Cognitive Level: Applying

Client Need & Sub: Safe and Effective Care Environment: Management of Care

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: III.6. Integrate evidence, clinical judgment, interprofessional perspectives, and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Knowledge and Science; Practice-Know-How; Translate research into practice in order to promote quality and improve practices | Nursing/Integrated Concepts: Nursing Process: Diagnosis

Learning Outcome: 1.2 Apply the attitudes, mental habits, and skills necessary for clinical reasoning when using the nursing process in patient care.

MNL Learning Outcome: 2. Recognize the skills necessary for clinical reasoning when using the nursing process in patient care.

36) The nurse is hired to coordinate care in a community health clinic that opened after the implementation of the Affordable Care Act. Which types of care should the nurse expect to provide? Select all that apply.

1. Health promotion

2. Disease prevention

3. Chronic disease management

4. Rehabilitation

5. Palliative care

Page Ref: 2

Cognitive Level: Applying

Client Need & Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: VII.5. Use evidence-based practices to guide health teaching, health counseling, screening, outreach, disease and outbreak investigation, referral and follow-up throughout the lifespan | NLN Competencies: Context and Environment; Knowledge; Environmental health; health promotion/disease prevention (e.g., transmission of disease, disease patterns, epidemiological principles); chronic disease management; healthcare systems; transcultural approaches to health; family dynamics | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 1.4 Explain the activities and characteristics of the nurse as caregiver, educator, advocate, leader and manager, and researcher.

MNL Learning Outcome: 4. Consider the various role of the nurse as in medical-surgical nursing practice.

37) The nurse manager is evaluating the use of evidence-based practice guidelines to guide care on a patient care area. Which observation indicates that these guidelines are being used appropriately? Select all that apply.

1. Guidelines are posted on the staff bulletin board in the break room.

2. A guideline was quoted in a narrative note in a patient's medical record.

3. A guideline is placed in the Kardex to support the use of a nursing diagnosis for a patient's health problem.

4. Guidelines are accessed through the clinical documentation system by nurses prior to writing patient care plans.

5. A guideline was referenced prior to implementing skin care interventions for a patient prone to pressure ulcer formation.

Page Ref: 5

Cognitive Level: Applying

Client Need & Sub: Safe and Effective Care Environment: Management of Care

Standards: QSEN Competencies: III.B.6. Participate in structuring the work environment to facilitate integration of new evidence into standards of practice | AACN Essentials Competencies: III.2. Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science; Knowledge; What is evidence-based practice (EBP)? Informatics? | Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 1.1 Describe the core competencies for healthcare professionals: Patient-centered care, interprofessional teams, evidence-based practice, quality improvement, safety, and health information technology.

MNL Learning Outcome: 1. Demonstrate use of the core competencies for healthcare professionals in nursing practice.

38) An interprofessional team is meeting to create a care bundle to prevent the development of contractures in patients with limb paralysis from neurological health problems. Which action should the committee members include when creating this care bundle? Select all that apply.

1. Define the patient population

2. Identify three to five interventions

3. Ensure the elements of the bundle are independent

4. Ensure the bundle elements are descriptive

5. Mandate that the bundle elements are prescriptive

Page Ref: 11

Cognitive Level: Applying

Client Need & Sub: Safe and Effective Care Environment: Management of Care

Standards: QSEN Competencies: III.B.6. Participate in structuring the work environment to facilitate integration of new evidence into standards of practice | AACN Essentials Competencies: III.9. Describe mechanisms to resolve identified practice discrepancies between identified standards and practice that may adversely impact patient outcomes | NLN Competencies: Context and Environment; Knowledge; Codes of ethics, regulatory and professional standards, ethical decision-making models, scope of practice considerations, principles of informed consent, confidentiality, patient self-determination | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 1.2 Apply the attitudes, mental habits, and skills necessary for clinical reasoning when using the nursing process in patient care.

MNL Learning Outcome: 2. Recognize the skills necessary for clinical reasoning when using the nursing process in patient care.

39) The nurse is coordinating care for patients within a patient-centered medical home (PCMH). Which action should the nurse prepare to complete when functioning in this role? Select all that apply.

1. Communicate with the patient after discharge.

2. Monitor the implementation of the plan of care.

3. Manage the accuracy, timeliness, and cost of care.

4. Develop the plan of care with the patient and family.

5. Collaborate with the patient to implement the plan of care.

Page Ref: 17

Cognitive Level: Applying

Client Need & Sub: Safe and Effective Care Environment: Management of Care

Standards: QSEN Competencies: IV.A.1. Describe strategies for learning about the outcomes of care in the setting in which one is engaged in clinical practice | AACN Essentials Competencies: II.11. Employ principles of quality improvement, healthcare policy, and cost-effectiveness to assist in the development and initiation of effective plans for the microsystem and/or system-wide practice improvements that will improve the quality of healthcare delivery | NLN Competencies: Teamwork; Knowledge; Scope of practice, roles, and responsibilities of healthcare team members, including overlaps | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 1.4 Explain the activities and characteristics of the nurse as caregiver, educator, advocate, leader and manager, and researcher.

MNL Learning Outcome: 4. Consider the various role of the nurse as in medical-surgical nursing practice.

40) The nurse is using clinical reasoning to plan patient care. Which foundational source of knowledge should the nurse use? Select all that apply.

1. Know the profession

2. Know self

3. Know the case

4. Know the patient

5. Know the patient's health insurance

Page Ref: 6

Cognitive Level: Applying

Client Need & Sub: Safe and Effective Care Environment: Management of Care

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: I.7. Integrate the knowledge and methods of a variety of disciplines to inform decision making | NLN Competencies: Context and Environment; Knowledge; Change, uncertainty, complexity theories, impact of continual knowledge explosion and constant evolution of technology, decision making in uncertainty, management of conflicting information, blurring of role boundaries, and the resultant uncertainty about role expectation | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 1.2 Apply the attitudes, mental habits, and skills necessary for clinical reasoning when using the nursing process in patient care.

MNL Learning Outcome: 2. Recognize the skills necessary for clinical reasoning when using the nursing process in patient care.