are Environment: The Management of Care Practice Questions (GRADE A ASSUARED)

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NCLEX-RN Practice Test Questions with Rationales The Safe & Effective Care Environment: The Management of Care Practice Questions 1. You are caring for a client at the end of life. The clien... t tells you that they are grateful for having considered and decided upon some end of life decisions and the appointments of those who they wish to make decisions for them when they are no longer able to do so. During this discussion with the client and the client’s wife, the client states that “my wife and I are legally married so I am so glad that she can automatically make all healthcare decisions on my behalf without a legal durable power of attorney when I am no longer able to do so myself” and the wife responds to this statement with, “that is not completely true. I can only make decisions for you and on your behalf when these decisions are not already documented on your advance directive.” How should you, as the nurse, respond to and address this conversation between the husband and wife and the end of life? A. You should respond to the couple by stating that only unanticipated treatments and procedures that are not included in the advance directive can be made by the legally appointed durable power of attorney for healthcare decisions. B. You should be aware of the fact that the wife of the client has a knowledge de cit relating to advance directives and durable powers of attorney for healthcare decisions and plan an educational activity to meet this learning need. C. You should be aware of the fact that the client has a knowledge de cit relating to advance directives and durable powers of attorney for healthcare decisions and plan an educational activity to meet this learning need. D. You should reinforce the wife’s belief that legally married spouses automatically serve for the other spouse’s durable power of attorney for health care decisions and that others than the spouse cannot be legally appointed while people are married 2. The Patient Self Determination Act of the United States protects clients in terms of their rights to what? Select all that apply. A. Privacy and to have their medical information conTdential unless the client formally approves the sharing of this information with others such as family members. B. Make healthcare decisions and to have these decisions protected and communicated to others when they are no longer competent to do so. C. Be fully informed about all treatments in term of their bene ts, risks and alternatives to them so the client can make a knowledgeable and informed decision about whether or not to agree to having it D. Make decisions about who their health care provider is without any coercion or undue in uence of others including healthcare providers. 3. Your client is in the special care area of your hospital with multiple trauma and severe bodily burns. This 45 year old male client has an advance directive that states that the client wants all life saving measures including cardiopulmonary resuscitation and advance cardiac life support, including mechanical ventilation. As you are caring for the client, the client has a complete cardiac and respiratory arrest. This client has little of no chance for survival and they are facing imminent death according to your professional judgement, knowledge of pathophysiology and your critical thinking. You believe that all life saving measures for this client would be futile. What is the rst thing that you, as the nurse, should do? A. Call the doctor and advise them that the client’s physical status has signiVcantly changed and that they have just had a cardiopulmonary arrest. B. Begin cardiopulmonary resuscitation other emergency life saving measures. C. Notify the family of the client’s condition and ask them what they should be done for the client. D. Insure that the client is without any distressing signs and symptoms at the end of life. 4. You are caring for a high risk pregnant client who is in a life threatening situation. The fetus is also at high risk for death. Clinical decisions are being made that concern you because some of these treatments and life saving measures promote the pregnant woman’s life at the same time that they signi cantly jeopardize the fetus’ life and viability and other decisions can preserve the fetus’s life at the expense of the pregnant woman’s life. Which role of the nurse is the priority at this time? A. Case manager B. Collaborator C. Coordinator of care D. Advocacy 5. A nurse who organizes and establishes a political action committee (PAC) in their local community to address issues relating to the accessibility and a ordability of healthcare resources in the community is serving in which capacity and role of the registered nurse? A. Client advocate B. Collaborator C. Politician D. Entrepreneur 6. Which of the following are the ve Rights of Supervision? SHARES A. The right task, the right circumstances, the right person, the right competency, and the right supervision or feedback B. The right task, the right circumstances, the right person, the right direction or communication, and the right supervision or feedback C. The right competency, the right education and training, the right scope of practice, the right environment and the right client condition D. The right competency, the right person, the right scope of practice, the right environment and the right client condition 7. The registered nurse, prior to the delegation of tasks to other members of the nursing care team, evaluates the ability of sta members to perform assigned tasks for the position as based on which legal consideration? A. The American Nurses Association’s Scopes of Practice B. The American Nurses Association’s Standards of Care C. State statutes D. Federal law 8. The best way to objectively evaluate the e ectiveness of an individual sta member’s time management skills in a longitudinal manner is to: A. Observe the sta member during an entire shift of duty to determine whether or not the nurse has accurately and appropriately established priorities. B. Observe the sta member during an entire shift of duty to determine whether or not the nurse has accurately and appropriately completed priority tasks. C. Ask the staJ member how they feel like they have been able to employ their time management skills for the last six months. D. Collect outcome data over time and then aggregate and analyze this data to determine whether or not the sta member has completed reasonable assignments in the allotted time before the end of their shift of duty. SHARES 9. Which of the following patient care tasks is coupled with the appropriate member of the nursing care team in terms of their legal scope of practice? A. An unlicensed staG member who has been “certiDed” by the employing agency to monitor telemetry: Monitoring cardiac telemetry B. An unlicensed assistive sta member like a nursing assistant who has been “certi ed” by the employing agency to insert a urinary catheter: Inserting a urinary catheter C. A licensed practical nurse: The circulating nurse in the perioperative area D. A licensed practical nurse: The rst assistant in the perioperative area 10. You are providing care to a permanently disabled Iraqi war veteran who is 28 years of age. When he returned home from the war at the age of 24 years of age 2 years ago he was deemed permanently disabled by both the Veterans Administration (VA) and the Social Security Administration. He receives a substantial monthly service connected disability check from the Veterans Administration and he has no spouse or legal dependents. Which type of governmental health insurance is he now entitled to? A. Only the VA health care services because he is not 65 years of age B. Medicare because he has been deemed permanently disabled for 2 years C. Medicaid because he is permanently disabled and not able to work D. Choices B and C SHARES 11. You are a registered nurse who is performing the role of a case manager in your hospital. You have been asked to present a class to newly employed nurses about your role, your responsibilities and how they can collaborate with you as the case manager. Which of the following is a primary case management responsibility associated with reimbursement that you should you include in this class? A. The case manager’s role in terms of organization wide performance improvement activities B. The case manager’s role in terms complete, timely and accurate documentation C. The case manager’s role in terms of the clients’ being at the appropriate level of care D. The case manager’s role in terms of contesting denied reimbursements 12. Select the nurse case management model used for patient care delivery that is accurately paired with one of its descriptors: A. The ProACT Model: Registered nurses perform the role of the primary nurse in addition to the related coding and billing functions SHARES B. The Collaborative Practice Model: The registered nurse performs the role of the primary nurse in addition to the role of the clinical case manager with administrative, supervisory and Cscal responsibilities C. The Case Manager Model: The management and coordination of care for clients throughout a facility who share the same DRG or medical diagnosis D. The Triad Model of Case Management: The joint collaboration of the social worker, the nursing case manager, and the utilization review team 13. Which of these case management methods employs the intrinsic use of multidisciplinary plans of care that are based on the client’s current condition, and re ect interventions and expected outcomes within a pre-established time line? A. The Case Manager Model B. The ProACT Model C. The Collaborative Practice Model D. The Triad Model of Case Management 14. Which type of legal consent is indirectly given by the client by the very nature of their voluntary acute care hospitalization? A. An opt out consent B. An implicit consent C. An explicit consent D. No consent at all is given 15. You are asked by your supervisor to take photographs of the residents and their family members who are attending a holiday dinner and celebration at your long term care facility. What should you do? A. Take the photographs because these photographs are part of the holiday tradition at this facility B. Take the photographs because all of the residents are properly attired and in a digniUed condition C. Refuse to take the photographs unless you have the consent of all to do so D. Refuse to take the photographs because this is not part of the nurse’s role 16. Select the law that is accurately paired with its description in terms of client rights. A. The Patient Self Determination Act: The client’s right to choose the level of care B. The Patient Self Determination Act: The clients’ right to healthcare insurance coverage for mental health disorders C. The Mental Health Parity Act: The privacy and security of technological psychiatric information D. The Health Insurance Portability and Accountability Act (HIPAA): The privacy and security of technological medical information 17. Select the member of the multidisciplinary team that you would most likely collaborate with when the client is at risk for falls due to an impaired gait. A. The physical therapist B. TheSHARESoccupational therapist C. The podiatrist D. The nurse practitioner 18. Select the member of the multidisciplinary team that you would most likely collaborate with when the client can bene t from the use of adaptive devices for cutting food? A. The physical therapist B. The occupational therapist C. The dietician D. The podiatrist 19. What is the primary goal of multidisciplinary case conferences? A. To ful ll the nurse’s role in terms of collaboration B. To plan and provide for optimal client outcomes C. To solve complex multidisciplinary patient care problems D. To provide educational experiences for experienced nurses 20. Which member of the multidisciplinary team would you most likely collaborate with when your pediatric client has had a traumatic amputation one or more months ago? A. A Pedorthist B. A pediatric nurse practitioner C. A trauma certi ed clinical nurse specialist D. A prosthetist 21. Con icts, according to Lewin, include which types of con ict? Select all that are accurate. A. Conceptualization conKicts B. Avoidance - Avoidance con$icts C. Approach - Approach con$icts D. Resolvable con icts E. Unresolvable con icts F. Double Approach - Avoidance con icts G. Approach-Avoidance con icts . 22. Select the types and stages of con ict that are accurately paired with their description. Select all that apply. A. Frustration: The phase of conJict that is characterized with personal agendas and obstruction B. Conceptualization: The phase of con ict that occurs when contending parties have developed a clear and objective understanding of the nature of the con ict and factors that have led to it C. Taking action: The phase of con6ict that is characterized with individual responses to and feelings about the con ict D. Resolution: The type of conJict that can be resolved E. Avoidance-Avoidance: A stage of conEict that occurs when there are NO alternatives that are SHARES acceptable to the contending parties F. Approach- Approach Con icts: The type of con ict that occurs when the people involved in the con ict want more than one alternatives or actions that could resolve the conXict. G. Approach-Avoidance Con icts: The type of con ict that occurs when the people involved in the con ict believe that all of the alternatives are NEITHER completely satisfactory nor completely dissatisfactory. 23. You are the chair person for the healthcare facility’s newly formed multidisciplinary Safety Committee. During the Forming stage of this group’s development major con icts have arisen. Which technique of con ict resolution should you use to resolve these con icts? A. Passivity B. Compromise C. Competition D. AccommodatingSHRES Others 24. The stages of con ict and con ict resolution in the correct sequential order are: A. Conceptualization B. Frustration C. Resolution D. Taking action Correct Response: B, A, D, C The stages of conGict and conEict resolution in the correct sequential order are frustration, conceptualization, and taking action. 25. Which federal law is most closely associated with the highly restrictive “need to know”? A. The Patient Self Determination Act B. The Mental Health Parity Act C. The Health Insurance Portability and Accountability Act D. The Americans with Disabilities Act of 1990 26. Which of the following personnel do not have the “right to know” medical information? A. The facility’s Performance Improvement Director who is not a healthcare person and who has no direct contact with clients B. A nursing student who is caring for a client under the supervision of the nursing instructor C. The facility’s Safety O[cer who is not a healthcare person and who has no direct contact with clients D. A department supervisor with no direct or indirect care duties 27. You are the Nurse Manager for the trauma unit. Which of these sta comments or statements indicate the need for you to provide an educational activity relating to con dentiality and information security? A. “A computer in the hallway was left unattended and a client’s medical record was visible to me.” B. “I just saw a nursing student looking at the medical record for a client that they are NOT caring for during this clinical experience.” SHARES C. “As I was walking past the nursing station, I saw a dietician reading the progress notes written by members of the laboratory department in addition to other dieticians’ progress notes.” D. “I refused the nursing supervisor’s request to share my electronic password for the new nurse on the unit.” 28. Which of the following terms is used to describe the sound, timely, smooth, unfragmented and seamless transition of the client from one level of acuity to another? A. Case management B. Continuity of care C. Medical necessity D. Critical pathway 29. The Joint Commission on the Accreditation of Healthcare Organizations mandates standardized “hand of” change of shift reporting. Which of the following is a standardized “hand o_” change of shift reporting system that you may want to consider for implementation on your nursing care unit? A. The Four P's B. UBAR C. ISBAR D. MAUMAR 30. Select the standardized “hand o_” change of shift reporting system that is accurately paired with its elements. A. SBAR: Symptoms, background, assessment and recommendations B. ISBAR: Interventions, symptoms, background, assessment and recommendations C. The Five Ps: The patient, plan, purpose, problems and precautions D. BATON: Background, assessment, timing, ownership and next plans SHARES SHARES 31. Number the priority of the following conditions using the numbers # 1 through # 6 with # 1 as the greatest priority and # 6 as the least priority. 1. Atrial brillation 2. First degree heart block 3. Shortness of breath upon exertion 4. An obstructed airway 5. Fluid needs 6. Respect and esteem by others A. 3,4,2,1,5,6 B. 3,4,5,1,2,6 C. 2,3,5,1,4,6 D. 3,2,4,1,5,6 32. The 2nd priority needs according to the MAAUAR method of priority setting include which of the following? A. Assessment B. Movement C. Understanding level SHARES D. Risks 33. Which of these skills is most closely related to successfully meeting the established priority needs of a group of clients? A. Time management skills B. Communication skills C. Collaboration skills D. Supervision skills 34. Which is most closely aligned with ethics? A. Morals B. Laws C. Statutes D. Client rights 35. Select the ethical term that is accurately paired with it brief description. A. Deontology: The school of ethical of thought that requires that only the means to the goal must be ethical. B. Utilitarianism: The school of ethical of thought that requires that only the end goal must be ethical. C. Deontology: The school of ethical of thought that requires that only the end goal must be ethical. D. Utilitarianism: The school of ethical of thought that requires that only the means to the goal must be ethical. 36. What ethical principle below is accurately paired with a way that ethical principle is applied into nursing practice? A. Justice: Equally dividing time and other resources among a group of clients B. Bene cence: Doing no harm during the course of nursing care C. Veracity: Fully answering the client’s questions without any withholding of information D. Fidelity: Upholding the American Nurses Association’s Code of Ethics 37. You have been asked to teach an inservice class for nurses in your facility about ethics. Which of the following should you consider during the planning of this educational activity? A. Planning a way to evaluate the e ectiveness of the class by seeing a decrease in the amount of referrals to the facility’s Ethics Committee B. Establishing educational objectives for the class that reGect the methods and methodology that you will use to present the class content C. The need to exclude case studies from the class because this would violate client privacy and conQdentiality D. Some of the most commonly occurring bioethical concerns including genetic engineering into the course content 38. One of the roles of the registered nurse in terms of informed consent is to: A. Serve as the witness to the client’s signature on an informed consent. B. Get and witness the client’s signature on an informed consent. C. Get and witness the durable power of attorney for health care decisions’ signature on an informed consent. D. None of the above 39. Which of the following is most closely aligned with the principles and concepts of informed consent? A. Justice B. Fidelity C. Self determination D. Nonmal cence SHARES 40. Which of the following is NOT an essential minimal component of the teaching that occurs prior to getting an informed consent? A. The purpose of the proposed treatment or procedure B. The expected outcomes of the proposed treatment or procedure C. Who will perform the treatment or procedure D. When the procedure or treatment will be done 41. Legal prohibitions against sharing passwords are legally based on: A. TheSHARESecurity Rule B. The American Nurses Association’s Code of Ethics C. The American Hospital’s Patients’ Bill of Rights D. The Autonomy Rule 42. Which of these statements related to information technology is accurate? A. Social networks and cell phone cameras pose low risk in terms of information technology security and con dentiality. B. The security of technological data and information in healthcare environments is most often violated by those who work there. C. The security of technological data and information in healthcare environments is most often violated by computer hackers. D. Computer data deletion destroys all evidence of the data. SHARES 43. Select the legal term that is accurately paired with its description. A. Assault: Touching a person without their consent B. Battery: Threatening to touch a person without their consent C. Slander: False oral defamatory statements. D. Slander: False written defamatory statements. 44. You have loosely applied a bed sheet around your client’s waist to prevent a fall from the chair. What have you done? A. Ensured the client’s safety which is a high patient care priority B. Violated Respondeat Superior C. Violated the client’s right to dignity D. Committed a crime 45.SHARESWhich statement about Respondeat Superior is accurate? A. Respondeat Superior does not mean that a nurse cannot be held liable. B. Respondeat Superior does not mean that a nurse cannot be held libel. C. Respondeat Superior is an ethical principle. D. Respondeat Superior is a law. 46. Which of these choices contains the six elements necessary for malpractice? A. Causation, foreseeability, damages to the patient, a duty that was owed to the client and this duty was breached, and direct rather than indirect harm to the client. B. Causation, foreseeability, damages to the patient, a duty that was owed to the client and this duty was breached, and direct and/or indirect harm to the client. C. Causation, correlation, damages to the patient, a duty that was owed to the client and this duty was breached, and direct and/or indirect harm to the client. D. Causation, foreseeability, damages to the patient, a duty that was owed to the client and this duty was breached, and a medical license. 47. The current focus of performance improvement activities is to facilitate and address: A. Sound structures like policies and procedures B. Processes and how they are being done SHARES C. Optimal client outcomes D. Optimal staC performance 48. What is the term that is used to describe a healthcare related incident or accident that may have possibly led to client harm? A. An adverse event B. A root cause C. A healthcare acquired event D. A sentinel event 49. The primary purpose of root cause analysis is to: A. Discover a process Caw B. Determine who erred C. Discover environmental hazards D. Determine basic client needs 50. Which question is asked more than any other root cause analysis activity? A. What? B. Why? C. Who? D. When? 51. The primary distinguishing characteristic of risk management when compared and contrasted to performance improvement is that risk management activities focus on: A. Historical data and performance improvement activities focus on current data. B. Current data and performance improvement activities focus on historical data. C. Decreasing Cnancial liability and performance improvement activities focus on process improvements. D. Decreasing falls and performance improvement activities focus on process improvements. 52. Which statement about referrals is accurate? A. Referrals complement the healthcare teams’ abilities to provide optimal care to the client. B. Referrals simply allow the client to be discharged into the community with the additional care they need. C. Nurses facilitate referrals to only the resources within the facility. [Show More]

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