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CliffsTestPrep NCLEX-RN (2011)

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    CliffsTestPrep ® NCLEX-PN ® An American BookWorks Corporation Project Contributing Authors/Consultants Amy Anderson, RN, MSN Texas Tech University Health Sciences Center, School of Nursing, TX Wanda Bradshaw, RNC, MSN Duke University, NC Valerie Eschiti, RN, MSN, CHTP, HNC Midwestern State University, TX Sara Freuchting, RN, MNSc, CCRN, APRN, BC University of Arkansas at Little Rock, AR Sharon Krumm, RN, MN, CCRN Arkansas State University, AR Mary Alice Momeyer, MSN, CNP Ohio State University Cynthia O’Neal, PhD, RN Texas Tech University Health Sciences Center School of Nursing, TX Deborah Persell, MSW, RN, CPNP Arkansas State University, AR Vicki A. Schnetter, MSN, RN Texas Tech University Health Sciences Center School of Nursing, TX Brenda Leigh Yolles Smith, EdD RN, MN, CNM, ICCE Arkansas State University, AR Carolyn Mathis White, RN, MSN, FNP, PNP, JD University of South Alabama, AL Joan Williams, MS, RN, CS, CNP

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    CliffsTestPrep ® NCLEX-PN ® An American BookWorks Corporation Project Contributing Authors/Consultants Amy Anderson, RN, MSN Texas Tech University Health Sciences Center, School of Nursing, TX Wanda Bradshaw, RNC, MSN Duke University, NC Valerie Eschiti, RN, MSN, CHTP, HNC Midwestern State University, TX Sara Freuchting, RN, MNSc, CCRN, APRN, BC University of Arkansas at Little Rock, AR Sharon Krumm, RN, MN, CCRN Arkansas State University, AR Mary Alice Momeyer, MSN, CNP Ohio State University Cynthia O’Neal, PhD, RN Texas Tech University Health Sciences Center School of Nursing, TX Deborah Persell, MSW, RN, CPNP Arkansas State University, AR Vicki A. Schnetter, MSN, RN Texas Tech University Health Sciences Center School of Nursing, TX Brenda Leigh Yolles Smith, EdD RN, MN, CNM, ICCE Arkansas State University, AR Carolyn Mathis White, RN, MSN, FNP, PNP, JD University of South Alabama, AL Joan Williams, MS, RN, CS, CNP

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    Author’s Acknowledgments American BookWorks Corporation would like to acknowl- edge and thank the contributions of Linda A. Razer to this project. Publisher’s Acknowledgments Editorial Project Editor: Suzanne Snyder Acquisitions Editor: Greg Tubach Copy Editor: Katie Robinson Technical Editor: Sue A. Wise RN, MS, LSW Edison State Community College Production Proofreader: Melissa D. Buddendeck Wiley Publishing, Inc. Composition Services Note: If you purchased this book without a cover, you should be aware that this book is stolen property. It was reported as “unsold and destroyed” to the publisher, and neither the author nor the publisher has received any payment for this “stripped book.” CliffsTestPrep ® NCLEX-PN ® Published by: Wiley Publishing, Inc. 111 River Street Hoboken, NJ 07030-5774 www.wiley.com Copyright © 2005 Wiley, Hoboken, NJ Published by Wiley, Hoboken, NJ Published simultaneously in Canada Library of Congress Cataloging-in-Publication data is available from the publisher upon request. ISBN-13: 978-0-7645-7287-6 ISBN-10: 0-7645-7287-3 Printed in the United States of America 10 9 8 7 6 5 4 3 2 1 1B/QY/QT/QV/IN No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, scanning, or otherwise, except as permitted under Sections 107 or 108 of the 1976 United States Copyright Act, without either the prior written permis- sion of the Publisher, or authorization through payment of the appropriate per-copy fee to the Copyright Clearance Center, 222 Rosewood Drive, Danvers, MA 01923, 978-750-8400, fax 978-646-8600, or on the web at www.copyright.com. Requests to the Publisher for permission should be addressed to the Legal Department, Wiley Publishing, Inc., 10475 Crosspoint Blvd., Indianapolis, IN 46256, 317-572-3447, fax 317-572-4355, or online at http://www.wiley.com/go/ permissions. THE PUBLISHER AND THE AUTHOR MAKE NO REPRESENTATIONS OR WARRANTIES WITH RESPECT TO THE ACCURACY OR COMPLETENESS OF THE CONTENTS OF THIS WORK AND SPECIFICALLY DISCLAIM ALL WARRANTIES, INCLUDING WITHOUT LIMITATION WARRANTIES OF FITNESS FOR A PARTICULAR PURPOSE. NO WARRANTY MAY BE CREATED OR EXTENDED BY SALES OR PROMOTIONAL MATERIALS. THE ADVICE AND STRATEGIES CONTAINED HEREIN MAY NOT BE SUITABLE FOR EVERY SITUATION. THIS WORK IS SOLD WITH THE UNDER- STANDING THAT THE PUBLISHER IS NOT ENGAGED IN RENDERING LEGAL, ACCOUNTING, OR OTHER PROFESSIONAL SERVICES. IF PROFES- SIONAL ASSISTANCE IS REQUIRED, THE SERVICES OF A COMPETENT PROFESSIONAL PERSON SHOULD BE SOUGHT. NEITHER THE PUBLISHER NOR THE AUTHOR SHALL BE LIABLE FOR DAMAGES ARISING HEREFROM. THE FACT THAT AN ORGANIZATION OR WEBSITE IS REFERRED TO IN THIS WORK AS A CITATION AND/OR A POTENTIAL SOURCE OF FURTHER INFORMATION DOES NOT MEAN THAT THE AU- THOR OR THE PUBLISHER ENDORSES THE INFORMATION THE ORGANIZATION OR WEBSITE MAY PROVIDE OR RECOMMENDATIONS IT MAY MAKE. FURTHER, READERS SHOULD BE AWARE THAT INTERNET WEBSITES LISTED IN THIS WORK MAY HAVE CHANGED OR DISAP- PEARED BETWEEN WHEN THIS WORK WAS WRITTEN AND WHEN IT IS READ. Trademarks: Wiley, the Wiley Publishing logo, CliffsNotes, the CliffsNotes logo, Cliffs, CliffsAP, CliffsComplete, CliffsQuickReview, CliffsStudySolver, CliffsTestPrep, CliffsNote-a-Day, cliffsnotes.com, and all related trademarks, logos, and trade dress are trademarks or registered trademarks of John Wiley & Sons, Inc. and/or its affiliates. All other trademarks are the property of their respective owners. Wiley Publishing, Inc. is not associated with any product or vendor men- tioned in this book. For general information on our other products and services or to obtain technical support, please contact our Customer Care Department within the U.S. at 800-762-2974, outside the U.S. at 317-572-3993, or fax 317-572-4002. Wiley also publishes its books in a variety of electronic formats. Some content that appears in print may not be available in electronic books. For more information about Wiley products, please visit our web site at www.wiley.com.

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    Table of Contents Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 PART I: SUBJECT AREA REVIEW CHAPTERS Coordinated Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Advance Directives • Advocacy • Client Care Assignments • Client Rights • Concepts of Management and Supervision • Confidentiality • Consultation with Members of the Health Care Team • Continuity of Care • Establishing Priorities • Ethical Practice • Informed Consent • Legal Responsibilities • Performance Improvement (Quality Assurance) • Referral Process • Resource Management Safety and Infection Control . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59 Accident/Error Prevention • Handling Hazardous and Infectious Materials • Home Safety • Injury Prevention • Internal and External Disaster Plans • Medical and Surgical Asepsis • Reporting of Incident/Event/Irregular Occurrence/Variance • Safe Use of Equipment • Security Plans • Standard/Transmission-Based/Other Precautions • Use of Restraints/Safety Devices Health Promotion and Maintenance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105 Aging Process • Ante/Intra/Postpartum and Newborn Care • Data Collection Techniques • Developmental Stages and Transitions • Disease Prevention • Expected Body Image Changes • Family Interaction Patterns • Family Planning • Health Promotion/Screening Programs • High Risk Behaviors • Human Sexuality • Immunizations • Lifestyle Choices • Self-Care Psychosocial Integrity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 175 Abuse or Neglect • Behavioral Interventions • Behavioral Management • Coping Mechanisms • Crisis Intervention • Cultural Awareness • End-of-Life Concepts • Grief and Loss • Mental Health Concepts • Mental Illness Concepts • Religious or Spiritual Influences on Health • Sensory/Perceptual Alterations • Situational Role Changes • Stress Management • Substance-Related Disorders • Suicide/Violence Precautions • Support Systems • Therapeutic Communication • Therapeutic Environment • Unexpected Body Image Changes Basic Care and Comfort . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 219 Assistive Devices • Elimination • Mobility/Immobility • Non-Pharmacological Comfort Interventions • Nutrition and Oral Hydration • Palliative/Comfort Care • Personal Hygiene • Rest and Sleep Pharmacological Therapies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 259 Adverse Effects • Expected Effects • Medication Administration • Pharmacological Actions • Pharmacological Agents • Side Effects

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    Reduction of Risk Potential . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 303 Diagnostic Tests • Laboratory Values • Potential for Alterations in Body Systems • Potential for Complications of Diagnostic Tests/Treatments/Procedures/Surgery, or Health Alterations • Therapeutic Procedures • Vital Signs Physiological Adaptation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 337 Alterations in Body Systems • Basic Pathophysiology • Fluid and Electrolyte Imbalances • Medical Emergencies • Radiation Therapy • Unexpected Response to Therapies PART II: NCLEX-PN PRACTICE TESTS NCLEX-PN Practice Test 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 393 Answers and Explanations for Practice Test 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 413 NCLEX-PN Practice Test 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 427 Answers and Explanations for Practice Test 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 449 NCLEX-PN Practice Test 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 465 Answers and Explanations for Practice Test 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 487 End-User License Agreement. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 503 iv CliffsTestPrep NCLEX-PN

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    1 Introduction This book has been written to help you prepare for—and pass—the new NCLEX-PN. The NCLEX (National Council Licensure Examination) is required to obtain a license to practice as a practical or vocational nurse. The exam is admin- istered by the National Council of State Boards of Nursing and assures that your license is acceptable throughout the entire United States and its territories. By passing this test, you will be able to practice as a practical/vocational nurse. The test is based on the specialized knowledge that you should have at this point, and it tests the skills necessary to contribute meaningfully to the nursing process. Because this is a test of basic competency, you are only required to demonstrate your abilities as an entry-level nurse in this exam. It is not a test for the more-experienced nurse because you will not encounter questions about more- sophisticated elements of the nursing profession. Neither is it an indicator of how you will fare in the profession. During the computerized examination, you will answer between 85 and 205 questions, so there is a limit to the amount of material that is covered on the test. In this book, we’ve tried to give as much material as possible, based on previous tests. The questions are written by nurse-educators, who are familiar with the material covered on the NCLEX-PN and prepare students for this exam. The CAT Exam Because the NCLEX-PN is computerized, it is called a CAT test, which stands for Computerized Adaptive Testing. The computer adapts to your responses. You begin with a moderately difficult question, and if you answer correctly, the next question is slightly harder. If you answer incorrectly, the next question is slightly easier. Essentially, the computer selects questions based on your abilities. The more questions you answer, the more the computer understands your re- sponses and can tailor the questions for you. If you answer most of the questions correctly, you might have to answer only 85 questions to demonstrate your mastery of the necessary material to pass the NCLEX-PN. If you answer a sig- nificant number of questions incorrectly, the computer keeps trying easier questions until you answer correctly. The maximum number of questions is 205. You cannot skip questions as you work through the test because each new question is predicated on the previous re- sponse. You need to read carefully and answer each question. However, if you cannot decide on an answer to a specific question, you have to select any answer to move on to the next question. The entire testing period is five hours. This includes a brief tutorial and sample questions, as well as scheduled breaks during the testing period. How to Use This Book This book contains eight chapters; each chapter contains questions based on the newest version of the exam. It covers the following topics, based on Client Needs categories. There are four basic Client Needs categories. As you see below, two of these categories are broken down into six subcategories. All the topics and subtopics are covered in this book, al- though many of them might be combined into similar topic areas. Safe and Effective Care Environment Coordinated Care Safety and Infection Control Health Promotion and Maintenance Psychosocial Integrity

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    2 CliffsTestPrep NCLEX-PN Physiological Integrity Basic Care and Comfort Pharmacological Therapies Reduction of Risk Potential Physiological Adaptation We’ve included explanations with each of the answers to the questions to help you understand the material in greater depth. We’ve explained the correct answers, but in many cases, we’ve explained why the other choices are incorrect. By combining the answers with the questions, you have immediate feedback. You should, of course, know much of this material already, but there are some topics that you might not be as familiar with as you are with others that are pre- sented in this book. The recommended method is to: 1. Read the question. 2. Try to understand what the question is asking. 3. Try to determine the answer. 4. Check the answer from the choices that accompany each question. Certain important concepts are integrated throughout the Client Needs categories and subcategories: 1. Clinical Problem-Solving Process (Nursing Process). This is the scientific approach to client care that includes data collection, planning, implementation, and evaluation. 2. Caring. This is the interaction between you, as the practical/vocational nurse, and the clients, their families, or their significant others. It requires mutual respect and trust. 3. Communication and Documentation. It is very important that you be clear and concise in your interactions with clients, their families, and members of your health care team. This requires the ability to communicate both verbally and nonverbally, and to be accountable in keeping and maintaining records and client charts. 4. Teaching and Learning. You must demonstrate the appropriate skills and attitudes that promote change in your- self and others by learning and teaching. The ability to share information with clients and their families appropri- ately is very important. About the Content As we said, there are eight Client Needs chapters, and within those chapters are individual subcategories, for which you’ll be responsible. Following is a list of the Client Needs chapters and subcategories and the percentage of questions that appear on the test for each. Keep in mind that the test might include material not covered in these chapters. Safe and Effective Care Environment Coordinated Care (11%–17%) Advance Directives Advocacy Client Care Assignments Client Rights Concepts of Management and Supervision Confidentiality Consultation with Members of the Health Care Team Continuity of Care Establishing Priorities

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    Ethical Practice Informed Consent Legal Responsibilities Performance Improvement (Quality Assurance) Referral Process Resource Management Safety and Infection Control (8%–14%) Accident/Error Prevention Handling Hazardous and Infectious Materials Home Safety Injury Prevention Internal and External Disaster Plans Medical and Surgical Asepsis Reporting of Incident/Event/Irregular Occurrence/Variance Safe Use of Equipment Security Plans Standard/Transmission-Based/Other Precautions Use of Restraints/Safety Devices Health Promotion and Maintenance (7%–13%) Aging Process Ante/Intra/Postpartum and Newborn Care Data Collection Techniques Developmental Stages and Transitions Disease Prevention Expected Body Image Changes Family Interaction Patterns Family Planning Health Promotion/Screening Programs High-Risk Behaviors Human Sexuality Immunizations Lifestyle Choices Self-Care Psychosocial Integrity (8%–14%) Abuse or Neglect Behavioral Interventions Behavioral Management Coping Mechanisms Crisis Intervention Cultural Awareness End-of-Life Concepts Grief and Loss 3 Introduction

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    Mental Health Concepts Mental Illness Concepts Religious or Spiritual Influences on Health Sensory/Perceptual Alterations Situational Role Changes Stress Management Substance-Related Disorders Suicide/Violence Precautions Support Systems Therapeutic Communication Therapeutic Environment Unexpected Body Image Changes Physiological Integrity Basic Care and Comfort (11%–17%) Assistive Devices Elimination Mobility/Immobility Nonpharmacological Comfort Interventions Nutrition and Oral Hydration Palliative/Comfort Care Personal Hygiene Rest and Sleep Pharmacological Therapies (9%–15%) Adverse Effects Expected Effects Medication Administration Pharmacological Actions Pharmacological Agents Side Effects Reduction of Risk Potential (10%–16%) Diagnostic Tests Laboratory Values Potential for Alterations in Body Systems Potential for Complications of Diagnostic Tests/Treatments/Procedures/Surgery or Health Alterations Therapeutic Procedures Vital Signs Physiological Adaptation (12%–18%) Alterations in Body Systems Basic Pathophysiology Fluid and Electrolyte Imbalances Medical Emergencies 4 CliffsTestPrep NCLEX-PN

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    Radiation Therapy Unexpected Response to Therapies All the listed topics and subtopics are covered in this book, although many of them might be combined into similar topic areas. Types of Questions Most of the questions are multiple choice with four choices. Some alternate-format questions are included here, however, that are similar to those recently added to the NCLEX-PN. The alternate-format questions include fill-in-the-blank questions and hot-spot questions. Hot-spot questions ask you to identify a correct answer choice from an illustration, table, or chart. You click on the correct answer choice with the on-screen cursor. The computer can identify the spot where you’ve clicked. The Multiple-Choice Format Most of the standardized tests that you’ve taken during your education have contained multiple-choice questions. Multiple-choice questions are difficult for some test-takers. If you approach these questions carefully, following the tips that we give you in this section, they should be easier than you think. Let’s analyze the concept of the multiple-choice question. Keep in mind that these questions are created to test your ability to recognize the correct answer from four choices. Questions are comprised of several parts. ■ the question stem ■ the correct choice ■ distracters Writers create multiple-choice test questions using the following plan: ■ One choice is absolutely correct. ■ One or two choices are absolutely incorrect (distracters). ■ One or two choices might be similar to the correct answer, but might not answer the specific question—or might contain some information that is not accurate (distracters). How do you approach the questions? First, read the question and see whether you know the answer. If you know it automatically, you can look at the choices and select the correct one. Let’s look at a very simple example: 1. Mammography is used to detect which of the following conditions? 1. pain 2. tumor 3. edema 4. epilepsy This is a very simple question and answer. It’s a question that most people know, without the benefit of a nursing educa- tion. You should know that mammography is used to detect tumors or cysts in the breasts (Choice 2). It is not used to detect any of the other conditions. You should know that a mammogram is the image produced by a low-dose X-ray of the breast. If you don’t know the answer, you have certain options, using the process of elimination. 5 Introduction

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    Are there any choices that you can immediately eliminate? For example, Choice 1 is not likely to be identified by mam- mography. It’s possible that a client experiencing pain has a mammography to identify the source of the pain, but the mammography cannot detect pain. Thus you can eliminate that answer. Now you’ve improved your odds of answering the question correctly. Instead of having only a 25% chance (one out of four choices) of identifying the correct answer, you now have a 33% chance (one out of three choices). Now move to the next choice. It’s possible that mammography is used to locate tumors. (Yes, we know this is the correct answer, but the exercise here is to demonstrate how to eliminate the choices if you don’t know that answer.) The next choice is edema. If you know that edema is a swelling caused by an abnormal accumulation of fluid in body tissues, you might think it possible that a mammogram can spot the fluid, and that might be a possible answer. Hold on to that choice for a moment, and move to Choice 4, epilepsy. Epilepsy is a disorder of the central nervous system, and you should know this. Is it possible for a mammogram to spot a nervous disorder? This can’t be a correct choice if you know that a mammogram is an X-ray. So you can eliminate that choice also. This leaves only two choices—tumor or edema. At this point, if you really don’t know the answer, you have to guess. But at this stage, having eliminated two very clear incorrect choices, you have a 50% chance (one out of two choices) to guess the correct answer. It is important to read the question carefully. Look at the following: 2. All the following should be performed when fetal heart monitoring indicates fetal distress except: 1. increasing maternal fluids 2. administering oxygen 3. decreasing maternal fluids 4. turning the mother How did you answer this question? Did you take note of the word except ? All the choices are correct except for Choice 3. This is the only intervention that should not be performed when fetal distress is indicated. Finally, pay attention to words like always , never, and not . You should be careful if a question asks you to choose which of the choices is not . . .! Or, as in the question above, “All are correct except . . .” Some questions might ask about measurements. For example, there is a big difference between 0.401, 4.01, 40.1, and 401. Keep decimal points in mind as you read these types of questions. Make sure, also, that you know measurements like liters, milliliters, and fluid ounces. As you go through this book, take your time with the questions and answers. Try to analyze what you answered incor- rectly and learn from the answers and explanations. Identify those questions where you are able to use the process of elimination. Check how well you perform on those questions. How many do you know? Don’t worry about how well or how poorly you do. Take the time to do an analysis of your results. These are some of the secrets to being a successful test-taker. You must be prepared by your education and have the knowledge and skills to take the test. You have a better chance if you practice the techniques of answering multiple-choice questions. 6 CliffsTestPrep NCLEX-PN

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    Alternate-Format Questions As mentioned previously, most of the questions on the test are four-choice, multiple-choice questions. Alternate-format questions have been recently added to the NCLEX-PN to allow test-takers to show their knowledge in different ways. There are four types of alternate-format questions that you might see on the NCLEX-PN: 1. Multiple-choice questions might have more than one correct choice. However, you will see a prompt that tells you to select all the answer choices that apply. There might be more than four choices in these questions. 2. Fill-in-the-blank questions ask you to type in a specific number or word. 3. Calculation or ordered-response questions ask you to compute an answer or itemize answers in the correct order. 4. Hot-spot questions ask you to identify with the cursor the appropriate area on a picture or other graphic on the screen. Why have alternate-format questions been added to the NCLEX-PN? It is believed that you are able to demonstrate your competence in certain areas beyond which multiple-choice questions can test. If, for example, you are asked to do a problem that requires calculations, by actually doing them yourself, you prove yourself more capable than merely selecting the correct answer from four choices (especially because you’ve learned the secrets of answering these types of questions earlier in this section). Sample Alternate-Format Questions Try the following questions, and then check your answers in the following section. 1. The nurse has auscultated a heart murmur during a routine assessment on a client. Which of the following characteristics of the murmur should indicate to the nurse that the murmur is most likely functional or innocent? Select all that apply. _____ changes with position _____ grade III/VI _____ diastolic _____ rarely transmitted _____ varies in intensity from visit to visit _____ holosystolic _____ general good health _____ disappears with valsalva maneuver 7 Introduction

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    2. The physician has ordered 350 mg Ampicillin IM. Look at the following label for a 1 gram vial of Ampicillin. How many milliliters of reconstituted Ampicillin should the nurse administer? 3. A nurse is documenting the completed health history of a client. In what order should the nurse document the components of the history? 1. review of systems 2. chief complaint 3. social history 4. past medical history 5. history of present illness 6. family history Type the numbers for the components in order. _______________ For IM use, add 3.5 mL diluent (read accompanying circular). Resulting solution contains 250 mg ampicillin per mL. Use solution within 1 hour. This vial contains ampicillin sodium equivalent to 1 gram ampicillin. Usual Dosage: Adults–250 to 500 mg IM q. 6h. READ ACCOMPANYING CIRCULAR for detailed indications, IM or IV dosage and precautions. Cont. Exp. Date: NDC 0015-7404-20 NSN 6505-00-993-3518 EQUIVALENT TO 1 gram AMPICILLIN STERILE AMPICILLIN SODIUM, USP For IM or IV use CAUTION: Federal law prohibits dispensing without prescription. 8 CliffsTestPrep NCLEX-PN

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    4. The nurse is completing the growth chart of an 18-month-old male child. The child weighed 13 kg and was 85 cm long. Identify on the growth chart where the nurse should plot the child’s weight. L E N G T H L E N G T H W E I G H T W E I G H T Birth 3 9 6 Birth 3 12 9 6 18 21 24 27 30 33 36 15 2 3 4 5 6 7 10 12 14 16 8 6 kg lb AGE (MONTHS) 12 15 18 21 24 27 30 33 36 kg Motherís Stature F atherís Stature Gestational Date Age Weight Length Head Circ. Age: Weeks Birth Comment AGE (MONTHS) 8 9 10 11 12 13 14 15 16 17 90 95 100 cm cm 100 lb 16 18 20 22 24 26 28 30 32 34 36 38 95 90 75 50 25 10 5 40 45 50 55 60 65 70 75 80 90 95 85 95 90 75 50 25 10 5 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 in in 41 40 39 38 37 36 35 Birth to 36 months: Boys Length-for-age and Weight-for-age percentiles NAME RECORD # Published May 30, 2000 (modified 4/20/01). SOURCE: Developed by the National Center for Health Statistics in collaboration with the National Center for Chronic Disease Prevention and Health Promotion (2000). http://www.cdc.gov/growthcharts 9 Introduction

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    Answers to Alternate-Format Questions 1. __X_ changes with position ____ grade III/VI ____ diastolic __X_ rarely transmitted __X_ varies in intensity from visit to visit ____ holosystolic __X_ general good health __X_ disappears with valsalva maneuver Characteristics of functional or innocent murmurs include usually grade I–II/VI; changes with position; varies in loudness or presence from visit to visit; increases in intensity with fever, anemia, exercise, or anxiety; musical or vibratory; systolic; short duration; best heard at the left-lower sternal border or pulmonic area; rarely transmitted; might disappear with valsalva maneuver; vital signs normal; electrocardiograph normal; and general good health. Characteristics of pathologic murmurs include significant medical/cardiac history; loud, harsh, or continuous; diastolic or late systolic; holosystolic or pansystolic; associated abnormalities; associated failure to thrive, congestive heart failure or other systemic illness; and no change with position. 2. For IM use, the nurse must reconstitute the Ampicillin with 3.5 milliliters (mL) of diluent. This results in a concentration of 250 mg/mL. 250mg : 1 mL = 350 mg : x mL (multiply the means by the extremes) 250 x = 350 x = 1.4 mL The nurse should administer 1.4 mL 3. 2, 5, 4, 6, 3, 1 The health history begins with the chief complaint, in which the client describes in his or her own words the reason for the visit. The history of the present illness follows and includes the onset, location, duration, character, aggravating/associated factors, relieving factors, and temporal factors. The client’s past medical history follows and includes hospitalizations, surgeries, serious illnesses, usual childhood illnesses, immunizations, food/drug/ environmental allergies, and any recent screening tests. The family history should include three generations and identify serious or hereditary diseases that run in the family. Social history includes habits, sexual history, home conditions, occupation, environmental concerns, religious practices, diet, and substance abuse/use. Finally, the review of systems is included in a complete health history to identify any concerns within a body system. 10 CliffsTestPrep NCLEX-PN

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    4. The child’s weight should be plotted using the lower portion of the page on the weight graph at the intersection of the vertical line corresponding with 18 months and the horizontal line of 13 kg. The child’s weight is between the 75th and 90th percentile. The upper portion of the graph is for the child’s length and should not be used to plot the weight. L E N G T H L E N G T H W E I G H T W E I G H T Birth 3 9 6 Birth 3 12 9 6 18 21 24 27 30 33 36 15 2 3 4 5 6 7 10 12 14 16 8 6 kg lb AGE (MONTHS) 12 15 18 21 24 27 30 33 36 kg Motherís Stature F atherís Stature Gestational Date Age Weight Length Head Circ. Age: Weeks Birth Comment AGE (MONTHS) 8 9 10 11 12 13 14 15 16 17 90 95 100 cm cm 100 lb 16 18 20 22 24 26 28 30 32 34 36 38 95 90 75 50 25 10 5 40 45 50 55 60 65 70 75 80 90 95 85 95 90 75 50 25 10 5 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 in in 41 40 39 38 37 36 35 Birth to 36 months: Boys Length-for-age and Weight-for-age percentiles NAME RECORD # Published May 30, 2000 (modified 4/20/01). SOURCE: Developed by the National Center for Health Statistics in collaboration with the National Center for Chronic Disease Prevention and Health Promotion (2000). http://www.cdc.gov/growthcharts 11 Introduction

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    How did you do? As you can see, they’re not particularly difficult, but do require you to do a little more work. If you know the material, you will have no trouble. Scoring High on the NCLEX-PN To do well on this exam, there are several steps you can take. First, make sure you understand the material. How do you do that? Recognize that this test is a minimum-skills test and does not require you to use high-tech information or knowledge that an experienced practical/vocational nurse already possesses. Go back to your nursing-school notes. And most important, use this book. It has been set up in such a way that you can continually check your understanding of the material by providing the answers to each and every question. Second, be diligent in your studying. Go through each chapter and answer the questions. Then see how you did after each question. Did you understand the question? Did you know the answer immediately, or did you have to use the process of elimination? Third, take the practice tests. Although the actual NCLEX-PN is a computerized exam, it is still helpful to take a pen- and-pencil test. Yes, you have to answer the full complement of 205 questions this way, but it serves a couple of pur- poses. You are able to get an idea of what it’s like to take the NCLEX-PN, and you are exposed to more than 800 additional questions among these four exams—and you acquire understanding of the material presented here. When taking these practice tests, set yourself up in a quiet room under test-taking conditions. Time yourself, and see how long it takes to answer all the questions. Although the length of the actual test experience can be as long as five hours, some of that time is taken up by a tutorial, review practice exams, and breaks. Okay, give yourself a break after you have completed one-third of the practice test. Get up and walk around, have a glass of water, and then return to the test. If you don’t need the break, keep going. After you’ve completed the test, take a break and come back to it the next day after you’ve given yourself a rest. Then check the answers. After checking your score, go back to those questions that were incorrect and try to understand why they were wrong. Were they careless errors? Did you understand the topic? On the actual test, work steadily. Keep in mind that you can’t skip questions on the computer, so you’re forced to pro- vide an answer. Don’t spend too much time on any one question. It’s best to read the question carefully, look at the answer choices, select one, and move on. Be confident. Remember, you’ve studied for the exam, you’ve taken practice tests, and you know the material. There will always be some questions for which you don’t know the answers, but do the best that you can, and continue to believe in your ability to answer as many questions as possible correctly. Have a Study Plan There is no one, correct way to study. Individuals learn differently. However, if you expect to do well on the test by cramming in the last week prior to the exam, you will be disappointed. The only way to prepare is to follow a sensible study plan that you can create yourself. We suggest reading through the book, chapter by chapter, and answering the questions as you go along. Read the explanations for the answers. In this way, you’ll be reviewing material that you probably know already and, at the same time, learning some information that you might have forgotten. There are eight basic chapters in the book. If you spend one week per chapter, you’ll have plenty of time to absorb the material. At the end of that time, you should take the practice tests—one day to take a test and one day to check your answers. Based on these suggestions, you can get through the entire book in 12 weeks. Finally, keep a record of those questions that you have trouble with. When you’ve completed the entire chapter, go back and review them again. Good luck on the exam! 12 CliffsTestPrep NCLEX-PN

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    S S U U BJ BJ E E CT AR CT AR EA EA R R EVI EVI EW EW C C HAPTE HAPTE R R S S There are additional questions and answers for chapters 3 and 4 on the CD-ROM. PART I

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    15 Coordinated Care This chapter contains questions and answers from the following topic areas: ■ Advance Directives ■ Advocacy ■ Client Care Assignments ■ Client Rights ■ Concepts of Management and Supervision ■ Confidentiality ■ Consultation with Members of the Health Care Team ■ Continuity of Care ■ Establishing Priorities ■ Ethical Practice ■ Informed Consent ■ Legal Responsibilities ■ Performance Improvement (Quality Assurance) ■ Referral Process ■ Resource Management 1. A 97-year-old man has severe coronary artery disease. His daughter informs you that he has a living will and a durable power of attorney for health care (DPAHC). These documents allow the daughter to: 1. sell her father’s house for funds to be used in his care. 2. make all decisions if her father becomes incompetent. 3. make health care decisions based on her father’s designated wishes if he is not competent or able to speak for himself. 4. have no say in her father’s care because the documents do not convey legal authority. (3) A DPAHC designates legal authority for health care decision-making to a specific individual. Decision-making is to be guided by the living will. Choices 1 and 2 are incorrect because the client has only designated authority for health care decision-making, not financial or other decision-making. Choice 4 is incorrect because legal authority is delegated by a DPAHC. 2. While helping Mrs. Smith with her mouth care the evening before she is scheduled for exploratory abdominal surgery, she asks, “What do you think I should do if it’s cancer?” The response, “Let’s hope not. It’s such a bad disease. Almost everyone I’ve taken care of with cancer dies in a short time,” is an expression of: 1. personal opinion. 2. professional values. 3. ethical values. 4. moral values. (1) The response conveys a personal opinion based on experience. Choice 2 is incorrect. Professional values are shaped by education and professional standards of practice, which are not conveyed in the response. Choice 3 is incorrect; ethi- cal values are based on beliefs regarding right and wrong. Choice 4 is incorrect; moral values are based on sociocultural influences. 3. It is appropriate to share personal values with a client: 1. if you believe the client can benefit from your advice. 2. when you need to make a choice for the client. 3. when the client asks for your opinion and you state it as such. 4. to settle a difference of opinion. (3) It is appropriate to share personal values with a client if he or she seeks your input and understands that it is your personal opinion only. However, nurses should always be judicious when sharing personal values with clients. Choices 1, 2, and 4 are incorrect.

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    16 Part I: Subject Area Review Chapters 4. If a client is deemed incompetent, it means that: 1. he or she can’t afford to pay his or her hospital bill. 2. he or she won’t follow medical direction. 3. a court proceeding has declared him or her unable to make his or her own decisions. 4. as a nurse, you have assessed that he or she is not making good choices or decisions. (3) Only a court can determine competency status based on medical and psychological evaluations. Choices 1, 2, and 4 are incorrect. Choice 1 speaks to financial status only, which is not an issue of competence. Choice 2 describes nonad- herence, not incompetence. Choice 4 falsely implies that a nurse can judge competence based on his or her own percep- tions of the quality of the client’s decision-making. 5. A DNRCC code status means: 1. the client should not have his or her symptoms actively treated. 2. the client’s care is of lower priority than another client who has a full code status. 3. therapies and treatments for the client have been limited to those that promote comfort. 4. it’s no longer necessary to take the client’s vital signs. (3) Clients with a DNRCC code status should have quality symptom management to ensure comfort without efforts to sustain or prolong life. Choices 1, 2, and 4 are incorrect. All clients should have equal access to care regardless of code status. The nurse is responsible for continuous client assessment and for ensuring that comfort goals are met. 6. An 85-year-old male client is unconscious and unable to speak for himself. His daughter produces his advanced directive stating that she is responsible for making health care decisions on his behalf. This type of advance directive is: 1. a living will. 2. a durable power of attorney for health care (DPAHC). 3. a durable power of attorney for finance (DPAF). 4. a guardianship. (2) Choices 1, 3, and 4 are incorrect. A living will is a written expression of personal wishes regarding the end of life. A DPAF gives authority for financial decision-making only. A guardianship is court appointed. 7. Quality of life is: 1. an individual’s perception of his or her well being. 2. determined by a legally responsible person. 3. based on financial resources. 4. consistent by legal definition in all health care settings. (1) Quality of life is based on an individual’s personal biopsychosocial and spiritual beliefs. Choices 2, 3, and 4 are incorrect. 8. In dealing with illness, a nurse should pursue values clarification with a client when: 1. the client and nurse have different opinions. 2. the nurse is unsure of the client’s values. 3. the client has embraced nontraditional values. 4. the client verbalizes personal conflict. (4) Choices 1, 2, and 3 are incorrect. Differing opinions do not necessarily mean a lack of clarity of values. Unless the client has a value conflict, it is not appropriate for the nurse to address values because the client has the right to privacy and autonomy.

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    9. Advance directives are: 1. a source of information about a client’s values and wishes to be used when he or she is unable to express them. 2. an irrevocable listing of personal wishes. 3. transferable from state to state. 4. legal only if they have been recorded in court proceedings. (1) Choice 2 is incorrect because advance directives are not irrevocable. Choice 3 is incorrect because the format dif- fers from state to state. Choice 4 is incorrect because advance directives are legally binding if executed according to state guidelines and do not require court action. 10. The term DNR refers to: 1. CPR only. 2. a decision regarding care in an acute care hospital. 3. the use of artificial nutrition and hydration. 4. the use of medications and treatments to achieve a client’s comfort goals. (4) Choice 1 is incorrect because, although CPR is a component of DNR, depending on a state’s definitions and proto- cols, DNR can include other aspects of care. Choice 2 is incorrect because DNR status applies across the entire care con- tinuum. Choice 3 is incorrect because the use of artificial nutrition and hydration is only part of the DNR discussion. 11. A living will addresses a client’s wishes regarding: 1. fluid and hydration treatment. 2. place of burial. 3. financial disbursements upon death. 4. dispersement of personal property. (1) Choices 2, 3, and 4 are incorrect. Financial and personal property are not addressed in a living will. 12. Nursing advocacy is: 1. making decisions for clients. 2. encouraging clients to follow all orders from the doctor. 3. encouraging and supporting client decisions concerning rights and health care choices. 4. completion of all forms for clients. (3) Nursing advocacy includes encouraging and supporting client decisions concerning rights and health care choices. It is built on the ethical principle of autonomy, which is a client’s right. 13. Nursing advocacy includes all the following activities except: 1. maintaining clients’ rights in clinical trials. 2. caring for those who cannot care for themselves. 3. educating clients regarding treatment choices. 4. discouraging clients from making decisions based on cost. (4) Advocacy includes caring for those who cannot care for themselves and emphasizes support in decision-making so that clients who are competent have the information necessary to make informed decisions regarding treatments, costs, care needs, rights in research, and risks of treatment. 17 Coordinated Care

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    14. Your Emergency Department client is a 10-year-old with contusions that might have been inflicted by a caregiver. A nurse advocate facilitating the client’s care should perform all the following activities except: 1. identifying and documenting the client’s condition. 2. telling the client’s mother. 3. following the facility’s protocol for mandatory reporting of suspicion of child abuse. 4. discussing the findings with the physician in charge. (2) In instances of suspected child abuse, the nurse advocate has a responsibility to the client to convey the concern verbally to the physician in charge, in writing through complete factual documentation, and by following the facility’s protocol for reporting the suspicion. 15. An 85-year-old man with end-stage prostate cancer has a living will expressing his desire for a dignified death and comfort care measures without resuscitation. His daughter has concerns about the living will. As a nurse advocate, your role is to: 1. support the daughter’s decision. 2. encourage the client to revoke his living will. 3. support the client’s decision and encourage him to discuss his feelings with his daughter. 4. ignore the client’s decision to deny resuscitation. (3) The nurse advocate’s role is to explore the client’s decision with him, support his decision-making authority, and encourage a discussion between the client and his daughter regarding his wishes. 16. A wandering Alzheimer’s client is in restraints in an acute care unit. The nursing advocate finding this situation at the beginning of a shift should perform the following action: 1. remove the restraints on rounds and continue with rounds. 2. remove the restraints and instruct the client not to wander. 3. call the physician for a prn sedative order for the client. 4. assess the client for safety and arrange for a family member to provide supervision. (4) The nurse must provide the least-restrictive environment that is safe for the client. The safety of the client must be assessed and, if possible, a family member or caregiver known to the client should be enlisted to assist in maintaining the safety of the client without restraints. 17. The advocacy role of the professional nurse provides the opportunity to impact all the following areas except: 1. safe standards of practice. 2. safe staffing laws. 3. reasonable workloads. 4. increased cohesiveness of values in society. (4) Nursing, through professional organizations and political action, has the opportunity to affect standards of practice, safe staffing laws, and reasonable workloads. 18. As a nurse advocate, the nurse might find herself in the role of: 1. mentor. 2. role model. 3. nurse manager. 4. all of the above. (4) Nurse advocates function as client advocates, advocates for other nurses, and advocates for the nursing profession as a whole. In these roles, the nurse might function as a role model, mentor, nurse manager, and direct provider of care, among other roles. 18 Part I: Subject Area Review Chapters

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    19. Nursing advocacy for clients is intended to assist clients in maintaining: 1. maximal health. 2. an independent living situation. 3. autonomy. 4. a driver’s license. (3) The nurse advocate assists clients in maintaining as much autonomy as possible. Autonomy is a client’s right. 20. As an advocate for the profession of nursing, the nurse performs all the following activities except: 1. following the standards of care for the client group with which the nurse works. 2. encouraging others to become nurses. 3. supporting safe working conditions for nurses. 4. encouraging nursing research by nursing educators only. (4) Being an advocate for the profession of nursing includes encouraging and mentoring others to become nurses, supporting political issues affecting the profession of nurses (such as safe working conditions), following appropriate standards of care for clients, and supporting nursing research by all levels of nurses (including clinicians, educators, administrators, and researchers). 21. A 60-year-old home care client has just lost her husband of 40 years. The nurse advocate should encourage her to: 1. have her annual gynecologic exam early. 2. return to dating as quickly as possible. 3. visit a bereavement counselor or talk with a trusted family chaplain as necessary. 4. resign from work. (3) The nurse advocate for a new widow should encourage the widow to work through her grieving process by talking with a counselor or chaplain. Changing work or social relationships quickly might not allow for the grief work this client requires after the loss of her husband. 22. An important influence that a nurse advocate engaged in political and social activities can have is: 1. encouraging persons to complete advance directives. 2. making contributions to political action committees. 3. assisting his or her son’s soccer team as the first-aid provider. 4. becoming an effective time manager. (1) One influential and far-reaching activity in which nurse advocates can engage is the encouragement of individuals to complete legal documents and advance directives that define their wishes for their health and illness care, should they be unable to communicate these wishes themselves. Involvement with the patient to improve his or her health care man- agement through clear communication of the patient’s wishes is the best nursing advocacy behavior listed. 23. Coordination of care in case management includes all the following activities except: 1. organizing resources for use by clients. 2. choosing a treatment option for clients based on proximity to the clients’ homes. 3. securing resources for in-home therapy based on clients’ preferences. 4. integrating client-chosen options for care into the medical treatment plan. (2) Choosing treatment options for clients based on geography rather than the clients’ choices of a need-based treatment provider is incorrect; all other choices are appropriate. 19 Coordinated Care

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    24. A recently widowed 56-year-old client is receiving dialysis and tells the nurse he does not like to cook for himself. As his case manager, the nurse should refer him to: 1. the local visiting nurses association (VNA). 2. Hospice. 3. American Association of Retired Persons (AARP). 4. Meals on Wheels. (4) Meals on Wheels is a community provider of nutritional meal assistance. The local VNA provides skilled therapeu- tic services. Hospice provides terminally ill individuals with palliative care at the end of life. AARP is an organization of older adults that provides education, insurance, information services, and political action for seniors. 25. Case-management services begin with: 1. implementation of a case-management plan. 2. monitoring of the case-management process to change plans if needed. 3. assessment. 4. evaluation. (3) The steps in case management are assessment, planning, implementation, coordination, monitoring, and evaluation. 26. An 80-year-old male client is being discharged from the hospital with a new diagnosis of lung cancer. His adult children have made arrangements for him to live with his youngest son. To promote optimal continuity of care, the nurse should: 1. immediately arrange for Hospice care. 2. convince the family that institutionalized care is better for the client. 3. assist with the discharge as planned. 4. explore options for community health services with the family. (4) The nurse should explore options for community health services to facilitate care given by family members and assist them in meeting the client’s needs at home. Hospice may not be the most appropriate choice, as criteria for Hospice eligibility have not been clearly met. Institutionalized care might be needed in the future. The family should be assisted in its desire to care for the client at home. 27. When planning for a client’s discharge from the hospital, the nurse needs information about all the following except: 1. type of insurance. 2. availability of caregivers for the client. 3. transportation available. 4. banking services used. (4) Information about the client’s financial institution and banking services is not necessary for discharge planning. Information about insurance, transportation, and caregiver availability is important when planning discharge. 28. A client is planning to be admitted to the hospital for elective surgery on Monday. When should her discharge planning begin? 1. when her physician writes the discharge order 2. at the time of admission 3. after surgery, during the discharge planner’s rounds 4. when the nurse is able to assess her postoperative status (2) Discharge planning should begin at the time of entry into the health care institution to adequately plan for and meet the client’s anticipated needs. 20 Part I: Subject Area Review Chapters

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    29. A client has had a total knee replacement. Which of the following statements made by the client indicates the need for further teaching before discharge? 1. “I have four steps into my house, and I know I’ll be able to do that without my cane—right?” 2. “I will continue my exercise program with my therapist at home.” 3. “I will watch my knee for redness—I don’t want an infection.” 4. “I will let my granddaughter pick my tomatoes—I know I shouldn’t be bending over to do that.” (1) A client discharged after a total knee replacement should use assistive devices for walking and stair-climbing until mobility and balance are fully restored. Use of such devices is discontinued by the physical therapist. All other choices are appropriate. 30. A discharge planner can be: 1. a master’s prepared nurse only. 2. a registered nurse or social worker. 3. an insurance company representative. 4. a physician. (2) Discharge planners are licensed social workers or registered nurses with advanced training in organizing and plan- ning for transitions from one health care facility to another, or from a health care facility to a client’s home. A master’s degree in nursing or medical degree is not required. Insurance company representatives can provide information to dis- charge planners for use in assisting clients with service choices. 31. Diagnostic-related groups (DRGs) are part of a client classification scheme designed to: 1. assign clients with the same diagnosis to the same hospital unit. 2. monitor quality of care given to clients. 3. classify clients by diagnosis and relate this information to reimbursement. 4. determine occupancy in a hospital. (3) DRGs are part of a classification system that groups clients by diagnosis for the purpose of reimbursement for care at a hospital, other health care facility, or home care service. 32. Case management has all the following benefits except: 1. improved outcomes of care for clients. 2. improved client satisfaction with care received. 3. decreased caregiver education needs. 4. cost-effective care provision. (3) Case management does not decrease client or caregiver education needs but facilitates meeting these needs earlier and more efficiently in the client encounter. 33. Case management is different than managed care in that: 1. managed care is a function of a health care reimbursement system, but case management is a structure for providing continuity of care. 2. managed care is an insurance company construct only. 3. case management only applies to areas of reimbursable services. 4. case management occurs only in conjunction with hospitalization. (1) Managed care refers to management of the business of health care, including the care of many persons. Case man- agement is a system for providing and organizing continuity of care services for individual clients. 21 Coordinated Care

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    34. Which of the following was developed by the American Hospital Association (AHA) to define the rights and responsibilities of clients in the acute care setting? 1. Code of Ethics 2. Hospital Advocacy 3. Patient’s Bill of Rights 4. Omnibus Budget Reconciliation Act (OBRA) Regulations (3 ) The Patient’s Bill of Rights, developed by the AHA, defines the rights and responsibilities of clients in acute care settings. The ANA (American Nurses’ Association) Code of Ethics provides ethical guidance for nurses. Hospital Advocacy is a program used by hospitals to assist clients in making decisions concerning their rights and health care choices. The OBRA sets standards related to quality of care in long-term care facilities. 35. The rights of clients described in the AHA’s Patient’s Bill of Rights include all the following rights except: 1. privacy and confidentiality. 2. the right to refuse to participate in research. 3. care without respect for continuity. 4. the right to refuse treatment. (3) The Patient’s Bill of Rights describes the rights to privacy and confidentiality, refusal to participate in research, continuity of care, and refusal of treatment. 36. A client is considering participating in a multisite trial of a new cancer drug. According to the AHA’s Patient’s Bill of Rights, it is important for the client to know that: 1. all costs of research are paid by the client. 2. the client has the right to refuse to participate in research without fearing loss of care. 3. physicians on the team will no longer be caring for the client if the client does not participate in the research. 4. the research study is the client’s only hope of treatment. (2) The Patient’s Bill of Rights describes the right of the client to refuse to participate in research without fearing loss of care. The client continues to be cared for by physicians and nurses on the team, and other treatment options might be offered. In most cases, the costs of participation in a drug trial are, at least partially, paid from the research study budget. 37. The AHA’s Patient’s Bill of Rights applies in: 1. a hospital. 2. a nursing home. 3. a free-standing urgent-care facility. 4. home care. (1) The Patient’s Bill of Rights is specific to the acute care setting. Other types of facilities and health care settings have similar documents that address client rights. 38. A client’s right to care has been a cornerstone in resolving ethical dilemmas related to the cost and affordability of health care. Determining how to protect a client’s right to care has presented challenges to nurses in all the following ways except: 1. providing considerate and respectful care. 2. providing care when the client refuses care based on cost. 3. preserving continuity of care when the availability of providers is limited due to cost. 4. providing care when the availability of community resources is limited. (1) The nursing profession is committed to the provision of considerate and respectful care for all clients as specified in the Nursing Code of Ethics and in the AHA’s Patient’s Bill of Rights. The challenge of providing clients with opti- mum health care is often related to the availability and cost of the care. 22 Part I: Subject Area Review Chapters

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    39. The client’s right to give informed consent applies to which of the following procedures? 1. insertion of an internal defibrillator 2. surgical excision of a skin lesion 3. physical therapy exercises 4. all procedures (4) The AHA’s Patient’s Bill of Rights states that a client has the right to give informed consent for all procedures and to refuse treatment. 40. When entering a hospital, a client signs a general consent form. This consent is used to document the client’s consent for: 1. all ongoing care in the hospital. 2. general treatment but does not waive the client’s right to refuse specific treatment. 3. the administration of research medications and treatments. 4. waiving the confidentiality of the client’s medical record. (2) The general consent form signed at hospital admission gives general consent for treatment in the hospital; however, the client maintains the right to refuse specific treatment. The client’s right to confidentiality is not compromised by his refusal of specific treatment. 41. A client has been admitted to a four-bed room with three other clients. Which right might be breached due to the setting? 1. the right to refuse treatment 2. the right to examine and question the bill 3. the right to privacy and confidentiality 4. the right to information regarding diagnosis, treatment, and prognosis (3) In a multiclient room setting, the staff must be especially aware of the risk of breaching the client’s right to privacy and confidentiality. 42. A client wishes to leave the hospital against medical advice. Which right is this client exercising? 1. the right to refuse treatment 2. the right to privacy 3. the right to be given information about a diagnosis 4. the right to confidentiality (1) When a client chooses to leave the hospital against medical advice, the client is exercising the right to refuse treat- ment. The rights to privacy, confidentiality, and information regarding care and treatment are not altered by this choice. 43. The AHA’s Patient’s Bill of Rights: 1. is legally binding. 2. describes rights of nursing home residents. 3. was developed by the American Heart Association. 4. is built around the core concept of autonomy of clients. (4) Client autonomy is the guiding concept of the AHA’s Patient’s Bill of Rights. It is applicable in acute care hospitals as a guideline and is not law. 23 Coordinated Care

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    44. The AHA’s Patient’s Bill of Rights is upheld by all the following nursing activities except: 1. client education. 2. documentation of refusal of treatment. 3. provision of privacy for treatment procedures and discussions of prognosis. 4. use of restraints. (4) The use of restraints violates a client’s rights to autonomy and respectful and considerate care. Choices 1, 2, and 3 uphold client rights. 45. Organizational theory includes groups of related concepts that: 1. provide a structure for determining when to form an organization. 2. are used to explain components of organization. 3. are helpful in defining family dysfunction. 4. are not helpful in defining outcomes for effective organizational functioning. (2) Organizational theory is a group of related concepts, principles, and hypotheses that is used to explain components of organizations and how they behave. The theory might or might not provide a structure, help to define the dysfunction found in a family, or define outcomes of effective functioning. 46. Motivation can be described in all the following ways except: 1. providing someone with an incentive. 2. a state of mind in which a person views a task or goal. 3. not possible in assisting a client to achieve a functional outcome. 4. a process that assists a client to achieve a goal based on perceived need. (3) Motivation can provide incentives to achieve functional outcomes. Motivation can be a state of mind in which a person views a task or goal, as well as an important aspect of assisting a client in the achievement of goals. 47. Which of the following time-management tips is the least useful and productive for a nurse manager? 1. Adopt a strategy that attempts to take care of all details. 2. Work on the most important task first. 3. Make a written note of tasks, activities, and obligations to be completed. 4. Only accept assignments that the nurse manager is able to complete. (1) The most important task should be worked on first. Being overly focused on details may interfere with accomplish- ing the larger task at hand. Often details can be delegated to those doing the work and have more effective outcomes. Written notes can prevent memory lapses. Accepting assignments that the nurse manager is not able to complete leads to the risk of unsafe care, frustration, and poor work performance. 48. A new manager does not seem to trust that assignments will be completed as delegated without significant supervision and direction. This style of management is called: 1. laissez-faire. 2. autocratic. 3. democratic. 4. diplomatic. (2) This leader is exhibiting an autocratic leadership style. Laissez-faire leadership is passive without overt interven- tion. A democratic leader takes information and suggestions from participants into consideration when making deci- sions. “Diplomatic” describes a communication style, not a style of leadership. 24 Part I: Subject Area Review Chapters

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