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CliffsTestPrep NCLEX-RN (2011)

Learn faster with CliffsTestPrep NCLEX-RN (2011), featuring key study points for certification.

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CliffsTestPrep NCLEX-RN (2011) - Page 1 preview imageCliffsTestPrep®NCLEX-PN®An American BookWorks Corporation ProjectContributing Authors/ConsultantsAmy Anderson, RN, MSNTexas Tech University Health Sciences Center,School of Nursing, TXWanda Bradshaw, RNC, MSNDuke University, NCValerie Eschiti, RN, MSN, CHTP, HNCMidwestern State University, TXSara Freuchting, RN, MNSc, CCRN,APRN, BCUniversity of Arkansas at Little Rock, ARSharon Krumm, RN, MN, CCRNArkansas State University, ARMary Alice Momeyer, MSN, CNPOhio State UniversityCynthia O’Neal, PhD, RNTexas Tech University Health Sciences CenterSchool of Nursing, TXDeborah Persell, MSW, RN, CPNPArkansas State University, ARVicki A. Schnetter, MSN, RNTexas Tech University Health Sciences CenterSchool of Nursing, TXBrenda Leigh Yolles Smith, EdD RN,MN, CNM, ICCEArkansas State University, ARCarolyn Mathis White, RN, MSN, FNP,PNP, JDUniversity of South Alabama, ALJoan Williams, MS, RN, CS, CNP
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CliffsTestPrep NCLEX-RN (2011) - Page 4 preview imageCliffsTestPrep®NCLEX-PN®An American BookWorks Corporation ProjectContributing Authors/ConsultantsAmy Anderson, RN, MSNTexas Tech University Health Sciences Center,School of Nursing, TXWanda Bradshaw, RNC, MSNDuke University, NCValerie Eschiti, RN, MSN, CHTP, HNCMidwestern State University, TXSara Freuchting, RN, MNSc, CCRN,APRN, BCUniversity of Arkansas at Little Rock, ARSharon Krumm, RN, MN, CCRNArkansas State University, ARMary Alice Momeyer, MSN, CNPOhio State UniversityCynthia O’Neal, PhD, RNTexas Tech University Health Sciences CenterSchool of Nursing, TXDeborah Persell, MSW, RN, CPNPArkansas State University, ARVicki A. Schnetter, MSN, RNTexas Tech University Health Sciences CenterSchool of Nursing, TXBrenda Leigh Yolles Smith, EdD RN,MN, CNM, ICCEArkansas State University, ARCarolyn Mathis White, RN, MSN, FNP,PNP, JDUniversity of South Alabama, ALJoan Williams, MS, RN, CS, CNP
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CliffsTestPrep NCLEX-RN (2011) - Page 5 preview imageAuthor’s AcknowledgmentsAmerican BookWorks Corporation would like to acknowl-edge and thank the contributions of Linda A. Razer to thisproject.Publisher’s AcknowledgmentsEditorialProject Editor:Suzanne SnyderAcquisitions Editor:Greg TubachCopy Editor:Katie RobinsonTechnical Editor:Sue A. Wise RN, MS, LSWEdison State Community CollegeProductionProofreader:Melissa D. BuddendeckWiley Publishing, Inc. Composition ServicesNote: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 thepublisher, and neither the author nor the publisherhas received any payment for this “stripped book.”CliffsTestPrep®NCLEX-PN®Published by:Wiley Publishing, Inc.111 River StreetHoboken, NJ 07030-5774www.wiley.comCopyright © 2005 Wiley, Hoboken, NJPublished by Wiley, Hoboken, NJPublished simultaneously in CanadaLibrary of Congress Cataloging-in-Publication data is available from the publisher upon request.ISBN-13:978-0-7645-7287-6ISBN-10:0-7645-7287-3Printed in the United States of America10 9 8 7 6 5 4 3 2 11B/QY/QT/QV/INNo 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, MA01923, 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 LegalDepartment, 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 COMPLETENESSOF THE CONTENTS OF THIS WORK AND SPECIFICALLY DISCLAIM ALL WARRANTIES, INCLUDING WITHOUT LIMITATION WARRANTIES OFFITNESS FOR A PARTICULAR PURPOSE. NO WARRANTY MAY BE CREATED OR EXTENDED BY SALES OR PROMOTIONAL MATERIALS. THEADVICE 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 THEPUBLISHER NOR THE AUTHOR SHALL BE LIABLE FOR DAMAGES ARISING HEREFROM. THE FACT THAT AN ORGANIZATION OR WEBSITE ISREFERRED 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 ITMAY 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. at800-762-2974, 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 informationabout Wiley products, please visit our web site at www.wiley.com.
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CliffsTestPrep NCLEX-RN (2011) - Page 6 preview imageTable of ContentsIntroduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1PART I: SUBJECT AREA REVIEW CHAPTERSCoordinated Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15Advance Directives • Advocacy • Client Care Assignments • Client Rights • Concepts ofManagement and Supervision • Confidentiality • Consultation with Members of theHealth Care Team • Continuity of Care • Establishing Priorities • Ethical Practice •Informed Consent • Legal Responsibilities • Performance Improvement (QualityAssurance) • Referral Process • Resource ManagementSafety and Infection Control . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59Accident/Error Prevention • Handling Hazardous and Infectious Materials • HomeSafety • Injury Prevention • Internal and External Disaster Plans • Medical andSurgical Asepsis • Reporting of Incident/Event/Irregular Occurrence/Variance • Safe Useof Equipment • Security Plans • Standard/Transmission-Based/Other Precautions • Useof Restraints/Safety DevicesHealth Promotion and Maintenance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105Aging Process • Ante/Intra/Postpartum and Newborn Care • Data Collection Techniques• Developmental Stages and Transitions • Disease Prevention • Expected Body ImageChanges • Family Interaction Patterns • Family Planning • Health Promotion/ScreeningPrograms • High Risk Behaviors • Human Sexuality • Immunizations • Lifestyle Choices• Self-CarePsychosocial Integrity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 175Abuse or Neglect • Behavioral Interventions • Behavioral Management • CopingMechanisms • Crisis Intervention • Cultural Awareness • End-of-Life Concepts • Griefand Loss • Mental Health Concepts • Mental Illness Concepts • Religious or SpiritualInfluences on Health • Sensory/Perceptual Alterations • Situational Role Changes •Stress Management • Substance-Related Disorders • Suicide/Violence Precautions •Support Systems • Therapeutic Communication • Therapeutic Environment • UnexpectedBody Image ChangesBasic Care and Comfort . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 219Assistive Devices • Elimination • Mobility/Immobility • Non-Pharmacological ComfortInterventions • Nutrition and Oral Hydration • Palliative/Comfort Care • PersonalHygiene • Rest and SleepPharmacological Therapies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 259Adverse Effects • Expected Effects • Medication Administration • PharmacologicalActions • Pharmacological Agents • Side Effects
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CliffsTestPrep NCLEX-RN (2011) - Page 7 preview imageReduction of Risk Potential . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 303Diagnostic Tests • Laboratory Values • Potential for Alterations in Body Systems •Potential for Complications of Diagnostic Tests/Treatments/Procedures/Surgery, orHealth Alterations • Therapeutic Procedures • Vital SignsPhysiological Adaptation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 337Alterations in Body Systems • Basic Pathophysiology • Fluid and Electrolyte Imbalances• Medical Emergencies • Radiation Therapy • Unexpected Response to TherapiesPART II: NCLEX-PN PRACTICE TESTSNCLEX-PN Practice Test 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 393Answers and Explanations for Practice Test 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 413NCLEX-PN Practice Test 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 427Answers and Explanations for Practice Test 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 449NCLEX-PN Practice Test 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 465Answers and Explanations for Practice Test 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 487End-User License Agreement. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 503ivCliffsTestPrep NCLEX-PN
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CliffsTestPrep NCLEX-RN (2011) - Page 8 preview image1IntroductionThis book has been written to help you prepare for—and pass—thenewNCLEX-PN. The NCLEX (National CouncilLicensure 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 theentire 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 specializedknowledge that you should have at this point, and it tests the skills necessary to contribute meaningfully to the nursingprocess. Because this is a test of basic competency, you are only required to demonstrate your abilities as an entry-levelnurse 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 amountof material that is covered on the test. In this book, we’ve tried to give as much material as possible, based on previoustests. The questions are written by nurse-educators, who are familiar with the material covered on the NCLEX-PN andprepare students for this exam.The CAT ExamBecause the NCLEX-PN is computerized, it is called a CAT test, which stands for Computerized Adaptive Testing. Thecomputeradaptsto your responses. You begin with a moderately difficult question, and if you answer correctly, thenext question is slightly harder. If you answer incorrectly, the next question is slightly easier. Essentially, the computerselects 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 answeronly 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. Themaximum 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 specificquestion, 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 breaksduring the testing period.How to Use This BookThis book contains eight chapters; each chapter contains questions based on the newest version of the exam. It coversthe 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 EnvironmentCoordinated CareSafety and Infection ControlHealth Promotion and MaintenancePsychosocial Integrity
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CliffsTestPrep NCLEX-RN (2011) - Page 9 preview image2CliffsTestPrep NCLEX-PNPhysiological IntegrityBasic Care and ComfortPharmacological TherapiesReduction of Risk PotentialPhysiological AdaptationWe’ve included explanations with each of the answers to the questions to help you understand the material in greaterdepth. We’ve explained the correct answers, but in many cases, we’ve explained why the other choices are incorrect. Bycombining the answers with the questions, you have immediate feedback. You should, of course, know much of thismaterial 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 includesdata collection, planning, implementation, and evaluation.2. Caring.This is the interaction between you, as the practical/vocational nurse, and the clients, their families, ortheir significant others. It requires mutual respect and trust.3. Communication and Documentation.It is very important that you be clear and concise in your interactionswith clients, their families, and members of your health care team. This requires the ability to communicate bothverbally 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 ContentAs we said, there are eight Client Needs chapters, and within those chapters are individual subcategories, for whichyou’ll be responsible. Following is a list of the Client Needs chapters and subcategories and the percentage of questionsthat appear on the test for each. Keep in mind that the test might include material not covered in these chapters.Safe and Effective Care EnvironmentCoordinated Care (11%–17%)Advance DirectivesAdvocacyClient Care AssignmentsClient RightsConcepts of Management and SupervisionConfidentialityConsultation with Members of the Health Care TeamContinuity of CareEstablishing Priorities
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CliffsTestPrep NCLEX-RN (2011) - Page 10 preview imageEthical PracticeInformed ConsentLegal ResponsibilitiesPerformance Improvement (Quality Assurance)Referral ProcessResource ManagementSafety and Infection Control (8%–14%)Accident/Error PreventionHandling Hazardous and Infectious MaterialsHome SafetyInjury PreventionInternal and External Disaster PlansMedical and Surgical AsepsisReporting of Incident/Event/Irregular Occurrence/VarianceSafe Use of EquipmentSecurity PlansStandard/Transmission-Based/Other PrecautionsUse of Restraints/Safety DevicesHealth Promotion and Maintenance(7%–13%)Aging ProcessAnte/Intra/Postpartum and Newborn CareData Collection TechniquesDevelopmental Stages and TransitionsDisease PreventionExpected Body Image ChangesFamily Interaction PatternsFamily PlanningHealth Promotion/Screening ProgramsHigh-Risk BehaviorsHuman SexualityImmunizationsLifestyle ChoicesSelf-CarePsychosocial Integrity(8%–14%)Abuse or NeglectBehavioral InterventionsBehavioral ManagementCoping MechanismsCrisis InterventionCultural AwarenessEnd-of-Life ConceptsGrief and Loss3Introduction
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CliffsTestPrep NCLEX-RN (2011) - Page 11 preview imageMental Health ConceptsMental Illness ConceptsReligious or Spiritual Influences on HealthSensory/Perceptual AlterationsSituational Role ChangesStress ManagementSubstance-Related DisordersSuicide/Violence PrecautionsSupport SystemsTherapeutic CommunicationTherapeutic EnvironmentUnexpected Body Image ChangesPhysiological IntegrityBasic Care and Comfort (11%–17%)Assistive DevicesEliminationMobility/ImmobilityNonpharmacological Comfort InterventionsNutrition and Oral HydrationPalliative/Comfort CarePersonal HygieneRest and SleepPharmacological Therapies (9%–15%)Adverse EffectsExpected EffectsMedication AdministrationPharmacological ActionsPharmacological AgentsSide EffectsReduction of Risk Potential (10%–16%)Diagnostic TestsLaboratory ValuesPotential for Alterations in Body SystemsPotential for Complications of Diagnostic Tests/Treatments/Procedures/Surgery or Health AlterationsTherapeutic ProceduresVital SignsPhysiological Adaptation (12%–18%)Alterations in Body SystemsBasic PathophysiologyFluid and Electrolyte ImbalancesMedical Emergencies4CliffsTestPrep NCLEX-PN
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CliffsTestPrep NCLEX-RN (2011) - Page 12 preview imageRadiation TherapyUnexpected Response to TherapiesAll the listed topics and subtopics are covered in this book, although many of them might be combined into similartopic areas.Types of QuestionsMost 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 questionsand 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 FormatMost 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 tipsthat 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 yourability to recognize the correct answer from four choices. Questions are comprised of several parts.■the question stem■the correct choice■distractersWriters 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 mightcontain 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 itautomatically, 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.pain2.tumor3.edema4.epilepsyThis 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 todetect any of the other conditions. You should know that a mammogram is the image produced by a low-dose X-ray ofthe breast.If you don’t know the answer, you have certain options, using the process of elimination.5Introduction
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CliffsTestPrep NCLEX-RN (2011) - Page 13 preview imageAre 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 themammography cannot detect pain. Thus you can eliminate that answer. Now you’ve improved your odds of answeringthe 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 correctanswer, but the exercise here is to demonstrate how to eliminate the choices if you don’t know that answer.) The nextchoice is edema. If you know that edema is a swelling caused by an abnormal accumulation of fluid in body tissues, youmight think it possible that a mammogram can spot the fluid, and that might be a possible answer. Hold on to that choicefor 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 spota nervous disorder? This can’t be a correct choice if you know that a mammogram is an X-ray. So you can eliminatethat 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) toguess 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 distressexcept:1.increasing maternal fluids2.administering oxygen3.decreasing maternal fluids4.turning the motherHow did you answer this question? Did you take note of the wordexcept? All the choices are correct except for Choice 3.This is the only intervention that shouldnotbe performed when fetal distress is indicated.Finally, pay attention to words likealways,never,andnot. You should be careful if a question asks you to choose whichof the choices isnot. . .! Or, as in the question above, “All are correctexcept. . .”Some questions might ask about measurements. For example, there is a big difference between 0.401, 4.01, 40.1, and401. Keep decimal points in mind as you read these types of questions. Make sure, also, that you know measurementslike 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 ofelimination. Check how well you perform on those questions. How many do you know? Don’t worry about how well orhow 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 havethe knowledge and skills to take the test. You have a better chance if you practice the techniques of answeringmultiple-choice questions.6CliffsTestPrep NCLEX-PN
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CliffsTestPrep NCLEX-RN (2011) - Page 14 preview imageAlternate-Format QuestionsAs mentioned previously, most of the questions on the test are four-choice, multiple-choice questions. Alternate-formatquestions 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 youto 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 thescreen.Why have alternate-format questions been added to the NCLEX-PN? It is believed that you are able to demonstrateyour competence in certain areas beyond which multiple-choice questions can test. If, for example, you are asked todo a problem that requires calculations, by actually doing them yourself, you prove yourself more capable than merelyselecting the correct answer from four choices (especially because you’ve learned the secrets of answering these typesof questions earlier in this section).Sample Alternate-Format QuestionsTry 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 followingcharacteristics 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 maneuver7Introduction
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CliffsTestPrep NCLEX-RN (2011) - Page 15 preview image2.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 thecomponents of the history?1.review of systems2.chief complaint3.social history4.past medical history5.history of present illness6.family historyType the numbers for the components in order._______________For IM use, add 3.5 mL diluent (readaccompanying circular). Resultingsolution contains 250 mg ampicillinper mL.Use solution within 1 hour.This vial contains ampicillin sodiumequivalent to 1 gram ampicillin.Usual Dosage:Adults–250 to500 mg IM q. 6h.READ ACCOMPANYING CIRCULARfor detailed indications, IM or IVdosage and precautions.Cont.Exp. Date:NDC 0015-7404-20NSN 6505-00-993-3518EQUIVALENT TO1 gramAMPICILLINSTERILE AMPICILLINSODIUM, USPFor IM or IV useCAUTION: Federal law prohibitsdispensing without prescription.8CliffsTestPrep NCLEX-PN
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CliffsTestPrep NCLEX-RN (2011) - Page 16 preview image4.The nurse is completing the growth chart of an 18-month-old male child. The child weighed 13 kg and was 85 cmlong. Identify on the growth chart where the nurse should plot the child’s weight.LENGTHLENGTHWEIGHTWEIGHTBirth396Birth3129618212427303336152345671012141686kglbAGE (MONTHS)121518212427303336kgMotherís StatureF atherísStatureGestationalDateAgeWeightLengthHeadCirc.Age:WeeksBirthCommentAGE (MONTHS)8910111213141516179095100cmcm100lb16182022242628303234363895907550251054045505560657075809095859590755025105151617181920212223242526272829303132333435363738394041inin41403938373635Birth to 36 months: BoysLength-for-age and Weight-for-age percentilesNAMERECORD #PublishedMay 30, 2000 (modified 4/20/01).SOURCE: Developed by the National Center for Health Statistics in collaboration withthe National Center for Chronic Disease Prevention and Health Promotion (2000).http://www.cdc.gov/growthcharts9Introduction
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CliffsTestPrep NCLEX-RN (2011) - Page 17 preview imageAnswers to Alternate-Format Questions1.__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 maneuverCharacteristics of functional or innocent murmurs include usually grade I–II/VI; changes with position; varies inloudness or presence from visit to visit; increases in intensity with fever, anemia, exercise, or anxiety; musical orvibratory; 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 aconcentration of 250 mg/mL.250mg : 1 mL = 350 mg :xmL (multiply the means by the extremes)250x= 350x= 1.4 mLThe nurse should administer 1.4 mL3.2, 5, 4, 6, 3, 1The health history begins with the chief complaint, in which the client describes in his or her own words thereason 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 followsand 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 andidentify serious or hereditary diseases that run in the family. Social history includes habits, sexual history, homeconditions, occupation, environmental concerns, religious practices, diet, and substance abuse/use. Finally, thereview of systems is included in a complete health history to identify any concerns within a body system.10CliffsTestPrep NCLEX-PN
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CliffsTestPrep NCLEX-RN (2011) - Page 18 preview image4.The child’s weight should be plotted using the lower portion of the page on the weight graph at the intersection of thevertical line corresponding with 18 months and the horizontal line of 13 kg. The child’s weight is between the 75thand 90th percentile. The upper portion of the graph is for the child’s length and should not be used to plot the weight.LENGTHLENGTHWEIGHTWEIGHTBirth396Birth3129618212427303336152345671012141686kglbAGE (MONTHS)121518212427303336kgMotherís StatureF atherísStatureGestationalDateAgeWeightLengthHeadCirc.Age:WeeksBirthCommentAGE (MONTHS)8910111213141516179095100cmcm100lb16182022242628303234363895907550251054045505560657075809095859590755025105151617181920212223242526272829303132333435363738394041inin41403938373635Birth to 36 months: BoysLength-for-age and Weight-for-age percentilesNAMERECORD #PublishedMay 30, 2000 (modified 4/20/01).SOURCE: Developed by the National Center for Health Statistics in collaboration withthe National Center for Chronic Disease Prevention and Health Promotion (2000).http://www.cdc.gov/growthcharts11Introduction
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CliffsTestPrep NCLEX-RN (2011) - Page 19 preview imageHow did you do? As you can see, they’re not particularly difficult, but do require you to do a little more work. If youknow the material, you will have no trouble.Scoring High on the NCLEX-PNTo 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 anddoes not require you to use high-tech information or knowledge that an experienced practical/vocational nurse alreadypossesses. Go back to your nursing-school notes. And most important, use this book. It has been set up in such a waythat 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 aftereach question. Did you understand the question? Did you know the answer immediately, or did you have to use theprocess 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 800additional 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 seehow long it takes to answer all the questions. Although the length of the actual test experience can be as long as fivehours, some of that time is taken up by a tutorial, review practice exams, and breaks. Okay, give yourself a break afteryou have completed one-third of the practice test. Get up and walk around, have a glass of water, and then return to thetest. 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. Thencheck the answers. After checking your score, go back to those questions that were incorrect and try to understand whythey 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 theanswer choices, select one, and move on. Be confident. Remember, you’ve studied for the exam, you’ve taken practicetests, and you know the material. There will always be some questions for which you don’t know the answers, but dothe best that you can, and continue to believe in your ability to answer as many questions as possible correctly.Have a Study PlanThere is no one, correct way to study. Individuals learn differently. However, if you expect to do well on the test bycramming in the last week prior to the exam, you will be disappointed. The only way to prepare is to follow a sensiblestudy plan that you can create yourself. We suggest reading through the book, chapter by chapter, and answering thequestions as you go along. Read the explanations for the answers. In this way, you’ll be reviewing material that youprobably 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 thematerial. At the end of that time, you should take the practice tests—one day to take a test and one day to check youranswers. Based on these suggestions, you can get through the entire book in 12 weeks. Finally, keep a record of thosequestions that you have trouble with. When you’ve completed the entire chapter, go back and review them again.Good luck on the exam!12CliffsTestPrep NCLEX-PN
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CliffsTestPrep NCLEX-RN (2011) - Page 20 preview imageSS UU BJBJ EE CT ARCT AR EAEARR EVIEVI EWEW CC HAPTEHAPTE RR SSThere are additional questions and answers for chapters 3 and 4 on the CD-ROM.PART I
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CliffsTestPrep NCLEX-RN (2011) - Page 21 preview image
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CliffsTestPrep NCLEX-RN (2011) - Page 22 preview image15Coordinated CareThis 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 CareTeam■Continuity of Care■Establishing Priorities■Ethical Practice■Informed Consent■Legal Responsibilities■Performance Improvement (Quality Assurance)■Referral Process■Resource Management1.A 97-year-old man has severe coronary artery disease. His daughter informs you that he has a living will and adurable 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 speakfor 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 tobe guided by the living will. Choices 1 and 2 are incorrect because the client has only designated authority for healthcare decision-making, not financial or other decision-making. Choice 4 is incorrect because legal authority is delegatedby a DPAHC.2.While helping Mrs. Smith with her mouth care the evening before she is scheduled for exploratory abdominalsurgery, she asks, “What do you think I should do if it’s cancer?” The response, “Let’s hope not. It’s such a baddisease. 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 shapedby 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 socioculturalinfluences.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 yourpersonal opinion only. However, nurses should always be judicious when sharing personal values with clients. Choices1, 2, and 4 are incorrect.
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CliffsTestPrep NCLEX-RN (2011) - Page 23 preview image16Part I: Subject Area Review Chapters4.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 4are 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 tosustain or prolong life. Choices 1, 2, and 4 are incorrect. All clients should have equal access to care regardless of codestatus. 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 advanceddirective stating that she is responsible for making health care decisions on his behalf. This type of advancedirective 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 areincorrect.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 theclient has a value conflict, it is not appropriate for the nurse to address values because the client has the right to privacyand autonomy.
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CliffsTestPrep NCLEX-RN (2011) - Page 24 preview image9.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 tostate 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 activitiesexcept: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 sothat clients who are competent have the information necessary to make informed decisions regarding treatments, costs,care needs, rights in research, and risks of treatment.17Coordinated Care
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CliffsTestPrep NCLEX-RN (2011) - Page 25 preview image14.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 activitiesexcept: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 concernverbally to the physician in charge, in writing through complete factual documentation, and by following the facility’sprotocol 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 deathand comfort care measures without resuscitation. His daughter has concerns about the living will. As a nurseadvocate, 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, andencourage 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 atthe 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 beassessed and, if possible, a family member or caregiver known to the client should be enlisted to assist in maintainingthe safety of the client without restraints.17.The advocacy role of the professional nurse provides the opportunity to impact all the following areasexcept: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 professionas a whole. In these roles, the nurse might function as a role model, mentor, nurse manager, and direct provider of care,among other roles.18Part I: Subject Area Review Chapters
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CliffsTestPrep NCLEX-RN (2011) - Page 26 preview image19.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 activitiesexcept: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 appropriatestandards 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 talkingwith a counselor or chaplain. Changing work or social relationships quickly might not allow for the grief work thisclient 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 individualsto complete legal documents and advance directives that define their wishes for their health and illness care, should theybe 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 activitiesexcept: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 treatmentprovider is incorrect; all other choices are appropriate.19Coordinated Care
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CliffsTestPrep NCLEX-RN (2011) - Page 27 preview image24.A recently widowed 56-year-old client is receiving dialysis and tells the nurse he does not like to cook forhimself. 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 organizationof 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 adultchildren 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 andassist them in meeting the client’s needs at home. Hospice may not be the most appropriate choice, as criteria forHospice eligibility have not been clearly met. Institutionalized care might be needed in the future. The family shouldbe 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 followingexcept: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 dischargeplanning begin?1.when her physician writes the discharge order2.at the time of admission3.after surgery, during the discharge planner’s rounds4.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 meetthe client’s anticipated needs.20Part I: Subject Area Review Chapters
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CliffsTestPrep NCLEX-RN (2011) - Page 28 preview image29.A client has had a total knee replacement. Which of the following statements made by the client indicates theneed 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 untilmobility and balance are fully restored. Use of such devices is discontinued by the physical therapist. All other choicesare 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’sdegree 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 careat a hospital, other health care facility, or home care service.32.Case management has all the following benefitsexcept: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 earlierand 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 forproviding 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.21Coordinated Care
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CliffsTestPrep NCLEX-RN (2011) - Page 29 preview image34.Which of the following was developed by the American Hospital Association (AHA) to define the rights andresponsibilities of clients in the acute care setting?1.Code of Ethics2.Hospital Advocacy3.Patient’s Bill of Rights4.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 caresettings. The ANA (American Nurses’ Association) Code of Ethics provides ethical guidance for nurses. HospitalAdvocacy is a program used by hospitals to assist clients in making decisions concerning their rights and health carechoices. 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 rightsexcept: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’sBill 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 lossof care. The client continues to be cared for by physicians and nurses on the team, and other treatment options might beoffered. 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 settingshave 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 affordabilityof health care. Determining how to protect a client’s right to care has presented challenges to nurses in all thefollowing waysexcept: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 specifiedin 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.22Part I: Subject Area Review Chapters
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CliffsTestPrep NCLEX-RN (2011) - Page 30 preview image39.The client’s right to give informed consent applies to which of the following procedures?1.insertion of an internal defibrillator2.surgical excision of a skin lesion3.physical therapy exercises4.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 andto refuse treatment.40.When entering a hospital, a client signs a general consent form. This consent is used to document the client’sconsent 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 hisrefusal 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 thesetting?1.the right to refuse treatment2.the right to examine and question the bill3.the right to privacy and confidentiality4.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 privacyand confidentiality.42.A client wishes to leave the hospital against medical advice. Which right is this client exercising?1.the right to refuse treatment2.the right to privacy3.the right to be given information about a diagnosis4.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 hospitalsas a guideline and is not law.23Coordinated Care
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CliffsTestPrep NCLEX-RN (2011) - Page 31 preview image44.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 3uphold 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 componentsof organizations and how they behave. The theory might or might not provide a structure, help to define the dysfunctionfound in a family, or define outcomes of effective functioning.46.Motivation can be described in all the following waysexcept: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 aperson 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 leadsto 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 significantsupervision 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.24Part I: Subject Area Review Chapters
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