Test Bank For Understanding Medical-Surgical Nursing, 5th Edition

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Chapter 1. Critical Thinking and the NursingProcessChapter 1. Critical Thinking and the Nursing ProcessMultiple ChoiceIdentify the choice that best completes the statement or answers the question.____ 1. After receiving morning report, which patient should the licensed practical nurse/licensedvocational nurse (LPN/LVN) assess first?a. A patient who needs discharge teachingb. A patient who needs assistance to ambulatec. A patient who states, “No one cares about me.”d. A patient who has a temperature of 106°F (41.1°C)____ 2. During a class discussion, two nursing students demonstrated intellectual courage. Whataction did the nursing students perform?a. Considered being in the other person’s situationb. Expected proof that the use of restraints is safec. Conducted additional research on the use of restraints in patient cared. Listened to each other’s point of view regarding the use of patient restraints____ 3. The nursing staff is planning a celebratory dinner and cake for a newly licensed practicalnurse. Which of the new nurse’s human needs is supported by these actions?a. Self-esteemb. Physiologicalc. Self-actualizationd. Safety and security____ 4. A patient with a newly fractured femur reports a pain level of 8/10, and analgesic medicationis not due for another 50 minutes. Which actions should the nurse take?a. Reposition the patient.b. Give the medication in 30 minutes.c. Notify the registered nurse (RN) or physician.d. Tell the patient it is too early for pain medication.____ 5. The nursing instructor is planning a teaching session on critical thinking for students. Whatshould the instructor say when explaining critical thinking?

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a. “Collect data concerning the patient’s problem.”b. “Think of different ways to help relieve a patient’s problem.”c. “Determine if an action worked to eliminate a patient problem.”d. “Use knowledge and skills to make the best decision for patient care.”____ 6. The nurse is planning care and setting goals for a newly admitted patient. Who should thenurse include when conducting these nursing actions?a. Patientb. Nurse managerc. Patient’s family membersd. Patient’s health care provider (HCP)____ 7. While caring for a patient 4 hours after a surgical procedure, the LPN/LVN notesserosanguineous drainage on the patient’s dressing. Which statement should the nurse use todocument the finding?a. “Normal drainage noted.”b. “Moderate drainage recently noted.”c. “Scant serosanguineous drainage seen on dressing.”d. “Pale pink drainage, 2 cm by 1 cm, noted on dressing.”____ 8. The nurse is caring for a patient who is scheduled for surgery. Which data should the nursecollect to identify safety and security needs?a. Meal patternsb. Sleep patternsc. Anxiety about surgeryd. Effectiveness of pain medication____ 9. The nurse is reviewing data collected during patient care. Which data should the nursedocument as objective?a. Patient is pleasant.b. Urine output is 300 mL.c. “It has been a good day.”d. Patient’s appetite is poor.____ 10. The nurse is determining diagnoses appropriate for a patient recovering from surgery.Which nursing diagnoses should the nurse identify as the highest priority for this patient?a. Acute painb. Impaired mobility

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c. Deficient knowledged. Impaired skin integrity____ 11. The nurse suspects a patient is experiencing adverse effects to a newly prescribedantihypertensive medication. After being informed that the effects are expected, the nurse remainsconcerned and conducts an Internet search on the patient’s manifestations. Which critical thinkingbehavior did the nurse implement?a. Sense of justiceb. Intellectual couragec. Intellectual empathyd. Intellectual perseverance____ 12. The nurse is identifying outcomes for a patient with a Fluid Volume Deficit. Whichoutcome should the nurse use to guide the patient’s care?a. Patient’s fluid intake will be measured daily.b. Patient’s intake will be 3000 mL daily.c. Fluids will be at the bedside for the patient.d. Fluids the patient likes will be at the bedside.____ 13. The nurse is caring for a patient with the diagnosis of Fluid Volume Excess. Whichinformation should the LPN/LVN use to determine if care was effective?a. Restrict the patient’s fluid intake.b. Measure the patient’s daily weight.c. Teach the patient to monitor fluid balance.d. Discuss the patient’s care plan with the RN.____ 14. A RN delegates a patient care assignment to the LPN/LVN. Which phase of the nursingprocess should the LPN/LVN perform independently?a. Assessmentb. Planning carec. Implementationd. Nursing diagnosis____ 15. The nurse is caring for a patient with a painful back injury that occurred 6 months ago.Which three-part nursing diagnosis should the nurse use to guide this patient’s care?a. Pain as evidenced by herniated lumbar diskb. Acute pain related to inability to sit as evidenced by muscle spasmsc. Chronic pain related to muscle spasms as evidenced by patient pain rating of 8 and difficulty

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walkingd. Acute pain related to patient pain rating of 6 as evidenced by muscle spasms and nervecompression____ 16. The RN implements an intervention to improve a patient’s appetite. After implementing theintervention for two meals, the LPN/LVN notes no improvement in the patient’s eating. What actionshould the LPN/LVN take?a. Develop a new plan of care.b. Revise the patient outcome to one that is achievable.c. Collaborate on a new nursing diagnosis with the RN.d. Provide data to the RN to assist in evaluation of the plan.____ 17. During morning report, the LPN/LVN is assigned a group of patients. Which patient shouldthe LPN/LVN see first?a. A patient scheduled for magnetic resonance imaging (MRI) due to back painb. A patient reporting constipation and stomach crampsc. A 2-day postsurgical patient reporting pain at a level of 6d. A patient with pneumonia who is short of breath and anxious____ 18. The LPN/LVN is reviewing a patient’s list of nursing diagnoses. Which diagnoses shouldthe LPN/LVN identify as a priority for this patient?a. Anxietyb. Constipationc. Deficient fluid volumed. Ineffective airway clearance____ 19. The nurse is using the nursing process when caring for a patient. In which order should thenurse implement this process?a. Nursing diagnosis, intervention, rationale, evaluation, planningb. Data collection, intervention, nursing diagnosis, rationale, evaluationc. Assessment, nursing diagnosis, planning, implementation, evaluationd. Data collection, evaluation, nursing diagnosis, implementation, rationale____ 20. The nurse is determining a patient’sproblems. What step of the nursing process is the nurseperforming?a. Assessmentb. Outcome planningc. Nursing diagnosis

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d. Nursing intervention____ 21. The nurse is preparing to determine if a patient is meeting planned outcomes. Whatmeasurable information should the nurse use to make this determination?a. P-E-S formatb. Objective observationsc. Subjective terminologyd. Open-ended time frames____ 22. The nurse is planning a patient’s care based on Maslow’s hierarchy of needs. Which humanneed should the nurse identify as requiring his or her immediate attention?a. Heart rate 38 and irregularb. Plans to return to college in a yearc. Needs walker adjusted to safely ambulated. Desire to learn how to self-inject medication____ 23. While being taught to apply a topical medication, the patient begins to vomit. Which actionshould the nurse take to meet the patient’s human needs?a. Provide a clean gown before resuming the teaching.b. Position an emesis basin for patient use while teaching.c. Provide medication prescribed for nausea and vomiting.d. Wait for the vomiting to stop and begin the teaching session again.____ 24. The nurse approaches a person in a restaurant who appears to be experiencing respiratorydistress. Which action should the nurse perform first?a. Diagnose the problem.b. Help the person lie down.c. Gather data from other people.d. Collect data about the person’s condition.____ 25. The nurse identifies the diagnosis Fluid Volume Overload as appropriate for a patient withheart failure. Which collected data should the nurse use to provide evidence for this diagnosis?a. Skin warm to the touchb. Oriented to person onlyc. Respiratory rate 20 and shallowd. +3 pitting edema of both feet and ankles____ 26. After identifying nursing diagnoses, the nurse plans outcomes for a patient withgastroesophageal reflux disease. Which outcome should the nurse use to evaluate this patient’s care?

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a. The patient will have less heartburn.b. The patient will sleep through the night.c. The patient’s esophageal burning will resolve 30 minutes after taking oral antacids.d. The patient will state that burning only occurs when eating foods high in acid content.Multiple ResponseIdentify one or more choices that best complete the statement or answer the question.____ 27. After collecting data the nurse identifies diagnoses to guide the patient’s care. Whichdiagnoses did the nurse document correctly? (Select all that apply.)a. Diabetesb. Acute painc. Pancreatitisd. Activity intolerancee. Impaired physical mobility____ 28. A patient with a family history of diabetes is experiencing high blood glucose levels,confusion, an unsteady gait, and dehydration. Which nursing diagnoses should the nurse identify asappropriate for this patient’s care? (Select all that apply.)a. Diabetesb. Dehydrationc. Risk for fallsd. Hyperglycemiae. Deficient fluid volume____ 29. The nurse identifies the diagnosis Potential for Ineffective Gas Exchange as appropriate fora patient with pneumonia. Which independent nursing actions should the nurse plan for this problem?(Select all that apply.)a. Apply oxygen, 2 liters, per nasal cannula.b. Turn and reposition in bed every 2 hours.c. Coach to deep breathe and cough every hour.d. Administer intramuscular antibiotic medication.e. Encourage to drink 240 mL of fluid every 2 hours.____ 30. The nurse finishes collecting data on a patient with injuries from a motor vehicle crash.Which data should the nurse document as objective? (Select all that apply.)a. Patient in no acute distressb. “I can’t believe I wrecked my car.”

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c. Complains of pain when moving armsd. Oxygen saturation level 92% on room aire. Mid-forehead wound 3 cm long, oozing bloodOther31. A patient with a history of respiratory disease is recovering from total hip replacement surgery. Inwhich order should the nurse address the patient’s diagnoses? (Place in order from 1 to 4.)A. _____ Acute pain related to surgeryB. _____ Risk for injury related to unsteady gaitC. _____ Deficient knowledge related to use of a walkerD. _____ Impaired gas exchange related to compromised respiratory system32. The nurse is caring for a patient recovering from a stroke. Use the nursing process to order theobservations made or actions performed while caring for this patient (AE).A. Hand grasp absent left handB. Alteration in Cerebral PerfusionC. The patient flexed left thumb and index finger.D. Coached to squeeze rubber ball placed in left hand.E. The patient will be able to self-feed using left hand.Chapter 1. Critical Thinking and the Nursing ProcessAnswer SectionMULTIPLE CHOICE1. ANS: DD. According to Maslow, humans’ basic physiological needs have the highest priority, and thesepatients’ health problems should be addressed first. Life-threatening needs are ranked first; health-threatening needs are second; and health-promoting needs are last. The elevated temperature has thegreatest urgency. A, B, and C are not as high priority.PTS: 1 DIF: ModerateKEY: Client Need: Safe and Effective Care EnvironmentManagement of Care | Cognitive Level:Application2. ANS: DD. Intellectual courage is looking at other points of view. A. Intellectual empathy allows a person to

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consider another’s situation. B. Intellectual integrity is seeking the same level of proof forcomparable items. C. Intellectual perseverance is continuing to search for evidence about a concern.PTS: 1 DIF: ModerateKEY: Client Need: Safe and Effective Care EnvironmentManagement of Care| Cognitive Level:Application3. ANS: AA. Recognizing a person’s accomplishments enhances self-esteem. B. C. D. The staff’s actions arenot meeting physiological, self-actualization, or safety and security needs of the new nurse.PTS: 1 DIF: Moderate KEY: Client Need: Psychosocial Integrity4. ANS: CC. The patient should not have to wait for pain relief. The LPN should inform the RN or physician,so new pain relief orders can be obtained. A. The patient who has a fractured femur is experiencingacute pain. Repositioning a patient with a new fracture is not likely to relieve pain. B. Giving themedication before the prescribed time is beyond the nurse’s scope of practice. D. The nurse needs todo more than expect the patient to wait for pain relief.PTS: 1 DIF: ModerateKEY: Client Need: Safe and Effective Care EnvironmentManagement of Care | Cognitive Level:Application5. ANS: DD. Critical thinking is using knowledge and skills to make the best decisions possible in patient caresituations. A. Collecting data describes assessment. B. Thinking of different ways to help a patientwith a problem is planning. C. Determining if an action worked to eliminate a patient problem isevaluation.PTS: 1 DIF: ModerateKEY: Client Need: Safe and Effective Care EnvironmentManagement of Care | Cognitive Level:Application6. ANS: AA. Planning care and setting goals are actions performed with the patient. The patient must be inagreement with the plan for it to be successful in meeting the desired outcomes. B. The nursemanager may or may not be aware of the patient’s care needs. C. The patient’s family may or may

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not be aware of the patient’s care needs. D. The focus of nursing care is different from that of theHCP.PTS: 1 DIF: ModerateKEY: Client Need: Safe and Effective Care EnvironmentManagement of Care | Cognitive Level:Application7. ANS: DD. Objective data are pieces of factual information obtained through physical assessment anddiagnostic tests observable or knowable through the five senses. The nurse should document exactlywhat is seen. A. B. C. These statements are interpretations of the data and use words that have vaguemeanings, which should be avoided when documenting.PTS: 1 DIF: ModerateKEY: Client Need: Physiological IntegrityPhysiological Adaptation | Cognitive Level: Application8. ANS: CC. A threat toa person’s safety and security, such as surgery, creates anxiety. The patient’s anxietylevel will help the nurse plan care to meet safety and security needs. A, B, and D describe data usedto support the patient’s physiological needs.PTS: 1 DIF: ModerateKEY: Client Need: Psychosocial Integrity | Cognitive Level: Application9. ANS: BB. Objective data are factual information such as the volume of urine output. A. This is an opinionthat the nurse has about the patient’s behavior and is too vague to document as objective data. C.This statement is in quotations, so it is something that the patient subjectively stated. D. This is anopinion the nurse has about the patient’s appetite and is too vague to document as objective data.PTS: 1 DIF: ModerateKEY: Client Need: Safe and Effective Care EnvironmentManagement of Care | Cognitive Level:Application10. ANS: AA. Using Maslow’s hierarchy, pain is the highest priority nursing diagnosis for a postoperativepatient. B. D. These diagnoses would be equally important after the patient’s pain is addressed,

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because they focus on physiological needs. C. This diagnosis can be addressed at a later time oncephysiological needs have been met.PTS: 1 DIF: ModerateKEY: Client Need: Safe and Effective Care EnvironmentManagement of Care | Cognitive Level:Application11. ANS: DD. Intellectual perseverance is not giving up. A. A sense of justice examines motives when makingdecisions. B. Intellectual courage looks at other points of view, even when the nurse does not agreewith them. C. Intellectual empathy understands how another person feels when making decisions.PTS: 1 DIF: ModerateKEY: Client Need: Safe and Effective Care EnvironmentManagement of Care | Cognitive Level:Analysis12. ANS: BB. This outcome provides objective measurable data. A. C. D. These statements are nursing actions.PTS: 1 DIF: ModerateKEY: Client Need: Physiological IntegrityPhysiological Adaptation | Cognitive Level: Application13. ANS: BB. To evaluate the effectiveness of the plan of care and the actions implemented, the nurse mustassess the outcome for the patient’s nursing diagnosis and determine if the outcome has beenachieved or if revisions are needed. For this patient, a change in weight is an objective measurementfor determining if interventions to address Fluid Volume Excess have been effective. A. Restrictingfluid intake is an action. Evaluation is required to determine patient outcome and effective care. C.Teaching the patient to monitor fluid balance is an intervention and will not help determine theeffectiveness of care. D. Although discussing the plan of care with the RN is relevant to the patient’scare, it will not help determine effectiveness of care provided.PTS: 1 DIF: DifficultKEY: Client Need: Safe and Effective Care EnvironmentManagement of Care | Cognitive Level:Analysis14. ANS: CC. The LPN/LVN independently provides direct patient care. A. B. D. The LPN/LVN assists the RN

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with collecting data, formulating nursing diagnoses, determining outcomes, and planning care tomeet patient needs.PTS: 1 DIF: ModerateKEY: Client Need: Safe and Effective Care EnvironmentManagement of Care | Cognitive Level:Application15. ANS: CC. “Chronic pain related to muscle spasms as evidenced by patient pain rating of 8 and difficultywalking” uses the three-part, or Problem, Etiology, and Signs/Symptoms, system with measurabledata as evidence. This best guides the nurse’s care and evaluation of the outcome. A. This statementincludes a medical diagnosis. B. D. There is not enough measurable evidence for these nursingdiagnosis statements.PTS: 1 DIF: ModerateKEY: Client Need: Physiological IntegrityBasic Care and Comfort | Cognitive Level: Application16. ANS: DD. The role of the LPN/LVN includes data collection and assisting in evaluating outcomes. TheLPN/LVN should provide new data to the RN, so they can revise the plan of care together. A. B. Thisis not done independently. C. A new diagnosis may be appropriate, but is not carried outindependently of the RN.PTS: 1 DIF: ModerateKEY: Client Need: Safe and Effective Care EnvironmentManagement of Care | Cognitive Level:Application17. ANS: DD. Using Maslow’s hierarchy of needs and considering which patient problems are life-threatening,shortness of breath is most important. A. B. C. Problems of pain, constipation, and scheduled testsare all important, but not immediately life-threatening.PTS: 1 DIF: DifficultKEY: Client Need: Physiological IntegrityPhysiological Adaptation | Cognitive Level: Analysis18. ANS: DD. Ineffective airway clearance is the highest priority, because it can be life-threatening. B. C. These

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diagnoses are important; however they are not immediately life-threatening. A. Anxiety is the lowestpriority, because physiological needs must be addressed first.PTS: 1 DIF: ModerateKEY: Client Need: Physiological IntegrityPhysiological Adaptation | Cognitive Level: Analysis19. ANS: CC. The nurse should implement the steps of the nursing process by beginning with assessment,formulating nursing diagnoses, planning care, implementing care, and then evaluating care. A. B. D.These lists do not implement the steps of the nursing process in appropriate order. Rationale is not astep in the nursing process.PTS: 1 DIF: ModerateKEY: Client Need: Safe and Effective Care EnvironmentManagement of Care | Cognitive Level:Application20. ANS: CC. A nursing diagnosis is a clinical judgment about individual, family, or community response toactual or potential health problems or life processes. Nursing diagnoses are standardized labels thatmake an identified problem understandable to all nurses. A. Assessment is the collection of data usedto identify patient problems. B. Outcome planning occurs after a patient’s problems have beenidentified. D. Interventions are provided after the problems, plan, and outcome have been identified.PTS: 1 DIF: ModerateKEY: Client Need: Safe and Effective Care EnvironmentManagement of Care | Cognitive Level:Application21. ANS: BB. Measurable means that an outcome can be observed or is objective. It should not be vague or opento interpretation. A. Problem-Etiology-Symptoms (PES) format refers to nursing diagnoses, notoutcomes measurement. C. Subjective terminology is the use of patient statements to supportobjective data. D. Open-ended time frames do not help with measurement.PTS: 1 DIF: ModerateKEY: Client Need: Safe and Effective Care EnvironmentManagement of Care | Cognitive Level:Application

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22. ANS: AA. According to Maslow, basic needs or physiological needs must be met first. A heart rate of 38 andirregular is a physiological need. C. Safety and security needs are met after physiological needs havebeen satisfied. Safe ambulation would be addressed next. D. Self-esteem needs are met after safetyand security needs have been addressed. The desire to be independent with medication injections canbe addressed after safety and security needs. B. Planning to return to college is an example of self-actualization, which is a need that can be addressed last.PTS: 1 DIF: ModerateKEY: Client Need: Safe and Effective Care EnvironmentManagement of Care | Cognitive Level:Analysis23. ANS: CC. Basic physiological needs must be met first. Since the patient is vomiting, the nurse shouldprovide the medication prescribed for nausea and vomiting. A. B. D. These actions do not take thepatient’s physiological needs into consideration. The patient will not be able to achieve a higher levelof the hierarchy before basic physiological needs are met.PTS: 1 DIF: ModerateKEY: Client Need: Safe and Effective Care EnvironmentManagement of Care | Cognitive Level:Application24. ANS: DD. The first step in the nursing process is to collect data, and the patient should come first. C. Thenurse can collect data from other people if necessary. A. Diagnosing the problem would occur aftercollecting data. B. Helping the person lie down is implementing an action to address the problem.PTS: 1 DIF: ModerateKEY: Client Need: Physiological IntegrityPhysiological Adaptation | Cognitive Level: Analysis25. ANS: DD. Collected data that the nurse should use as evidence for the diagnosis are signs and symptomsrelated to the diagnosis. For Fluid Volume Overload, edema would be used as evidence that thepatient’s tissue is accumulating extra fluid. A. Skinwarm to the touch is an opinion. B. Oriented toperson only is objective data; however, it does not apply to the nursing diagnosis. C. Respiratory rate20 and shallow is objective data; however, it does not apply to the nursing diagnosis.

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PTS: 1 DIF: ModerateKEY: Client Need: Physiological IntegrityPhysiological Adaptation | Cognitive Level: Analysis26. ANS: CC. Outcomes should be measurable and realistic for the patient; they should include an appropriatetime frame for achievement. A. Outcomes should not be vague or open to interpretation, with the useof subjective words such as “normal,” “large,” “small,” or “moderate.” B. Sleeping through the nightmay or may not be associated with the patient’s problem. D. Stating that the burning only occurswhen eating foods high in acid content is a patient observation that could be used for subjective datacollection.PTS: 1 DIF: ModerateKEY: Client Need: Physiological IntegrityPhysiological Adaptation | Cognitive Level: AnalysisMULTIPLE RESPONSE27. ANS: B, D, EB. D. E. Acute Pain, Activity Intolerance, and Impaired Physical Mobility are nursing diagnoses. A.C. Diabetes and Pancreatitis are medical diagnoses.PTS: 1 DIF: ModerateKEY: Client Need: Safe and Effective Care EnvironmentManagement of Care | Cognitive Level:Analysis28. ANS: C, EC. E. Deficient fluid volume and Risk for falls are nursing diagnoses related to the patient’ssymptoms and condition. A. B. D. Diabetes, Dehydration, and Hyperglycemia are medical problems.The nurse assists with medical diagnoses; however, the nurse does not diagnose and treat medicalproblems.PTS: 1 DIF: ModerateKEY: Client Need: Physiological IntegrityPhysiological Adaptation | Cognitive Level: Application29. ANS: B, C, EB. C. E. Independent nursing actions arethose that can be implemented without an HCP’s order. A.D. Interventions that need an HCP’s order include administering oxygen and medication. These arecollaborative interventions.

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PTS: 1 DIF: ModerateKEY: Client Need: Physiological IntegrityPhysiological Adaptation | Cognitive Level: Application30. ANS: D, ED. E. Data that can be observed are objective. Objective data would include an oxygen saturationlevel of 92% on room air and a wound on the forehead, 3 cm in length and oozing blood. A. The“patient in no acute distress” is an opinion about the patient’s status. B. A direct patient quote issubjective data. C. Complaining of pain when moving arms needs additional information to beobjective such as the patient’s pain rating on a scale of 1 to 10and the exact location of the arm pain.PTS: 1 DIF: ModerateKEY: Client Need: Safe and Effective Care EnvironmentManagement of Care | Cognitive Level:ApplicationOTHER31. ANS:D, A, B, CD. In a nursing plan of care, the patient’s most urgent problem is listed first. According to Maslow’shierarchy of human needs, this usually involves a physiological need, such as oxygen or water,because these are life-sustaining needs. If several physiological needs are present, life-threateningneeds are ranked first; health-threatening needs are second; and health-promoting needs, althoughimportant, are last. In this case, Ineffective Gas Exchange is potentially life-threatening and would befirst. A. Acute Pain is the next most urgent need. B. Risk for Injury is less critical than pain, becauseit is a potential problem rather than an actual problem. C. Deficient Knowledge comes last, because itis health- promoting and is considered psychosocial rather than physical/physiological.PTS: 1 DIF: ModerateKEY: Client Need: Physiological IntegrityPhysiological Adaptation | Cognitive Level: Application32. ANS:A, B, E, D, CA. Assessed data is the absence of a left hand grasp. B. The nursing diagnosis that would beassociated with the absence of a hand grasp would be Alteration in Cerebral Perfusion. E. The goal ofnursing care would be for the patient to self-feed using the left hand. D. Coaching to squeeze arubber ball in the left hand is an intervention to improve left hand function. C. The patient flexing the

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left thumb and index finger evaluates the success of the intervention of squeezing a rubber ball in theleft hand.PTS: 1 DIF: DifficultKEY: Client Need: Physiological IntegrityPhysiological Adaptation | Cognitive Level: AnalysisChapter 2. Evidence-Based PracticeChapter 2. Evidence-Based PracticeMultiple ChoiceIdentify the choice that best completes the statement or answers the question.____ 1. The nurse working in a radiation oncology department wants to reduce the incidence of skinbreakdown in patients who receive beam radiation. Which question should the nurse use to guide aliterature search about this topic?a. How often do patients with beam radiation experience skin breakdown?b. Why do patients who get radiation beam therapy have skin breakdown?c. What nursing interventions minimize the occurrence of skin breakdown in patients receiving beamradiation?d. How does our rate of skin breakdown in patients receiving beam radiation compare to otherinstitutions in the city?____ 2. The nurse who works on a medical-surgical unit reads an article about a research studyregarding nursing care in the intensive care unit (ICU) and decreased nosocomial infections. Whichaction should the nurse take in exploring this research topic?’a. Institute a pilot study utilizing the outlined nursing care.b. Discuss the research with the chief of nursing at the institution.c. Do a journal search and look for similar studies related to non-ICU patients.d. Take the article to the nurse manger in the ICU and suggest a new policy be developed.____ 3. A licensed practical nurse (LPN) working on the pediatric floor is interested in improvingpatient outcomes for children with asthma. Which clinical question would best guide the nurse’s nextsteps?a. How many patients with asthma have a pet dog or cat?b. What is the monthly admission rate of patients with asthma to the unit?c. What patient education materials are available to address effective management of asthma inpediatric patients?

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d. How has the occurrence rate of asthma in children under the age of 5 changed since the hospitalinstituted a no smoking policy for the hospital grounds?____ 4. The nurse is preparing to give oral care to a patient receiving tube feedings. Which approachshould the nurse use to provide care that is based on EBP?a. Use a soft toothbrush and toothpaste to brush the teeth.b. Have the patient use swish-and-swallow Nystatin twice a day.c. Increase oral suctioning to every 2 hours using toothette suction devices.d. Use mouthwash and toothettes to swab the teeth and mouth three times a day.____ 5. The nurse is planning to review a research article for applicability to EBP. Which acronymshould the nurse use to guide this review?a. RIGHTb. MYWAYc. ASKMMEd. ASKWHY____ 6. The nurse working on the burn unit is interested in understanding the rate of renalcompromise with a burn. Which step should the nurse take first?a. Complete a literature review.b. Work with a medical librarian to identify key words.c. Develop a clinical question that can guide further research.d. Join the policy and procedure committee to evaluate care in the hospital.____ 7. A nursing committee developed an evidence-based intervention that it would like to initiateinstitute-wide. Which step should the committee take to implement the intervention?a. Conduct a small pilot study involving the proposed change.b. Ask the charge nurse to propose the change to administration.c. Poll the nursing staff to determine its attitude toward change.d. Invite nursing experts in the city to review the proposed change.____ 8. The nurse is researching evidence to address a clinical problem. Which evidence should thenurse focus as being the highest level supporting practice?a. Evidence obtained from quasi-experimental research studiesb. Evidence from a systematic review of all relevant randomized clinical trialsc. Evidence from the opinion of authorities and/or reports of expert committeesd. Evidence obtained from at least one well-designed randomized controlled trial____ 9. A nursing student asks the registered nurse (RN) preceptor why EBP is important. How

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should the nurse respond to the student?a. “EBP makes nursing more professional.”b. “EBP helps ensure we can demand more pay.”c. “EBP helps validate the difference nurses really make.”d. “EBP guides nursing decisions to optimize effective care.”____ 10. The nurse is reviewing a proposal for changing the type of needleless systems currentlyused to administer intravenous (IV) medications in the hospital. Which part of the proposal mosteffectively supports the proposed change?a. A pilot study is planned.b. Two cases of staff injury related to needle sticks have occurred in the past 3 years.c. A single randomized clinical trial is cited as evidence to support the new policy.d. The supporting evidence includes research conducted at an outpatient hematology center.____ 11. The staff development instructor is preparing a presentation on EBP for the nursing staff.Which should the instructor include as being the most important reason for using EBP?a. Saves moneyb. Optimizes carec. Reduces staff errord. Improves access to care____ 12. The nurse is researching articles prior to determining the best practice for providing anaspect of patient care. On what type of article should the nurse focus when researching best practice?a. Expert opinionb. Systematic reviewc. Traditional practiced. Quasi-experimental studies____ 13. The nurse wants to find research studies on infection rates as they relate to specific handwashing products. Where should the nurse search for these articles?a. Medlineb. PubMedc. CINAHLd. Cochrane Reviews____ 14. The nurse researcher is designing a study using the quasi-experimental approach. What typeof data will the nurse obtain from this study design?a. Uncontrolled results

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b. Outcome tracking over 10 yearsc. Controlled comorbid conditionsd. Modifiable and non-modifiable risk factors____ 15. The nurse is planning to evaluate care provided to a patient. Which step should the nursetake to learn if the best possible care is being provided?a. Measure outcomes.b. Review the literature.c. Construct a burning clinical question.d. Determine the validity of clinical research.____ 16. After completing all of the steps in the research process, the nurse identifies a positiveresponse to a new intervention for foot ulcer care. Which step in EBP should the nurse perform now?a. Publish and share the results of the study.b. Complete a cost-benefit analysis of the results.c. Evaluate the validity of related research studies.d. Conduct a pilot project using the proposed intervention.____ 17. The nurse is using Level II research when planning best practices for skin care. Which typeof evidence is the nurse using?a. Cochrane Reviewb. A quasi-experimental studyc. Joanna Briggs Best Practice Reviewd. A randomized controlled trial (RCT)____ 18. While reviewing a patient care assignment with unlicensed assistive personnel (UAP), thenurse explains the reason for turning and repositioning a patient every 2 hours. Why did the nursinginclude this information?a. Ensures that evidence-based care is providedb. Guarantees that the patient will receive morning carec. Helps UAP focus on the action being performedd. Helps UAP with time management of tasks to complete____ 19. Prior to administering a prescribed medication to a patient, the nurse talks with the healthcare provider (HCP) regarding expected effects and then contacts the pharmacist to review theguidelines for administration. Which Quality and Safety Education for Nurses (QSEN) focus is thenurse demonstrating?a. Informatics

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b. Patient-centered carec. Quality improvementd. Teamwork and collaboration____ 20. The nurse identifies an intervention that has been proven to enhance patient safety. Whatshould the nurse do before implementing this intervention?a. Analyze the intervention to determine if it is appropriate for the patient.b. Ask the charge nurse if the intervention can be implemented.c. Find out if the patient wants the intervention to be performed.d. Conduct a pilot study to see if the intervention works on the care area.Multiple ResponseIdentify one or more choices that best complete the statement or answer the question.____ 21. The nurse is implementing dependent interventions when providing patient care. Whichactions are dependent nursing interventions? (Select all that apply.)a. Low sodium soft dietb. Music therapy as desiredc. Bathroom privileges as toleratedd. Give Tylenol 650 mg orally every 4 hours prn paine. Wet-to-moist dressing changes every 6 hours while awake____ 22. The nurse is planning a quasi-experimental study. Which criteria support the nurse’sapproach? (Select all that apply.)a. 28 volunteer patients who agree to try a new type of mouthwashb. An experimental group and a control group each with 225 patientsc. 14 individuals on a medical unit who complete the same questionnaired. Tracking of pneumonia rates for all patients receiving artificial tube feedingse. Identification of oral flora in nursing home patients who receive artificial feedings____ 23. The nurse is working with a committee to determine EBP approaches for patient care.Which steps will the committee members include when determining EBP? (Select all that apply.)a. Evaluate the change.b. Measure the outcome.c. Ask the nursing experts.d. Manipulate current practice.e. Search for the best available evidence.____ 24. The nurse is considering the importance of safety when providing patient care. At which

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times should the nurse be particularly alert for safety hazards? (Select all that apply.)a. When providing patient medicationsb. When identifying a patient for a treatmentc. When washing hands after providing cared. When stocking the supply room with linense. When raising the siderails on a patient’s bed____ 25. The nurse is implementing the QSEN focus of patient-centered care. Which nursing actionssupport this focus? (Select all that apply.)a. Individualize interventions.b. Schedule interventions to meet the patient’s needs.c. Evaluate interventions for applicability to the patient.d. Scan prescribed medications using the bar-coding system.e. Document responses to treatment in the electronic medical record.Chapter 2. Evidence-Based PracticeAnswer SectionMULTIPLE CHOICE1. ANS: CAsking a burning clinical question is the first step in the evidence-based practice (EBP) process. It isimportant to include related factors in the question and to focus on nursing interventions and care. Inthis situation, the nurse should focus on nursing care that may reduce the occurrence of skinbreakdown for the specific patient population of interest. A. B. The frequency of skin breakdown andwhy patients develop skin breakdown does not help identify ways to prevent skin breakdown. D.Information on statistics from other organizations will not help the nurse identify ways to preventskin breakdown.PTS: 1 DIF: ModerateKEY: Client Need: Safe and Effective Care EnvironmentManagement of Care | Cognitive Level:Application2. ANS: CClinical reality can be very different from research situations. It could be unsafe to apply researchfindings in an environment that differs from the one in the study, so the next step would be toidentify current research related to the current population. A. A pilot study would be premature. B.

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Discussing the research with the chief of nursing would not help explore the topic. D. Taking thearticle to the head nurse in the ICU would not help with the issue of nosocomial infections on themedical-surgical unit.PTS: 1 DIF: ModerateKEY: Client Need: Safe and Effective Care EnvironmentSafety and Infection Control | CognitiveLevel: Application3. ANS: CAsking a burning clinical question is the first step in the EBP process. It is important to includerelated factors in the question and to focus on nursing interventions and care. For this scenario, thenurse would focus on nursing care that affects patient outcomes for the specific patient population ofinterest. Patient education is a critical component of nursing care. A. B. D. Information about pets,admission rates of patients with asthma, and asthma occurrence since the implementation of a nosmoking policy will not help improve patient outcomes for children with asthma.PTS: 1 DIF: ModerateKEY: Client Need: Safe and Effective Care EnvironmentManagement of Care | Cognitive Level:Application4. ANS: DEvidence-based information shows the use of toothbrushes for oral care is much more effective thanfoam swabs in removing plaque from the teeth. B. Swish-and swallow Nystatin is a medication thattreats oral thrush and is not routinely used to provide oral care. C. Oral suctioning is not an approachto provide oral care. D. Toothettes are not an effective mechanism for providing oral care.PTS: 1 DIF: ModerateKEY: Client Need: Physiological IntegrityBasic Care and Comfort | Cognitive Level: Application5. ANS: CAn acronym that can be used to recall the steps of the evidence-based process is ASKMME: Ask,Search, Think, Measure, Make It Happen, and Evaluate. A. B. D. RIGHT, MYWAY, and ASKWHYare not acronyms used to recall the steps of the evidence-based process.PTS: 1 DIF: EasyKEY: Client Need: Safe and Effective Care EnvironmentManagement of Care | Cognitive Level:Application

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6. ANS: CAsking a burning clinical question is the first step in the EBP process. A. B. Conducting a literaturesearch and working with a medical librarian to identify key words would be done after the clinicalquestion is formulated. D. Evaluating the impact of care or changes in care is the last step in the EBPprocess.PTS: 1 DIF: ModerateKEY: Client Need: Safe and Effective Care EnvironmentManagement of Care | Cognitive Level:Application7. ANS: AUsually a small pilot study within the institution is done before any institute-wide change in practiceis made. B. The charge nurse will not have the evidence needed to propose the change toadministration. C. Polling the nursing staff is not going to help with implementing the change. D.Nursing experts might not have the information needed to determine if the change is appropriatewithin the organization.PTS: 1 DIF: ModerateKEY: Client Need: Safe and Effective Care EnvironmentManagement of Care | Cognitive Level:Application8. ANS: BLevel I is the best evidence and is an analysis of many well-conducted, randomized, controlled trials.It is a systematic review of studies. D. Level II evidence is obtained from at least one well-designedrandomized controlled trial. A. Level III is evidence obtained from quasi-experimental researchstudies. C. Level IV is evidence from the opinion of authorities and/or reports of expert committees.PTS: 1 DIF: ModerateKEY: Client Need: Safe and Effective Care EnvironmentManagement of Care | Cognitive Level:Application9. ANS: DEvidence-based nursing practice is much more than just evaluating research studies to determinewhat results to apply to nursing practice. Evidence-based nursing practice is a systematic process thatutilizes current evidence to make decisions about the care of patients, including evaluation of qualityand applicability of existing research, patient preferences, costs, clinical expertise, and clinical

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settings. A. B. EBP is not used to support professionalism in nursing or as a mechanism to increasenurses’ salaries. C. EBP also isnot used to validate the importance of nursing care.PTS: 1 DIF: ModerateKEY: Client Need: Safe and Effective Care EnvironmentManagement of Care | Cognitive Level:Application10. ANS: AA small pilot study is typically done before an institute-wide change is made. B. This would not be astatistically significant number to support the need for change. C. More evidence or evidence of ahigher level would better support the proposed change. D. It is important to consider the context inwhich the evidence will be used, and research involving a population similar to that of the nurse’sinstitution is helpful.PTS: 1 DIF: DifficultKEY: Client Need: Safe and Effective Care EnvironmentManagement of Care | Cognitive Level:Application11. ANS: BThe use of EBP allows nurses to give patients the best care possible, which is the goal of all caringnurses. It is considered the gold standard for nursing care. A. C. EBP does not necessarily savemoney or reduce staff errors. D. EBP does not influence access to health care.PTS: 1 DIF: ModerateKEY: Client Need: Safe and Effective Care EnvironmentManagement of Care | Cognitive Level:Application12. ANS: BSystematic review, or Level I evidence, is the best evidence; it is an analysis of several well-conducted, randomized, controlled trials. A. Expert opinion is Level IV evidence, which isconsidered the weakest evidence. C. Traditional practice is not a type of evidence for EBP analysis.D. Quasi-experimental studies are considered Level III evidence, because these studies do not controlfactors that could falsely change the results and are less predictive of the effectiveness of nursingcare.

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PTS: 1 DIF: ModerateKEY: Client Need: Safe and Effective Care EnvironmentManagement of Care | Cognitive Level:Application13. ANS: CThe only database specific to nursing is CINAHL. CINAHL is available through school libraries andhospital libraries. A. B. Medline and PubMed are the same resource and are used for medicalliterature. D. Cochrane Reviews focus on reviews of nursing literature.PTS: 1 DIF: ModerateKEY: Client Need: Safe and Effective Care EnvironmentSafety and Infection Control | CognitiveLevel: Application14. ANS: AQuasi-experimental research studies do not control for factors that could falsely change results and assuch, are less predictive of the effectiveness of nursing care. B. Outcome tracking over 10 years is alongitudinal study design, however, does not explain the type of data that will be obtained. C.Control of comorbid conditions describes a Level II design study. D. Modifiable and non-modifiablerisk factors would not be identified through a quasi-experimental approach, because the variables orfactors are not controlled.PTS: 1 DIF: ModerateKEY: Client Need: Safe and Effective Care EnvironmentManagement of Care | Cognitive Level:Analysis15. ANS: ANurses will know from measured outcomes that they are giving the best care possible based on theevidence available at the time. B. Reviewing the literature helps with planning care. C. Constructinga burning question is used to identify the best possible practice for care. D. Determining the validityof clinical research is used to analyze research studies for best practices.PTS: 1 DIF: ModerateKEY: Client Need: Safe and Effective Care EnvironmentManagement of Care | Cognitive Level:Application16. ANS: AThe steps of EBP are Ask, Search, Think, Measure, Make It Happen, and Evaluate. Since the nurse

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completed Ask, Search, Think, and Measure, the next step is Make It Happen. B. A cost-benefitanalysis should have been completed already. C. Related research studies should have been validatedalready. D. A pilot project should have been completed already.PTS: 1 DIF: ModerateKEY: Client Need: Safe and Effective Care EnvironmentPhysiological Integrity | Cognitive Level:Application17. ANS: DA randomized controlled trial is considered Level II evidence. A. C. The Cochrane Review andJoanna Briggs Best Practices Review are considered Level I evidence. B. A quasi-experimental studyis considered Level III evidence.PTS: 1 DIF: ModerateKEY: Client Need: Safe and Effective Care EnvironmentManagement of Care | Cognitive Level:Analysis18. ANS: AEvidence-based care should be given at all times if possible and in all settings where nursing care isgiven. A way to ensure that evidence-based care is provided is to explain why the care should begiven at the time the care is delegated. B. C. D. Explaining the reason for the care is not done toguarantee that the patient will receive morning care, help the UAP focus on actions, or help with timemanagement.PTS: 1 DIF: ModerateKEY: Client Need: Safe and Effective Care EnvironmentManagement of Care | Cognitive Level:Analysis19. ANS: DDiscussing expected effects of a prescribed medication with an HCP and reviewing guidelines foradministration of the medication with the pharmacist demonstrate teamwork and collaboration. A.Informatics is the management of patient confidential information. B. Patient-centered care iscreating an individualized plan of care for a patient. C. Quality improvement is a process to improvepatient care.

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PTS: 1 DIF: ModerateKEY: Client Need: Safe and Effective Care EnvironmentManagement of Care | Cognitive Level:Analysis20. ANS: AIt takes critical thinking to use safety interventions at the right times and in the right circumstances.Using them appropriately helps provide safer care with fewer errors. A. The nurse does not need toask for permission to use a safety intervention. C. The patient will most likely want all safetyinterventions to be used. D. A pilot study does not need to be conducted before implementing asafety intervention.PTS: 1 DIF: ModerateKEY: Client Need: Safe and Effective Care EnvironmentManagement of Care | Cognitive Level:ApplicationMULTIPLE RESPONSE21. ANS: A, C, D, EDependent nursing interventions are those delegated by a physician. B is an independent nursingintervention that does not require a physician’s order.PTS: 1 DIF: ModerateKEY: Client Need: Physiological IntegrityBasic Care and Comfort | Cognitive Level: Analysis22. ANS: A, C, D, EQuasi-experimental studies do not control factors that could falsely change the results and as such,are less predictive of the effectiveness of nursing care. No control exists if there is only one groupbeing tracked or if patients are collected on a volunteer basis. B. The use of an experimental groupand a control group describes a randomized controlled trial study.PTS: 1 DIF: DifficultKEY: Client Need: Safe and Effective Care EnvironmentManagement of Care | Cognitive Level:Analysis23. ANS: A, BThe steps in the EBP process are Ask, Search, Think, Measure, Make It Happen, and Evaluate. Anacronym to remember these steps is ASKMME. C. D. Asking nursing experts and manipulatingcurrent practice are not steps in the EBP process.

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PTS: 1 DIF: ModerateKEY: Client Need: Safe and Effective Care EnvironmentManagement of Care | Cognitive Level:Application24. ANS: A, B, C, ESafety goals increase awareness and understanding of patient safety. They address administeringmedications safely, identifying patients correctly, identifying operative sites correctly, improvingcommunication, reducing fall injuries, and reducing the risk of infection. D. Safety goals would notbe applicable while stocking a supply room with linens.PTS: 1 DIF: ModerateKEY: Client Need: Safe and Effective Care EnvironmentSafety and Infection Control | CognitiveLevel: Application25. ANS: A, B, CA. When collaborating on the development of nursing care plans, it is important to individualizeinterventions to provide patient-centered care. B. As nursing interventions are performed, they shouldmeet the patient’s preferred schedules. C. Nurses should always evaluate each suggested interventionto see if it fits the patient. D. E. Scanning medication using a bar-coding system and documenting inthe electronic medical record are actions that support the focus of informatics.PTS: 1 DIF: ModerateKEY: Client Need: Safe and Effective Care EnvironmentManagement of Care | Cognitive Level:AnalysisChapter 3. Issues in Nursing PracticeChapter 3. Issues in Nursing PracticeMultiple ChoiceIdentify the choice that best completes the statement or answers the question.____ 1. After working a 12-hour shift, the nurse is asked to work part of the next shift due to shortstaffing. Which obligation to work should the nurse use to guide the response to this request?a. Justiceb. Welfarec. Moral

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d. Legal____ 2. The family of a patient who has been diagnosed with cancer does not want the patient to betold about the diagnosis. The patient asks the nurse, “Do I have cancer?” Which ethical principlesshould the nurse consider when resolving this situation?a. Autonomy and veracityb. Beneficence and justicec. Welfare rights and moral obligationsd. Nonmaleficence and legal obligations____ 3. A patient tells the nurse that the Patient’s Bill of Rights gives patients the legal right to readtheir medical information. Which of these responses would be appropriate for the nurse to make?a. “I’ll ask yourphysician if you can read the record.”b. ”Are you concerned about the care you are receiving?”c. ”I’ll stay here with you while you read it in case you have any questions.”d. ”Let me check with the charge nurse first.”____ 4. The nurse assigned to care for a patient who has HIV accepts the patient assignment despitebelieving that the patient’s condition is a punishment from God. With which ethical principle is thisnurse’s behavior associated?a. Justiceb. Veracityc. Beneficenced. Nonmaleficence____ 5. While planning patient care, the nurse considers what needs to be done to limit any liability.Which action should the nurse take to minimize liability when providing patient care?a. Ensure patients’ rights.b. Follow verbal orders.c. Follow directions exactly as given.d. Verify employer’s liability insurance.____ 6. A patient is identified to participate in a new drug study, but does not understand the drug orthe study. Which ethical principle should the nurse use to prevent the patient from participating in thestudy?a. Veracityb. Autonomyc. Nonmaleficence

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d. Standard of Best Interest____ 7. The nurse educator is preparing a seminar that focuses on the impact of technology onpatient care. Which effect of technology on ethical decision making should the educator include inthis seminar?a. Ethical situations remain similar to what they have always been in health care.b. Nurses have fewer ethical decisions, because computers now make many decisions.c. Ethical dilemmas have become more complex owing to technologies that prolong life.d. Nurses can postpone ethical decisions, because technology allows patients to live longer.____ 8. The nurse is concerned about a patient’s ability to make decisions about a proposed treatmentplan. Which patient characteristic is causing the nurse to have this concern?a. Lower socioeconomic statusb. Authoritarian family relationshipc. Past experience with hospitalizationd. Lack of information about treatment____ 9. A patient has a living will and gives it to the nurse to follow. The patient says, “Do not tellmy family about the living will.” Which action should the nurse take?a. Send a copy of the living will to medical records.b. Assure the patient that the nurse will not tell anyone.c. Encourage the patient to discuss the living will with the family.d. Return the living will to the patient until the family is informed.____ 10. The nurse is caring for an 80-year-old patient. Which statement made by the nurse conveysdignity and respect to the patient?a. “Honey, I have your medications.”b. “I have your medications for you, dear.”c. “I have your medications for you.”d. “It’s time for us to take our medications.”____ 11. The charge nurse is concerned that an HCP is breaching a patient’s confidentiality. Whatdid the charge nurse observe to come to this conclusion?a. A physician asking a nurse if a friend has cancerb. Use of patient initials on nurse’s assignment worksheetc. A nurse asking an unknown physician for identificationd. A nurse reviewing charts of assigned patients for orders____ 12. The nurse is reviewing information on the state board of nursing website prior to renewing
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