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Nursing Student Quizzes & Sample Tests | Free Quizzes for Nurses

This page contains all of our free interactive quizzes and sample tests for nursing students and current nurses. This page is designed to help nursing students and current nurses succeed. Whether you want to practice some dosage and calculations problems, practice for HESI or NCLEX, this page can help.

We are constantly adding new quizzes and tests–so make sure to bookmark this page, and check back for updates. Also, please help us spread the word–let your friends know about this page so they can enjoy these quizzes and tests. Consider sharing on your Facebook or other social media.

List of all of Our Videos

View all of RegisteredNurseRN’s YouTube videos (teaching tutorials, NCLEX tips, nursing school questions, career help and more)

Nurse Sarah’s Notes and Merch

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“ Fluid and Electrolytes Notes, Mnemonics, and Quizzes by Nurse Sarah “. These notes contain 84 pages of Nurse Sarah’s illustrated, fun notes with mnemonics, worksheets, and 130 test questions with rationales.

-You can get an eBook version here or a physical copy of the book here.

“ ABG Interpretation Notes, Mnemonics, and Workbook by Nurse Sarah “. These notes contain 64 pages of Nurse Sarah’s illustrated, fun notes with mnemonics, and worksheets that include over 90 ABG practice problems and 60 test review questions covering ABG concepts.

NCLEX Practice Test

We have developed NCLEX practice quizzes to help you prepare for the NCLEX exam. These quizzes are designed to test your knowledge on what you may encounter on the NCLEX exam. Each quiz has rationals and you will be able to see what you got right and wrong.

Respiratory System

  • Respiratory Sounds (Comprehensive)
  • Wheezes (high-pitched) Lung Sounds Quiz
  • Rhonchi Lung Sounds Quiz
  • Fine Crackles Lung Sounds Quiz
  • Stridor Lung Sounds Quiz
  • Coarse Crackles Lung Sounds Quiz
  • Pleural Friction Rub Quiz
  • Lung Sounds Quiz
  • ARDS NCLEX Questions
  • Tuberculosis NCLEX Questions
  • Asthma Quiz
  • Pneumothorax Quiz
  • Chest Tube Care Quiz
  • Chronic Bronchitis vs Emphysema Quiz
  • COPD (chronic obstructive pulmonary disease) Quiz
  • Lung Anatomy and Physiology Quiz
  • Pneumonia Quiz
  • Coronavirus (COVID-19) Quiz

EKG/ECG Quizzes

  • Premature Ventricular Contractions (PVCs) Quiz
  • ECG Identify Rhythms Quiz
  • Junctional Tachycardia Rhythm Quiz
  • Accelerated Junctional Rhythm Quiz
  • Junctional Escape Rhythm Quiz
  • Pulseless Electrical Activity (PEA) Quiz
  • Asystole Rhythm Quiz
  • Ventricular Tachycardia (V-tach) Quiz
  • Ventricular Fibrillation (V-fib) Quiz
  • Atrial Fibrillation (A-Fib) Quiz
  • Atrial Flutter Quiz
  • Normal Sinus Rhythm Quiz
  • Third-Degree (Complete) Heart Block Quiz
  • Second-Degree type II (Mobitz type II) Quiz
  • Second-Degree type I (Mobitz type I Wenckebach) Quiz
  • First-Degree Heart Block Quiz
  • Sinus Tachycardia ECG/EKG Quiz
  • Sinus Bradycardia ECG/EKG Quiz
  • ECG/EKG Interpretation Basics Quiz
  • QRS Complex Measurement Quiz
  • PR Interval Measurement on EKG Quiz
  • EKG Rhythm Quiz on Heart Blocks
  • EKG Rhythm Quiz on Atrial Fibrillation & Atrial Flutter
  • EKG Rhythm Strip on PQRST Quiz
  • Car Seat Safety NCLEX Questions
  • Adolescent Growth Development NCLEX Questions Quiz
  • School-age Growth Developmental NCLEX Questions Quiz
  • Preschooler Growth Development Milestones NCLEX Questions
  • Toddler Developmental Milestones NCLEX Questions
  • Infant Developmental Milestones NCLEX Questions
  • Newborn (Infant) Reflexes NCLEX Questions
  • Truncus Arteriosus NCLEX Questions
  • Coarctation of the Aorta NCLEX Questions
  • Transposition of the Great Arteries NCLEX Questions
  • Atrial Septal Defect NCLEX Questions
  • Ventricular Septal Defect NCLEX Questions
  • Patent Ductus Arteriosus NCLEX Questions
  • Tetralogy of Fallot NCLEX Questions
  • Cystic Fibrosis NCLEX Questions
  • Epiglottitis 
  • Immunization Schedule (Ages 0 to 6 years) 
  • NCLEX Peds Metabolic & Endocrine Disorders 
  • Safe Dosage Calculations for Pediatrics
  • NCLEX Pediatric Nursing Developmental Stages
  • Glasgow Coma Scale NCLEX Questions
  • Alzheimer’s Disease (dementia) NCLEX Questions
  • Autonomic Dysreflexia NCLEX Questions
  • Guillain-Barré Syndrome NCLEX Questions
  • Seizures NCLEX questions
  • Multiple Sclerosis 
  • How to Calculate Cerebral Perfusion Pressure Quiz
  • Increased Intracranial Pressure (ICP) Quiz
  • Parkinson’s Disease Quiz
  • Stroke (CVA) Quiz
  • Cholinergic Crisis vs. Myasthenic Crisis Quiz
  • Myasthenia Gravis Quiz
  • Sympathetic vs. Parasympathetic Nervous System Quiz
  • Cancer Staging and Grading NCLEX Questions
  • HIV (AIDS) NCLEX Questions Nursing Quiz
  • Metabolic Panel (CMP vs. BMP) Quiz
  • PT/INR vs. aPTT Quiz
  • Complete Blood Count (CBC) NCLEX Questions
  • Labs to Know for NCLEX Quiz
  • Sickle Cell Anemia Quiz
  • Blood Transfusion Quiz
  • Blood Types Quiz
  • Pernicious Anemia Quiz
  • Iron-deficiency Anemia Quiz

Autoimmune Disorders

  • Systemic Lupus Erythematosus NCLEX Questions

Dosage Calculations

Many students struggle in their Dosage Calculations nursing school class. While the math can be difficult to learn at first, it does get much easier in time. Here are some tests you can practice:

  • IV Completion and Infusion Time (Flow Rates gtts/min)
  • Desired Over Have Practice Questions
  • Insulin Drip Calculations Quiz
  • How to Read a Medication Label Nursing Quiz
  • 24-Hour Clock vs. 12-Hour Clock Practice Quiz
  • COMPREHENSIVE: Dosage Calculations
  • Body Surface Area Calculations 
  • Tube Feeding Nursing Calculations
  • Dopamine IV Drip Calculation
  • Heparin Drip Practice Problems
  • IV Infusion Time Quiz
  • Celsius and Fahrenheit Conversion Quiz
  • Grain Nursing Dosage Calculations Quiz
  • Safe Dosage Calculations for Pediatrics Quiz
  • Weight-based Calculations Quiz
  • Drug Reconstitution Calculation Quiz
  • IV Infusion Rates Quiz
  • IV Flow Rates Quiz
  • IV Bolus Quiz
  • Oral Medication Quiz
  • Capsules & Tablets Quiz
  • Conversions Quiz

Pharmacology

  • SSRIs Antidepressant NCLEX Questions
  • Rights of Medication Administration
  • Barbiturates NCLEX Questions
  • Benzodiazepines NCLEX Questions
  • Medication Frequencies Time Abbreviation Quiz
  • Medication Administration Routes and Abbreviations Quiz
  • Statins (HMG-CoA Reductase Inhibitors) NCLEX Questions
  • Antidotes for Meds NCLEX Quiz
  • Beta Blockers NCLEX Questions
  • Calcium Channel Blockers NCLEX Questions
  • Potassium-Sparing Diuretic NCLEX Questions
  • Thiazide Diuretics NCLEX Questions
  • Loop Diuretics NCLEX Questions
  • ARBs Angiotensin II Receptor Blockers NCLEX Questions
  • ACE Inhibitors NCLEX Questions
  • Heparin NCLEX Questions
  • Warfarin (Coumadin) NCLEX Questions
  • Digoxin NCLEX Questions
  • Aminoglycosides (Antibiotics) NCLEX Questions
  • Macrolides (Antibiotics) NCLEX Questions
  • Fluoroquinolones (Antibiotics) NCLEX Questions
  • Cephalosporins (Antibiotics) NCLEX Questions

Eye Disorders

  • Glaucoma NCLEX Questions
  • Cataracts NCLEX Questions

Anatomy & Physiology Quizzes

These anatomy and physiology quizzes are designed to help you understand exam material in your lecture class. Each quiz is specially made to test your knowledge on anatomy terms, function, and location of material. We tried to compile the most common used test questions asked in an Anatomy and Physiology class.

  • Medical Terminology Prefixes Quiz
  • Medical Terminology Suffixes Quiz
  • Layers of the Heart Wall Quiz
  • Regional Terms Anatomy Quiz
  • Skin Glands Anatomy Quiz
  • Nail Anatomy Quiz
  • Tooth Anatomy Quiz (structure and tissues)
  • Types of Teeth Quiz
  • Biceps Brachii Anatomy Quiz
  • Brachialis Anatomy Quiz
  • Body Movement Terms Quiz (Comprehensive)
  • Flexion and Extension Quiz
  • Rotation Quiz
  • Gliding Quiz
  • Abduction and Adduction Quiz
  • Circumduction Quiz
  • Elevation and Depression Quiz
  • Protrusion, Excursion, Retrusion Quiz
  • Protraction vs. Retraction Quiz
  • Inversion vs. Eversion Quiz
  • Dorsiflexion vs. Plantarflexion Quiz
  • Opposition and Reposition Quiz
  • Pronation vs. Supination Quiz
  • Smooth Muscle Quiz
  • Cardiac Muscle Tissue Quiz
  • Skeletal Muscle Tissue Quiz
  • Muscle Anatomy Quiz
  • Vertebral Column Ligaments Quiz
  • Vertebral Column Quiz
  • Sacrum Anatomy Quiz
  • Coccyx Bone Anatomy Quiz
  • Rib Bone Anatomy Quiz
  • Sternum Quiz
  • Female vs. Male Pelvis Quiz
  • Pelvis Quiz
  • Patella Quiz
  • Tibia and Fibula Quiz
  • Bone Types Quiz
  • Bones of the Foot Quiz
  • Clavicle and Scapula Quiz
  • Radius Ulna Bone Quiz
  • Humerus Bone Quiz
  • Hand, Wrist, Arm Bones Quiz
  • Skull Bones Quiz (Cranial and Facial)
  • Body Cavities and Membranes Quiz
  • Abdominal Regions and Quadrants Quiz
  • Anatomical Body Planes and Sections Quiz
  • Directional Terms Quiz
  • Kidney and Nephron Quiz
  • Respiratory System Quiz
  • Human Bones Quiz
  • Cranial Nerves Quiz
  • Quiz on the Pelvis
  • Anatomy & Physiology of the Spine & Ribs Quiz
  • Anatomy & Physiology Neuron Structure Quiz
  • Anatomy & Physiology Skin Integumentary System  Quiz
  • Anatomy & Physiology Cell Structure & Function Quiz
  • Electrical Conduction System of the Heart Quiz
  • Blood Flow of Heart Quiz
  • True vs. False Labor NCLEX Questions
  • Preeclampsia and Eclampsia NCLEX Questions
  • Fetal Station Quiz
  • Presumptive, Probable, Positive Pregnancy Signs Quiz
  • Gestational Diabetes NCLEX Questions
  • Gravidity and Parity Quiz
  • Fetal Circulation Quiz
  • Fundal Height NCLEX Questions
  • Abruptio Placentae vs. Placenta Previa Quiz
  • Stages of Labor Quiz
  • APGAR Scoring Quiz
  • Menstrual Cycle Quiz
  • GTPAL Calculating Quiz
  • Naegele’s Rule Quiz
  • Fetal Heart Tone Decelerations Quiz
  • NCLEX Maternity Nursing OB Assessment  Part 1
  • NCLEX Maternity Nursing Prenatal Part 2

Nursing Disaster Management

  • Disaster Triage NCLEX Questions

Cardiovascular

  • Coronary Artery Anatomy Quiz
  • Angina NCLEX Questions
  • DVT (Deep Vein Thrombosis) NCLEX Questions
  • Peripheral Vascular Disease (PVD) NCLEX Questions
  • Renin-Angiotensin-Aldosterone System (RAAS) Quiz
  • Preload vs. Afterload Nursing Quiz
  • Myocardial Infarction (MI) Quiz
  • Coronary Artery Disease Quiz
  • Pericarditis Quiz
  • Endocarditis Quiz
  • Heart Failure Quiz
  • Heart Sounds Quiz

Gastrointestinal

  • T-Tube NCLEX Questions
  • Cholecystitis NCLEX Questions
  • Hepatitis NCLEX Questions
  • Cirrhosis Quiz
  • Pancreatitis Quiz
  • Celiac Disease Quiz
  • Peptic Ulcer Disease Quiz
  • Diverticulosis and Diverticulitis Quiz
  • Crohn’s Disease vs. Ulcerative Colitis Quiz
  • Crohn’s Disease Quiz
  • Ulcerative Colitis Quiz
  • Appendicitis Quiz
  • Ostomy Care Quiz

Musculoskeletal

  • Assistive Devices NCLEX Questions (Crutches, Canes, Walkers)
  • Walker (Assistive Devices) NCLEX Questions
  • Canes (Assistive Devices) NCLEX Questions
  • Crutches (Assistive Devices) NCLEX Questions
  • Fractures Quiz
  • Osteoporosis Quiz
  • Osteoarthritis vs. Rheumatoid Arthritis Quiz
  • Osteoarthritis Quiz
  • Rheumatoid Arthritis Quiz

Integumentary

  • Skin Cancer NCLEX Questions
  • Parkland Burn Formula
  • Rule of Nines for Burns
  • Pressure Ulcers
  • Neurogenic Shock NCLEX Questions
  • Anaphylactic Shock NCLEX Questions
  • Septic Shock NCLEX Questions
  • Hypovolemic Shock NCLEX Questions
  • Cardiogenic Shock NCLEX Questions
  • Stages of Shock NCLEX Questions

Fundamentals

  • Patient Positioning (New)
  • Delegation NCLEX Questions
  • Intake and Output Calculation Practice
  • Personal Protective Equipment (PPE) Quiz
  • Isolation Precautions Quiz
  • NCLEX Nursing Fundamentals Perioperative Quiz
  • NCLEX Positioning Patients Fundamentals 
  • Chronic Kidney Disease (End Stage Renal Failure) Quiz
  • Acute Kidney Injury (Acute Renal Failure) Quiz
  • Nephrotic Syndrome vs Glomerulonephritis Quiz
  • Nephrotic Syndrome Quiz
  • Acute Glomerulonephritis Quiz
  • Renal Calculi (Kidney Stones) Quiz
  • Urinary Tract Infection Quiz
  • Nephron Function Quiz (Part 2)
  • Kidney and Nephron Anatomy Quiz (Part 1)

Endocrine Disorders

  • Cushing’s Disease and Syndrome NCLEX Questions
  • Pheochromocytoma Quiz
  • Hypoparathyroidism vs Hyperparathyroidism Quiz
  • Myxedema Coma Quiz
  • Grave’s Disease Quiz
  • Thyroid Storm Quiz
  • Hypothyroidism vs Hyperthyroidism Quiz
  • DKA vs HHNS Quiz
  • Hyperglycemic Hyperosmolar Nonketotic Syndrome (HHNS) Quiz
  • Diabetic Ketoacidosis Quiz
  • Diabetes Mellitus NCLEX  Part 1 Quiz
  • Diabetes Pharmacology & Nursing Management Part 2 Quiz
  • Addison’s Disease vs Cushing’s Syndrome/Disease Quiz
  • SIADH vs Diabetes Insipidus Quiz
  • Adrenal Crisis (Addisonian Crisis) Quiz

Fluid & Electrolytes Quizzes

  • Colloids Nursing Solutions Quiz
  • Fluid Movement Capillary Wall (Oncotic and Hydrostatic Pressure)
  • Cell Membrane Transport Quiz (Diffusion, Osmosis, Active Transport)
  • Hormones in Fluid Regulation (RAAS and Thirst Mechanism)
  • Fluid Volume Deficit (Hypovolemia)
  • Fluid Volume Overload Excess (Hypervolemia)
  • IV Fluid Types NCLEX Questions
  • Hyperchloremia vs. Hypochloremia NCLEX Questions
  • Fluid and Electrolyte Nursing Quiz (Comprehensive)
  • Hypophosphatemia vs Hyperphosphatemia Quiz
  • Hypomagnesemia vs Hypermagnesemia Quiz
  • Hyponatremia vs Hypernatremia Quiz
  • Hypocalcemia vs Hypercalcemia Quiz
  • Isotonic, Hypotonic, & Hypertonic IV Solution Quiz
  • Hypokalemia vs Hyperkalemia Quiz

Arterial Blood Gas Quizzes

  • Metabolic Acidosis vs Metabolic Alkalosis Quiz
  • Respiratory Acidosis vs Respiratory Alkalosis Quiz
  • ABG (arterial blood gas) Quiz

NCLEX Quizzes by Subject

  • Hypertension NCLEX Quiz  (include pharmacology questions)
  • NCLEX Oncological Cancer Disorders
  • NCLEX Integumentary Skin System   (skin disorders)  Part 1
  • NCLEX Integumentary System (Pressure Ulcers & Burns) Part 2
  • NCLEX Fluids & Electrolytes
  • NCLEX Nutrition Quiz
  • NCLEX Taking Care of Patients with Tubes

ATI TEAS Math Practice Tests

  • Solving Equations with One Unknown Variable Quiz
  • Multiplying & Dividing Decimal Numbers Quiz
  • Order of Operations Quiz
  • Multiplying & Dividing Fractions Quiz
  • Subtracting Whole Numbers Quiz
  • Adding & Subtracting Fractions Quiz

CPR Quizzes

CPR Quiz for an Adult Victim

Video Teaching Tutorials for NCLEX

Easy Way to Understand Fetal Heart Tone Decelerations

Electrical Conduction System of the Heart

EKG PQRST Rhythm Strip

Easy Way to Memorize Blood Flow of the Heart

How to Analyze ABGs with the Tic Tac Toe Method

What is the Metric Table and How to Use it?

What is Dimensional Analysis and How to Set up a Problem

Video 1: Solving Basic Metric Conversions using Dimensional Analysis

Video 2: Solving IV Bolus Problems using Dimensional Analysis

Video 3: Solving Oral Drug Problems with Dimensional Analysis

Video 4: Solving IV Drip Factors gtt/min

Video 5: Solving IV Infusion Rates mL/hr

We’ll be adding more and more quizzes over time , so make sure to bookmark this page and come back often. Also, we’d really appreciate it if you would share it on Facebook, Twitter, or other social media. Thanks so much!

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Home / NCLEX-RN Practice Test Questions

NCLEX-RN Practice Test Questions

Keith E. Sax, BSN, RN

You've learned about the NCLEX-RN exam, studied the sections, and are ready to put your knowledge to the test. Take our practice NCLEX exam below to get ready for the real deal.

Jump to Section

Click on the section names below to jump to a particular section of the RegisteredNursing.org NCLEX-RN Practice Exam.

  • The Safe and Effective Care Environment: The Management of Care
  • The Safe and Effective Care Environment: Safety and Infection Control
  • Health Promotion and Maintenance
  • Psychosocial Integrity
  • Physiological Integrity: Basic Care and Comfort
  • Physiological Integrity: Pharmacological and Parenteral Therapies
  • Physiological Integrity: Reduction of Risk Potential
  • Physiological Integrity: Physiological Adaptation

The NCLEX-RN Test Plan is organized into four major Client Needs categories. Two of the four categories are divided into subcategories as shown below:

  • Management of Care – 17% to 23%
  • Safety and Infection Control – 9% to 15%
  • Health Promotion and Maintenance – 6% to 12%
  • Psychosocial Integrity – 6% to 12%
  • Basic Care and Comfort – 6% to 12%
  • Pharmacological and Parenteral Therapies – 12% to 18%
  • Reduction of Risk Potential – 9% to 15%
  • Physiological Adaptation – 11% to 17%

For more practice test questions from professional sources try these .

NCLEX-RN

The Safe & Effective Care Environment: The Management of Care Practice Questions

You should respond to the couple by stating that only unanticipated treatments and procedures that are not included in the advance directive can be made by the legally appointed durable power of attorney for healthcare decisions.

  • You should be aware of the fact that the wife of the client has a knowledge deficit relating to advance directives and durable powers of attorney for healthcare decisions and plan an educational activity to meet this learning need.
  • You should be aware of the fact that the client has a knowledge deficit relating to advance directives and durable powers of attorney for healthcare decisions and plan an educational activity to meet this learning need.
  • You should reinforce the wife’s belief that legally married spouses automatically serve for the other spouse’s durable power of attorney for health care decisions and that others than the spouse cannot be legally appointed while people are married

Correct Response: A

Both the client and the client’s spouse have knowledge deficits relating to advance directives. Legally married spouses do not automatically serve for the other spouse’s durable power of attorney for health care decisions; others than the spouse can be legally appointed while people are married.

  • Privacy and to have their medical information confidential unless the client formally approves the sharing of this information with others such as family members.
  • Make healthcare decisions and to have these decisions protected and communicated to others when they are no longer competent to do so.
  • Be fully informed about all treatments in term of their benefits, risks and alternatives to them so the client can make a knowledgeable and informed decision about whether or not to agree to having it
  • Make decisions about who their health care provider is without any coercion or undue influence of others including healthcare providers.

Correct Response: B,D

The Patient Self Determination Act, which was passed by the US Congress in 1990, gives Americans the right to make healthcare decisions and to have these decisions protected and communicated to others when they are no longer competent to do so. These decisions can also include rejections for future care and treatment and these decisions are reflect in advance directives. This Act also supports the rights of the client to be free of any coercion or any undue influence of others including healthcare providers.

The Health Insurance Portability and Accountability Act (HIPAA) supports and upholds the clients’ rights to confidentially and the privacy of their medical related information regardless of its form. It covers hard copy and electronic medical records unless the client has formally approved the sharing of this information with others such as family members.

The elements of informed consent which includes information about possible treatments and procedures in terms of their benefits, risks and alternatives to them so the client can make a knowledgeable and informed decision about whether or not to agree to having it may be part of these advanced directives, but the law that protects these advance directives is the Patient Self Determination Act.

  • Call the doctor and advise them that the client’s physical status has significantly changed and that they have just had a cardiopulmonary arrest.
  • Begin cardiopulmonary resuscitation other emergency life saving measures.
  • Notify the family of the client’s condition and ask them what they should be done for the client.
  • Insure that the client is without any distressing signs and symptoms at the end of life.

Correct Response: B

You must immediately begin cardiopulmonary resuscitation and all life saving measures as requested.by the client in their advance directive despite the nurse’s own beliefs and professional opinions. Nurses must uphold the client’s right to accept, choose and reject any and all of treatments, as stated in the client’s advance directive.

You would not call the doctor first; your priority is the sustaining of the client’s life; you would also not immediately notify the family for the same reason and, when you do communicate with the family at a later time, you would not ask them what should or should not be done for the client when they wishes are already contained in the client’s advance directive.

Finally, you would also insure that the client is without pain and all other distressing signs and symptoms at the end of life, but the priority and the first thing that you would do is immediately begin cardiopulmonary resuscitation and all life saving measures as requested by the client in their advance directive, according to the ABCs and Maslow’s Hierarchy of Needs.

  • Case manager
  • Collaborator
  • Coordinator of care

Correct Response: D

The priority role of the nurse is advocacy. The nurse must serve as the advocate for both the fetus and the mother at risk as the result of this ethical dilemma where neither option is desirable. As an advocate, the nurse would seek out resources and people, such as the facility’s ethicist or the ethics committee, to resolve this ethical dilemma.

  • Client advocate
  • Entrepreneur

A nurse who organizes and establishes a political action committee (PAC) in their local community to address issues relating to the accessibility and affordability of healthcare resources in the community is serving as the client advocate. As you should know, the definition of “client” includes not only individual clients, and families as a unit, but also populations such as the members of the local community.

Although the nurse, as the organizer of this political action committee (PAC), will have to collaborate with members of the community to promote the accessibility and affordability of healthcare resources in the community, this is a secondary role rather than the primary role.

Additionally, although the nurse is serving in a political advocacy effort, the nurse is not necessarily a politician and there is no evidence that this nurse is an entrepreneur.

  • The right task, the right circumstances, the right person, the right competency, and the right supervision or feedback
  • The right task, the right circumstances, the right person, the right direction or communication, and the right supervision or feedback
  • The right competency, the right education and training, the right scope of practice, the right environment and the right client condition
  • The right competency, the right person, the right scope of practice, the right environment and the right client condition

The Five Rights of Delegation include the right task, the right circumstances, the right person, the right direction or communication, and the right supervision or feedback.

The right competency is not one of these basic Five Rights, but instead, competency is considered and validated as part of the combination of matching the right task and the right person; the right education and training are functions of the right task and the right person who is able to competently perform the task; the right scope of practice, the right environment and the right client condition are functions of the legal match of the person and the task; and the setting of care which is not a Right of Delegation and the matching of the right person, task and circumstances.

  • The American Nurses Association’s Scopes of Practice
  • The American Nurses Association’s Standards of Care
  • State statutes
  • Federal law

Correct Response: C

The registered nurse, prior to the delegation of tasks to other members of the nursing care team, evaluates the ability of staff members to perform assigned tasks for the position as based on state statutes that differentiate among the different types of nurses and unlicensed assistive personnel that are legally able to perform different tasks.

Although the American Nurses Association’s Standards of Care guide nursing practice, these standards are professional rather than legal standards and the American Nurses Association does not have American Nurses Association’s Scopes of Practice, only the states’ laws or statutes do.

Lastly, scopes of practice are within the legal domain of the states and not the federal government.

  • Observe the staff member during an entire shift of duty to determine whether or not the nurse has accurately and appropriately established priorities.
  • Observe the staff member during an entire shift of duty to determine whether or not the nurse has accurately and appropriately completed priority tasks.
  • Ask the staff member how they feel like they have been able to employ their time management skills for the last six months.
  • Collect outcome data over time and then aggregate and analyze this data to determine whether or not the staff member has completed reasonable assignments in the allotted time before the end of their shift of duty.

The best way to objectively evaluate the effectiveness of an individual staff member’s time management skills in a longitudinal manner is to collect outcome data over time, and then aggregate and analyze this data to determine whether or not the staff member has completed reasonable assignments in the allotted time before the end of their shift of duty. Another way to perform this longitudinal evaluation is to look at the staff member’s use of over time, like the last six months, when the unit was adequately staffed.

Observing the staff member during an entire shift of duty to determine whether or not the nurse has accurately and appropriately established priorities is a way to evaluate the short term abilities for establishing priorities and not assignment completion and observing the staff member during an entire shift of duty to determine whether or not the nurse has accurately and appropriately completed priority tasks is a way to evaluate the short term abilities for completing established priorities and not a complete assignment which also includes tasks that are not of the highest priority.

Lastly, asking the staff member how they feel like they have been able to employ their time management skills for the last six months is the use of subjective rather than objective evaluation.

  • An unlicensed staff member who has been “certified” by the employing agency to monitor telemetry: Monitoring cardiac telemetry
  • An unlicensed assistive staff member like a nursing assistant who has been “certified” by the employing agency to insert a urinary catheter: Inserting a urinary catheter
  • A licensed practical nurse: The circulating nurse in the perioperative area
  • A licensed practical nurse: The first assistant in the perioperative area

An unlicensed staff member who has been “certified” by the employing agency to monitor telemetry can monitor cardiac telemetry; they cannot, however, interpret these cardiac rhythms and initiate interventions when interventions are indicated. Only the nurse can perform these roles.

Unlicensed assistive staff member like a nursing assistant cannot under any circumstances be certified” by the employing agency to insert a urinary catheter or insert a urinary catheter because this is a sterile procedure and, legally, no sterile procedures can be done by an unlicensed assistive staff member like a nursing assistant.

Lastly, the role of the circulating nurse is within the exclusive scope of practice for the registered nurse and the role of the first assistant is assumed only by a registered nurse with the advanced training and education necessary to perform competently in this capacity. Neither of these roles can be delegated to a licensed practical nurse or an unlicensed assistive staff member like a nursing assistant or a surgical technician.

  • Only the VA health care services because he is not 65 years of age
  • Medicare because he has been deemed permanently disabled for 2 years
  • Medicaid because he is permanently disabled and not able to work
  • Choices B and C

This client is legally eligible for Medicare because he has been deemed permanently disabled for more than 2 years in addition to the VA health care services. People over the age of 65 and those who are permanently disabled for at least two years, according to the Social Security Administration, are eligible for Medicare.

Based on the information in this scenario, the client is not eligible for Medicaid because has a “substantial” VA disability check on a monthly basis and is not indigent and with a low income.

  • The case manager’s role in terms of organization wide performance improvement activities
  • The case manager’s role in terms complete, timely and accurate documentation
  • The case manager’s role in terms of the clients’ being at the appropriate level of care
  • The case manager’s role in terms of contesting denied reimbursements

Registered nurse case managers have a primary case management responsibility associated with reimbursement because they are responsible for insuring that the client is being cared for at the appropriate level of care along the continuum of care that is consistent with medical necessity and the client’s current needs. A failure to insure the appropriate level of care jeopardizes reimbursement. For example, care in an acute care facility will not be reimbursed when the client’s current needs can be met in a subacute or long term care setting.

Nurse case managers do not have organization wide performance improvement activities, the supervision of complete, timely and accurate documentation or challenging denied reimbursements in their role. These roles and responsibilities are typically assumed by quality assurance/performance improvement, supervisory staff and medical billers, respectively.

  • The ProACT Model: Registered nurses perform the role of the primary nurse in addition to the related coding and billing functions
  • The Collaborative Practice Model: The registered nurse performs the role of the primary nurse in addition to the role of the clinical case manager with administrative, supervisory and fiscal responsibilities
  • The Case Manager Model: The management and coordination of care for clients throughout a facility who share the same DRG or medical diagnosis
  • The Triad Model of Case Management: The joint collaboration of the social worker, the nursing case manager, and the utilization review team

The Triad Model of case management entails the joint collaboration of the social worker, the nursing case manager, and the utilization review team.

The Professionally Advanced Care Team, referred to as the ProACT Model, which was developed at the Robert Wood Johnson University Hospital, entails registered nurses serving in the role of both the primary nurse the clinical case manager with no billing and coding responsibilities; these highly specialized and technical billing and coding responsibilities are done by the business office, medical billers and medical coders.

The Case Manager Model entails the registered nurses’ role in terms of case management for a particular nursing care unit for a group of clients with the same medical diagnosis or DRG. In contrast to this Case Manager Model of Beth Israel Hospital, the Collaborative Practice Model of case management entails the role of some registered nurses in a particular healthcare facility to manage, coordinate, guide and direct the complex care of a population of clients throughout the entire healthcare facility who share a particular diagnosis or Diagnostic Related Group.

  • The Case Manager Model
  • The ProACT Model
  • The Collaborative Practice Model
  • The Triad Model of Case Management

The Case Manager Model and the Collaborative Practice Model of case management are the only models of case management that employ the mandated and intrinsic use of critical pathways which are multidisciplinary plans of care that are based on the client’s current condition, and that reflect interventions and expected outcomes within a pre-established time line.

The ProACT Model, the Collaborative Practice Model and the Triad Model of Case Management do not necessarily employ critical pathways; these models can use any system of medical records and documentation.

  • An opt out consent
  • An implicit consent
  • An explicit consent
  • No consent at all is given

The type of legal consent that is indirectly given by the client by the very nature of their voluntary acute care hospitalization is an implicit consent indirectly given by the client by the very nature of their voluntary acute care hospitalization is an implicit consent.

An explicit consent, on the other hand, is the direct and formal consent of the client; and an opt out consent is given when a patient does NOT refuse a treatment; this lack of objections by the patient indicates that the person has consented to the treatment or procedure with an opt out consent.

  • Take the photographs because these photographs are part of the holiday tradition at this facility
  • Take the photographs because all of the residents are properly attired and in a dignified condition
  • Refuse to take the photographs unless you have the consent of all to do so
  • Refuse to take the photographs because this is not part of the nurse’s role

You should refuse to take the photographs unless you have the consent of all to do so because to do otherwise is a violation of the residents’ rights to privacy and confidentiality as provided in the Health Insurance Portability and Accountability Act (HIPAA). This, rather than the false belief that this is not part of the nurse’s role, is the reason that you would not automatically take these photographs.

Regardless of whether or not these photographs are part of the holiday tradition at this facility and whether or not the residents are properly attired and in a dignified condition, no photographs can be legally taken without the residents’ permission and consent.

  • The Patient Self Determination Act: The client’s right to choose the level of care
  • The Patient Self Determination Act: The clients’ right to healthcare insurance coverage for mental health disorders
  • The Mental Health Parity Act: The privacy and security of technological psychiatric information
  • The Health Insurance Portability and Accountability Act (HIPAA): The privacy and security of technological medical information

The Health Insurance Portability and Accountability Act (HIPAA) protects the client’s legal rights to the privacy, security and confidentiality of all medical information including data and information that is technologically stored and secured.

The Patient Self Determination Act uphold the client’s right to choose and reject care and not the level of care that is driven and decided upon as based on medical necessity and health insurance reimbursement; this Act also does not give client’s the right to any health insurance including healthcare insurance coverage for  mental health disorders.

Lastly, the Mental Health Parity and Addiction Equality Act, passed in 2008, mandates insurance coverage for mental health and psychiatric health services in a manner similar to medical and surgical insurance coverage; it does not protect the privacy and security of technological psychiatric information, HIPAA does.

  • The physical therapist
  • The occupational therapist
  • The podiatrist
  • The nurse practitioner

The member of the multidisciplinary team that you would most likely collaborate with when the client is at risk for falls due to an impaired gait is a physical therapist. Physical therapists are licensed healthcare professionals who assess, plan, implement and evaluate interventions including those related to the patient’s functional abilities in terms of their gait, strength, mobility, balance, coordination, and joint range of motion. They also provide patients with assistive aids like walkers and canes and exercise regimens.

Occupational therapists assess, plan, implement and evaluate interventions including those that facilitate the patient’s ability to achieve their highest possible level of independence in terms of their activities of daily living such as bathing, grooming, eating and dressing.

Podiatrists care for disorders and diseases of the foot; and nurse practitioners, depending on their area of specialty, may also collaborate with nurses when a client is affected with a disorder in terms of gait, strength, mobility, balance, coordination, and joint range of motion, however the member of the multidisciplinary team that you would most likely collaborate with when the client is at risk for falls due to an impaired gait is a physical therapist.

  • The dietician

The member of the multidisciplinary team that you would most likely collaborate with when the client can benefit from the use of adaptive devices for eating is the occupational therapist. Occupational therapists assess, plan, implement and evaluate interventions including those that facilitate the patient’s ability to achieve their highest possible level of independence in terms of their activities of daily living such as bathing, grooming, eating and dressing. Many of these interventions include adaptive devices such as special eating utensils and grooming aids.

Physical therapists are licensed healthcare professionals who assess, plan, implement and evaluate interventions including those related to the patient’s functional abilities in terms of their gait, strength, mobility, balance, coordination, and joint range of motion. They also provide patients with assistive aids like walkers and canes and exercise regimens.

Dieticians assess, plan, implement and evaluate interventions including those relating to dietary needs of those patients who need regular or therapeutic diets. They also provide dietary education and work with other members of the healthcare need when a client has dietary needs secondary to physical disorders such as dysphagia; and podiatrists care for disorders and diseases of the foot.

  • To fulfill the nurse’s role in terms of collaboration
  • To plan and provide for optimal client outcomes
  • To solve complex multidisciplinary patient care problems
  • To provide educational experiences for experienced nurses

The primary goal of multidisciplinary case conferences is to plan care that facilitates optimal client outcomes. Other benefits of multidisciplinary case conferences include the fulfillment of the nurse’s role in terms of collaboration and collegiality, to solve complex multidisciplinary patient care problems so that optimal client outcomes can be achieved and also to provide educational experiences for nurses; these things are secondary rather than primary goals.

  • A Pedorthist
  • A pediatric nurse practitioner
  • A trauma certified clinical nurse specialist
  • A prosthetist

The member of the multidisciplinary team would you most likely collaborate with when your pediatric client has had a traumatic amputation secondary to a terrorism blast explosion a month ago or more ago is a prosthetist. Prosthetists, in collaboration with other members of the healthcare team, assess patients and then design, fit and supply the patient with an artificial body part such as a leg or arm prosthesis. They also follow-up with patients who have gotten a prosthesis to check and adjust it in terms of proper fit, patient comfort and functioning.

Pedorthists modify and provide corrective footwear and employ supportive devices to address conditions which affect the feet and lower limbs. Lastly, you may collaborate with a trauma certified clinical nurse specialist and a pediatric nurse practitioner but this consultation and collaboration should begin immediately upon arrival to the emergency department, and not a month after the injury.

  • Conceptualization conflicts
  • Avoidance - Avoidance conflicts
  • Approach - Approach conflicts
  • Resolvable conflicts
  • Unresolvable conflicts
  • Double Approach - Avoidance conflicts
  • Approach-Avoidance conflicts

Correct Response: B, C, F, G

According to Lewin, the types of conflict are Avoidance-Avoidance conflicts, Approach- Approach conflicts, Double Approach - Avoidance conflicts and Approach-Avoidance conflicts.

  • Frustration: The phase of conflict that is characterized with personal agendas and obstruction
  • Conceptualization: The phase of conflict that occurs when contending parties have developed a clear and objective understanding of the nature of the conflict and factors that have led to it
  • Taking action: The phase of conflict that is characterized with individual responses to and feelings about the conflict
  • Resolution: The type of conflict that can be resolved
  • Avoidance-Avoidance: A stage of conflict that occurs when there are NO alternatives that are acceptable to the contending parties
  • Approach- Approach Conflicts: The type of conflict that occurs when the people involved in the conflict want more than one alternatives or actions that could resolve the conflict.
  • Approach-Avoidance Conflicts: The type of conflict that occurs when the people involved in the conflict believe that all of the alternatives are NEITHER completely satisfactory nor completely dissatisfactory.

Correct Response: C, F, G

Taking action is the phase of conflict that is characterized with individual responses to and feelings about the conflict; Approach- Approach conflicts are a type of conflict that occurs when the people involved in the conflict want more than one alternatives or actions that could resolve the conflict; and Approach-Avoidance conflicts are a type of conflict that occurs when the people involved in the conflict believe that all of the alternatives are NEITHER completely satisfactory or completely dissatisfactory.

Frustration is the phase of conflict that occurs when those involved in the conflict believe that their goals and needs are being blocked and not met, and not necessarily characterized with personal agendas and obstruction; conceptualization is the phase of conflict that occurs when those involved in the conflict begin to understand what the conflict is all about and why it has occurred. This understanding often varies from person to person and this personal understanding may or may not be accurate, clear or objective, and not a clear and objective understanding of the nature of the conflict and factors that have led to it; resolution is a phase of conflict resolution, not a type of conflict, that is characterized when the contending parties are able to come to some agreement using mediation, negotiation or another method; an Avoidance-Avoidance conflict is a type of conflict and not a phase of conflict, that occurs when there are NO alternatives that are acceptable to any the contending parties; Approach- Approach conflicts occur when the people involved in the conflict want more than one alternative or action that could resolve the conflict; and lastly, Double Approach - Avoidance is a type of conflict and not a stage of conflict that occurs when the people involved in the conflict are forced to choose among alternatives and actions, all of which have BOTH  positive and negative aspects to them.

  • Competition
  • Accommodating Others

Conflicts can be effectively resolved using a number of different strategies and techniques such as compromise, negotiation, and mediation.

Avoidance of the conflict, withdrawing in addition to other passivity, competition, and accommodating others are not effective and healthy conflict resolution techniques.

  • Conceptualization
  • Frustration
  • Taking action

Correct Response: B, A, D, C

The stages of conflict and conflict resolution in the correct sequential order are frustration, conceptualization, and taking action.

  • The Patient Self Determination Act
  • The Mental Health Parity Act
  • The Health Insurance Portability and Accountability Act
  • The Americans with Disabilities Act of 1990

The federal law is most closely associated with the highly restrictive “need to know” is the Health Insurance Portability and Accountability Act. This law restricts access to medical information to only those persons who have the need to know this information in order to provide direct and/or indirect care to the client.

The Mental Health Parity Act passed in 2008, mandates insurance coverage for mental health and psychiatric health services in a manner similar to medical and surgical insurance coverage.

And, lastly the Americans with Disabilities Act of 1990 and the Rehabilitation Act of 1973 forbid and prohibit any discrimination against people with disabilities.

  • The facility’s Performance Improvement Director who is not a healthcare person and who has no direct contact with clients
  • A nursing student who is caring for a client under the supervision of the nursing instructor
  • The facility’s Safety Officer who is not a healthcare person and who has no direct contact with clients
  • A department supervisor with no direct or indirect care duties

A department supervisor with no direct or indirect care duties does not have the “right to know” medical information; all of the others have the “right to know” medical information because they provide direct or indirect care to clients.

For example, both the facility’s Performance Improvement Director who is not a healthcare person and who has no direct contact with clients and the facility’s Safety Officer who is not a healthcare person and who has no direct contact with clients provide indirect care to clients. For example, they collect and analyze client data in order to fulfill their role and responsibilities in terms of process improvements and the prevention of incidents and accidents, respectively.

Nursing and other healthcare students also have the “need to know” medical information so that they can provide direct client care to their assigned client(s).

  • “A computer in the hallway was left unattended and a client’s medical record was visible to me.”
  • “I just saw a nursing student looking at the medical record for a client that they are NOT caring for during this clinical experience.”
  • “As I was walking past the nursing station, I saw a dietician reading the progress notes written by members of the laboratory department in addition to other dieticians’ progress notes.”
  • “I refused the nursing supervisor’s request to share my electronic password for the new nurse on the unit.”

A staff members comment, “As I was walking past the nursing station, I saw a dietician reading the progress notes written by members of the laboratory department in addition to other dieticians’ progress notes” “indicates the need for the Nurse Manager to provide an educational activity relating to confidentiality and information security because dieticians often have the “need to know” about laboratory data so that they can, for example, assess the client’s nutritional status in terms of their creatinine levels.

The report that the nursing student was “looking at the medical record for a client that they are NOT caring for during this clinical experience” indicates that the  reporting staff member is correctly applying the principles for maintaining confidentiality and privacy of information; the report that a “computer in the hallway was left unattended and a client’s medical record was visible to me” indicates that the  reporting staff member is correctly applying the principles for maintaining confidentiality and privacy of information; and lastly, “I refused the nursing supervisor’s request to share my electronic password for the new nurse on the unit” also indicates that the staff member is knowledgeable about privacy and confidentiality.

  • Case management
  • Continuity of care
  • Medical necessity
  • Critical pathway

The continuity of care is defined as the sound, timely, smooth, unfragmented and seamless transition of a client from one area within the same healthcare facility, from one level of care to a higher and more intense level of care or to a less intense level of care based on the client’s status and level of acuity, from one healthcare facility to another healthcare facility and also any discharges to the home in the client’s community.

Case management and critical pathways may be used to facilitate the continuity of care, but they are not the sound, timely, smooth, unfragmented and seamless transition of the client from one level of acuity to another. Lastly, medical necessity is necessary for reimbursement and it is one of the considerations for moving the client from one level of acuity to another but medical necessity is not the continuity of care.

  • The Four P's

The standardized “hand off” change of shift reporting system that you may want to consider for implementation on your nursing care unit is ISBAR. Other standardized change of shift “hand off” reports, as recommended by the Joint Commission on the Accreditation of Healthcare Organization, include:

  • SBAR, not IBAR
  • The Five Ps not the Four Ps and

Lastly, MAUUAR is a method of priority setting and not a standardized “hand off” change of shift reporting system.

  • SBAR: Symptoms, background, assessment and recommendations
  • ISBAR: Interventions, symptoms, background, assessment and recommendations
  • The Five Ps: The patient, plan, purpose, problems and precautions
  • BATON: Background, assessment, timing, ownership and next plans

The Five Ps are the patient, plan, purpose, problems and precautions.

The elements of the other standardized reporting systems are listed below:

SBAR stands for:

  • S: Situation: The patient’s diagnosis, complaint, plan of care and the patient's prioritized needs
  • B: Background: The patient’s code or DNR status,  vital Signs, medications and lab results
  • A: Assessment: The current assessment of the situation and the patient’s status and
  • R: Recommendations:  All unresolved issues including things like pending diagnostic testing results and what has to be done over the next few hours

ISBAR stands for:

  • I: Introduction: The introduction of the nurse, the nurse’s role in care and the area or department that you are from
  • R: Recommendations: All unresolved issues including things like pending diagnostic testing results and what has to be done over the next few hours

BATON stands for:

  • B: Background: Past and current medical history, including medications
  • A: Actions: What actions were taken and/or those actions that are currently required
  • T: Timing: Priorities and level of urgency
  • O: Ownership: Who is responsible for what? and
  • N: Next: The future plan of care

IPASS stands for:

  • I ntroduction: The introduction of the nurse, the nurse’s role in care and the area or department that you are from
  • P: Patient: The patient’s name, age, gender, location and other demographic data
  • A: Assessment: The current assessment of the situation and the patient’s status
  • S: Situation: The patient’s diagnosis, complaint, plan of care and the patient's prioritized needs and
  • S: Safety concerns: Physical, mental and social risks and concerns
  • Atrial fibrillation
  • First degree heart block
  • Shortness of breath upon exertion
  • An obstructed airway
  • Fluid needs
  • Respect and esteem by others
  • 3,4,2,1,5,6
  • 3,4,5,1,2,6
  • 2,3,5,1,4,6
  • 3,2,4,1,5,6

Correct Response:

Client needs are prioritized in a number of different ways including Maslow’s Hierarchy of Human Needs and the ABCs. In terms of priorities from # 1 to # 6 the conditions above are prioritized as follows:

The ABCs identifies the airway, breathing and cardiovascular status of the patient as the highest of all priorities in that sequential order; and Maslow’s Hierarchy of Needs identifies the physiological or biological needs, including the ABCs, the safety/psychological/emotional needs, the need for love and belonging, the needs for self-esteem and the esteem by others and the self-actualization needs in that order of priority.

  • Understanding level

One of the 2 nd priority needs according to the MAAUAR method of priority setting is risks.

The ABCs / MAAUAR method of priority setting places the ABCs, again, as the highest and greatest priorities which are then followed with the 2 nd and 3 rd priority level needs of the MAAUAR method of priority setting.

The 2 nd priority needs according to the MAAUAR method of priority setting after the ABCs include M-A-A-U-A-R which stands for:

  • M ental status changes and alterations
  • A cute pain
  • A cute urinary elimination concerns
  • U naddressed and untreated problems that require immediate priority attention
  • A bnormal laboratory and other diagnostic data that are outside of normal limits and
  • R isks including those relating to a healthcare problem like safety, skin breakdown, infection and other medical conditions

The 3 rd level priorities include all concerns and problems that are NOT covered under the 2 nd level priority needs and the ABCs. For example, increased levels of self care abilities and skills and enhanced knowledge of a medical condition are considered 2 nd level priority needs.

  • Time management skills
  • Communication skills
  • Collaboration skills
  • Supervision skills

Time management skills are most closely related to successfully meeting the established priority needs of a group of clients.

In addition to prioritizing and reprioritizing, the nurse should also have a plan of action to effectively manage their time; they should avoid unnecessary interruptions, time wasters and helping others when this helping others could potentially jeopardize their own priorities of care.

Although good communication skills, collaboration skills and supervision are necessary for the delivery of nursing care, it is time management skills that are most closely related to successfully meeting the established priority needs of a group of clients.

  • Client rights

Morals are most closely aligned with ethics. Ethics is a set of beliefs and principles that guide us in terms of the right and wrong thing to do which is the most similar to ethics.

Laws and statutes defined what things are legal and what things are illegal. Lastly, client rights can serve as a factor to consider when ethical decisions are made; but they are not most closely aligned with ethics, but only, one consideration of many that can be used in ethical decision making.

  • Deontology: The school of ethical of thought that requires that only the means to the goal must be ethical.
  • Utilitarianism: The school of ethical of thought that requires that only the end goal must be ethical.
  • Deontology: The school of ethical of thought that requires that only the end goal must be ethical.
  • Utilitarianism: The school of ethical of thought that requires that only the means to the goal must be ethical.

The two major classifications of ethical principles and ethical thought are utilitarianism and deontology. Deontology is the ethical school of thought that requires that both the means and the end goal must be moral and ethical; and the utilitarian school of ethical thought states that the end goal justifies the means even when the means are not moral.

  • Justice: Equally dividing time and other resources among a group of clients
  • Beneficence: Doing no harm during the course of nursing care
  • Veracity: Fully answering the client’s questions without any withholding of information
  • Fidelity: Upholding the American Nurses Association’s Code of Ethics

Fully answering the client’s questions without any withholding of information is an example of the application of veracity into nursing practice. Veracity is being completely truthful with patients; nurses must not withhold the whole truth from clients even when it may lead to patient distress.

Justice is fairness. Nurses must be fair when they distribute care and resources equitably, which is not always equally among a group of patients. Beneficence is doing good and the right thing for the patient; it is nonmaleficence that is doing no harm.

  • Planning a way to evaluate the effectiveness of the class by seeing a decrease in the amount of referrals to the facility’s Ethics Committee
  • Establishing educational objectives for the class that reflect the methods and methodology that you will use to present the class content
  • The need to exclude case studies from the class because this would violate client privacy and confidentiality
  • Some of the most commonly occurring bioethical concerns including genetic engineering into the course content

You would consider including some of the most commonly occurring bioethical concerns including genetic engineering into the course content.

You would also plan how you could evaluate the effectiveness of the class by seeing an increase, not a decrease in the amount of referrals to the facility’s Ethics Committee, because one of the elements of this class should address ethical dilemmas and the role of the Ethics Committee in terms of resolving these.

You would additionally establish educational objectives for the class that reflect specific, measurable learner outcomes and not the methods and methodology that you will use to present the class content; and lastly, there is no need to exclude case studies from the class because “sanitized” medical records can, and should be, used to avoid any violations of client privacy and confidentiality.

  • Serve as the witness to the client’s signature on an informed consent.
  • Get and witness the client’s signature on an informed consent.
  • Get and witness the durable power of attorney for health care decisions’ signature on an informed consent.
  • None of the above

One of the roles of the registered nurse in terms of informed consent is to serve as the witness to the client’s signature on an informed consent.

Other roles and responsibilities of the registered nurse in terms of informed consent include identifying the appropriate person to provide informed consent for client, such as the client, parent or legal guardian, to provide written materials in client’s spoken language, when possible, to know and apply the components of informed consent, and to also verify that the client comprehends and consents to care and procedures.

The registered nurse does not get the client’s or durable power of attorney for health care decisions’ signature on an informed consent, this is the role and responsibility of the physician or another licensed independent practitioner.

  • Self determination
  • Nonmalficence

Self-determination is most closely aligned with the principles and concepts of informed consent. Self-determination supports the client’s right to choose and reject treatments and procedures after they have been informed and fully knowledgeable about the treatment or procedure.

Justice is fairness. Nurses must be fair when they distribute care and resources equitably, which is not always equally among a group of patients; fidelity is the ethical principle that requires nurses to be honest, faithful and true to their professional promises and responsibilities by providing high quality, safe care in a competent manner; and, lastly, nonmaleficence is doing no harm, as stated in the historical Hippocratic Oath.

  • The purpose of the proposed treatment or procedure
  • The expected outcomes of the proposed treatment or procedure
  • Who will perform the treatment or procedure
  • When the procedure or treatment will be done

The minimal essential components of the education that occurs prior to getting an informed consent include the purpose of the proposed treatment or procedure, the expected outcomes of the proposed treatment or procedure, and who will perform the treatment or procedure. It is not necessary to include when the treatment or procedure will be done at this time.

Other essential elements include:

  • The benefits of the proposed treatment or procedure
  • The possible risks associated with the proposed treatment or procedure
  • The alternatives to the particular treatment or procedure
  • The benefits and risks associated with alternatives to the proposed treatment or procedure
  • The client’s right to refuse a proposed treatment or procedure
  • The Security Rule
  • The American Nurses Association’s Code of Ethics
  • The American Hospital’s Patients’ Bill of Rights
  • The Autonomy Rule

Prohibitions against sharing passwords are legally based on the Security Rule of HIPAA mandates administrative, physical, and technical safeguards to insure the confidentiality, integrity, and availability of electronic protected health information.  This rule relates to electronic information security as well as other forms of information.

The American Nurses Association’s Code of Ethics and the American Hospital’s Patients’ Bill of Rights both address client confidentiality and their rights to privacy, however, these statements are not legal, but instead ethical and regulatory statements; and lastly, there is no autonomy law or rule.

  • Social networks and cell phone cameras pose low risk in terms of information technology security and confidentiality.
  • The security of technological data and information in healthcare environments is most often violated by those who work there.
  • The security of technological data and information in healthcare environments is most often violated by computer hackers.
  • Computer data deletion destroys all evidence of the data.

The security of technological data and information in healthcare environments is most often violated by those who work there. The vast majority of these violations occur as the result of inadvertent breaches with carelessness and the lack of thought on the part of employees. Technology is a double edged sword.

Technological advances such as cell phone cameras, social networks like Facebook, telephone answering machines and fax machines pose great risk in terms of the confidentiality and the security of medical information. Computer data deletion does not always destroy all evidence of the data; data remains.

  • Assault: Touching a person without their consent
  • Battery: Threatening to touch a person without their consent
  • Slander: False oral defamatory statements.
  • Slander: False written defamatory statements.

Slander is false oral defamatory statements; and libel is written defamation of character using false statements.

Assault, an intentional tort, is threatening to touch a person without their consent; and battery, another intentional tort, is touching a person without their consent.

  • Ensured the client’s safety which is a high patient care priority
  • Violated Respondeat Superior
  • Violated the client’s right to dignity
  • Committed a crime

When you loosely apply a bed sheet around your client’s waist to prevent a fall from the chair, you have falsely imprisoned the client with this make shift restraint. False imprisonment is restraining, detaining and/or restricting a person’s freedom of movement. Using a restraint without an order is considered false imprisonment even when it is done to protect the client’s safety.

Respondeat Superior is the legal doctrine or principle that states that employers are legally responsible for the acts and behaviors of its employees. Respondeat Superior does not, however, relieve the nurse of legal responsibility and accountability for their actions. They remain liable.

There is no evidence in this question that you have violated the client’s right to dignity.

  • Respondeat Superior does not mean that a nurse cannot be held liable.
  • Respondeat Superior does not mean that a nurse cannot be held libel.
  • Respondeat Superior is an ethical principle.
  • Respondeat Superior is a law.

Respondeat Superior does not mean that a nurse cannot be held liable and not libel which is a written defamation of character using false statements. Liability is legal vulnerability.

Respondeat Superior is the legal doctrine or principle and not a law or ethical principle.

  • Causation, foreseeability, damages to the patient, a duty that was owed to the client and this duty was breached, and direct rather than indirect harm to the client.
  • Causation, foreseeability, damages to the patient, a duty that was owed to the client and this duty was breached, and direct and/or indirect harm to the client.
  • Causation, correlation, damages to the patient, a duty that was owed to the client and this duty was breached, and direct and/or indirect harm to the client.
  • Causation, foreseeability, damages to the patient, a duty that was owed to the client and this duty was breached, and a medical license.

The six essential components of malpractice include causation, foreseeability, damages to the patient, a duty that was owed to the client and this duty was breached, and, lastly, this breach of duty led to direct and/or indirect harm to the client.

A medical license is not necessary; nurses and other healthcare professionals can be found guilty of malpractice. Lastly, correlation is the relationship of simultaneously changing variables. For example, a ppositive correlation exists when the two variables both increase or decrease; and a negative occurs when one variable increases and the other decreases.

  • Sound structures like policies and procedures
  • Processes and how they are being done
  • Optimal client outcomes
  • Optimal staff performance

The current focus of performance improvement activities is to facilitate and address optimal client outcomes. Throughout the last several decades performance improvement activities have evolved from a focus on structures to a focus on process and now, to a focus on outcomes.

Staff performance is not the focus of performance improvement activities but instead the focus of competency assessment and validation.

  • An adverse event
  • A root cause
  • A healthcare acquired event
  • A sentinel event

A sentinel event is an event or occurrence, incident or accident that has led to or may have possibly led to client harm. Even near misses, that have the potential for harm, are considered sentinel events because they have the potential to cause harm in the future.

An adverse event, like an adverse effect of a medication, has actually led to an adverse response; it is not a near miss. A root cause is a factor that has led to a sentinel event; and there is no such thing as a healthcare acquired event.

  • Discover a process flaw
  • Determine who erred
  • Discover environmental hazards
  • Determine basic client needs

The primary purpose of root cause analysis is to discover process flaws. Root cause analysis and a blame free environment are essential to a successful performance improvement activity, therefore, root cause analysis does not aim to determine who erred and made a mistake. Root cause analysis explores and digs down to the roots of the problem, its root causes and the things, not people, which are the real reasons why medical errors and mistakes are made.

It is nursing assessment that determines the basic client needs and environmental surveillance that discovers environmental safety hazards, and not root cause analysis.

Root cause analysis activities ask “Why”, rather than “Who”, which would place blame on a person or group of people: and What? and When? Questions are rarely asked.

  • Historical data and performance improvement activities focus on current data.
  • Current data and performance improvement activities focus on historical data.
  • Decreasing financial liability and performance improvement activities focus on process improvements.
  • Decreasing falls and performance improvement activities focus on process improvements.

The primary distinguishing characteristic of risk management when compared and contrasted to performance improvement is that risk management activities focus on decreasing financial liability and performance improvement activities focus on process improvements.

Risk management focuses on decreasing and eliminating things that are risky and place the healthcare organization in a position of legal liability. Some examples of risk management activities include preventing hazards and adverse events such as patient falls and infant abduction and the legal liabilities associated with these events.

Referrals complement the healthcare teams’ abilities to provide optimal care to the client.

  • Referrals simply allow the client to be discharged into the community with the additional care they need.
  • Nurses facilitate referrals to only the resources within the facility.

When clients have assessed needs that cannot be fulfilled and met by the registered nurse in collaboration with other members of the nursing care team, the registered nurse should then seek out resources, as well as utilize and employ different internal or external resources such as a physical therapist, a clergy member or a home health care agency in the community and external to the nurse’s healthcare agency.

The Safe & Effective Care Environment: Safety & Infection Control Practice Questions

  • The sensitizing dose of penicillin can lead to anaphylaxis.
  • The second dose of penicillin can lead to distributive shock.
  • You should be aware of the fact that about 10% of the population has an allergy to both penicillin and latex.
  • You should be aware of the fact that about 20% of the population has an allergy to both penicillin and latex.

The second dose of penicillin can lead to anaphylactic shock which is a form of distributive shock.

The first exposure to penicillin, referred to as the “sensitizing dose”, sensitizes and prepares the body to respond to a second exposure or dose. It is then the second exposure or dose that leads to anaphylaxis, or anaphylactic shock.

It is estimated that approximately 10% of people have had a reaction to penicillin. Some of these reactions are an allergic response and others are simply a troublesome side effect. There is no scientific data that indicates that 10% or 20% of the population has an allergy to both penicillin and latex.

  • A 77 year old female client in a client room that has low glare floors.
  • An 87 year old female client in a client room that has low glare floors.
  • A 27 year old sedated male client.
  • A 37 year old male client with impaired renal perfusion.

The 27 year old sedated male client is at greatest risk for falls.

Some of the risk factors associated with falls are sedating medications, high glare, not low glare, floors and other environmental factors such as clutter and scatter rugs, not low glare floors, a history of prior falls, a fear of falling, incontinence, confusion, sensory deficits, a decreased level of consciousness, impaired reaction time, advancing age, poor muscular strength, balance, coordination, gait and range of motion and some physical disorders, particularly those that affect the musculoskeletal or neurological systems; falls are not associated with poor and impaired renal perfusion.

  • The nurse should advise clients in a smoke filled room to open the windows.
  • The first thing that the nurse should do when using a fire extinguisher to put out a small fire is to aim the fire extinguisher at the base of the fire.
  • Rapidly lift and move a client away from the source of the fire when their slippers are on fire.
  • The home health care nurse should advise the client that the best fire extinguisher to have in the home is an ABC fire extinguisher.

The home health care nurse should advise the client that the best fire extinguisher to have in the home is an ABC fire extinguisher because this one fire extinguisher is a combination of a type A fire extinguisher, a type B and a type C, which put out all types of fires including common household solids like wood, household oils like kitchen grease and electrical fires.

The nurse should advise the client GET LOW AND GO if a room fills with smoke. They should not take any time to open window.

The first thing to do when using a fire extinguisher is to pull the pin and then aim it at the base of the fire. Later, you would squeeze the trigger and sweep the spray over and over again over the base of the fire. The acronym PASS is used to remember these sequential steps.

When a person has clothing that has caught on fire, the person should STOP, DROP AND ROLL. Tell the person, to STOP, DROP, and to not run, and as you also cover the person with a blanket to smother the fire.

  • A tornado that has touched down on the healthcare facility
  • A severe cyclone that has destroyed nearby homes
  • A massive train accident that brings victims to your facility
  • An act of bioterrorism in a nearby factory

A tornado that has touched down on the healthcare facility is an example of an internal disaster because this tornado has directly affected the healthcare facility. Tornados, cyclones, hurricanes and other severe weather emergencies can be both an internal disaster when they affect the healthcare facility and also an external disaster when they impact on the lives of those living in the community. Hurricane Katrina is a good example of a weather emergency that affected not only healthcare facilities but also members of the community.

  • Use a slide board.
  • Use a mechanical lift.
  • Use a gait belt.
  • Notify the client's doctor that the client cannot be safely transferred by you.

The best and safest way to transfer this paralyzed client when you suspect that you will need the help of another for the client’s first transfer out of bed is to use a mechanical lift. It is not necessary or appropriate to notify the doctor.

Mechanical lifts are used mostly for patients who are obese and cannot be safely moved or transferred by two people, and also for patients who are, for one reason or another, not able to provide any help or assistance with their lifts and transfers, such as a person who is paralyzed.

A gait or transfer belt and slide boards are assistive devices that can be used to assist with transfers and lifting however, they are not appropriate for this client as based on your assessment.

  • Advise the nurse that the legs must be close together for stability during lifting and transfers.
  • Advise the nurse that the legs should be one in front of the other and not spread apart during a transfer.
  • Validate the nurse’s competency in terms of the application of body mechanics principles during a transfer.
  • Validate the nurse’s competency in terms of the application of ergonomics principles during a transfer.

You should validate the nurse’s competency in terms of the application of body mechanics principles during a transfer because the nurse had spread her legs apart during the transfer to provide a wide base of support, which is a basic principle of body mechanics and not ergonomics.

Simply defined ergonomics addresses correct bodily alignment such as the lumbar curve accommodation in an ergonomically designed chair; and body mechanics is the safe use of the body using the correct posture, bodily alignment, balance and bodily movements to safely bend, carry, lift and move objects and people.

  • The client has refrigerated foods labelled with an expiration date.
  • You assess that the home is free of scatter rugs that many use to protect the feet against hard floors.
  • The client uses the FIFO method for insuring food safety.
  • The client assures you that the smoke alarm batteries are replaced annually to insure that they work.

When the client assures the nurse that they replace their smoke alarm batteries annually to insure that they work, the assessing nurse should immediately know that the client is in need of education relating to the fact that smoke alarm batteries should be changed at least twice a year.

The client has demonstrated that they are knowledgeable about food safety and environmental safety because they have expiration dates on refrigerated foods, they use the FIFO method for food safety and they do not use scatter rugs which can lead to falls.

The FIFO rule is F irst I n is F irst O ut. In other words, the first foods in the pantry or refrigerator are the first foods that should be consumed or discarded.

  • It is clear?
  • It is damaging to the lungs.
  • It is damaging to the spleen and the liver.
  • It leads to the over production of hemoglobin.

Carbon monoxide is particularly dangerous because it is clear, invisible and odorless. Carbon monoxide poisoning can occur when a person is exposed to an excessive amount of this odorless and colorless gas; it  severely impairs the body to absorb life sustaining oxygen which is the result of this deadly gas and not damage to the lungs. This oxygen absorption deficit can lead to serious tissue damage and death. For these reasons, home carbon monoxide alarms are recommended.

These dangers are associated with deoxygenation and not splenic or hepatic damage or the over production of hemoglobin.

  • Sentinel event.
  • System variance.
  • Adverse effect.
  • Provider variance.

The lack of necessary supplies and equipment to adequately and safely care for patients is an example of a system variance.

A variance is defined as a deviation that leads to a quality defect or problem. Variances can be classified as a practitioner variance, a system/institutional variance, a patient variance, a random variance and a specific variance.

A sentinel event is defined as is an event or occurrence, incident or accident that has led to or may possibly lead to client harm. Adverse effects are serious and unanticipated responses to interventions and treatments, including things like medications.

  • Notify the doctor.
  • Render care.
  • Assess the cleint.
  • Notify the nurse manager.

The first thing that you should do immediately after a client accident is to assess the client and the second thing you should do is render care after this assessment and not before it.

Lastly, notifications to the doctor and the nurse manager are only done after the client is assessed and emergency care, if any, is rendered.

  • Counsel the staff about their need to stop wasting the resources of this department.
  • Check the equipment yourself to determine the accuracy of this equipment department.
  • Ignore it because everyone can make an innocent mistake.
  • Plan an educational activity about determining what equipment to send for repairs.

You should plan an educational activity about determining what equipment should and should not be sent for repairs. This data suggests that the staff members need education and training about the proper functioning of equipment used on the nursing care unit.

Counseling the staff about their need to stop wasting the resources of this department is placing blame and this blame may prevent future valid returns of equipment.

You should not check the equipment yourself to determine the accuracy of this equipment department because they are the experts, not you, with these matters.

You should also not ignore it because everyone can make an innocent mistake. The issue has to be addressed and corrected.

  • Education and training on all pieces of equipment
  • Pilot testing new equipment
  • Reading all the manufacturer’s instructions
  • Researching the equipment before recommending its purchase

Education and training on all pieces of equipment is an essential component for insuring that medical equipment is being used safely and properly by those who you supervise. Other essential components include validated and documented competency to use any and all pieces of equipment by a person qualified to do so, preventive maintenance and the prompt removal of all unsafe equipment from service.

Pilot testing new equipment, researching the equipment before recommending its purchase, and reading the entire manufacturer’s instructions are things done prior to the purchase of the equipment and these things do not impact on the safety of the piece of medical equipment.

  • A possible vulnerability of the facility’s information technology to hacking
  • The assisted suicide of a client in your facility by the spouse of the client
  • Vulnerability to computer hacking
  • Potential information theft

The assisted suicide of a client in your facility by the spouse of the client is a security concern that is also a sentinel event that must be reported.

A possible vulnerability of the facility’s information technology to hacking, vulnerability to computer hacking and potential information theft is security concerns but they are not sentinel events that must be reported.

  • Training all nurses to serve as a part of a security response team
  • Training all clerical staff to be a part of a security response team
  • The restriction of visitors in a special care area
  • Bar coded client identification bands to insure proper identification

The restriction of visitors in a special care area is an effective security plan that you may want to consider for implementation within your facility.

Some of the other security measures that you may want to consider include security alert systems to alert staff to a security breach such as security breach of the newborn nursery, the use of visitor identification badges or stickers that identify people who are authorized to be in a facility, closed circuit monitoring and alarm systems in high risk areas such as the emergency care area, automatically locking security doors, and electronic wristbands for the newborn and the mother to prevent infant abductions.

Special assignments and training for a group of people so that this specially trained group can act when a security breach occurs is also a good idea but it is not necessary to train all nurses or clerical staff; it is sufficient to train a limited group of people, provided an ample number of these team members are assigned and available on all tours of duty around the clock, including on holidays.

  • Sterile items ONLY are placed on the sterile field.
  • The nurse must keep the sterile field below waist level.
  • Coughing or sneezing over the sterile field contaminates the sterile field.
  • The nurse must maintain a 1/2 inch border around the sterile field that is not sterile.
  • Moisture and wetness contaminate the sterile field.
  • Sterile masks are used by staff and the client when a sterile field is being set up and/or maintained

Correct Response: A, C, E

Sterile items ONLY are placed on the sterile field; coughing or sneezing over the sterile field contaminates the sterile field; and all moisture and wetness contaminate the sterile field.

Some of the other principles that are applied to setting up and maintaining a sterile field include keeping the sterile field above the waist level and preventing coughing or sneezing by professional staff and the client during the set up and during the maintenance of the sterile field. If there is a danger that anyone may cough or sneeze over the field, the professional staff and/or the client should don a mask to prevent contamination. Lastly, a one inch border, not a ½ border that is not sterile is maintained around the perimeter of the sterile field.

  • A physical restraint: A physical restraint is a manufactured device that is used, when necessary, to prevent falls.
  • A physical restraint: A physical restraint is any mechanical device, material, or equipment attached to or adjacent to the resident’s body that the individual cannot remove easily which restricts freedom of movement or normal access to one’s body.
  • A chemical restraint: A chemical restraint is a drug used for sedation to prevent falls.
  • A chemical restraint: A chemical restraint is a drug used for discipline or convenience and not required to treat medical symptoms.

A chemical restraint: A chemical restraint is a drug used for discipline or convenience and not required to treat medical symptoms, according to the Centers for Medicare and Medicaid Services.

The most complete and accurate definition of a physical restraint is any manual method or physical or mechanical device, material, or equipment attached to or adjacent to the resident’s body that the individual cannot remove easily which restricts freedom of movement or normal access to one’s body and is NOT a safety devices that is routinely used for certain procedures, according to the Centers for Medicare and Medicaid Services.

  • Informed consent for the restraint
  • The reason for the restraint
  • The type of restraint to be used
  • Client behaviors that necessitated the restraints

The minimal components of orders for restraint include the reason for and rationale for the use of the restraint, the type of restraint to be used, how long the restraint can be used, the client behaviors that necessitated the use of the restraints, and any special instructions beyond and above those required by the facility’s policies and procedures.

Informed consent is not necessary for the initiation or the use of restraints

  • The vascular phase
  • The prodromal phase
  • The incubation phase
  • The initial injury
  • The exudate phase
  • The convalescence phase

The stages of the inflammatory process in correct sequential order are:

  • The initial tissue injury which can result from an infection or a traumatic cause
  • The vascular response. The release of histamine, prostaglandins and kinins. These substances lead to vasodilation which increases the necessary blood supply to the injured tissue and the area surrounding
  • The exudate response. The release of leukocytes, including macrophages and neutrophils, to the injured area to combat the infection.

The signs of infection such as the incubation, prodromal and convalescence stages, in the correct sequential order are:

  • The incubation period
  • The illness stage
  • The convalescence stage

Health Promotion & Maintenance Practice Questions

  • The infant had doubled their birth weight at twelve months.
  • The infant had tripled their birth weight at twelve months.
  • The mother reports that the infant is drinking 60 mLs per kilogram of its body weight.
  • The infant had grown ¼ inch since last month.

The normal assessment data for the infant at 12 months of age is that the infant has doubled their birth weight at 12 months of age.

The mother’s reports that the infant is drinking 60 mLs per kilogram of its body weight and the fact that the infant had grown ¼ inch since last month are not normal assessment data. Infants are fed breast milk or formula every two to four hours with a total daily intake of 80 to 100 mLs per kilogram of body weight.

As the neonate grows, they gain five to seven ounces during the first six months and then they double their birth weight during the first year; the head circumference increases a half inch each month for six months and then two tenths of an inch until the infant is one year of age. Similarly, the height or length of the newborn increases an inch a month for the first 6 months and then 1/2 inch a month until the infant is 1 year of age.

  • The Programmed Longevity Theory
  • The Immunological Theory of Aging
  • The Endocrine Theory
  • The Rate of Living Theory

The theory of aging that supports your belief that strict infection control prevention measures are necessary is the Immunological Theory of Aging. The Immunological Theory of Aging states that aging leads to the decline of the person’s defensive immune system and the decreased ability of the antibodies to protect us against infection.

The Programmed Longevity Theory of aging states that genetic instability and changes occur such as some genes turning on and off lead to the aging process; the Endocrine Theory of aging states that aging results from hormonal changes and the biological clock’s ticking; and Rate of Living Theory states that one’s longevity is the result of one’s rate of oxygen basal metabolism.

Other theories of aging are:

  • Wear and Tear Theory: This theory describes aging as a function of the simple wearing out of the tissues and cells as one ages.
  • Cross Linking Theory: This theory of aging explains that aging results for cell damage and disease from cross linked proteins in the body.
  • Free Radicals Theory: This theory is based on the belief that free radicals in the body lead to cellular damage and the eventual cessation of organ functioning.
  • Somatic DNA Damage Theory: Somatic DNA Damage theory is based on the belief that aging and death eventually occur because DNA damage, as continuously occurs in the human cells, continues to the point where they can no longer be repaired and replaced and, as a result, they accumulate in the body.
  • Increased creatinine clearance.
  • Impaired immune system.
  • Decreased hepatic metabolism.
  • Increased bodily fat.

The elderly population is at risk for more side effects, adverse drug reactions, and toxicity and over dosages of medications because the elderly have a decrease in terms of their hepatic metabolism secondary to the hepatic functioning changes of the elderly secondary to a decreased hepatic blood flow and functioning.

The elderly have decreased rather than increased creatinine clearance; the immune system is also decreased in terms of its functioning, however, this change impacts on the elderly’s ability to resist infection rather than impacting a medication’s side effects, adverse drug reactions, toxicity and over dosages; and, lastly, a decrease in terms of bodily fat, rather than an increase in terms of bodily fat impacts on medications. The distribution of drugs is impaired by decreases in the amount of body water, body fat and serum albumin; drug absorption is decreased with the aged patient’s increases in gastric acid pH and decreases in the surface area of the small intestine which absorbs medications and food nutrients.

The expected date of delivery is calculated using Nagle’s rule which is:

The first day of last menstrual period – 3 months + 7 days = the estimated date of delivery

For example, when the first day of the last menstrual period is 10/20/2016 you would:

  • Subtract three months from 10/20/2016 and then you get 7/20/2016 and then
  • Add seven days to 7/20/2016 and then get 7/27/2016, after which you would
  • Add one year to 7/27/2016 to get the estimated date of delivery for7/27 of the following year which is 7/27/2017.
  • You should explain that fetal lie is where the fetus’ presenting part is within the birth canal during labor, among other information about the other assessments.
  • You should explain that fetal presentation is the relationship of the fetus’s spine to the mother’s spine, among other information about the other assessments.
  • You should explain that fetal attitude is the relationship of the fetus’ presenting part to the anterior, posterior, right or left side of the mother’s pelvis, among other information about the other assessments.
  • You should explain that fetal station is the level of the fetus’ presenting part in relationship to the mother’s ischial spines, among other information about the other assessments.

You should explain that fetal station is the level of the fetus’ presenting part in relationship to the mother’s ischial spines. Fetal station is measured in terms of the number of centimeters above or below the mother’s ischial spines.  Fetal station is -1 to -5 when the fetus is from 1 to 5 centimeters above the ischial spines and it is from +1 to +5 when the fetus is from 1 to 5 centimeters below the level of the maternal ischial spines.

Fetal lie is defined as the relationship of the fetus’s spine to the mother’s spine. Fetal lie can a longitudinal, transverse or oblique life. Longitudinal lie, the most common and normal lie, occurs when the fetus’ spine is aligned with the mother’s spine in an up and down manner; a transverse lie occurs when the fetus’ spine is at a right ninety degree angle with the maternal spine; and, lastly, an oblique lie occurs when the fetus’ spine is  diagonal to the mother’s spine.

Fetal presentation is defined by where the fetus’ presenting part is within the birth canal during labor. The possible fetal presentations are the cephalic presentation, the cephalic vertex presentation, the cephalic sinciput presentation, the cephalic face presentation, the cephalic brow presentation, the breech presentation, the complete breech presentation, the frank breech presentation, the shoulder breech presentation, and the footling presentation.

Fetal attitude is the positioning of the fetus’s body parts in relationship to each other. The normal attitude is general flexion in the “fetal position”. All attitudes, other than the normal attitude, can lead to a more intense and prolonged labor.

Fetal position is the relationship of the fetus’ presenting part to the anterior, posterior, right or left side of the mother’s pelvis.

  • You should apply the principles of initiative when caring for preschool children.
  • You should apply the principles of sensorimotor thought when caring for preschool children.
  • You should apply the principles of intimacy when caring for the adolescent.
  • You should apply the principles of concrete operations when caring for the adolescent.

You should apply the principles of initiative when caring for preschool children. The developmental task for preschool children is initiative, according to Eric Erickson.

The other developmental tasks, according to Eric Erickson are:

  • Infant: Trust
  • Toddler: Autonomy
  • School Age Child: Industry
  • Adolescent: Identity formation
  • Young Adult: Intimacy
  • Middle Aged Adult: Generativity
  • Older Adults: Ego integrity

In the correct sequential order, Jean Piaget’s levels of cognitive development include:

  • Sensorimotor thought: Infancy to About 2 Years of Age
  • Preoperational and symbolic functioning: From 2 to 7 Years of Age
  • Concrete operations: 7 to 11 Years of Age
  • Formal operations: 12 Years of Age
  • Childhood immunizations
  • Separation anxiety

The expected life transition should you apply into your practice for these pediatric clients as you are caring for pediatric clients of all ages is puberty.

Throughout the life span, there are several significant expected life transitions that require the person to cope and adjust. Some of these expected life transitions include puberty, maternal and paternal attachments and bonding to the neonate, pregnancy, care of the newborn, parenting, and retirement.

Although young children will experience separation anxiety and they will also be maintained on an immunization schedule, these are not expected life changes.

  • The Biophysical Dimension
  • The Psychological and Emotional Dimension
  • The Spiritual Dimension
  • The Health Systems Dimension

The Dimensions Model of Health includes six dimensions that impact on the client, including the community. The Spiritual Dimension is not one of these six dimensions.

These dimensions are the:

  • Biophysical Dimension
  • Psychological and Emotional Dimension
  • Health Systems Dimension
  • Behavioral Dimension
  • Socio-Cultural Dimension
  • Physical Environment Dimension
  • Mediterranean ethnicity for cystic fibrosis.
  • African American ethnicity for Tay Sachs disease.
  • British Isles ethnicity for psychiatric mental health disorders.
  • Saudi Arabian ethnicity for sickle cell anemia.

You would identify a client who is of Saudi Arabian ethnicity for sickle cell anemia. Other ethnicities at greatest risk for sickle cell anemia include those who are African, Latin Americans, Southern Europeans and some clients from some Mediterranean nations.

Other disorders and diseases and the ethnicities associated with them are listed below

  • Thalassemia: Clients with a Mediterranean ethnicity
  • Tay Sachs Disease: Ashkenazi Jewish people
  • Cystic Fibrosis: Clients with a European ethnicity
  • Psychiatric Mental Health Disorders: African Americans and Native Americans
  • Hypertension: African Americans, Pacific  Islanders , Native  Americans, Alaskan natives, Hispanic and Caribbean clients
  • Diabetes: African Americans, Caribbeans, Native Americans and clients from India, Pakistan and Bangladesh
  • Cancer: Caucasians and clients from Scotland and Ireland
  • The need for a targeted assessment is based on the application of the nurse’s knowledge of pathophysiology and the presenting symptoms.
  • The need for a targeted assessment is based on the application of the nurse’s knowledge of developmental needs and developmental delays.
  • Targeted assessment is done on an annual basis for existing clients rather than a complete assessment that is done for new clients.
  • Targeted assessments consist of a brief medical history and a complete assessment consists of a complete health history and a complete physical assessment.

The need for a targeted assessment is based on the application of the nurse’s knowledge of pathophysiology and the presenting symptoms. Targeted assessments and screenings are done in addition to routine and recommended screenings when a particular disorder has a genetic pathophysiological component for risk and when a client is presenting with a particular sign or symptom.

For example, a targeted assessments relating to nutritional status may be indicated when an infant or young child is listless and not gaining weight according the established criteria; an adolescent may be target screened for visual acuity when a high school teacher reports that the teen does not seem to be able to read things on the blackboard; and a toddler may be target screened when the parent reports that the child is not responding to their name.

  • Genetic predisposition
  • Lifestyle choices
  • High risk behaviors
  • An external locus of control

Life style choices are the risk factors that are most likely able to be corrected. Poor life style choices place a person at risk and they are often considered also risky behaviors.

As discussed before, some risks are preventable and correctable and others are not. For example, genetics, age and gender are NOT modifiable risks, but the risks associated with life style choices are modifiable, correctable and able to be eliminated when the person changes their behavior in reference to these risky behaviors.

Some risky life style choices include:

  • Excessive sun exposure
  • The lack of regular exercise
  • A poor diet
  • Cigarette smoking and the use of other tobacco products
  • Alcohol use
  • Illicit drug use
  • Unprotected sex
  • Avocational and hobby choices such as rock climbing
  • Inadequate sleep and rest

Genetic predisposition is an innate and not correctable risk factor and an external locus of control can lead to poor life style choices, however, this is not the most likely correctable risk factor.

  • A transdermal contraceptive patch
  • A diaphragm
  • A vaginal contraceptive ring

You would not recommend any of the above methods of contraception for this family.

You would not recommend the use of a transdermal contraceptive patch or a vaginal contraceptive ring for the couple because both of these contraceptive methods are contraindicated when the woman has a history of deep vein thrombosis and cigarette smoking; and you would also not recommend a diaphragm because the compliance of this couple cannot trusted because the couple has a history of the lack of adherence to medical regimens.

  • Information about the lack of scientific evidence regarding the effectiveness of all herbs.
  • Data to support the fact that magnets can be effective in terms of fibromyalgia pain, and as such, may be a good choice for this client.
  • Research that suggests that prayer is an effective alternative method to relieve pain and stress that can be helpful to this client.
  • Information that contraindicates the use of biofeedback because this alternative, complementary health practice can interfere with the client’s pacemaker functioning.

Scientific data now indicates that prayer is effective for the relief of stress, anxiety and pain, and as such, may be helpful to this client.

Some herbs, minerals and supplements are scientifically deemed as safe and effective and others are not scientifically effective and they can also lead to harm; at the current time, the National Institutes of Health (NIH) states that magnets are not scientifically effective and they are also not considered safe for clients with a pacemaker or insulin pump because these internally implanted devices can be adversely affected by the magnetic force of the magnet; and, lastly, biofeedback does not interfere with the client’s pacemaker functioning.

  • A social worker
  • A physical therapist
  • An occupational therapist
  • A speech therapist

The healthcare professional would you most likely refer this family to in order to address this deficit in terms of their instrumental activities of daily living (ADLs) is a social worker.

The activities of daily living are differentiated in terms of the basic activities of daily living and the instrumental activities of daily living. Examples of basic activities of daily living include things like bathing, mobility, ambulation, toileting, personal care and hygiene, grooming, dressing, and eating. Deficits in terms of the basic activities of daily living are best addressed by a physical and/or occupational therapist.

The instrumental activities of daily living are more advanced than the basic activities of daily living. The instrumental activities of daily living include things like grocery shopping, housework, meal preparation, the communication with others using something like a telephone, and having transportation. Deficits in terms of the instrumental activities of daily living are best addressed by a social worker. For example, the social worker may assist the client in terms of their transportation and they can also teach the client about how to grocery shop, for example.

  • Olfactory Cranial Nerve: The sensory nerve that transmits the sense of smell to the olfactory foramina of the nose
  • Optic Cranial Nerve: This sensory nerve transmits the sense of vision from the retina to the brain.
  • Oculomotor Cranial Nerve: This motor and sensory nerve controls eye movements and visual acuity.
  • Trochlear Cranial Nerve: This motor nerve innervates eye ball movement and the superior oblique muscle of the eyes.
  • Abducens Cranial Nerve: This motor nerve innervates and controls the abduction of the eye using the lateral rectus muscle.
  • Facial Cranial Nerve: This motor nerve controls facial movements, some salivary glands and gustatory sensations from the anterior part of the tongue.
  • Glossopharyngeal Cranial Nerve: This sensory nerve This nerve gives us the sense of taste from the posterior tongue, and it also innervates the parotid glands

Correct Response: A,B,D,E

The olfactory cranial nerve is a sensory nerve that transmits the sense of smell to the olfactory foramina of the nose; the optic cranial nerve is also a sensory nerve and it transmits the sense of vision from the retina to the brain.

The trochlear cranial nerve is a motor nerve that innervates eye ball movement and the superior oblique muscle of the eyes; and the abducens cranial nerve is a motor nerve that innervates and controls the abduction of the eye using the lateral rectus muscle.

The oculomotor cranial nerve is a motor nerve controls eye movements, the sphincter of the pupils and the ciliary body muscles; it has no sensory function. The facial cranial nerve is a motor and sensory nerve which controls facial movements, some salivary glands and gustatory sensations from the anterior part of the tongue. And, lastly, the glossopharyngeal cranial nerve is both a motor and sensory nerve that gives us the sense of taste from the posterior tongue, and it also innervates the parotid glands.

  • The Taylor test
  • The Rinne test
  • The Babinski test
  • The APGAR test

The sense of hearing is assessed using the Rinne test and the Weber test and a tuning fork.

A Taylor hammer, not a Taylor test, is used to check reflexes like the biceps and triceps reflexes; the Babinski sign occurs when the foot goes into dorsiflexion and the great toe curls up; this sign is an abnormal response to this stimulation and it can indicate the presence of deep vein thrombosis. And lastly, the APGAR test is used to assess the neonate immediately after birth in terms of the infant’s appearance, grimace and reflexes, appearance in terms of skin color, and respiratory rate and effort.

  • Light palpation
  • Deep palpation

Deep palpation is cautiously done after light palpation when necessary because the client’s responses to deep palpation may include their tightening of the abdominal muscles, for example, which will make the light palpation less effective for this assessment, particularly if an area of pain or tenderness has been palpated.

Inspection is typically the first step and percussion of the abdomen should be done prior to any palpation, particularly deep palpation.

The five types of sounds that are elicited during percussion are flatness, resonance, hyperresonance, tympany and dullness. Dullness is heard when percussion is done over a solid organ like the liver and spleen.

Flatness is normally assessed over muscles and bones; resonance is a hollow sound that is heard, for example, over the air filled lungs; and hyperresonance, which is a booming sound that is heard over abnormal lung tissue, as occurs among clients with chronic obstructive pulmonary disease (COPD); and, lastly, tympany is heard over the stomach with air as a drum like sound.

  • A complete medical history, a general survey and a complete physical assessment.
  • A complete medical history, a general survey and a focused physical assessment.
  • A client interview, a significant other interview, a general survey and a complete physical assessment.
  • A client interview, a significant other interview, a general survey and a focused physical assessment.

A comprehensive health assessment includes a complete medical history, a general survey and a complete physical assessment.

Although a complete medical history is done using a client interview and a significant other interview for much data, it is the health history and not the interview that is part of the comprehensive health assessment. A focused assessment is done as based on some pathology, sign or symptom and it is not considered a part of a comprehensive health assessment.

  • Tympany: A hollow sound
  • Dullness: A thud like sound
  • Dullness: A hollow sound
  • Resonance: A booming sound

Dullness is a thud like sound and not a hollow sound. Tympany is a drum like sound; and resonance is a hollow sound.

Psychosocial Integrity Practice Questions

  • A couple which consists of a husband and wife both of whom are affected with Alzheimer’s disease
  • A poverty stricken couple without any healthcare resources in the community
  • A pregnant woman and a husband who was physically abused as a young child
  • A wealthy couple with feelings that they are immune from punishment and above the law

A pregnant woman and a husband who was physically abused as a young child is the couple is at most risk for domestic violence because pregnancy and a personal prior history of abuse are two commonly occurring risk factors among abused woman and male abusers, respectively.

Current research indicates that abuse and neglect affect all people of all ages and of all socioeconomic classes including the wealthy as well as the poverty stricken.

Other patient populations at risk of abuse and neglect include female gender, infants, children, the cognitively impaired, the developmentally challenged, the elderly and those with physical or mental disabilities; some of the other traits and characteristics associated with abusers include substance related use and abuse, a psychiatric mental health disorder, poor parenting skills, poor anger management skills, poor self-esteem, poor coping skills, poor impulse control, immaturity, and the presence of a current crisis.

  • Restrain the client
  • Place the client in seclusion
  • Get an order for a sedating medication
  • Establish trust with the client.

The first thing that you should do to prevent violence towards others is to establish trust with the client. The first step in the nurse-client relationship is to establish trust in this therapeutic relationship. Without trust future collaboration, interventions and client outcomes cannot be accomplished to facilitate appropriate and safe behaviors.

Restraints and seclusion are not indicated until others are in imminent danger because of this client’s current violent behaviors and not a history of it. Lastly, sedating medications to prevent violence are also not the first things that are done.

  • Psychological dependence secondary to amphetamine use
  • Substance abuse secondary to amphetamine use
  • Addiction secondary to amphetamine use
  • Physical dependence secondary to amphetamine use

The appropriate nursing diagnosis for this client is “Psychological dependence secondary to amphetamine use”. Psychological dependence is defined as the person’s need to continue the use of the substance to avoid any unpleasant feelings and experiences that can occur when the substance is not taken. Amphetamines and hallucinogenic drugs like LSD are often associated with psychological dependence.

Substance abuse, simply defined, is one’s overindulgence of an addictive substance which can be alcohol, prescription drugs and/or illicit, illegal drugs. Substance abuse does not include prescribed medications, such as narcotic pain medications, that are being used for medical reasons; however, these same medications when used after there is no longer a medical need to use them is considered substance abuse.

Addiction is defined as the unending and constant need for the person to have the chosen substance even when the use of the substance causes the client to have serious physical, psychological, social and/or economic consequences and harm including a loss of control over the substance abuse and use. Contrary to popular opinion, addiction can occur with and without physical dependence.

Physical dependence occurs when the cessation of a drug causes adverse physical effects; these ill effects are typically greater and more intense when the cessation of the drug is rapid and abrupt. Some of the drugs that are most often associated with physical dependence include cocaine, opioid drugs, alcohol and benzodiazepines. As previously stated, physical dependence does not necessarily indicate addiction; addiction can be present with or without any physical dependency.

  • Orem’s Self Care Model
  • Nagi's Model
  • A cognitive model of disability
  • A biomedical model of disability

Nagi’s Model of disability model describes disabilities and its limitations are the result of a discrepancy between the client’s abilities and the limitations of the physical and social environment within which the client lives.

Although clients with disabilities should be assessed and have interventions related to their self care abilities, Dorothea Orem’s Self Care Model is not a model of disability. This model describes self care needs and abilities as wholly compensatory, partly compensatory and supportive educative.

Cognitive models of disability focus on the importance of affected client’s ability to remain as independent as possible and ways that the empowered client can exercise their own self-determination, confidence, self efficacy, and control.

Lastly, biomedical models address pathology, impairments and the manifestations of impairments that can be cured or lead to death.

The characteristics of the stages or phases of crisis, in the correct sequential order, are:

  • Level 1 Crisis Signs and Symptoms: Patients experiencing a level one crisis typically experience anxiety and they also typically begin to use one or more psychological ego defense mechanisms.
  • Level 2 Crisis Signs and Symptoms: Patients experiencing a level two crisis most likely exhibit some loss of their ability to function. They may also try to experiment with alternative methods of coping in order to deal with the crisis that is not being effectively coped with using one’s currently used coping mechanisms.
  • Level 3 Crisis Signs and Symptoms: Patients experiencing a level three crisis show the signs and symptoms of the General Adaptation Syndrome which is characterized with fight, flight and panic as discussed above under the section entitled “Coping Mechanisms: Introduction”.
  • Level 4 Crisis Signs and Symptoms: Clients experiencing a level four crisis exhibit severe signs and symptoms such as being totally detached and removed from others, feeling overwhelmed, becoming disoriented, and even with thoughts of violence toward self and others.
  • Displacement
  • Sublimation
  • Dissociation
  • Reaction formation

Dissociation is the psychological ego defense mechanism occurs when the client detaches and dissociates with person or time to avoid the stress until they are ready to cope with it.

Displacement transforms the target of one’s anger and hostility from one person to another person or object. Displacement allows the person to ventilate and act out on their anger in a less harmful and a more socially acceptable manner.

A client uses the ego defense mechanism of sublimation when they transform and replace unacceptable urges and feelings into a socially acceptable urge or feeling.

A client is using reaction formation when the client acts and behaves in a manner that is completely the polar opposite of their true feelings.

  • Jean Watson's
  • Martha Rogers'
  • Nagi's theory
  • Madeleine Leininger’s theory

The theoretical framework that you would recommend that this committee should consider when addressing mutiethnicity and the culturally diverse nature of this facility for this philosophy is Madeleine Leininger’s theory.

Madeleine Leininger’s theory of Transcultural Nursing and her book “Culture Care Diversity and Universality: A Theory of Nursing” “searches for comprehensive and holistic care data relying on social structure, worldview, and multiple factors in a culture in order to get a holistic knowledge base about care” (Leininger, 2006, p. 219)

Jean Watson’s Jean Watson developed the Human Caring Theory which states that caring is the essence of nursing. Watson's theory has the four major concepts of health, nursing, society/environment and human being. Caring consists of the following 10 nursing interventions that demonstrate genuine caring.

Martha Rogers’ theory is the Science of Unitary Human Beings which is based on general systems theory without any focus on multiethnicity and cultural diversity; and lastly, Nagi’s Model of disability model describes disabilities and its limitations are the result of a discrepancy between the client’s abilities and the limitations of the physical and social environment within which the client lives.

  • The client will accept impending death
  • Guilt related to past transgressions
  • Spiritual distress related to guilt
  • Pain related to end of life symptoms

“The client will accept impending death” is the client goal would be the most likely appropriate and expected for the vast majority of these clients. In fact, one of the primary goals of hospice and palliative care is to facilitate the client’s and family member’s acceptance.

Other goals are the freedom for guilt, spiritual distress and pain at the end of life; therefore, these diagnoses are not expected.

  • The client will be free of constipation
  • The client will remain free of pain and distress
  • The administration of an antiemetic to prevent vomiting and further dehydration
  • The administration of an enema to correct the constipation

Based on this client’s signs and symptoms and the fact that the client is expected to die in a day or two, the appropriate client outcome for this client is that the client will remain free of pain and distress.

“The client will be free of constipation” requires interventions such as an enema which are not indicated when death is imminent unless, of course, the client is adversely affected with pain and discomfort as the result of it which is not the case with this client. Additionally, the administration of an antiemetic to prevent vomiting is not indicated because there is no evidence in this question that the client is actually vomiting.

  • “You should try to come to a few sessions at least because they may be very informative to you”.
  • “You are probably correct. This really is not your problem”.
  • “Despite the fact that it is your grandson’s drug addiction, situations such as this affect all members of the family including grandparents who live in the home.”
  • "You should attend because the doctor has ordered family therapy for you as extended family members”.

You should respond to the grandparents’ statement with “Despite the fact that it is your grandson’s drug addiction, situations such as this affect all members of the family including grandparents who live in the home”.

After this statement, you should also educate the grandparents about the fact that group and family therapy is often indicated when the family unit is affected with stressors and dysfunction because family members may not fully understand the need for the entire family unit to participate when only one member of the family is adversely affected with a stressor and poor coping and that all family members are affected when only one member of the family unit is adversely affected.

You would NOT state “You should try to come to a few sessions at least because they may be very informative to you” because these sessions are therapeutic and not educational; you would not state “You are probably correct. This really is not your problem” because this statement is not true; and you should also not state “You should attend because the doctor has ordered family therapy for you as extended family members” because this is not the real reason why attending these sessions is needed.

  • Engel's theory
  • Kubler Ross' theory
  • Lewin's theory
  • Warden's theory

The theory of grief and loss would you most likely integrate into your practice as you perform this role is Warden’s Four Tasks of Mourning. This theory has four tasks that people go through after the loss of a loved one. These tasks are accepting the loss, coping with the loss, altering, modifying and changing the environment to cope with and accommodate for the absence of the lost person, and, finally, resuming one’s life while still having a healthy connection with the loved one.

Engel’s Stages of Grieving include stages both prior to and after a loss and these stages are:

  • Shock and disbelief
  • Developing awareness
  • Restitution
  • Resolving the loss
  • Idealization

Kubler Ross’s Stages of Grieving occur prior to the death and these stages include:

Lastly, Lewin developed theories of change, leadership and conflict and NOT a theory related to grief after the loss of a loved one.

  • The concern related to the client’s cultural reluctance to report psychological symptoms because of some possible culturally based stigma associated with psychiatric mental health disorders
  • Concerns revolving around the lack of financial and health insurance resources to pay for psychological care
  • Concerns related to the compliance with psychological treatment regimens because of the client’s lack of social support systems
  • The concern related to the culturally based client apathy about nursing care and nursing assessments

The concern related to the client’s cultural reluctance to report psychological symptoms because of some possible culturally based stigma associated with psychiatric mental health disorders which is a barrier to assessment because the client fears being stigmatized and rejected when divulging psychological data including anxiety and other symptoms.

The lack of financial and health insurance resources to pay for psychological care, the lack of social support systems, and the client’s apathy are barriers to psychological care but these factors are not a barrier to a psychological assessment and these factors are not cultural, but instead social and psychological.

  • Cognitive psychotherapy
  • Behavioral psychotherapy
  • Cognitive behavioral psychotherapy
  • Psychoanalysis

Behavioral psychotherapy is particularly useful among clients who are adversely affected with phobias, substance related disorders, and other addictive disorders. Some of the techniques that are used with behavioral therapy include operant conditioning as put forth by Skinner, aversion therapy, desensitization therapy, modeling and complementary and alternative stress management techniques.

Cognitive psychotherapy is most often used to treat clients, including groups of clients, with depression, eating disorders, anxiety, and anxiety disorders to facilitate the altering of the clients’ attitudes and perspectives relating to stressors.

Cognitive behavioral psychotherapy, which is a combination of cognitive psychotherapy and behavioral psychotherapy and also referred to as dialectical behavioral therapy is most often used for clients affected with a personality disorder and those at risk for injury and harm to self and/or others.

Psychoanalysis, in contrast to cognitive behavioral therapy and other individual and group therapies, dives into the client’s subconscious and it often focuses on the past as well as the client’s current issues. This therapy is not conducted by registered nurses but, instead, by experienced psychotherapists.

The client religion that is the most pertinent to the role of the admissions coordinator of hospital who assigns the rooms and beds of clients who will be admitted is the Islam religion which requires that the followers face Mecca for daily prayer, therefore, Islam clients should be placed in a room that faces the holy city of Mecca.

Although most religions impact on the care of the client, only Islam is pertinent to the admissions coordinator. Other religions practices and their impact on health care are shown below:

  • Christians: End of life rituals like the Sacrament of the Sick, baptisms for newborns, fasting, and the Eucharist.
  • Judaism: Religious based circumcisions, a kosher diet which separates dairy foods from meat based foods, and death rituals called a Shiva.
  • Hinduism: Many followers are vegetarian; personal hygiene is paramount and they also have death rituals without the prolongation of life.
  • Mormonism: Baptism for the newborn, last rites at the time of death, communion, and burials of the dead. Additionally, the Mormon religion prohibits alcohol, tobacco, and caffeine.
  • Jehovah’s Witnesses: Prohibitions against blood transfusions, foods containing blood, homosexuality, sex before marriage, abortion, suicide, gambling, alcoholic beverages, tobacco and illicit drugs.
  • Psychotic symptoms related to sensory overload
  • Psychotic symptoms related to a previously undiagnosed psychosis
  • Visual disturbances related to dementia
  • Visual disturbances related to delirium

“Visual disturbances related to delirium” is the most appropriate nursing diagnosis for this client, as based on their signs, symptoms, past history and current medical status.

Delirium is characterized with a sudden and abrupt onset of episodic and intermittent periods of time vacillating between periods of impaired cognition and periods of mental clarity. Visual hallucinations are a sign of delirium and delirium can result from a number of different causes including dehydration and anticholinergic medications.

The signs and symptoms of sensory overload do not include visual hallucinations and a sudden and abrupt onset of episodic and intermittent periods of time vacillating between periods of impaired cognition and periods of mental clarity. Instead, the signs and symptoms of sensory overload include anxiety, restlessness, sleep deprivation, fatigue, poor problem solving and decision making skills, poor performance, and muscular tension.

There is no evidence in this question that the client has psychotic symptoms related to a previously undiagnosed psychosis; all the evidence substantiates the suspicion that the client is affected with delirium.

Lastly, dementia has a gradual and progressive onset rather than an abrupt and sudden onset.

  • Collect baseline blood pressure readings prior to the beginning of this educational series and then collect and compare blood pressure data during the series and after the series is completed.
  • Collect baseline blood pressure readings prior to the beginning of this educational series and then collect and compare blood pressure data after the series is completed.
  • Ask the clients how often they use the stress management techniques that they have learned during this educational series.
  • Use a questionnaire at the end of the series that asks the participants how they liked the class and what they learned during this educational series.

The best way to evaluate the effectiveness of this educational series is to collect baseline blood pressure readings prior to the beginning of this educational series and then collect and compare blood pressure data during the series and after the series is completed. This technique entails evaluating the outcomes of the education in terms of changes in the client and it also includes formative evaluation during the series and summative evaluation at the end of the series.

Collecting baseline blood pressure readings prior to the beginning of this educational series and then collecting and comparing blood pressure data after the series is completed gives us only summative evaluation; it does not provide you with formative evaluation.

Because the primary goal of this series is to lower the blood pressures of clients through the use of stress management techniques, asking  the clients how often they use the stress management techniques that they have learned during this educational series and using a questionnaire at the end of the series that asks the participants how they liked the class and what they learned during this educational series does not reflect data and information about the effectiveness of the classes in terms of reducing the blood pressures of hypertensive clients.

Tai Chi is a type of a mind body exercise that deeply focuses on breathing, movement and meditation. Yoga is similar to tai chi in that yoga also employs a combination of breathing, movement and meditation.

Reiki is done for the client when the therapist places their hands on or near the person’s body to promote the client’s energy field and its own natural healing processes. Feng shui is an eastern method of decorating using colors, items and the placement of objects in the environment to promote a harmonious relationship of man and its environment; and lastly Jiu Jitsu is a martial art.

  • You should advise the couple to move closer to their children so that they can care for their father.
  • You should teach the wife about this progressive disease and the need to promote as much independence as possible.
  • You should teach the wife about this progressive disease and the need to do all that she can for the husband to avoid his depression and frustration.
  • You should advise the couple to decrease their social activities in order to preserve the husband’s dignity and self-esteem.

You should teach the wife about this progressive disease and the need to promote as much independence as possible.  Client’s with Alzheimer’s disease and other disabilities, including physical disabilities, should be coached and encouraged to be as independent as possible.

Moving closer to the children may not be appropriate advice particularly if the children are unable or unwilling to care for their father. Lastly, you should advise the couple to continue their social activities and to only avoid those situations where the necessary compassion and understanding about the client and his condition are absent.

  • According to the Global Deterioration Scale, clients in the first stage of Alzheimer’s disease tend to cover up their failing abilities
  • According to the Reisberg Scale, clients in the first stage of Alzheimer’s disease tend to cover up their failing abilities
  • According to the Global Deterioration Scale, clients in the third stage of Alzheimer’s disease tend to cover up their failing abilities
  • According to the Reisberg Scale, clients in the fourth stage of Alzheimer’s disease tend to cover up their failing abilities

According to the Global Deterioration Scale, also referred to as the Reisberg Scale, clients in the third stage of Alzheimer’s disease tend to cover up their failing abilities.

The Global Deterioration Scale stages Alzheimer’s according to seven stages. These stages include

  • Stage 1: Cognitive abilities are intact.
  • Stage 2: Minimal and hardly noticeable forgetfulness occurs.
  • Stage 3: Mild changes in terms of cognition occur. The client may have difficulty in terms of their memory, which at times the client may “cover up” to avoid the detection by others. The signs and symptoms of this stage are similar to those of the Early Stage of Alzheimer’s disease, as discussed immediately above.
  • Stage 4: This stage is characterized with increasing confusion about recent events and conversations, mild problems with math and some rather routinized sequential tasks such as cooking. The client may withdraw from others and debate the fact that they are having some cognitive issues.
  • Stage 5:  Early Dementia occurs. Short and long term memory losses, a lack of orientation to place and time, poor judgment, and some of the client’s self care in terms of the activities of daily living become progressively more problematic. The client may need the assistance and supervision of others to promote the client’s highest possible level of independence in the performance of their basic activities of daily living.
  • Stage 6: This stage is referred to a Middle Dementia and moderately severe Alzheimer’s disease. There is almost complete short term and long term memory loss, communication is highly limited and it may only consist of nonverbal behavioral responses, and the client needs complete care to manage their activities of daily living. Sundowner’s syndrome is present and hallucinations as well as agitation may occur.
  • Stage 7: This stage is referred to as Late or Severe Dementia and Failure to Thrive. The client is in need of complete care; and immobilization, in addition to the hazards of immobility, may affect the client and the family members at this stage.
  • Probing for more information from the client
  • Sublimation to determine hidden messages
  • Providing privacy so the client is comfortable
  • Silence to allow contemplation and thought
  • A safe environment of care that is conducive to the prevention of medical errors.
  • A client care area that provides personal privacy and the confidentiality of medical information.
  • A European method of design and color to promote health and wellness.
  • The provision of a therapeutic environment of consistency to promote health.

A therapeutic milieu eliminates as many stressors from the environment as possible. The goal of this environment is to facilitate the client’s coping and recovery without the need to cope with these extraneous and avoidable stressors. Some of the elements of a therapeutic milieu environment include consistency, client rules, limitations and boundaries, and client expectations, including contracts, relating to appropriate behavior.

Physiological Integrity: Basic Care & Comfort Practice Questions

  • Psychomotor domain: The client will slightly bend their elbows when holding the hand grips.
  • Psychomotor domain: The client will rest their weight on the padded areas on the top of the crutches.
  • Cognitive domain: The client will slightly bend their elbows when holding the hand grips.
  • Cognitive domain: The nurse will tell the client how often the tips on the crutches must be replaced.

The client goal that is paired with its learning domain that should be included in the patient teaching plan for this client and the parents is “The client will slightly bend their elbows when holding the hand grips” which is part of the psychomotor domain and not the cognitive domain. Lastly, the “nurse will” is an intervention and not a client goal or expected outcome which should be learner, not nurse, oriented.

  • An aphasia aid
  • A button hook
  • Honey thickened liquids
  • A word board

The basic activity of daily living assistive device can be useful for the client who is affected with poor fine motor coordination is a button hook that would be used for the dressing activity of daily living.

An aphasia aid and a word board are assistive devices to facilitate communication when the client is affected with a communication deficit such as aphasia; and, lastly honey thickened liquids are indicated for clients with a swallowing disorder and they are not indicated for clients with poor fine motor coordination.

  • Place the client in a wheelchair to protect their safety in the clinic.
  • Remove the cane from the client to protect their safety.
  • Teach the client about the proper length of a cane.
  • Have the client use a wheelchair rather than the cane.

You should teach the client about the proper length of a cane. The proper length of the cane should be the length that only permits the client’s elbow to be slightly flexed. Some canes like a wooden cane are not adjustable to the client’s height and others can be adjusted to meet the height needs of the client.

You would not place the client in a wheelchair or ask the client to use a wheelchair and you would also not take the cane, which is their personal property, away from them. You would use this observation as a learning need assessment and, as such, you should teach the client about the proper length of a cane and help them to adjust the height of the cane if the client’s cane is a height adjustable one.

  • A cleansing enema
  • A retention enema
  • A return-flow enema

The most likely intervention for this client, after getting a doctor’s order, is a return flow enema. Return-flow enemas, similar to a carminative enema, are used to relieve flatus and stimulate peristalsis which is frequently a problem after a client has received anesthesia.

Cleansing enemas are used to relieve constipation; and a retention enema is used to administer a medication, to soften stool and to lubricate the rectum so that it is easier and more comfortable for the client to defecate.

Finally, the data in this question does not indicate that the client is constipated and in need of a laxative.

  • Both can lead to infection.
  • Both are invasive procedures.
  • Both are considered sentinel.
  • Both are the last resort.

The commonality that is shared in terms of both restraints and urinary catheters is that both are the last, not the first, treatment of choice. Both indwelling urinary catheters and restraints pose risks and complication; therefore, both of these interventions must be prevented with the use of preventive measures.

Indwelling urinary catheters are invasive but restraints are not invasive; indwelling urinary catheters can lead to infection but restraints do not. Lastly, neither are sentinel. A sentinel event is an event or occurrence, incident or accident that has led to or may have possibly led to client harm. Even near misses, that have the potential for harm, are considered sentinel events because they have the potential to cause harm in the future.

  • Any solid skin barrier
  • A hydrocolloid solid skin barrier
  • Hollister’s Flextend
  • A skin sealant

You would recommend a skin sealant, including products like Bard’s Protective Barrier and Convatec’s Allkare, which are a fast drying polymer transparent film that can be applied relatively simply with a wipe or a spray. These products are easy to use and less expensive than solid skin barriers, including Hollister’s Flextend and others containing hydrocolloids.

  • A prolapsed stoma
  • A vitamin B12 deficiency
  • Nocturnal enuresis
  • GI stone formation

Some of the complications associated with a colostomy include a prolapsed stoma, infection, dehiscence, an ischemic ileostomy, a peristomal hernia, stoma stenosis, stomal retraction, necrosis, mucocutaneous separation, stomal trauma, peristomal skin damage as the result of leakage and parastomal hernias.

A vitamin B12 deficiency, nocturnal enuresis and urinary stone formations are complications associated with urinary diversion and not fecal ostomy diversions.

  • Bone demineralization: Turning and positioning every 2 hours
  • Urinary stasis: The client will consume 1,000 mL of oral fluids per day
  • Muscle atrophy: The client will perform range of motion exercises at least 3 times a day
  • Hypercalcemia: Maintaining fluid intake of 1,000 mL per day

“The client will perform range of motion exercises at least 3 times a day” is an appropriate expected outcome of care that the nurse provides to prevent this complication.

Urinary stasis and hypercalcemia, both hazards of immobility, can be prevented when the client will consume 2,000 mL of oral fluids per day. Lastly, calcium loss from the bones can be prevented by weight bearing activity, and not turning and positioning in bed.

  • 1 on the scale of 1 to 3
  • 2 on the scale of 1 to 5
  • 3 on the scale of 0 to 5
  • 4 on the scale of 0 to 5

You would document this client’s muscular strength as a 3 on a scale of 0 to 5.

Muscular strength is classified on a scale of zero to five, as below.

  • Zero: No muscular contraction
  • One: No muscular movement, only a quiver is noted
  • Two: Muscular movement but only when assisted with gravity
  • Three: Muscular movement against gravity but not against resistance
  • Four: Muscular movement against resistance
  • Five: Full muscular movement and strength

You would document the size of this wound as 24 cm. After the wound is assessed and measured, the wound dimension is calculated by multiplying the length by the width by the depth of the wound. For example when the length of the sound is 3 cm deep, 2 cm long and 4 cm wide, it is calculated with 3 x 2 x 4 = 24 cm.

  • Secondary intention healing
  • Tertiary intention healing
  • Primary prevention healing
  • Secondary prevention healing

Secondary intention healing is the most likely type of wound healing for this client because of the risks associated with the deep infection associated with the ruptured appendix and the peritonitis.

Secondary intention healing, also referred to as healing by second intention, is done for contaminated wounds in order to prevent infections, to prevent the formation of abscesses and to promote healing from the bottom up to the outer surface of the skin so that any potential infection is not closed in at the bottom of the wound. These open wounds are irrigated with a sterile solution and then packed to keep them open and, over time, they will heal on their own. The resulting scar is more obvious than those scars that result from primary intention healing.

Primary intention healing is facilitated with wounds without infection. The wound edges are approximated and closed with a closure technique such as suturing, Steri Strips, and surgical glues.

Tertiary intention healing, also referred to as healing by tertiary intention, is a combination of secondary and primary healing. Tertiary intention healing begins with several days of open wound irrigations and packing, which is secondary healing, followed by the closure of the wound edges with approximation and suturing which is primary healing. Some traumatic wounds are healed with tertiary intention.

Primary, secondary and tertiary prevention strategies are prevention, interventions and restorative or rehabilitation care and not methods of wound healing.

  • A barrier film
  • An alginate dressing
  • Surgical laser debridement
  • Autolytic debridement

The treatment of pressure ulcers is complex and it often includes a combination of treatments and therapies. The RYB Color Code of Wounds is sometimes used by nurses to guide the treatment options. RYB stands for the colors of red, yellow and black. The rules of treatment for these three colors are:

  • Red: Covering with a dressing such as a hydrocolloid film, turning and positioning the client and avoiding pressure, friction and shearing
  • Yellow: Using an alginate dressing
  • Black: Debridement, including surgical laser debridement, mechanical debridement, autolytic debridement, enzymatic debridement and sharp instrument debridement, of the area to remove the black necrotic eschar.
  • Moritz Schiff’s theory of pain
  • The Intensive Theory of Pain
  • Melzack and Wall’s theory of pain
  • The Specificity Theory of Pain

Melzack and Wall’s Gate Control Theory of pain supports the belief that some of the factors that open this “gate” to pain are low endorphins and anxiety and that some of the factors that close this “gate” to pain are decreased anxiety and fear. The substantia gelatinosa is the “gate” that facilitates or blocks the transmission of pain.

The Specificity Theory of Moritz Schiff described pain as a sensation that was different from all the other senses in that pain had its own specific nervous system pathways from the spinal cord that traveled to the brain; the  Intensive Theory of pain is based on the belief that pain is an emotional state, rather than a sensory phenomenon; the Peripheral Pattern Theory of pain of Sinclair and Weddell describes pain as the result of an intense stimulus applied to the skin; and the Neuromatrix Theory of Pain supports the fact that pain is a dynamic and multidimensional process with physical, behavioral, perceptual, psychological and social responses and one that can only be described by the person who is experiencing it.

  • Pain level, the quality of the pain, the region or area of the pain, the severity of the pain, and the pain triggers
  • Precipitating factors, the quality of the pain, relief factors, the severity of the pain, and the pain triggers
  • Pain level, the quantitative numerical pain score, the region or area of the pain, the severity of the pain, and the pain triggers
  • Precipitating factors, the quality of the pain, the region or area of the pain, the severity of the pain, and the pain triggers

Precipitating factors, the quality of the pain, the region or area of the pain, the severity of the pain, and the pain triggers are the PQRSTs of the PQRST method of pain assessment.

The severity of the pain, which can include a quantitative, numerical pain score from 1 to 10, for example, is the S of the PQRST method of pain assessment.

  • Assessment data, biochemical data, clinical data and dietary data
  • Ancestral cultural data, biochemical data, clinical data and dietary data
  • Anthropometric data, biological data, chemical data and dietary data
  • Anthropometric data, biochemical data, clinical data and dietary data

Anthropometric data, biochemical data, clinical data and dietary data are the A, B, C and Ds of a complete and comprehensive nutritional assessment.

The elements of these A, B, C and Ds of nutritional assessment include:

  • A: Anthropometric Data:  This data includes variables such as height, weight, body mass index and arm measurements such as the mid arm circumference and the triceps skin fold.
  • B: Biochemical Data: Laboratory testing data like serum albumin, hemoglobin, urinary creatinine, and serum transferrin.
  • C: Clinical Data: The client’s skin condition, level of activity and status of the client’s mucous membranes.
  • D: Dietary Data: This data includes the client’s subjective reports of their food and fluid intake over the last 24 hours and the types of foods that are typically eating.
  • Constipation: The provision of a high fiber diet
  • Urinary pH changes: Encouraging ample oral fluid intake
  • Aspiration: Maintaining the client in at least a 30 degree angle
  • Aspiration: Maintaining the client in at least a 90 degree angle

Aspiration can be prevented by maintaining the client in at least a 30 degree angle; a 90 degree angle is not only not necessary, this angle places a client at greater risk for the development of a pressure ulcer.

Diarrhea, rather than constipation is a complication of tube feedings; and urinary pH changes are not a commonly occurring complication of tube feedings.

Some of the other complications and preventive measures are:

  • Diarrhea: Maintaining a slow rate of infusion whenever possible, changing the ordered rate and formula when necessary
  • Abdominal pain: Maintaining a slow rate of infusion whenever possible
  • Dehydration: Monitor the client for any signs and symptoms of dehydration, measure intake and output and notify the doctor of any abnormalities
  • Nausea and Vomiting: Slowing the rate down, changing the formula and antiemetic medications to stop the vomiting and to prevent any aspiration
  • Tube Dislodgment: Secure and monitor the tube
  • Locus of control
  • Bodily surface area
  • Diaphoresis

There are a wide variety of different factors that influence and impact on our clients’ hygiene habits and routines. For example, cultural practices and beliefs, ethnical factors, religious practices and beliefs, the client’s level of growth and development.

Although the locus of control, bodily surface area and diaphoresis in addition to other factors such as economic constraints, the client’s level of energy, the client’s level of cognition, and environmental factors can impact on hygiene, these are not factors that impact on the client’s hygiene and hygiene practices; they do not typically impact on the lifelong developed hygiene and hygiene practices.

  • The neonate: 10 to 15 hours a day
  • The toddler: 11 to 14 hours a day
  • The preschool child: 12 to 15 hours a day
  • The school age child: Less than 8 hours a day

The age group that is accurately paired with the normal and recommended hours of sleep each day is the toddler should sleep about 11 to 14 hours per day.

The neonate should sleep 14 to 17 hours per day; the preschool child should sleep 10 to 13 hours per day; and the school age child should sleep 9 to 11 hours per day.

Physiological Integrity: Pharmacological & Parenteral Therapies Practice Questions

  • Stop the intravenous flow
  • Slow down the intravenous flow
  • Notify the doctor

Your first priority intervention is to immediately stop the flow of the intravenous antibiotic because it is highly likely that the signs of anaphylaxis have occurred as the result of the client’s adverse effect to this antibiotic.

The next thing that you would do is assess the client to determine their physical status and to provide necessary emergency measures, including CPR, if it is indicated. Later, you would notify the doctor about this adverse reaction.

  • Mix a small amount of the medication in a small amount of the intravenous fluid and then examine this mixture for color changes
  • Refer to a compatibility chart
  • Call the doctor and ask if the medication is compatible with the particular intravenous fluid
  • Mix a small amount of the medication in a small amount of the intravenous fluid and then examine this mixture for any precipitates

The best way to determine whether or not a medication is compatible for a particular intravenous fluid is to refer to a compatibility chart.

Although, at times, incompatibility can be evidenced with changes such as those related to color changes and the formation of a cloudy solution or obvious precipitate, at other times incompatibility may not be noticeable. For this reason, nurses must refer to a compatibility or incompatibility chart before they mix medications or medications and solutions.

Lastly, there is no need to call the doctor for compatibilities when you have, and should use, a compatibility chart.

  • Prevent polypharmacy
  • Conserve financial resources
  • Prevent interactions
  • Prevent allergies

The medication reconciliation process to insure that the nurse is aware of all medications that the client is taking, some of which may have been ordered by a physician other than the client’s primary care doctor and some of which are over the counter or alternative therapies that the client has added. The complete and current list of medications is then reviewed by the nurse and possible interactions are identified and addressed with the client.

Although this medication reconciliation process can also save costs by eliminating unnecessary medications, particularly when the client is taking multiple medications (polypharmacy), this is not a primary purpose. Lastly, medications that the client is allergic to should never be given, therefore, these medications should not appear during the medication reconciliation process; they should never have been given to or taken by the client.

  • The fact that drugs classified as categories C, D and X are contraindicated for women who are pregnant.
  • The fact that drugs classified as categories A, B and C are contraindicated for women who are pregnant.
  • The fact that drugs classified as categories C, D and E are contraindicated for women who are pregnant.
  • The fact that drugs classified as categories C, D and Z are contraindicated for women who are pregnant.

Drugs classified as categories C, D and X are contraindicated for women who are pregnant because of the risks associated with these categories in terms of the developing fetus when these medications cross the placental barrier.

  • The nurse must be knowledgeable about the fact that this client has A and B agglutinins and lacks the Rh factor
  • The nurse must be knowledgeable about the fact that this client has B and O agglutinins and lacks the Rh factor
  • The nurse must be knowledgeable about the fact that this client has B agglutinins and lacks the Rh factor
  • The nurse must be knowledgeable about the fact that this client has A agglutinins and lacks the Rh factor

The nurse must be knowledgeable about the fact that this client has A agglutinins and they lack the Rh factor.

Type A blood has B agglutinins; type B blood has A agglutinins, type AB blood has no antibodies, or agglutinins, and type O blood has both A and B agglutinins.

People also have a rhesus, or Rh, factor antigen or the lack of it. Clients with an Rh positive blood, which is the vast majority of people, have Rh positive blood and people without the Rh factor antigen have Rh negative blood.

  • Hemolysis: Typing and cross matching the blood and checking for ABO compatibility prior to administration
  • Hemolysis: Insuring that the client does not have a prior history of hemolysis in the past
  • Febrile reactions: Insuring that the client does not have a prior history of hemolysis in the past
  • Febrile reactions: Typing and cross matching the blood and checking for ABO compatibility prior to administration

Hemolysis can be prevented by typing and cross matching the blood and checking for ABO compatibility prior to administration. This incompatibility can occur as the result of a laboratory error in terms of typing and cross matching and a practitioner error in terms of checking the blood and matching it to the client’s blood type.

Febrile reactions are the most commonly occurring reaction to blood and blood products administration. Although a febrile reaction can occur with all blood transfusions, it is most frequently associated with packed red blood cells and this reaction is not accompanied with hemolysis nor is it associated with its occurrence.

  • You must insure that the client has a patent intravenous catheter that is at least 20 gauge.
  • You will need the help of another nurse prior to the administration of these packed red blood cells.
  • The unit of packed red blood cells should start no more than 1 hour after it is picked up.
  • You must remain with and monitor the client for at least 30 minutes after the transfusion begins.

You will need the help of another nurse prior to the administration of these packed red blood cells. Two nurses must check the blood, the doctor’s order, the ABO compatibility and the client’s identity using at least two unique identifiers prior to the administration of this blood.

You must insure that the client has a patent intravenous catheter that is at least 18 gauge and not 20 gauge; you will be using normal saline and a Y infusion set for the administration of the blood because Ringer’s lactate and other intravenous solutions are not compatible with blood; blood should not remain in the client care area for more than 30 minutes so it is important that the nurse is prepared to begin the transfusion shortly after the blood is delivered to the patient care area; and, lastly, the nurse should remain with and monitor the client for at least 15 minutes  after the transfusion begins at a slow rate since most serious blood reactions and complications occur shortly after the transfusion begins.

  • A percutaneous, non tunneled subclavian catheter
  • A peripheral intravenous catheter that is 20 gauge
  • A multi lumen implanted tunneled and cuffed central venous catheter
  • A peripherally inserted central venous catheter

You would most likely anticipate that this client will be given a multi lumen implanted tunneled and cuffed central venous catheter because this multi trauma client is in need of multiple intravenous therapies such as blood, medications and total parenteral nutrition over an extended period of time.

A percutaneous, non tunneled subclavian catheter would not be the device of preference because percutaneous, non tunneled subclavian catheters are used when short term treatments are anticipated; a peripheral intravenous catheter that is at least 18 gauge is necessary for the administration of blood; and a peripherally inserted central venous catheter would also not be the venous access device of choice for this seriously ill client who will require long term treatments and care.

  • 1.5 tablets
  • 1.25 tablets
  • 1.33 tablets

You have to determine how many tablets the patient will take if the doctor has ordered 200 mg a day and the tablets are manufactured as 150 mg per tablet.

The mathematical rule for this type of calculation is:

Have         =  Desired Quantity           X

This problem is calculated as shown below.

200 mg: X tablets = 150 mg: 1 tablet

200 mg     =  150 mg

X tablets       1 tab

You will criss cross multiply the known numbers and then divide this product by the remaining number to solve for X, as below.

200 x 1 = 150 X

200/150 = 1.33 tabs rounded off to 1 1/3 tabs

You have to determine how many mLs the patient will take if the doctor has ordered 10 mg twice a day and there are 12 mg in each mL.

10 mg: X mL  = 12 mg: 1 mL

10 mg     =  12 mg X mL          1 mL

10 x 1 = 10 X

10/12 = 0.833 mL rounded off to 0.8 mL

You have to determine how many mLs the patient will take if the doctor has ordered 6,500 units of heparin subcutaneously and there are 4,500 units in one mL.

6,500 units: X mL = 4,500 units: 1 mL

6,500 units     =  4,500 units X mL                  1 mL

6,500 x 1 = 6,500

6,500/4,500 = 1.44 mL which is rounded off to 1.4 mL

To calculate the number of mg that this pediatric  client will receive in each dose, you will have to calculate the client’s weight in kg and then determine the total mg for the day after which you will divide the daily dosage by 2 because the order is for two equally divided doses each day.

The steps for this calculation are shown below:

This is how to determine the client’s weight in terms of kg:

48 pounds: x kg = 2.2 pounds: 1 kg

48 pounds    =  2.2 pounds x kg                    1 kg

48 x 1 = 48

48/2.2 = 21.81 or 21.81 kg

This is how to determine the client’s total daily dosage when the doctor has ordered has ordered 5 mg/kg/day:

21.81 kg x 5 = 109.05 mg per day

This is how to determine the client’s dose for each of the two divided doses:

109.05/2 = 54.53 mg which is rounded off to 55 mg for each of two divided doses.

The first step of this calculation is to calculate the number of mLs, or cc s, per hour and then  determine the number of drops per minute. This calculation is done as follows:

1000 ml  = 125 mL per hour 8 hrs

The next step is done using this rule that reflects the fact that there are 60 minutes per hour in order to determine the number of mLs per minute .

1 hour   =  The ordered mL per hour 125 mLs X min                        60 min

1 hour   =  125  mL  X min      60 min

60 x 1 = 60

88/60 =  2.08 mL per minute

Finally, the number of drops per minute is calculated by using the intravenous infusion set’s drop factor  by using this rule.

Volume per minute x Drop factor

2.08 x 20 = 41.6 gtts per minute which is rounded off to 42 gtts per minute

With this type of calculation, the amount of normal saline that will be added to a powder in a vial to reconstitute the medication is important, instead, it is the amount of medication that results after the addition of the normal saline. For example, this reconstituted medication yields it is the yield of 12 mg in an mL that is relevant. It is this that will be used in the calculation.

This calculation is done as shown below:

12 mg  = 25 mg 1 mL      X mL

25 x 1 = 25

25/12 = 2.08 mL which is 2.1 mL rounded off

When the doctor has ordered 1200 mLs of intravenous fluid every 8 hours, you would calculate the number of mLs per hour, as below.

1200/8 = 150 mLs per hour

From 8 am to 12 noon there are 4 hours so:

150 mLs x 4 = 600 mLs

Because you had 600 mLs at 8 am, you should be prepared to hand another intravenous bag because this 600 mLs should all be infused at 12 noon.

  • Question the order because Benadryl is an antihistamine and not a sleeping medication.
  • Refuse to give the Benadryl because this medication is a stimulant.
  • Question the order because Benadryl is contraindicated when the client has a sleep inducement disorder.
  • Give the Benadryl because sleep inducement is an accepted off label use of this medication.

You would administer this Benadryl because sleep inducement is an accepted off label use of this medication. When a medication is used for any other than these established and approved uses, this usage is referred to as an “off label use”.

  • The “right” verification
  • The “right” to refuse
  • The “right” documentation
  • The “right” client education

The “right verification” is not one of the “Ten Rights of Medication Administration”. The verification of the doctor’s order for a medication is to confirm the right paint, medication, dose, route and time or frequency, it, in itself, is not one of the “10 Rights”.

The “Ten Rights of Medication Administration” are the right, or correct:

  • Time or frequency
  • Client education
  • Documentation
  • Right to refuse
  • Assessment and
  • Gluteus maximus muscle.
  • Vastus lateralis muscle.
  • Deltoid muscle.
  • The sternocledomastoid muscle.

The administration of an intramuscular injection to a neonate should be given in the vastus lateralis, rectus femoris and ventrogluteal muscle sites and not the deltoid or the gluteus maximus muscles because these muscles have not yet developed.

The sternocledomastoid muscle is not an intramuscular injection site.

  • A subcutaneous injection site
  • The PQRST technique
  • The Z track technique
  • The sublingual site

You would expect to use to use the Z track technique to administer ferrous sulfate.

Ferrous sulfate IM is given using the Z Track technique to avoid the leakage and dark staining of the injection site with this medication.

Ferrous sulfate is not administered with a subcutaneous injection or using the sublingual route. Lastly, the PQRST method is used to assess pain and not used as a guideline for medication administration.

  • 1,5,4,2,3,6
  • 4,3,2,6,1,5
  • 4,2,5,3,1,6
  • 1,5,3,6,4,2

The steps for mixing NPH, the long acting insulin, with regular insulin, the short acting insulin in the correct sequential order are:

  • Prep the top of the longer acting insulin vial with an alcohol swab.
  • Inject air that is equal to the ordered dosage of the longer acting insulin using the insulin syringe. Do NOT withdraw the longer acting insulin yet.
  • Prep the top of the shorter acting insulin with an alcohol swab
  • Inject air that is equal to the ordered dosage of the shorter acting insulin using the same insulin syringe.
  • Withdraw the ordered dosage of the shorter acting insulin using the same insulin syringe.
  • And, then lastly, withdraw the ordered dosage of the longer acting insulin using the same insulin syringe.
  • Allow the nurse to administer the injection.
  • Ask the nurse to use the vastus lateralis muscle instead.
  • Ask the nurse to verify the doctor’s order again.
  • Stop the nurse from administering the injection.

You would stop the nurse from administering the injection when you observe that the nurse has palpated the gluteus maximum muscle to determine the correct site. Intramuscular injection sites are determined by using boney landmarks and not by palpating the muscle.

You would not allow the nurse to administer the injection and you would not ask the nurse to use the vastus lateralis muscle instead because nothing indicates the need to do so. Lastly, you would verify the doctor’s order prior to entering the room and preparing to administer the injection and not during the time that the intramuscular site is being identified.

  • You have failed to have another nurse witness the 0.8 mLs and the 0.2 mLs of waste.
  • You have failed to have another nurse witness the 0.8 mLs of waste.
  • You have failed to have another nurse witness the 0.2 mLs of waste.
  • You have failed ask another nurse to verify the calculation of the dosage.

You have failed to have another nurse witness the 0.8 mLs and the 0.2 mLs.

All controlled substances are documented on the narcotics record as soon as they are removed, and all controlled substances that are wasted for any reason, either in its entirety or only partially, must be witnessed or documented by the wasting nurse and another nurse. Both nurses document this wasting.

It should not be necessary for you to ask another nurse to verify this calculation; the nurse is accountable and responsible for accurate dosage calculations.

The procedure for this medication reconciliation process is:

2. Compile a list of current medications and other preparations 1. Compile a list of newly prescribed medications 4. Compare the two lists and make note of any discrepancies and inconsistencies 5. Employ critical thinking and professional judgments during the comparisons of the two lists 6. Communicate and document the new list of medications to the appropriate healthcare providers

  • The client with heart failure who is receiving Ringer’s lactate
  • The client with cancer who is receiving bendamustine
  • The client who is receiving potassium supplementation intravenously
  • The client who is receiving total parenteral nutrition

The client with cancer who is receiving bendamustine is at greatest risk for extravasation. Extravasation occurs when vesicant and other vein irritating drugs infiltrate into the tissue. In severe cases, extravasation can lead to necrosis and the loss of an affected limb. Bendamustine is a vesicant chemotherapy drug.

Extravasation is not associated with the intravenous administration of Ringers lactate or potassium supplementation intravenously because this solution and medication are not vesicants. These intravenous preparations can lead to infiltration but not extravasation.  Lastly, the client who is receiving total parenteral nutrition is at risk for other complications such as infection, but not extravasation.

  • Infection: Lowering the limb to promote circulation
  • Infiltration: The application of cold to the site
  • Extravasation: The aspiration of contents including blood from the IV cannula
  • Hematoma: The administration of dexrazonxane

In addition to other interventions, intravenous fluid contents including blood are aspirated from the IV cannula.

Other interventions include immediate cessation of the infusion, elevating the limb, applying warm compresses initially to rid the area of any remaining drug that is in the tissues which is then followed by cool compresses to reduce any swelling, and the administration of an ordered substance specific medication such as dexrazoxane.

One of the interventions for infection include the elevation, not lowering, of the affected limb; infiltration is treated with the application of warm, not cold, compresses and one of the interventions for hematoma is the application of pressure and heat and not the administration of dexrazonxane.

  • Assess motor functioning.
  • Assess sensory functioning.
  • Evaluate responses to a tactile stimulation.
  • Evaluate responses to a pain analgesic.

The CRIES scale is used to evaluate the neonate’s response to a pain analgesic; this pain scale is also used to assess pain among neonates.

Observational behavioral pain assessment scales for the pediatric population are used among children less than three years of age. Some of these standardized pediatric pain scales, in addition to the CRIES scale, include the FACES Pain Scale, the Toddler Preschooler Postoperative Pain Scale (TPPPS), the Neonatal Infant Pain Scale (NIPS), the Children's Hospital of Eastern Ontario Pain Scale (CHEOPS), the Faces Legs Activity Cry Consolability Pain Scale (FLACC), the Visual Analog Scale (VASobs) the Observation Scale of Behavioral Distress (OSBD), the COMFORT Pain Scale and the Pre-Verbal Early Verbal Pediatric Pain Scale (PEPPS) that is used with toddlers.

  • Opioid Agonist: Dilaudid: Constipation
  • Opioid Agonist: Naloxone: Constipation
  • Opioid Antagonist: Dilaudid: Anaphylaxis
  • Opioid Antagonist: OxyContin: Anaphylaxis

Dilaudid is an opioid agonist that can cause constipation.

Other opioid agonists are codeine, OxyContin, Darvon, Dilaudid, Demerol and Percocet. The side effects and adverse reactions to this classification of drugs include constipation, sedation, nausea, dizziness, pruritus, and sedation, respiratory depression and arrest, hepatic damage, an anaphylactic reaction, circulatory collapse and cardiac arrest.

Opioid antagonists also referred to as opioid receptor antagonists, such as naloxone and naltrexone, can have side effects such as hepatic damage, joint pain, insomnia, vomiting, anxiety, headaches and nervousness.

  • Your client may be experiencing a fluid overload.
  • Your client may be experiencing an embolus.
  • Your client may be hyperglycemic.
  • Your client may have an inadvertent pneumothorax.

The client may be experiencing an embolus, which is a complication of total parenteral nutrition. Some of the signs and symptoms of an embolus are chest pain, dyspnea, shortness of breath, coughing, and respiratory distress.

Emboli, secondary to total parenteral nutrition occur when air is permitted to enter this closed system during tubing changes and when a new bottle or bag of hyperalimentation is hung. This complication can be prevented by instructing the client to perform the Valsalva maneuver and the nurse’s rapid changing of tubings and solutions when the closed system is opened to the air.

An inadvertent pneumothorax can occur and become symptomatic during the insertion of the TPN catheter and not four days later.

Other side effects of TPN and their signs and symptoms are listed below.

  • Infection: The classical signs of infection including a fever, malaise, swelling and redness at the insertion site, diaphoresis, chilling and pain in the area of the TPN catheter insertion site.
  • Fluid overload: Hypertension, edema, adventitious breath sounds like crackles and rales, shortness of breath, and bulging neck veins.
  • Hyperglycemia: High blood glucose levels, thirst, excessive urinary output, headache, nausea and fatigue.
  • Hypoglycemia: Low blood glucose levels, shakiness, clammy and cool skin, blurry vision, diaphoresis and unconsciousness and seizures.
  • Clients are at high risk for infection when they are getting TPN because they are immunocompromised.
  • Clients are at high risk for hyperglycemia when they are getting TPN because they are diabetic.
  • The client should perform the Valsalva maneuver when the nurse changes the TPN tubing.
  • The client should perform the Valsalva maneuver when the nurse changes the TPN dressing.

The client should perform the Valsalva maneuver when the nurse changes the TPN tubing to prevent an embolus which can occur when the tubing is opened to the air while it is being changed.

A mask, not the Valsalva maneuver, is indicated for TPN dressing changes.

Lastly, clients are at risk for infection secondary to TPN because these solutions are high in dextrose and because TPN is an invasive sterile procedure; and clients are at high risk for hyperglycemia when they are getting TPN because these solutions are high in dextrose and not because the client is already a diabetic client.

Physiological Integrity: Reduction of Risk Potential Practice Questions

  • Respiratory rate: 32 breaths per minute
  • Pulse: 110 beats per minute
  • Blood pressure: 55/82
  • “The respiratory rate is a little too fast but the other vital signs are normal.”
  • “The pulse rate is a little too fast but the other vital signs are normal.”
  • “The blood pressure is a little low but the other vital signs are normal.”
  • “All of these vital signs are normal for a child that is 2 years of age.”

All of these vital signs are normal for the toddler who is 2 years old. The normal vital signs for the toddler are:

  • Respiratory rate: From 20 to 40 per minute
  • Pulse rate: From 90 to 140 beats per minute
  • Blood pressure: Diastolic from 50 to 80 mm Hg and systolic from 80 to 112 mm Hg
  • Pulse: 100 beats per minute
  • Blood pressure: 85/55

The respiratory rate is a little too fast for this 5 year old preschool client. The normal respiratory rate for this client should be from 22 to 30 per minute.

The normal pulse rate and blood pressure for the preschool child are from 80 to 110 beats per minute and a diastolic from 50 to 78 mm Hg and a systolic from 82 to 110 mm Hg.

  • Pulmonary Artery Systolic Pressure: 22 mm Hg
  • Pulmonary Artery Wedge Pressure: 22 mm Hg
  • Pulmonary Artery Diastolic Pressure: 10 mm Hg
  • Central Venous Pressure: 5 mm Hg

You would report the pulmonary artery wedge pressure of 22 mm Hg because the normal pulmonary artery wedge pressure is from 4 to 12 mm Hg.

The other normal hemodynamic values are:

  • Pulmonary Artery Systolic Pressure: 15 to 26 mm Hg
  • Pulmonary Artery Diastolic Pressure: 5 to 15 mm Hg
  • Central Venous Pressure: 1 to 8 mm Hg
  • The need to cleanse the perineal area with circular wipes.
  • The need to cleanse the perineal area from the “dirtiest” to the “cleanest”.
  • The need to use a new antiseptic wipe for each wipe from the inner to the outer labia.
  • The need to use a new antiseptic wipe for each wipe from the outer to the inner labia.

You would instruct your female client to use a new antiseptic wipe for each wipe from the inner to the outer labia.

A principle of asepsis is the cleansing of areas from the cleanest to the dirtiest and NOT the reverse; therefore, the inner labia are cleansed before the outer labia. The female perineal area is prepped with straight strokes and wipes; and the male wipes with a circular pattern around the urinary meatus.

  • Turn the finger down so the blood will drop with gravity.
  • Wipe off the first drop of blood using sterile gauze.
  • Prick the side of the finger using the lancet.
  • Prick the pad of the finger using the lancet.

Pricking the pad of the finger using the lancet is NOT a step in the procedure for obtaining a blood glucose sample for testing. Instead, the side of the finger is pricked with the lancet.

The procedure for checking the client’s blood glucose levels in correct sequential order is as follows:

  • Verify and confirm that the code strip corresponds to the meter code.
  • Disinfect the client’s finger with an alcohol swab.
  •  Turn the finger down so the blood will drop with gravity.
  • Collect the next drop on the test strip.
  • Hold the gauze on the client’s finger after the specimen has been obtained.
  • Read the client’s blood glucose level on the monitor.
  • PaO2: 65 mm Hg
  • PaCO2: 40 mm Hg
  • Arterial blood pH: 7.39

You would report the client’s PaO2 of 65 mm Hg because it is not within normal parameters and it is also a significant change for the client. The normal partial pressure of oxygen (PaO2) is from 75 to 100 mm Hg.

The other blood gases, above, are within normal limits, as follows:

  • Partial pressure of carbon dioxide (PaCO2): 38 - 42 mmHg
  • Arterial blood pH: 7.38 - 7.42
  • Oxygen saturation (SaO2): 94 - 100%
  • Triglycerides: 75 mg/dL
  • Total cholesterol: 6.5 mmol/L
  • High-density lipoprotein (HDL): 60 mg/dL
  • Low-density lipoprotein (LDL): 955 mg/dL

You would report a total cholesterol level of 6.5 mmol/L because this value exceeds the high normal for total cholesterol which is 5.5 mmol/L and the normal range is from 3 to 5.5 mmol/L.

The other lipid levels are normal as follows:

  • Triglycerides: 50-150 mg/dL
  • High-density lipoprotein (HDL): 40-80 mg/dL
  • Low-density lipoprotein (LDL): 85-125 mg/dL
  • Albumin: 40 g/L
  • Amylase: 40 U/L
  • Direct bilirubin: 17 µmol/L
  • Total bilirubin: 17 µmol/L

You would report a direct bilirubin level of 17 µmol/L because this value exceeds the high normal for direct bilirubin which is 6 µmol/L and the normal range is from 0-6 µmol/L.

The other gastrointestinal related normal laboratory values are as follows:

  • Albumin: 35-50 g/L
  • Amylase: 30-125 U/L
  • Total bilirubin: 2-20 µmol/L
  • A 76 year old female client who has a history of alcohol abuse.
  • A 76 year old female client who has a history of radon gas exposure.
  • A 64 year old male client who has a history of cigarette smoking.
  • A 64 year old male client who has hypotension.

A 64 year old male client who has hypotension is at greatest risk for impaired vascular perfusion.

Other risk factors associated with impaired vascular and tissue perfusion are:

  • Hypervolemia
  • Hypovolemia
  • Low hemoglobin
  • An immobilized limb
  • Decreased cardiac output
  • Impaired oxygen transportation
  • Hypoventilation

Alcohol abuse, cigarette smoking and exposures to radon place people at risk for cancer, rather than impaired perfusion.

  • A 76 year old female client who has a history of diabetes.
  • A 64 year old male client who has a history of impaired oxygen transport.

The client who is at greatest risk for the development of cancer is the 76 year old female client who has a history of alcohol abuse. Data indicates that alcohol abuse can lead to cancer of the liver and other cancers.

Diabetes, a history of impaired oxygen transport and hypotension are risk factors associated with poor tissue perfusion, and not cancer.

  • The level of pain among school age children.
  • The risk for the impairment of skin integrity.
  • Levels of muscular strength.
  • Levels of mobility.

The Norton Scale measures the client’s risk for the impairment of skin integrity. The Norton Scale and the Braden Scale are standardized tools to screen clients for their risk of skin breakdown, pressure ulcers and an impairment of skin integrity.

Pain levels among school age children are measured with other standardized pain tools for pediatric clients; and levels of muscular strength and mobility are measured also with other standardized tests and not the Norton Scale.

  • Impaired tissue perfusion

Impaired tissue perfusion is an intrinsic, or internal, risk factor that places the client at risk for pressure ulcers.

Pressure, shearing and friction are extrinsic, or external, risk factors that places the client at risk for pressure impaired tissue perfusion.

Other intrinsic risk factors associated with skin breakdown include:

  • Poor nutritional status
  • A decreased level of consciousness including that which occurs with sedating medications
  • Fecal and/or urinary incontinence
  • Impaired circulation
  • Alterations in terms of the fluid balance
  • Altered neurological sensory functioning
  • Changes in terms of skin turgor
  • Boney prominences
  • Inflate the cuff if the cuff is deflated.
  • Deflate the cuff if the cuff is inflated.
  • Remove the inner cannula of the tube.
  • Call the doctor about this airway obstruction.

The first thing that you should do when you insert the suction catheter and you reach a point of resistance is to deflate the cuff when it is inflated and the second thing that you should do is to remove the inner cannula and suction out the mucous plug.

You would not call the doctor because there is an airway obstruction; you should correct this problem with the measures above.

  • Maintain the client with NPO status for at least 4 hours prior to this procedure.
  • Teach the client about the fact that they may experience muscle flaccidity.
  • Teach the client about the fact that they may have a headache after the ECT.
  • Maintain the client on continuous hemodynamic monitoring after the ECT.

You would teach the client about the fact that they may have a headache after the ECT. Other components of the teaching about the aftermath of the procedure that the client should know about include the fact that the client may have muscle soreness, not muscle flaccidity, confusion, amnesia and hypertension.

The client should be maintained as NPO for at least 6 hours before ECT; and it is not necessary to maintain the client on continuous hemodynamic monitoring after the ECT, however, the client’s vital signs should be monitored.

  • Strnagulation
  • Skin breakdown
  • Skin pallor

The neurological complication can occur when a vest restraint is too tight around the client’s body is numbness and tingling that, unless corrected, can lead to neurological damage.

Strangulation, skin breakdown and skin pallor can also occur when a restraint is too tight, however, these restraint complications are respiratory, integumentary system and circulatory system complications rather than neurological complications.

  • The appearance of petechiae
  • Aplastic anemia
  • The appearance of thrombophlebitis
  • Elevated platelets

The appearance of petechiae is a sign of thrombocytopenia which is a low platelet count. Other signs and symptoms include purpura, easy bruising, epistaxis, and spontaneous hemorrhage and bleeding.

Thrombocytopenia can occur as the result of several disorders and therapeutic treatments and interventions including aplastic anemia, HIV infection, a genetic disorder, cancer, particularly cancer that affects the bones, some viral pathogens like those that cause mononucleosis,  as well as from  therapeutic radiation therapy, chemotherapy and some medications such as Depakote.

  • Pneumothorax

The complication that you should be aware of during the immediate post-operative period of time after a thoracentesis is a pneumothorax.

The signs and symptoms of pneumothorax and hemothorax include dyspnea, chest pain, shortness of breath and pain. The treatment of a pneumothorax includes the correction of the underlying cause whenever possible and the placement of a chest tube to remove the blood and/or air in the pleural space which will re-expand the affected lung and recreate the negative pressure of the pleural space.

Infection would not be evident during the immediate post-operative period; and, aspiration is not a complication of a thoracentesis.

  • The client’s posterior tibia pulse is Grade B
  • The client’s posterior tibia pulse is Grade C
  • The client’s posterior tibia pulse is 1
  • The client’s posterior tibia pulse is 2

You would document this finding as “The client’s posterior tibia pulse is 1”.

The strength, volume and fullness of the peripheral pulses are categorized and documented as follows:

  • 0: Absent pulses
  • 1: Weak pulse
  • 2: Normal pulse
  • 3: Increased volume
  • 4: A bounding pulse

Grades and grading are not used in reference to pulses.

  • The Lazarus Cognitive Appraisal Scale
  • The Hamilton Rating Scale
  • The McGill Scale
  • The Rancho Los Amigos Scale

The tool or scale that you would use for a focused neurological assessment of your client is the Rancho Los Amigos Scale.

Levels of consciousness, which is part of a complete focused neurological assessment, can be determined and measured by using the standardized Glasgow Coma Scale for adults and children or the Rancho Los Amigos Scale. The Rancho Los Amigos Scale determines the patient’s level of awareness and functioning which can range from a 1 to an 8 when a 1 is the complete lack of all responsiveness to all stimulation and an 8 is when a patient is fully alert, oriented, appropriate and purposeful.

The McGill Pain Assessment is used to assess pain levels; the Lazarus Cognitive Appraisal Scale is used to assess levels of stress and coping; and the Hamilton Rating Scale is used to measure and assess depression.

  • A lack of zinc
  • A lack of vitamin E
  • High iron levels
  • High phosphorous levels

A lack of zinc, copper, iron and vitamins C and A are risks associated with impaired and delayed wound healing.

Other risk factors that impede wound healing are:

  • Advancing age
  • Nutritional status
  • Some poor lifestyle choices
  • Some medications
  • Some diseases and disorders
  • “The client is having anesthesia awareness which is not good.”
  • “This often happens during stage 2 of general anesthesia.”
  • "The client needs more general anesthesia.”
  • “The client is having a seizure.”

You should respond to this student nurse by stating, “This often happens during stage 2 of general anesthesia.”

Stage 2 of general anesthesia, often referred to as the Excitement Stage, is characterized with uncontrollable muscular activity, irregular respirations, an irregular cardiac rhythm, and, at times, vomiting. This stage does not indicate the need for more general anesthesia.

Anesthesia awareness, which is a rare complication of general anesthesia, is the lack of amnesia during surgery when the client remembers events during surgery and, at times, they remember the pain.

Lastly, there is no evidence in this question that the client is having a seizure.

  • Surgical site marking
  • Medication reconciliation
  • A neutral zone for sharps

Medication reconciliation prevents medication errors and other complications associated with medications and not a way to reduce surgical risks.

Surgical marking, time outs that are done after surgical site marking is done, and a neutral zone for sharps do reduce surgical risks such as wrong site surgery, wrong patient surgeries and sharps injuries.

Physiological Integrity: Physiological Adaptation Practice Questions

  • Exclude pregnant visitors from the client’s room.
  • Place the client in a negative pressure room.
  • Have all visitors wear protective masks and boots.
  • All of the above

You would exclude all pregnant visitors from the client’s room in order to protect the pregnant woman’s developing fetus. Brachytherapy is internally placed radioactive material to treat clients who are affected with tumor and cancer of the prostate, lungs, esophagus, cervix, endometrium, rectum, breast, head and neck.

Special radiation precautions are initiated when a client is receiving brachytherapy in order to protect visitors and health care staff from the harmful effects of the radiation. Some of the other special internal radiation precautions include:

  • The minimization of the duration of time that health care providers are in the client’s room to deliver care and services to the client
  • The placement of the client receiving internal radiation in a private room. A negative pressure room is not indicated for this client.
  • The prohibition of the client’s activities outside of their room
  • The initiation of complete bed rest for the client until the treatment is discontinued
  • The provision of education to the family members and other visitors that includes information about their need to limit the time of their visits to at least less than 1 hour, to stay at least 6 feet away from the client
  • The need for health care staff to minimize the amount of time spent in the room, to decline to enter the room if they are pregnant, to retain all supplies and equipment including things like bed linens in the client’s room until they are deemed safe for disposal by a person who is competent to make this decision, and how and when to report concerns about the client’s treatment such as when implanted seeds inadvertently leave the client’s body.
  • Oral dryness

Fibrosis is an adverse effect to therapeutic radiation therapy.

Radiation fibrosis can affect bones, nerves, ligaments, muscles, blood vessels, tendons, and the heart in addition to the lungs. Fibrosis occurs as the result of abnormal fibrin and protein accumulation within normal irradiated tissue.

Alopecia, and oral dryness which is also referred to as xerostomia, are side effects and complications to radiation, but not adverse effects.

Other side effects, complications and adverse effects associated with therapeutic radiation therapy are:

  • Skin damage
  • Damage to the mucosa
  • Dental caries and oral infections
  • Nausea and vomiting
  • Bone marrow suppression and immunosuppression
  • Radiation pneumonia
  • Placing the client in the Trendelenburg position
  • Monitoring the color of the stools
  • Using a Hoyer lift for patient transfers
  • Monitoring the arterial blood gases

You would monitor the color of the stools for the client who is receiving phototherapy. Phototherapy is used to treat psoriasis, but it is most commonly employed for the treatment of neonatal hyperbilirubinemia and jaundice which can occur among both full term and pre term infants.

You would also monitor and document the client’s:

  • Skin for changes in color that may indicate an increase or decrease in the amount of bilirubin in the client’s blood
  • Laboratory bilirubin levels to determine whether or not the client’s bilirubin levels are decreasing as the result of the phototherapy
  • Volume, color and characteristics of the stool because phototherapy can lead to frequent, loose stools as well as a color change to green colored stools
  • Hypokalemia: Hypermagnesemia
  • Hyponatremia: Dehydration
  • Hyperkalemia: Ketoacidosis
  • Hypercalcemia: Hypoparathyroidism

Ketoacidosis is a risk factor for hyperkalemia.

The risk factors for the other electrolyte disorders above are listed below.

  • Hypokalemia: Diarrhea, vomiting, and diaphoresis as well as some medications like diuretics and laxatives, and with other disorders and diseases such as ketoacidosis. Hypermagnesemia is not a risk factor for hypokalemia.
  • Hyponatremia: Thyroid gland disorders, cirrhosis, renal failure, heart failure, pneumonia, diabetes insipidus, Addison’s disease, hypothyroidism, primary polydipsia, severe diarrhea or vomiting cancer, and cerebral disorders. Dehydration is a risk factor associated with hypernatremia, not hyponatremia.
  • Hypercalcemia: Hyperparathyroidism, not hyperparathyroidism, some medications such as thiazide diuretics and lithium, some forms of cancer such as breast cancer and cancer of the lungs, with multiple myeloma, Paget’s disease, non weight bearing activity and elevated levels of calcitriol as occurs with sarcoidosis and tuberculosis.
  • Hypernatremia: Hepatic failure
  • Hypocalcemia: Vitamin A deficiency
  • Hypermagnesemia: Cushing’s disease
  • Hypomagnesemia: Crohn’s disease

Crohn’s disease is a risk factor for hypomagnesemia.

Other electrolyte disorder risk factors include:

  • Hypernatremia: Dehydration, renal failure, hyperglycemia and Cushing’s disease
  • Hypocalcemia: Vitamin D deficiency, Crohn’s disease, sepsis and pancreatitis
  • Hypermagnesemia: Addison’s disease, renal failure, diabetic ketoacidosis and dehydration
  • Phosphate: From 0.81 to 1.45 mmol/L.
  • Chloride: From 60 to 110 mEq/L.
  • Calcium: From 6.5 - 10.6 mg/dL.
  • Potassium: From 3.7 to 7.2 mEq/L.

The normal level of phosphate is from 0.81 to 1.45 mmol/L.

The other normal levels for these electrolytes are:

  • Chloride: From 97 to107 mEq/L.
  • Calcium: From 8.5 - 10.6 mg/dL.
  • Potassium: From 3.7 to 5.2 mEq/L.

nursing assignment questions

  • Idioventricular Rhythm
  • Bundle Branch Block
  • Sinus bradycardia
  • Atrial Flutter

Sinus bradycardia is a sinus rhythm that is like the normal sinus rhythm with the exception of the number of beats per minute. Sinus bradycardia has a cardiac rate less than 60 beats per minute, the atrial and the ventricular rhythms are regular, the P wave occurs prior to each and every QRS complex, the P waves are uniform in shape, the length of the PR interval is form 0.12 to 0.20 seconds, the QRS complexes are uniform and the length of these QRS complexes are from 0.06 to 0.12 seconds.

nursing assignment questions

  • Atrial flutter
  • Supraventricular Tachycardia
  • Premature Atrial Contractions

Atrial flutter, which is a relatively frequently occurring tachyarrhymia; this cardiac rhythm is characterized with an rapid atrial rate of 250 to 400 beats per minute, a variable ventricular rate, a regular atrial rhythm, a possibly irregular ventricular rhythm, the P waves are not normal, the flutter wave has a saw tooth look (f waves), the PR interval is not measurable, QRS complexes are uniform and the length of these QRS complexes are from 0.06 to 0.12 seconds.

nursing assignment questions

  • Torsades de Pointes
  • Accelerated Idioventricular Arrhythmia
  • First Degree Atrioventricular Heart Block
  • Supraventricular tachycardia

Supraventricular tachycardia, simply defined is all tachyarrhythmias with a heart rate of more than 150 beats per minute.

The atrial and ventricular cardiac rates are from 150 to 250 beats per minute, the cardiac rhythm is regular, the p wave may not be visible because it is behind the QRS complex, the PR interval is not discernable,  the QRS complexes look alike, and the length of the QRS complexes ranges from 0.06 to 0.12 seconds.

nursing assignment questions

  • Third Degree Heart Block
  • Second-Degree Atrioventricular Block, Type II
  • Ventricular fibrillation

The two types of ventricular fibrillation that can be seen on an ECG strip are fine ventricular fibrillation and coarse ventricular fibrillation; ventricular fibrillation occurs when there are multiple electrical impulses from several ventricular site. This results in erratic and uncoordinated ventricular and/or atrial contractions.

You would instill 250 mLs of irrigating solution after each suctioning of the nasogastric tube. The typical amount of irrigating solution is from 20 mLs to 300 mLs.

  • The compression of the renal medulla.
  • Syncope and dizziness of unknown origin.
  • Pressure on the vena cava which is a major vein in the body.
  • Pressure on the vena cava which is the largest artery in the body.

You should explain that superior vena cava syndrome is pressure on the vena cava which is a major vein, not an artery, in the body that carries blood from the systemic circulation to the right atrium of the heart. This pressure on the superior vena cava prevents the normal return of the body’s circulating blood to the heart.

The signs and symptoms of superior vena cava syndrome include tachypnea, dyspnea, venous stasis, a loss of consciousness, edema, seizures, respiratory and/or cardiac arrest and not syncope of unknown origin. This is a life threatening medical emergency.

  • Hypovolemic shock
  • Septic shock
  • A dissected thoracic aortic aneurysm

You would most likely suspect that this client is affected with a dissected thoracic aneurysm. Thoracic aorta rupture and dissections can present with symptoms that can include shortness of breath, dysphagia, dyspnea, coughing, and pain in the chest, arms, jaw, neck, and/or back.

The signs and symptoms of hypovolemic shock vary according to the stage of the shock; some of the signs and symptoms include hypotension, tachycardia, a lack of tissue perfusion, hyperventilation, decreased cardiac output, decreased urinary output, oliguria, anuria, metabolic acidosis, increased blood viscosity, and multisystem failure.

The signs and symptoms of septic shock include the classical signs of infection in addition to hypotension, confusion, metabolic acidosis, respiratory alkalosis, abnormal breath sounds like crackles and rales, a widened pulse pressure, and decreased cardiac output.

  • Part of the intestine slides into another part of the intestine.
  • The appendix ruptures.
  • An ileostomy stoma retracts below the abdominal surface.
  • Lungs are infiltrated.

Intussusception occurs when a part of the intestine slides into another part of the intestine. This medical emergency can lead to poor perfusion to the intestine.

The signs and symptoms of intussusception include knee to chest posturing, abdominal pain, bloody stool, fever, constipation, vomiting and diarrhea.

A ruptured appendix occurs when an infected appendix ruptures; a stoma retraction occurs when an ileostomy stoma retracts below the abdominal surface; and pneumonia occurs when the lungs become infiltrated.

  • The administration of a thrombolytic medication
  • The administration of hyroxyurea
  • Placing the client in the lithotomy position

You would expect to administer hydroxyurea which prevents the sickling of the client’s red blood cells. You would not administer a thrombolytic medication; however, you would likely administer analgesic medications for the pain associated with the sickle cell crisis.

The lithotomy position is used for procedures involving the pelvis, including gynecological examinations; and the Trendelenburg position is used when the client is in shock and with significant hypotension.

  • Perform the Valsalva maneuver
  • Encourage the person to continue coughing
  • Perform the Heimlich maneuver
  • Begin CPR and prepare for ACLS measures

You would encourage the person to continue coughing because this person has a partial airway obstruction.

You would perform the Heimlich maneuver when the person has a complete airway obstruction. CPR and ACLS may be necessary later, but not now as based on the fact that the person only has a partial airway obstruction. Lastly, the Valsalva maneuver is done when one exerts pressure against resistance.

  • Trichomoniasis
  • Staphylococcus aureus
  • Neisseria gonorrhoeae

Pelvic inflammatory disease is most often caused by the Neisseria gonorrhoeae and Chlamydia trachomatis pathogens; and it most often occurs as the result of untreated salpingitis, pelvic peritonitis, a tubo ovarian abscess and/or endometritis.

Unlike Neisseria gonorrhoeae, trichomoniasis and infections caused by E. coli and Staphylococcus aureus are not associated with the onset of pelvic inflammatory disease which can lead to infertility, increased risk for ectopic pregnancies, sepsis, septic shock and death when left untreated.

  • Adaptive immunity
  • Passive natural immunity
  • Active natural immunity
  • Active artificial immunity

The type of immunity occurs when a person has an infectious, communicable disease like the measles is active natural immunity.

Active immunity occurs as the result of our bodily response to the presence of an antigen, with the development of antibodies. Active immunity can be both natural and artificial. Natural active immunity occurs when the body produces antibodies after the client is infected with a pathogen; and artificial active immunity occurs when the body produces antibodies to an immunization vaccine such as those for pneumonia and a wide variety of childhood infectious diseases.

Adaptive immunity is the acquisition of antibodies or activated T cells in the body. Passive immunity occurs when an antibody is introduced into the body by either natural or artificial means. Passive natural immunity occurs when the fetus and neonate receive immunity as a natural process through the placenta; and passive artificial immunity occurs when the client receives an injection of immune globulin.

  • The incubation stage
  • The prodromal stage

The prodromal stage, or phase, of the infection process is characterized with general malaise, joint and muscular aches and pains, anorexia, and the presence of a headache. The prodromal stage begins with the onset of symptoms and this stage is characterized with the replication and reproduction of the pathogen.

The incubation stage is asymptomatic; the illness stage is the period of time that begins with continuation of the signs and symptoms and it continues until the symptoms are no longer as serious as they were before; and the convalescence stage is the period of recovery during which time the symptoms completely disappear.

  • They are not as effective as regular defibrillators.
  • They are replacing regular defibrillators in acute care settings.
  • Only BLS certified people in the community should use them.
  • They can be easily used by people with no healthcare experience.

Automated external defibrillators can be easily used by people with no healthcare experience. Automated external defibrillators are simple to use and there is no need to be able to recognize cardiac arrhythmias or interpret cardiac rhythm strips. Automated external defibrillations are intended to be used by the general public without any healthcare or nursing knowledge of experience; therefore, they are not restricted to only those BLS certified.

Although they are highly effective, they are not replacing the standard defibrillators in the acute care setting.

  • Episiotomy extension related to a forceps delivery
  • Respiratory depression related to NSAIDs
  • Hemothorax related to a latex allergy

Maternal trauma, lacerations, pelvic floor damage, bleeding and an inadvertent extension of the episiotomy to the anus when a forceps delivery of a new born is done.

Respiratory depression can occur as the result of narcotic analgesics such as morphine, and not NSAIDs; pneumothorax and hemothorax can occur as the result of an inadvertent perforation during invasive procedures such as the placement of a total parenteral nutrition catheter and a thoracentesis; and the signs and symptoms of a latex allergy include tachycardia, hypotension, dyspnea, chest pain tremors, and anaphylactic shock, not respiratory depression.

NCLEX Practice Questions & Tests for 2024

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NCLEX Practice Questions with Answers by Topic

  • Clinical Skills & Concepts
  • Fluid & Electrolytes
  • Mental Health
  • Pathophysiology
  • Pediatrics & OBGYN
  • Pharmacology

Clinical Skills & Concepts NCLEX Practice Questions

Access comprehensive NCLEX practice questions covering dosage calculations, EKG interpretation, Foley catheter insertion, and more.

Pregnant & elderly NCLEX practice questions with Nurse Mike and cartoon image of black pregnant woman

Fluid & Electrolytes NCLEX Practice Questions

Master essential concepts with NCLEX practice questions focusing on electrolyte lab values, fluid volume deficit, and fluid-electrolyte balance.

Fluid Volume Deficit (FVD) NCLEX Review with Nurse Linares

Med Surg NCLEX Practice Questions

Prepare for the NCLEX with targeted practice questions covering a wide range of medical-surgical topics, from acute coronary syndrome to stroke management.

Pressure Injuries NCLEX Practice Questions with Nurse Mike and cartoon image of bedsores

Mental Health NCLEX Practice Questions

Enhance your understanding of psychiatric nursing with NCLEX practice questions on cognitive behavioral therapy, therapeutic communication, and psychiatric disorders.

cognitive behavioral therapy (CBT) title card

Pathophysiology NCLEX Practice Questions

Dive deep into disease mechanisms with NCLEX practice questions exploring conditions like neurologic disorders, endocrine disorders, and stress physiology.

Neuro patho NCLEX practice questions with Nurse Mike and cartoon image of brain stem

Pediatrics & OBGYN NCLEX Practice Questions

Sharpen your knowledge of pediatric and obstetric nursing with NCLEX practice questions on topics such as infant reflexes, stages of labor, and menstrual cycle.

Menstrual Cycle NCLEX Practice Questions with Nurse Mike and cartoon image of ovaries

Pharmacology NCLEX Practice Questions

Strengthen your grasp of pharmacological principles with NCLEX practice questions covering a spectrum of medications, including analgesics, antibiotics, antipsychotics, and more.

Perfect Drug Card and Med Admin NCLEX Review

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NCLEX-RN Practice Questions for Exam Prep

Are you a nursing student preparing for the NCLEX exam in 2024?

As one of the most important exams in your career, having a comprehensive study plan that includes plenty of NCLEX practice questions is crucial. But finding the right resources can feel as overwhelming as studying for the exam!

So, what should an aspiring nurse do? First, take a deep breath, and rest assured you’ve come to the right place.

We’re here to help you prepare for success!

Empowering Your NCLEX Success in 2024

Unveiling your path to triumph, understanding the nclex-rn exam, the nclex-rn milestone, integrating practice nclex questions into prep, what’s different about the new nclex, evolution of the nclex test, adaptive testing and question variability, nclex exam question types, time limit and structure of the nclex-rn examination, strategic time management, scoring and passing standards for the nclex-rn examination, understanding nclex scoring, aiming for success, nclex-rn examination prep and study strategies, nclex-rn test plan, structured study planning, test-taking tactics, winning strategies, navigating exam day, get test ready with simplenursing.

  • NCLEX-RN Exam Frequently Asked Questions

The journey to becoming a registered nurse (RN) is an exciting one!

It’s a field full of opportunities to make a positive impact on people’s lives and further professional growth. But first, you must pass the National Council Licensure Examination for Registered Nurses (NCLEX-RN) — and that’s where we come in.

We designed our NCLEX practice question bank to help you feel confident and prepared to ace the exam in 2024.

When preparing for the NCLEX, every bit of knowledge and practice counts. That’s why you need a comprehensive guide and practice question bank that covers all the key areas you need to know to pass the exam in 2024.

But first, let’s look at what the NCLEX is all about.

The NCLEX-RN is a computer-based exam developed by the National Council of State Boards of Nursing (NCSBN).

It tests your knowledge and skills in four major categories:

  • Safe and Effective Care Environment: This category focuses on your understanding of nursing management and safety principles in various healthcare settings. It also includes legal and ethical considerations, as well as infection control protocols.
  • Health Promotion and Maintenance: This category tests your knowledge of promoting healthy practices for clients across the lifespan. Topics include disease prevention, health education, and screening.
  • Psychosocial Integrity: This category covers your understanding of nursing care’s psychological and social aspects. Topics include therapeutic communication, cultural sensitivity, and mental health disorders.
  • Physiological Integrity: Physiological integrity covers your understanding of the basic functions and systems of the human body. This includes topics like oxygenation, nutrition, mobility, and elimination. It also includes medication administration and other nursing interventions to promote physiological well-being.

The NCLEX-RN exam is a critical milestone for nursing professionals.

It’s the final step in becoming a licensed RN , and passing it demonstrates that an individual has the necessary knowledge and skills to provide safe, effective care to clients.

One of the primary reasons why the NCLEX-RN is so significant is because it sets a standard for professional nursing practice. By passing the exam, nurses demonstrate that they have met the minimum level of competency required to work in the field.

Additionally, the NCLEX-RN exam is a key component of ensuring client safety. Its rigorous testing process assesses critical thinking and clinical judgment.

Passing the NCLEX ensures that only competent, eligible individuals are providing care to clients.

Moreover, passing the exam is a personal achievement, representing years of hard work, dedication, and commitment to nursing.

One of the most effective ways to prepare for the NCLEX-RN exam is by practicing with NCLEX-style questions.

These questions mimic the format and style of the actual exam, making them an essential tool for improving test-taking skills and increasing confidence. Integrating practice NCLEX questions into your exam preparation allows you to familiarize yourself with the types of questions and the difficulty level you can expect on exam day.

Practicing with NCLEX-style questions also allows you to identify strengths and weaknesses, helping you focus study efforts on areas that need improvement.

Here are two examples of practice NCLEX questions:

  • Place the client in a restraint.
  • Encourage independence with activities of daily living.
  • Conduct hourly neurovascular checks.
  • Place a bed alarm.

Correct answer: D. Place a bed alarm.

Rationale: Placing a bed alarm is an appropriate intervention. It will alert the nurse when the client attempts to get out of bed, preventing falls.

  • “I can’t believe I have to give myself insulin shots every day.”
  • “I will need to limit my sugar intake and exercise regularly.”
  • “I guess I’ll have to switch to a low-carb diet now.”
  • “Diabetes is a lifelong condition, but I can cure it with medication.”

Correct answer: B. “I will need to limit my sugar intake and exercise regularly.”

Rationale: This statement indicates understanding the lifestyle changes necessary to manage Type 2 diabetes, including limiting sugar intake and exercising regularly. The other options either demonstrate a need for more understanding or provide incorrect information about the condition.

In addition to understanding the significance of the NCLEX-RN exam and the importance of practicing with NCLEX-style questions, it’s essential to be aware of recent changes to the exam.

In 2023, the NCSBN implemented a new version of the NCLEX-RN exam, the Next Generation NCLEX (NGN) . One key difference between the previous and the latest version is an increased emphasis on clinical judgment and decision-making skills.

The NGN project started in response to the evolving health care landscape and changing roles of nurses.

One significant change is new question types requiring test-takers to make decisions based on client scenarios rather than just recalling information. This shift puts a greater emphasis on critical thinking and decision-making skills, essential abilities for nurses at the bedside.

Another significant change in the NGN exam is the implementation of computerized adaptive testing (CAT).

This format tailors each question to an individual’s ability level, allowing for a more personalized and accurate assessment of their knowledge. In traditional exams, all test-takers receive the same questions, regardless of their abilities.

However, with CAT, individuals will receive different questions based on their previous responses, creating a more efficient and precise evaluation of their knowledge.

The NGN has introduced new NCLEX exam questions to assess higher-level thinking and clinical judgment skills.

These include:

  • Drag-and-Drop Cloze: When choosing a response, test-takers can drag an option to the answer box, keeping in mind that multiple answers might be correct. Test-takers can also drag the option back to its original list or eliminate it from the question entirely.
  • Drop-Down Cloze: This involves a section that offers a selection of drop-down choices for completing a sentence or paragraph, with each choice presenting three to five potential answers.
  • Drag-and-Drop Rational: This query involves a question with either a singular cause and effect or dual causes. Test-takers can select an answer from a list and place it over a specified target. They can easily drag the answer back to the list or remove it if they want to change their choice. This method ensures a dynamic and interactive approach to assessing understanding, allowing for a straightforward and efficient evaluation process.
  • Drop Down Rationale and Table: This type of question involves one sentence that outlines a cause and its effects, potentially leading to multiple outcomes. The response might take the form of a dyad, consisting of a single sentence with two options to choose from, or a triad, presenting a single sentence accompanied by three selectable options.
  • Matrix Multiple Choice and Response: These inquiries consist of four to ten lines, each offering two or three choices. Participants must select one option per line to proceed. Completing all selections is mandatory before moving on to the subsequent question.
  • Multiple Response Select N: This type stands out from other multiple-choice questions because test-takers select only a specified number of options, unlike in other formats where they might be allowed to choose all that apply.
  • Multiple Response Grouping: The multiple-choice question format involves a structured table containing two to five categories, each offering two to four choices. All categories feature an equal number of options, requiring test-takers to make at least one selection per category to proceed.
  • Highlight Text and Table: Taste-takers select key parts of the text to pinpoint what’s crucial for the task at hand. The type of question features answers broken down into manageable pieces, with a limit of ten options available. Test-takers have the flexibility to choose or remove options as they deem appropriate.
  • Trend: This question type explores the NCSBN Clinical Judgement Measurement Model (NCJMM), a series of steps to assess clinical judgment.

Test-takers must answer a minimum of 85 questions and a maximum of 150 questions. They must complete the exam in five hours, including breaks.

The test-taker’s performance determines the length of the exam. It automatically ends when the computer determines that the test-taker has reached or exceeded the passing standard. The recommended time to spend on each question is up to two minutes per question.

It’s essential to have a strategic plan in place to manage time effectively during the NCLEX-RN exam.

This includes practicing time management techniques during preparation, such as timing yourself while taking an NCLEX practice test and setting aside specific study periods for each subject area. On exam day, consider using a watch or timer to keep track of your pace and ensure you don’t spend too much time on a single question.

We also recommend taking breaks during the exam to avoid mental fatigue and keep your mind fresh for each section. Taking advantage of these breaks can help you recharge and refocus, increasing your overall performance on the exam.

Did you know an average of 42% of all NCLEX-RN takers will fail (including first-timers and retakers)?

We don’t say this to scare you but to emphasize the importance of understanding the scoring process and what it takes to pass.

The NCLEX-RN exam uses a CAT system to determine a test-taker’s final score. This adaptive system selects each question based on the test-taker’s previous responses, with the difficulty level increasing or decreasing depending on their performance.

It also allows for a more accurate measure of each individual’s nursing knowledge and clinical judgment.

The final score is determined by a pass/fail system, with the NCSBN establishing a minimum passing standard .

This passing standard is based on analyzing each question’s difficulty level and content to ensure only those who demonstrate a safe level of nursing knowledge and clinical judgment will pass the exam.

Aim for proficiency rather than just the minimum passing standard to increase your chances of passing the NCLEX-RN exam.

This means having a thorough understanding of nursing concepts and being able to apply them in different scenarios. Studying beyond what’s required and practicing with NCLEX sample questions can help you achieve this level of proficiency.

It’s also important to manage test anxiety and maintain a positive mindset during the exam. Remember that you have prepared for this moment.

Lastly, don’t be discouraged if you fail your first attempt. Many successful nurses have taken the NCLEX multiple times before passing.

Use your experience to identify areas of improvement and continue to strive for proficiency in all aspects of nursing.

Preparing for the NCLEX-RN exam can be daunting, but it’s manageable with the right strategies and study programs .

Here are tips to help you prepare.

The NCLEX-RN Test Plan is a detailed outline of the exam’s content and format.

Familiarizing yourself with the test plan early will help you create an effective study plan.

Create a structured study schedule that fits your learning style and personal commitments.

Some prefer studying for shorter periods with more frequent breaks, while others may work better with longer study sessions. Choose a method that works best for you and stick to it.

To supplement your studying, use comprehensive resources like:

  • NCLEX-RN practice questions
  • Online courses
  • Predictor tests
  • Review books

Knowing how to approach different types of questions can make a significant difference in your test score.

Three useful techniques include:

  • Reading the question and all possible answers carefully before choosing an answer
  • Eliminating obviously incorrect answers first to narrow down options
  • Ruling out extreme answers or those not supported by nursing principles

Understanding the exam format is crucial for success.

Answer each question to the best of your ability, as unanswered questions and incorrect answers can result in lower scores. Additionally, maintaining confidence during the exam is key.

Don’t let challenging questions discourage you.

On exam day, eat a healthy breakfast.

Stay focused during the exam by taking breaks and managing any test-related stress.

In addition to these general strategies, a comprehensive platform like SimpleNursing can increase your chances of success on the NCLEX exam.

We offer animated videos, cheat sheets , practice questions, colorful study guides, and more specifically designed for nursing students preparing for exams.

Don’t let test anxiety or lack of preparation prevent you from achieving your nursing career goals. Sign up for a free trial today and get one step closer to passing the NCLEX exam!

Frequently asked questions

What makes the nclex test questions so hard.

The NCLEX test questions assess critical thinking skills and the ability to make safe decisions as a nurse.

How many questions are on the NCLEX?

The NCLEX has between 85 and 150 questions, but the number of questions a test-taker receives depends on how they answer the previous questions.

Can I retake the NCLEX if I fail?

Yes. However, it is important to review and improve your study strategies . Using a digital NCLEX remediation tool , like SimpleNursing, can help you pinpoint areas for improvement.

How many times can I take the NCLEX?

You can retake the NCLEX up to eight times per year .

How do I get an NCLEX authorization to test (ATT)?

You’ll receive an ATT from the NCSBN after completing the required education and submitting an application.

How long does it take to get NCLEX results?

You typically receive results in about six weeks . But you can use the Pearson Vue NCLEX trick to get unofficial results.

What are the requirements for taking the NCLEX?

You must have graduated from an accredited nursing program . This requirement ensures that all test-takers have a solid foundation in nursing knowledge and skills . You must also complete clinical hours, have a criminal background check, and provide proof of identity.

What do I need to bring to the NCLEX?

You must bring a valid ID and your ATT. Consider bringing a watch and wearing clothing to help you stay comfortable during the exam. If you need accommodations , make sure to notify the testing center ahead of time.

Can I take the NCLEX at home?

No, the NCLEX is a proctored exam , and you must take it at an authorized testing center. There are no provisions for taking the exam remotely.

How do I schedule my NCLEX exam?

You can schedule your exam through the Pearson Vue website or by phone . You’ll need your ATT and payment information to complete the scheduling process.

Education: Bachelor of Arts in Communications, University of Alabama

These NCLEX Practice Questions are made to mimic the actual exam. As such, some question types are more easily viewed on desktop computers.

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Practice with NCLEX-Style Sample Questions

Practicing with high-quality Next Generation and NCLEX-style sample questions is the most effective way to prepare for the exam, because if practice feels like the actual exam, then the real thing will feel like practice.

Check out our free NCLEX sample questions below!

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The Best NCLEX-Style Practice Questions

We are committed to providing you with only the best questions and explanations. Our NGN practice questions include the same hallmark features that have helped over a million nurses succeed – clinically-relevant content, vivid imagery and illustrations, and in-depth explanations for correct and incorrect answers.

Benefit from Exam-Like Practice

Learn from detailed rationales, customize tests to your needs, free nclex-style sample practice questions.

The best way to become more familiar with NCLEX-style questions is by practicing them. You’ve been through nursing school, so you have the knowledge. Now you just need to apply it. Choose your exam below to answer a few exam style questions …

The questions on the NCLEX-RN are designed to test your critical thinking skills and ability to apply knowledge in real-world scenarios. Don’t waste time practicing low-level questions! Challenge yourself with our NCLEX-RN sample questions.

The nurse is caring for a client at 39 weeks gestation who is receiving an IV oxytocin infusion for induction of labor. The nurse notes recurrent late decelerations on the fetal monitor. Which of the following actions should the nurse take? Select all that apply .

1. Administer an IV fluid bolus
2. Apply abdominal vibroacoustic stimulation
3. Discontinue the IV oxytocin infusion
4. Prepare the client for an amnioinfusion
5. Reposition the client laterally

Explanation:

nursing assignment questions

A late deceleration is a gradual decrease in fetal heart rate (FHR) with a uterine contraction that reaches its lowest point (ie, nadir) after the contraction’s peak with a slow return to baseline. Late decelerations occur as a reflexive chemoreceptor response to temporary fetal hypoxemia or fetal metabolic acidemia (in severe cases). Uteroplacental insufficiency, uterine tachysystole , and maternal supine hypotension are common causes because they compromise perfusion and oxygen availability to the fetus.

Intrauterine resuscitation interventions to improve fetal perfusion and oxygenation include:

  • Administering an IV fluid bolus to increase maternal blood volume (Option 1)
  • Discontinuing the IV oxytocin infusion to reduce uterine stimulation and decrease contraction frequency because relaxation of the uterus increases uteroplacental blood flow and fetal oxygenation (Option 3)
  • Repositioning the client laterally to relieve compression of the maternal inferior vena cava , which can be occluded by the weight of the gravid uterus when supine (Option 5)

The mnemonic VEAL CHOP helps recall of causes of FHR changes on monitor tracings.

(Option 2) Vibroacoustic stimulation is used during nonreactive nonstress tests (ie, no accelerations) to provoke fetal movement, which helps determine whether the absence of expected accelerations is physiologic (eg, fetal sleep cycle) or pathophysiologic (ie, fetal acidemia). It is never performed during FHR decelerations or fetal bradycardia.

(Option 4) An amnioinfusion is indicated to relieve persistent, recurrent variable decelerations caused by umbilical cord compression. It is not indicated for late FHR decelerations or uterine tachysystole.

Educational objective: Late decelerations of fetal heart rate indicate compromised fetal oxygenation and perfusion. Intrauterine resuscitation interventions include administering an IV fluid bolus, discontinuing the IV oxytocin infusion, and repositioning the client laterally.

The nurse is delegating client care tasks to a licensed practical nurse (LPN) and unlicensed assistive personnel. Which of the following assignments are most appropriate to assign to the LPN? Select all that apply .

1. Administer a client’s daily dose of subcutaneous insulin glargine
2. Administer a scheduled oral analgesic to a 2 days postoperative client
3. Complete an admission nursing interview for a client admitted for elective hysterectomy
4. Reinforce teaching on self-administration of insulin to a client with diabetes mellitus
5. Tally the shift’s intake and outputs for the entire unit
Scope of practice
RN LPN/LVN UAP

*Limited assessments (eg, lung sounds, bowel sounds, neurovascular checks).

 = licensed practical nurse;  = licensed vocational nurse;  = registered nurse;  = unlicensed assistive personnel.

Nurses preparing to delegate client care to a licensed practical nurse (LPN) and/or unlicensed assistive personnel (UAP) should consider the 5 rights of delegation . The LPN can monitor and care for stable clients who have been initially evaluated by a registered nurse (RN). Interventions LPNs may perform include:

  • Administering oral and parenteral medications , but excluding administering IV medications, which vary by state legislation (Options 1 and 2)
  • Reinforcing teaching and skills that have been initially taught by the RN (Option 4)
  • Focused assessments (eg, bowel sounds) after the RN’s initial assessment

(Option 3) Performing admission or initial assessments is outside the scope of the LPN and UAP. The RN must perform initial assessments in order to analyze the findings and formulate the client’s plan of care before delegating tasks.

(Option 5) The LPN is capable of performing routine care (eg, calculating daily intake and output, toileting). However, the UAP may also perform these tasks, which frees the LPN to perform more complex duties. Therefore, the most appropriate staff member to assign the task of calculating intake and output to is the UAP.

Educational objective: Nurses preparing to delegate client care should consider the 5 rights of delegation. Appropriate tasks to delegate to a licensed practical nurse include administration of oral and parenteral medications, excluding IV route, and reinforcement of teaching previously provided by the registered nurse.

The nurse cares for a client with aortic stenosis who was admitted due to syncope on exertion and dyspnea. Identify the area where the nurse would best auscultate the client’s heart murmur.

Think of a location on the image which you deem right and click on ‘Show Correct Regions’ link to see if your selection is correct .

nursing assignment questions

Aortic stenosis (AS) is a type of valvular heart disease characterized by narrowing of the aortic valve opening, which limits the left ventricle’s ability to eject blood into the aorta. AS may occur from hardening (ie, calcification) of the valves, congenital heart disorders, or inflammation. If left untreated, AS may result in heart failure and pulmonary hypertension as compensatory mechanisms fail.

When assessing a client with AS, the nurse should auscultate in the aortic area (ie, second intercostal space at the right sternal border) for a loud, systolic ejection murmur heard following the first heart sound. The aortic area, rather than directly over the heart valve, is the preferred location for auscultation as the heart sounds travel in the direction the blood flows. Additional clinical manifestations of aortic stenosis include chest pain, shortness of breath, and/or syncope that are worsened by exertion.

Educational objective : Aortic stenosis is a type of valvular heart disease causing narrowing of the valve between the left ventricle and aorta, impairing ejection of blood from the heart. Nurses attempting to auscultate heart murmurs associated with aortic stenosis should listen at the right sternal border, second intercostal space (ie, aortic area).

A health care provider prescribes cefuroxime 30 mg/kg/day PO divided in equal doses every 12 hours for a child with a urinary tract infection. The child weighs 34 lb. Based on the available concentration of cefuroxime, how many mL would the nurse administer per dose? Click the exhibit button for additional information. Record your answer using one decimal place .

Answer:

Correct Answer : 4.6 mL

nursing assignment questions

Using dimensional analysis, the following steps are performed to calculate the volume of cefuroxime per dose in milliliters:

Identify the prescribed, available, and required medication information

Prescribed: 30 mg cefuroxime / kg / day   Available: 250 mg cefuroxime / 5 mL   Required: mL / dose

Convert the prescription to the volume needed for administration using dimensional analysis

Prescription × available data = mL per dose

( mg cefuroxime / kg / day ) ( kg / lb ) ( lb /   )( day / dose ) ( mL / mg cefuroxime ) = mL cefuroxime / dose

( 30 mg cefuroxime / kg / day ) ( kg / 2.2 lb ) ( 34 lb /   )( day / 2 doses ) ( 5 mL / 250 mg cefuroxime ) = 4.63 63 mL cefuroxime / dose

Round to the first decimal place

4.63 63 mL / dose = 4.6 mL / dose

Educational objective: To calculate the volume of cefuroxime in milliliters per dose, the nurse should first identify the prescribed dose (eg, 30 mg/kg/day) and available medication (eg, 250 mg/5 mL) and then convert to volume in milliliters per dose (eg, 4.6 mL).

Alternative Method :

The formula method is an alternate way to calculate medication dosages. However, this method may increase the occurrence of miscalculation and medication errors. If you choose to use this method, do not round calculations until the final step .

Using the formula method, the following steps are performed to calculate the volume of cefuroxime per dose in milliliters:

Convert pounds to kilograms

( kg / 2.2 lb ) ( 34 lb /   ) = 15.45 45 kg

Calculate the prescribed dose in milligrams

( 30 mg cefuroxime / kg / day ) ( 15.45 45 kg /   ) ( day / 2 doses ) = 231.81 81 mg cefuroxime / dose

Convert the prescription to administration volume

Prescribed dose / available dose x available volume = dose in ML

231.81 81 mg cefuroxime / 250 mg cefuroxime x 5 mL = 4.63 63 mL cefuroxime / dose

The nurse receives new prescriptions for a client with right lower quadrant pain and suspected acute appendicitis. Which prescription should the nurse implement first?

1. Administer 0.25 mg hydromorphone IV push for pain
2. Draw blood for complete blood count and electrolyte levels.
3. Initiate IV access and infuse normal saline 100 mL/hr
4. Obtain urine specimen for urinalysis

nursing assignment questions

Appendicitis is inflammation of the appendix and often results from obstruction by fecal matter. Appendiceal obstruction traps fluid and mucus typically secreted into the colon, causing increased intraluminal pressure and inflammation. As appendiceal intraluminal pressure and inflammation increase, blood circulation to the appendix is impaired, resulting in swelling and ischemia . These factors increase the risk for appendiceal perforation , a medical emergency , which may lead to peritonitis and sepsis .

When prioritizing care of the client with appendicitis, the nurse should utilize the ABCs (ie, a irway, b reathing, c irculation). Fluid resuscitation with IV crystalloids (eg, normal saline, lactated Ringer solution) is an important intervention aimed at preventing circulatory collapse resulting from fluid losses (eg, vomiting, diarrhea) and NPO status (Option 3).

(Option 1) Pain medications may be administered to promote comfort, but should be administered via IV route to maintain NPO status in case of emergency surgery. However, circulation takes priority over pain medication.

(Options 2 and 4) Blood and urine samples often are prescribed to assist with treatment and care decisions. However, the nurse should prioritize circulatory status over obtaining laboratory specimens.

Educational objective: Nurses caring for clients with appendicitis should prioritize client care according to the ABCs (ie, airway, breathing, circulation). Initiating IV crystalloids (eg, normal saline) is a priority action that prevents circulatory collapse resulting from fluid losses (eg, vomiting, diarrhea) and NPO status.

NCLEX-style practice questions can help you identify areas where you may need additional study or review. Every question in our NCLEX-PN QBank includes detailed rationales for the correct and incorrect answers, so you learn as you practice.

The nurse auscultates the heart sounds of a 77-year-old client with chronic heart failure. Which heart sound should the nurse document? Listen to the audio clip . (Headphones are required for best audio quality.)

1. Pericardial friction rub
2. S1, S2, no adventitious sounds
3. S3 extra heart sound
4. Systolic murmur

nursing assignment questions

S1 and S2 are the normal “lub-dub” heart sounds that result from closure of valves . Systole occurs between S1 and S2, with S1 indicating closure of the atrioventricular (tricuspid, mitral) valves and S2 indicating closure of the pulmonic and aortic valves.

S3 is an adventitious (extra) heart sound heard as “ DUB ” immediately following S2 (Option 3) . S3 occurs during early diastole as a result of rapid ventricular filling and is a normal finding in children and young adults. In older adults , S3 is an abnormal finding that often indicates heart failure because the sound results from decreased ventricular compliance.

S3 can be difficult to distinguish from S4 . S4 is a “LUB” sound that occurs immediately before S1, during late diastole, and indicates ventricular hypertrophy.

(Option 1) A pericardial friction rub is a creaky, grating sound heard throughout systole and diastole. Friction rub occurs with pericarditis and is due to friction between inflamed layers of pericardium.

(Option 2) S1 and S2 are the normal heart sounds heard during cardiac auscultation.

(Option 4) A murmur is a swooshing, blowing, or rumbling sound caused by turbulent blood flow (eg, from valve regurgitation or stenosis).

Educational objective: S3, the third heart sound, is a “DUB” sound that immediately follows S2. It is a normal finding in children and young adults. S3, an abnormal finding in older adults, often indicates heart failure.

A client with a hip fracture is placed in Buck traction. Which activities are appropriate for the nurse to include in the client’s plan of care? Select all that apply .

1. Assess for skin breakdown of the limb in traction
2. Ensure adequate pain relief
3. Keep the limb in a neutral position
4. Perform frequent neurovascular checks on the limb in traction
5. Reposition the client and use a wedge pillow for the entire unit

nursing assignment questions

Buck traction is a type of skin traction used to immobilize hip fractures and reduce pain and spasm until the client can undergo surgical repair of the fracture. A traction boot is applied to the leg, below the fracture site. A weight gently and continuously pulls on the leg and hip, helping maintain alignment of the limb. The nurse should ensure that the traction boot is fitted properly and that the limb remains straight in a neutral position (Option 3) .

Skin traction exerts pressure on nerves, blood vessels, and soft tissue. The nurse should frequently assess neurovascular status (eg, pulse, capillary refill, color, temperature, sensation, movement) and skin integrity in the limb to which the boot is applied (Options 1 and 4) . Overall pain level and efficacy of administered pain medications should be monitored closely, as increasing pain in the limb in traction may indicate neurovascular compromise (Option 2) .

(Option 5) Side-to-side repositioning of the client in Buck traction can cause injury. Side-to-side position changes cause the affected leg to be adducted or abducted, which, when paired with the force of traction, can increase spasm and pain and contribute to neurovascular and orthopedic compromise.

Educational objective: Buck traction is used to immobilize hip fractures and reduce pain and spasm until the fracture can be repaired surgically. The nurse caring for a client in Buck traction should frequently assess the neurovascular status and skin integrity of the affected limb and maintain it in a straight, neutral position.

The nurse is assigned to care for four clients. Which client should the nurse see first? .

1. Female client who had an arthroscopic rotator cuff repair with sling immobilization and reports moderate swelling and tingling of the hand and fingers
2. Female client who had an open reduction and internal fixation of the tibia and reports severe pain and pressure under the cast and inability to move the toes
3. Male client who has two new prosthetic legs applied after traumatic, bilateral, below-the-knee amputation and reports crushing pain in the amputated areas
4. Male client who has a hematocrit of 37% and hemoglobin of 12.5 g/dL and is prescribed enoxaparin 1 day after a total hip arthroplasty
Clinical manifestations of compartment syndrome (7 Ps)

Tingling, numbness, burning

Out of proportion to injury, unrelieved by medication

Taut skin, cast fits too tightly

Pale skin tone, decreased color, white, gray

Possibly weakened or lost

Cool skin temperature, matches room temperature

Weakness, loss of motor activity

Compartment syndrome occurs when swelling in a tissue compartment causes compression of arteries and nerves, typically after a direct injury (eg, fracture, dislocation) or medical device placement (eg, cast, splint). Tissue perfusion and nerve function distal to the swelling become impaired, causing signs of neurovascular compromise (eg, severe, unrelenting pain; paralysis ) due to tissue ischemia . Without relieving compartment pressure (ie, cast removal, fasciotomy), ischemia leads to permanent nerve and tissue damage and/or loss of limb (Option 2) .

(Option 1) Edema and numbness or tingling (paresthesia) of the hands and fingers commonly occur from inappropriate sling application. Numbness and tingling also are early signs of compartment syndrome. However, the client with late signs of compartment syndrome (eg, paralysis) should be seen first.

(Option 3) Clients with amputations may experience phantom limb pain that is severe and described as burning or crushing and requires pain management. However, limb-threatening emergencies should be managed first.

(Option 4) Slightly decreased hematocrit and hemoglobin levels (normal male: 39%-50%, 13.2-17.3 g/dL, respectively) are expected after hip arthroplasty due to intra- and postoperative blood loss.

Educational objective : Compartment syndrome is a condition of impaired circulation due to increased tissue pressure, often from edema or medical devices. Clients with signs of compartment syndrome (eg, severe, unrelenting pain; paralysis) require immediate assessment and intervention to prevent permanent tissue damage or loss of limb.

The nurse is reinforcing teaching about constipation prevention to a client. Which of the following client statements indicate appropriate understanding of the teaching? Select all that apply .

1. “Drinking more caffeinated drinks such as tea and soda helps to stimulate the bowel.”
2. “Having a routine for bowel movements is important, but I should not wait if I feel the urge.”
3. “I can use an over-the-counter laxative every other day if needed.”
4. “I should try to eat more fruits and vegetables every day.” on the limb in traction
5. “Increasing my daily exercise level may help keep my bowel movements regular.” pillow for the entire unit

nursing assignment questions

Constipation is a symptom of many disease processes (eg, Parkinson disease, diabetic neuropathy, depression), procedures (eg, abdominal surgery, bowel manipulation), and medications (eg, anticholinergics, diuretics, opioids). Immobility, low-fiber diets, decreased fluid intake , and irregular bowel habits increase the likelihood of constipation. Educate clients to prevent constipation by:

  • Encouraging a healthy bowel regimen (eg, avoid delaying defecation if the urge is felt, defecate at the same time daily when possible, track bowel movements to identify changes in patterns) (Option 2)
  • Increasing consumption of fruits and vegetables to reach a daily fiber intake of at least 20 g (unless contraindicated) because fiber softens and increases the bulk of stool, which promotes defecation (Option 4)
  • Increasing daily exercise because activity stimulates peristalsis and promotes defecation (Option 5)
  • Drinking 2-3 L of noncaffeinated fluids daily (unless contraindicated), which prevents drying and hardening of stool in the colon

(Option 1) Clients should avoid caffeinated beverages, which promote diuresis and dehydration and may lead to constipation.

(Option 3) Clients should avoid using laxatives and enemas unless prescribed by a health care provider because overuse can result in physical and psychological dependency.

Educational objective: Constipation is a symptom of many disease processes, procedures, and medications. To prevent constipation, educate the client to increase daily fiber intake, drink 2-3 L of fluids daily, increase daily activity levels, and initiate a bowel regimen (eg, avoiding delay of defecation, defecating at the same time each day).

The nurse is assigning client care tasks to unlicensed assistive personnel. Which statement by the nurse is appropriate?

1. “I need you to take vital signs on all clients in rooms 1 through 10 this morning.”
2. “Mrs. Jones fell out of bed during the night while walking to the commode. Please monitor her closely.”
3. “Please ensure that Mr. Garcia in room 8 ambulates several times.”
4. “Please take Mr. Wu’s vital signs in 10 minutes and let me know if his systolic blood pressure is
Five rights of delegation

When assigning client care, the nurse must consider the five rights of delegation. Right direction/communication involves clear and precise instructions about assigned tasks, including any specific information necessary for completion . Necessary information includes the specific tasks (eg, take vital signs), the time frame (eg, in 10 minutes), and when to report back to the nurse (eg, if systolic blood pressure is (Option 4) .

(Option 1) Assigning unlicensed assistive personnel (UAP) to measure vital signs “this morning” does not provide a clear time frame (eg, in 1 hour) for completion. In addition, there is no communication about what the nurse expects in terms of follow-up.

(Option 2) Instructing the UAP to monitor the client closely is an unclear direction because it does not provide specific actions to perform (eg, “Set the bed alarm.”), time intervals for performance (eg, “Check on the patient every hour.”), or criteria to report to the nurse (eg, “Notify me if the client attempts to exit the bed unassisted.”).

(Option 3) Instructing the UAP to assist with ambulation “several times” does not give a specific time frame or distance for the client to ambulate. The nurse should also communicate the conditions or aids needed to accomplish the task (eg, walks with assistance or rolling walker).

Educational objective: Nurses assigning client care to unlicensed assistive personnel must consider the five rights of delegation. Right direction/communication involves providing clear instructions about the assigned tasks, specific information needed for task completion, the time frame, and when to report back to the nurse.

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NGN Question Types & Scoring

The Next Generation NCLEX was launched on April 1, 2023 and the updated exam now contains new item types designed to better measure candidates’ clinical judgment. NCSBN also introduced a new partial credit NGN scoring model . Depending on the item type used, the 0/1 scoring rule, +/- scoring rule, or rationales scoring rule may be applied.

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PICOT Question Examples for Nursing Research

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Are you looking for examples of nursing PICOT questions to inspire your creativity as you research for a perfect nursing topic for your paper? You came to the right place.

We have a comprehensive guide on how to write a good PICO Question for your case study, research paper, white paper, term paper, project, or capstone paper. Therefore, we will not go into the details in this post. A good PICOT question possesses the following qualities:

  • A clinical-based question addresses the nursing research areas or topics.
  • It is specific, concise, and clear.
  • Patient, problem, or population.
  • Intervention.
  • Comparison.
  • Includes medical, clinical, and nursing terms where necessary.
  • It is not ambiguous.

For more information, read our comprehensive PICOT Question guide . You can use these questions to inspire your PICOT choice for your evidence-based papers , reports, or nursing research papers.

If you are stuck with assignments and want some help, we offer the best nursing research assignment help online. We have expert nursing writers who can formulate an excellent clinical, research, and PICOT question for you. They can also write dissertations, white papers, theses, reports, and capstones. Do not hesitate to place an order.

List of 180 Plus Best PICOT Questions to Get Inspiration From

Here is a list of nursing PICO questions to inspire you when developing yours. Some PICOT questions might be suitable for BSN and MSN but not DNP. If you are writing a change project for your DNP, try to focus on PICOT questions that align to process changes. 

  • Among healthy newborn infants in low- and middle-income countries (P), does early skin-to-skin contact of the baby with the mother in the first hour of life (I) compared with drying and wrapping (C) have an impact on neonatal mortality, hypothermia or initiation/exclusivity/ duration of breastfeeding (O)?
  • Is it necessary to test blood glucose levels 4 times daily for a patient suffering from Type 1 diabetes?
  • Does raising the head of the bed of a mechanically ventilated patient reduce the chances of pneumonia?
  • Does music therapy is an effective mode of PACU pain management for patients who are slowly coming out from their anesthesia?
  • For all neonates (P), should vitamin K prophylaxis (I) be given for the prevention of vitamin K deficiency bleeding (O)?
  • For young infants (0-2 months) with suspected sepsis managed in health facilities (P), should third generation cephalosporin monotherapy (I) replace currently recommended ampicillin-gentamicin combination (C) as first line empiric treatment for preventing death and sequelae (O)?
  • In low-birth-weight/pre-term neonates in health facilities (P), is skin-to-skin contact immediately after birth (I) more effective than conventional care (C) in preventing hypothermia (O)?
  • In children aged 259 months (P), what is the most effective antibiotic therapy (I, C) for severe pneumonia (O)?
  • Is skin-to-skin contact of the infant with the mother a more assured way of ensuring neonatal mortality compared to drying and wrapping?
  • Are oral contraceptives effective in stopping pregnancy for women above 30 years?
  • Is spironolactone a better drug for reducing the blood pressure of teenagers when compared to clonidine?
  • What is the usefulness of an LP/spinal tap after the beginning of antivirals for a pediatric population suffering from fever?
  • In children aged 259 months in developing countries (P), which parenteral antibiotic or combination of antibiotics (I), at what dose and duration, is effective for the treatment of suspected bacterial meningitis in hospital in reducing mortality and sequelae (O)?
  • Does the habit of washing hands third-generation workers decrease the events of infections in hospitals?
  • Is the intake of zinc pills more effective than Vitamin C for preventing cold during winter for middle-aged women?
  • In children with acute severe malnutrition (P), are antibiotics (I) effective in preventing death and sequelae (O)?
  • Among, children with lower respiratory tract infection (P), what are the best cut off oxygen saturation levels (D), at different altitudes that will determine hypoxaemia requiring oxygen therapy (O)?
  • In infants and children in low-resource settings (P), what is the most appropriate method (D) of detecting hypoxaemia in hospitals (O)?
  • In children with shock (P), what is the most appropriate choice of intravenous fluid therapy (I) to prevent death and sequelae (O)?
  • In fully conscious children with hypoglycaemia (P) what is the effectiveness of administering sublingual sugar (I)?
  • Is using toys as distractions during giving needle vaccinations to toddlers an effective pain response management?
  • What is the result of a higher amount of potassium intake among children with low blood pressure?
  • Is cup feeding an infant better than feeding through tubes in a NICU setup?
  • Does the intervention of flushing the heroin via lines a more effective way of treating patients with CVLs/PICCs?
  • Is the use of intravenous fluid intervention a better remedy for infants under fatal conditions?
  • Do bedside shift reports help in the overall patient care for nurses?
  • Is home visitation a better way of dealing with teen pregnancy when compared to regular school visits in rural areas?
  • Is fentanyl more effective than morphine in dealing with the pain of adults over the age of 50 years?
  • What are the health outcomes of having a high amount of potassium for adults over the age of 21 years?
  • Does the use of continuous feed during emesis a more effective way of intervention when compared to the process of stopping the feed for a short period?
  • Does controlling the amount of sublingual sugar help completely conscious children suffering from hypoglycemia?
  • Is the lithotomy position an ideal position for giving birth to women in labor?
  • Does group therapy help patients with schizophrenia to help their conversational skills?
  • What are the probable after-effects, in the form of bruises and other injuries, of heparin injection therapy for COPD patients?
  • Would standardized discharge medication education improve home medication adherence in adults age 65 and older compared to-standardized discharge medication education?
  • In patients with psychiatric disorders is medication non-compliance a greater risk compared with adults experiencing chronic illness?
  • Is the use of beta-blockers for lowering blood pressure for adult men over the age of 70 years effective?
  • Nasal swab or nasal aspirate? Which one is more effective for children suffering from seasonal flu?
  • What are the effects of adding beta-blockers for lowering blood pressure for adult men over the age of 70 years?
  • Does the process of stopping lipids for 4 hours an effective measure of obtaining the desired TG level for patients who are about to receive TPN?
  • Is medical intervention a proper way of dealing with childhood obesity among school-going children?
  • Can nurse-led presentations of mental health associated with bullying help in combating such tendencies in public schools?
  • What are the impacts of managing Prevacid before a pH probe study for pediatric patients with GERD?
  • What are the measurable effects of extending ICU stays and antibiotic consumption amongst children with sepsis?
  • Does the use of infrared skin thermometers justified when compared to the tympanic thermometers for a pediatric population?
  • What are the roles of a pre-surgery cardiac nurse in order to prevent depression among patients awaiting cardiac operation?
  • Does the increase in the habit of smoking marijuana among Dutch students increase the chances of depression?
  • What is the direct connection between VAP and NGT?
  • Is psychological intervention for people suffering from dementia a more effective measure than giving them a placebo?
  • Are alarm sensors effective in preventing accidents in hospitals for patients over the age of 65 years?
  • Is the sudden change of temperature harmful for patients who are neurologically devastated?
  • Is it necessary to test blood glucose levels, 4 times a day, for a patient suffering from Type 1 diabetes?
  • Is the use of MDI derive better results, when compared to regular nebulizers, for pediatric patients suffering from asthma?
  • What are the effects of IVF bolus in controlling the amount of Magnesium Sulfate for patients who are suffering from asthma?
  • Is the process of stopping lipids for 4 hours an effective measure of obtaining the desired TG level for patients who are about to receive TPN?
  • What are the standards of vital signs for a pediatric population?
  • Is daily blood pressure monitoring help in addressing the triggers of hypertension among males over 65 years?
  • Does receiving phone tweets lower blood sugar levels for people suffering from Type 1 diabetes?
  • Are males over the age of 30 years who have smoked for more than 1 year exposed to a greater risk of esophageal cancer when compared to the same age group of men who have no history of smoking?
  • Does the increase in the use of mosquito nets in Uganda help in the reduction of malaria among the infants?
  • Does the increase in the intake of oral contraceptives increase the chances of breast cancer among 20-30 years old women in the UK?
  • In postpartum women with postnatal depression (P), does group therapy (I) compared to individual therapy (C) improve maternal-infant bonding (O) after eight weeks (T)?
  • In patients with chronic pain (P), does mindfulness-based cognitive therapy (I) compared to pharmacotherapy (C) improve quality of life (O) after 12 weeks (T)?
  • In patients with type 2 diabetes (P), does continuous glucose monitoring (I) compared to self-monitoring of blood glucose (C) improve glycemic control (O) over a period of three months (T)?
  • In patients with chronic kidney disease (P), does a vegetarian diet (I) compared to a regular diet (C) slow the decline in renal function (O) after one year (T)?
  • In pediatric patients with acute otitis media (P), does delayed antibiotic prescribing (I) compared to immediate antibiotic prescribing (C) reduce antibiotic use (O) within one week (T)?
  • In older adults with dementia (P), does pet therapy (I) compared to no pet therapy (C) decrease agitation (O) after three months (T)?
  • In patients with chronic heart failure (P), does telemonitoring of vital signs (I) compared to standard care (C) reduce hospital readmissions (O) within six months (T)?
  • In patients with anxiety disorders (P), does exposure therapy (I) compared to cognitive therapy (C) reduce anxiety symptoms (O) after 12 weeks (T)?
  • In postpartum women with breastfeeding difficulties (P), does lactation consultation (I) compared to standard care (C) increase breastfeeding rates (O) after four weeks (T)?
  • In patients with chronic obstructive pulmonary disease (P), does long-acting bronchodilator therapy (I) compared to short-acting bronchodilator therapy (C) improve lung function (O) after three months (T)?
  • In patients with major depressive disorder (P), does bright light therapy (I) compared to placebo (C) reduce depressive symptoms (O) after six weeks (T)?
  • In patients with diabetes (P), does telemedicine-based diabetes management (I) compared to standard care (C) improve glycemic control (O) over a period of six months (T)?
  • In patients with chronic kidney disease (P), does a low-phosphorus diet (I) compared to a regular diet (C) decrease serum phosphate levels (O) after one year (T)?
  • In pediatric patients with acute gastroenteritis (P), does probiotic supplementation (I) compared to placebo (C) reduce the duration of diarrhea (O) within 48 hours (T)?
  • In patients with chronic pain (P), does acupuncture (I) compared to sham acupuncture (C) reduce pain intensity (O) after eight weeks (T)?
  • In older adults at risk of falls (P), does a home modification program (I) compared to no intervention (C) reduce the incidence of falls (O) over a period of six months (T)?
  • In patients with schizophrenia (P), does cognitive remediation therapy (I) compared to standard therapy (C) improve cognitive function (O) after one year (T)?
  • In patients with chronic kidney disease (P), does angiotensin-converting enzyme inhibitors (I) compared to angiotensin receptor blockers (C) slow the progression of renal disease (O) over a period of two years (T)?
  • In postoperative patients (P), does chlorhexidine bathing (I) compared to regular bathing (C) reduce the risk of surgical site infections (O) within 30 days (T)?
  • In patients with type 2 diabetes (P), does a low-carbohydrate, high-fat diet (I) compared to a low-fat diet (C) improve glycemic control (O) over a period of six months (T)?
  • In patients with chronic obstructive pulmonary disease (P), does pulmonary rehabilitation combined with telemonitoring (I) compared to standard pulmonary rehabilitation (C) improve exercise capacity (O) after three months (T)?
  • In patients with heart failure (P), does a nurse-led heart failure clinic (I) compared to usual care (C) improve self-care behaviors (O) after six months (T)?
  • In postpartum women with postnatal depression (P), does telephone-based counseling (I) compared to face-to-face counseling (C) reduce depressive symptoms (O) after eight weeks (T)?
  • In patients with chronic migraine (P), does prophylactic treatment with topiramate (I) compared to amitriptyline (C) reduce the frequency of migraines (O) after three months (T)?
  • In pediatric patients with acute otitis media (P), does watchful waiting (I) compared to immediate antibiotic treatment (C) reduce the duration of symptoms (O) within seven days (T)?
  • In older adults with dementia (P), does reminiscence therapy (I) compared to usual care (C) improve cognitive function (O) after three months (T)?
  • In patients with chronic heart failure (P), does telemonitoring combined with a medication reminder system (I) compared to telemonitoring alone (C) reduce hospital readmissions (O) within six months (T)?
  • In patients with asthma (P), does self-management education (I) compared to standard care (C) reduce asthma exacerbations (O) over a period of one year (T)?
  • In postoperative patients (P), does the use of wound dressings with antimicrobial properties (I) compared to standard dressings (C) reduce the incidence of surgical site infections (O) within 30 days (T)?
  • In patients with chronic kidney disease (P), does mindfulness-based stress reduction (I) compared to usual care (C) improve psychological well-being (O) over a period of three months (T)?
  • In adult patients with chronic pain (P), does biofeedback therapy (I) compared to relaxation techniques (C) reduce pain intensity (O) after eight weeks (T)?
  • In patients with type 2 diabetes (P), does a low-glycemic index diet (I) compared to a high-glycemic-index diet (C) improve glycemic control (O) over a period of six months (T)?
  • In patients with chronic obstructive pulmonary disease (P), does regular physical activity (I) compared to no physical activity (C) improve health-related quality of life (O) after three months (T)?
  • In patients with major depressive disorder (P), does mindfulness-based cognitive therapy (I) compared to antidepressant medication (C) reduce depressive symptoms (O) after eight weeks (T)?
  • In postpartum women (P), does perineal warm compresses (I) compared to standard perineal care (C) reduce perineal pain (O) after vaginal delivery (T)?
  • In patients with chronic kidney disease (P), does a low-protein, low-phosphorus diet (I) compared to a low-protein diet alone (C) slow the progression of renal disease(O) after two years (T)?
  • In pediatric patients with attention-deficit/hyperactivity disorder (P), does mindfulness-based interventions (I) compared to medication alone (C) improve attention and behavior (O) after six months (T)?
  • In patients with chronic pain (P), does cognitive-behavioral therapy (I) compared to physical therapy (C) reduce pain interference (O) after 12 weeks (T)?
  • In elderly patients with osteoarthritis (P), does aquatic exercise (I) compared to land-based exercise (C) improve joint flexibility and reduce pain (O) after eight weeks (T)?
  • In patients with multiple sclerosis (P), does high-intensity interval training (I) compared to moderate-intensity continuous training (C) improve physical function (O) after three months (T)?
  • In postoperative patients (P), does preoperative carbohydrate loading (I) compared to fasting (C) reduce postoperative insulin resistance (O) within 24 hours (T)?
  • In patients with chronic obstructive pulmonary disease (P), does home-based tele-rehabilitation (I) compared to center-based rehabilitation (C) improve exercise capacity (O) after six months (T)?
  • In patients with rheumatoid arthritis (P), does tai chi (I) compared to pharmacological treatment (C) reduce joint pain and improve physical function (O) after six months (T)?
  • In postpartum women with postpartum hemorrhage (P), does early administration of tranexamic acid (I) compared to standard administration (C) reduce blood loss (O) within two hours (T)?
  • In patients with hypertension (P), does mindfulness meditation (I) compared to relaxation techniques (C) reduce blood pressure (O) after eight weeks (T)?
  • In elderly patients with hip fractures (P), does multidisciplinary geriatric care (I) compared to standard care (C) improve functional outcomes (O) after three months (T)?
  • In patients with chronic kidney disease (P), does aerobic exercise (I) compared to resistance exercise (C) improve renal function (O) after six months (T)?
  • In patients with major depressive disorder (P), does add-on treatment with omega-3 fatty acids (I) compared to placebo (C) reduce depressive symptoms (O) after 12 weeks (T)?
  • In postoperative patients (P), does preoperative education using multimedia materials (I) compared to standard education (C) improve patient satisfaction (O) after surgery (T)?
  • In patients with type 2 diabetes (P), does a plant-based diet (I) compared to a standard diet (C) improve glycemic control (O) after three months (T)?
  • In patients with chronic obstructive pulmonary disease (P), does high-flow oxygen therapy (I) compared to standard oxygen therapy (C) improve exercise tolerance (O) after three months (T)?
  • In patients with heart failure (P), does nurse-led telephone follow-up (I) compared to standard care (C) reduce hospital readmissions (O) within six months (T)?
  • In postpartum women with postnatal depression (P), does online cognitive-behavioral therapy (I) compared to face-to-face therapy (C) reduce depressive symptoms (O) after eight weeks (T)?
  • In patients with chronic migraine (P), does mindfulness-based stress reduction (I) compared to medication alone (C) reduce the frequency and severity of migraines (O) after three months (T)?
  • In older adults with delirium (P), does structured music intervention (I) compared to standard care (C) reduce the duration of delirium episodes (O) during hospitalization (T)?
  • In patients with chronic low back pain (P), does yoga (I) compared to physical therapy (C) reduce pain intensity (O) after six weeks (T)?
  • In pediatric patients with acute otitis media (P), does watchful waiting with pain management (I) compared to immediate antibiotic treatment (C) reduce the need for antibiotics (O) within one week (T)?
  • In patients with schizophrenia (P), does family psychoeducation (I) compared to standard treatment (C) improve medication adherence (O) over a period of six months (T)?
  • In patients with chronic kidney disease (P), does a low-phosphorus diet (I) compared to a regular diet (C) slow the progression of renal disease (O) after one year (T)?
  • In postoperative patients (P), does wound irrigation with saline solution (I) compared to povidone-iodine solution (C) reduce the incidence of surgical site infections (O) within 30 days (T)?
  • In patients with type 1 diabetes (P), does continuous subcutaneous insulin infusion (I) compared to multiple daily injections (C) improve glycemic control (O) over a period of six months (T)?
  • In postoperative patients (P), does the use of prophylactic antibiotics (I) compared to no antibiotics (C) reduce the incidence of surgical site infections (O) within 30 days (T)?
  • In patients with chronic obstructive pulmonary disease (P), does smoking cessation counseling (I) compared to no counseling (C) decrease the frequency of exacerbations (O) over a period of six months (T)?
  • In patients with diabetes (P), does a multidisciplinary team approach (I) compared to standard care (C) improve self-management behaviors (O) over a period of one year (T)?
  • In pregnant women with gestational hypertension (P), does bed rest (I) compared to regular activity (C) reduce the risk of developing preeclampsia (O) before delivery (T)?
  • In patients with chronic kidney disease (P), does angiotensin-converting enzyme inhibitors (I) compared to placebo (C) slow the progression of renal disease (O) over a period of two years (T)?
  • In older adults with hip fractures (P), does early surgical intervention (I) compared to delayed surgery (C) improve functional outcomes (O) after six months (T)?
  • In patients with major depressive disorder (P), does exercise (I) compared to antidepressant medication (C) reduce depressive symptoms (O) after eight weeks (T)?
  • In children with autism spectrum disorder (P), does applied behavior analysis (I) compared to standard therapy (C) improve social communication skills (O) over a period of one year (T)?
  • In postoperative patients (P), does the use of incentive spirometry (I) compared to no spirometry (C) decrease the incidence of postoperative pulmonary complications (O) within seven days (T)?
  • In patients with hypertension (P), does a combination of diet modification and exercise (I) compared to medication alone (C) lower blood pressure (O) after six months (T)?
  • In patients with chronic obstructive pulmonary disease (P), does home oxygen therapy (I) compared to no oxygen therapy (C) improve exercise capacity (O) after threemonths (T)?
  • In patients with heart failure (P), does a multidisciplinary heart failure management program (I) compared to standard care (C) reduce hospital readmissions (O) within six months (T)?
  • In postpartum women with postnatal depression (P), does mindfulness meditation (I) compared to relaxation techniques (C) reduce depressive symptoms (O) after eight weeks (T)?
  • In patients with chronic kidney disease (P), does a low-sodium diet (I) compared to a regular diet (C) lower blood pressure (O) after six months (T)?
  • In pediatric patients with attention-deficit/hyperactivity disorder (P), does neurofeedback training (I) compared to medication (C) improve attention and behavior (O) after six months (T)?
  • In patients with chronic pain (P), does transcranial direct current stimulation (I) compared to sham stimulation (C) reduce pain intensity (O) after eight weeks (T)?
  • In older adults with osteoporosis (P), does a structured exercise program (I) compared to no exercise (C) improve bone mineral density (O) after six months (T)?
  • In patients with type 2 diabetes (P), does a low-carbohydrate, high-protein diet (I) compared to a standard diet (C) improve glycemic control (O) over a period of six months (T)?
  • In patients with chronic obstructive pulmonary disease (P), does mindfulness-based stress reduction (I) compared to usual care (C) improve dyspnea symptoms (O) after three months (T)?
  • In postpartum women with postnatal depression (P), does online peer support (I) compared to individual therapy (C) reduce depressive symptoms (O) after eight weeks (T)?
  • In patients with chronic kidney disease (P), does resistance training (I) compared to aerobic training (C) improve muscle strength (O) after six months (T)?
  • In pediatric patients with asthma (P), does a written asthma action plan (I) compared to verbal instructions (C) reduce emergency department visits (O) within six months (T)?
  • In patients with chronic pain (P), does yoga (I) compared to pharmacological treatment (C) reduce pain interference (O) after eight weeks (T)?
  • In older adults at risk of falls (P), does a multifactorial falls prevention program (I) compared to no intervention (C) reduce the rate of falls (O) over a period of six months (T)?
  • In patients with schizophrenia (P), does cognitive-behavioral therapy (I) compared to medication alone (C) reduce positive symptom severity (O) after six months (T)?
  • In postpartum women with breastfeeding difficulties (P), does breast massage (I) compared to no massage (C) improve milk flow (O) after four weeks (T)?
  • In patients with chronic obstructive pulmonary disease (P), does long-term oxygen therapy (I) compared to short-term oxygen therapy (C) improve survival rates (O) after one year (T)?
  • In patients with major depressive disorder (P), does repetitive transcranial magnetic stimulation (I) compared to sham treatment (C) reduce depressive symptoms (O) after six weeks (T)?
  • In patients with diabetes (P), does a digital health app (I) compared to standard care (C) improve medication adherence (O) over a period of six months (T)?
  • In patients with chronic kidney disease (P), does a low-potassium diet (I) compared to a regular diet (C) lower serum potassium levels (O) after one year (T)?
  • In pediatric patients with acute gastroenteritis (P), does oral rehydration solution (I) compared to intravenous fluid therapy (C) reduce hospital admissions (O) within 48 hours (T)?
  • In patients with chronic pain (P), does hypnotherapy (I) compared to no hypnotherapy (C) reduce pain intensity (O) after eight weeks (T)?
  • In older adults at risk of falls (P), does a tai chi program (I) compared to no exercise program (C) improve balance and stability (O) after six months (T)?
  • In patients with chronic heart failure (P), does a home-based self-care intervention (I) compared to standard care (C) reduce hospital readmissions (O) within six months (T)?
  • In patients with anxiety disorders (P), does acceptance and commitment therapy (I) compared to cognitive-behavioral therapy (C) reduce anxiety symptoms (O) after 12 weeks (T)?
  • In postpartum women with breastfeeding difficulties (P), does the use of nipple shields (I) compared to no nipple shields (C) improve breastfeeding success (O) after four weeks (T)?
  • In patients with chronic obstructive pulmonary disease (P), does a comprehensive self-management program (I) compared to usual care (C) improve health-related quality of life (O) after three months (T)?
  • In patients with major depressive disorder (P), does internet-based cognitive-behavioral therapy (I) compared to face-to-face therapy (C) reduce depressive symptoms (O) after eight weeks (T)?
  • Does the increase in the habit of smoking marijuana among Dutch students increase the likelihood of depression?
  • Does the use of pain relief medication during surgery provide more effective pain reduction compared to the same medication given post-surgery?
  • Does the increase in the intake of oral contraceptives increase the risk of breast cancer among women aged 20-30 in the UK?
  • Does the habit of washing hands among healthcare workers decrease the rate of infections in hospitals?
  • Does the use of modern syringes help in reducing needle injuries among healthcare workers in America?
  • Does encouraging male work colleagues to talk about sexual harassment decrease the rate of depression in the workplace?
  • Does bullying in boarding schools in Scotland increase the likelihood of domestic violence within a 20-year timeframe?
  • Does breastfeeding among toddlers in urban United States decrease their chances of obesity as pre-schoolers?
  • Does the increase in the intake of antidepressants among urban women aged 30 years and older affect their maternal health?
  • Does forming work groups to discuss domestic violence among the rural population of the United States reduce stress and depression among women?
  • Does the increased use of mosquito nets in Uganda help in reducing malaria cases among infants?
  • Can colon cancer be more effectively detected when colonoscopy is supported by an occult blood test compared to colonoscopy alone?
  • Does regular usage of low-dose aspirin effectively reduce the risk of heart attacks and stroke for women above the age of 80 years?
  • Is yoga an effective medical therapy for reducing lymphedema in patients recovering from neck cancer?
  • Does daily blood pressure monitoring help in addressing the triggers of hypertension among males over 65 years?
  • Does a regular 30-minute exercise regimen effectively reduce the risk of heart disease in adults over 65 years?
  • Does prolonged exposure to chemotherapy increase the risk of cardiovascular diseases among teenagers suffering from cancer?
  • Does breastfeeding among toddlers in the urban United States decrease their chances of obesity as pre-schoolers?
  • Are first-time mothers giving birth to premature babies more prone to postpartum depression compared to second or third-time mothers in the same condition?
  • For women under the age of 50 years, is a yearly mammogram more effective in preventing breast cancer compared to a mammogram done every 3 years?
  • After being diagnosed with blood sugar levels, is a four-times-a-day blood glucose monitoring process more effective in controlling the onset of Type 1 diabetes?

Related: How to write an abstract poster presentation.

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Nursing Homework Help

Unlock Potential In Answering Common Nursing Homework Questions: Your Comprehensive Guide

Unlock potential in answering common nursing homework questions : your comprehensive guide.

Are nursing homework questions causing you stress and confusion? Don’t worry; you’re not alone. Nursing students often find themselves grappling with a multitude of questions as they work on assignments. In this comprehensive guide, we’ll address various nursing homework questions and provide you with insights and solutions to enhance your understanding of the subject.

What Is Nursing Homework Questions ?

Before we dive into specific questions, let’s clarify what nursing homework entails. Nursing homework typically includes a variety of assignments, such as case studies, research papers, care plans, and more. These assignments are designed to help students develop critical thinking skills, apply theoretical knowledge, and prepare for real-world nursing scenarios.

Now, let’s explore some common nursing homework questions and find answers to each one.

1. How Can I Write an Effective Nursing Care Plan ?

Creating a nursing care plan is a crucial aspect of nursing education. To write an effective care plan, start by assessing the patient’s condition and identifying their needs. Use the nursing process – assessment, diagnosis, planning, implementation, and evaluation (ADPIE) – as your guide.

2. How Do I Perform a Comprehensive Health Assessment?

Health assessments are fundamental in nursing. Begin with a thorough patient history, followed by a head-to-toe physical examination. Document your findings accurately and communicate any concerns with the healthcare team.

3. What’s the Best Approach to Ethical Dilemmas in Nursing ?

Nursing often involves complex ethical dilemmas. When facing such situations, utilize ethical frameworks like deontology or utilitarianism to make well-considered decisions. Always prioritize patient well-being.

4. How Do I Write a Nursing Research Paper?

When working on nursing research papers, ensure you choose a compelling topic. Conduct comprehensive literature reviews and gather evidence-based data. Structure your paper with a clear introduction, methodology, results, discussion, and conclusion.

5. Can You Explain Evidence-Based Practice (EBP) in Nursing?

EBP is about integrating the best available research with clinical expertise. To practice EBP, identify clinical questions, search for evidence, critically appraise the research, and apply findings to patient care.

6. What’s the Key to Balancing Theory and Clinical Practice?

Nursing students often struggle with balancing theoretical knowledge and clinical skills. The key is practice. Engage in clinical experiences, ask questions, and seek guidance from clinical instructors.

7. How Do I Ensure Proper Documentation in Nursing ?

Accurate documentation is vital in nursing. Follow your institution’s documentation standards, record patient data promptly, and use objective language. Clear, thorough documentation ensures effective communication and patient safety.

8. What’s the Role of Nursing Informatics?

Nursing informatics involves using technology to manage healthcare data and improve patient outcomes. It plays a significant role in modern nursing practice. Learn how to use electronic health records (EHRs) and other informatics tools effectively.

9. How Can I Excel in Nursing Exams ?

To excel in nursing exams, create a study schedule, review your class notes, use practice questions, and seek assistance when needed. Active learning and regular revision are essential.

10. How Do I Stay Updated in the Field of Nursing ?

Nursing is a dynamic field with constant advancements. Stay updated by reading nursing journals, attending conferences, and participating in continuing education programs.

Incorporating these strategies into your nursing education will help you tackle various nursing homework questions with confidence. Remember that seeking guidance from your instructors and peers is also valuable.

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Explore More Resources Nursing Homework Questions

To enhance your understanding of nursing concepts further, consider exploring the following resources:

These resources can provide valuable insights and support your academic journey.

Nursing homework questions may vary, but with dedication, learning, and practice, you can navigate the challenges effectively. Stay curious, seek answers, and remember that nursing is a rewarding profession that involves a lifelong journey of learning.

Join the Nursing Community Nursing Homework Questions

Nursing is not just a profession; it’s a community of dedicated individuals working together to provide quality healthcare. Engage with the nursing community to gain support, share experiences, and stay motivated.

Seek Nursing Homework Help

If you ever find yourself overwhelmed with nursing homework, don’t hesitate to seek help. Many online platforms offer nursing homework assistance, providing expert guidance on assignments, papers, and exam preparation.

Connect with Nursing Tutors Nursing Homework Questions

Nursing tutors can be invaluable in your academic journey. They offer personalized assistance, helping you grasp challenging concepts and excel in exams. Find a qualified nursing tutor who aligns with your learning style.

Stay Informed

The field of nursing is constantly evolving. Staying informed about the latest trends, guidelines, and research is crucial. Subscribe to nursing publications and follow respected nursing organizations to receive updates.

Participate in Clinical Experiences

Clinical experiences are a fundamental part of nursing education. They allow you to apply classroom knowledge to real patient care. Take full advantage of these opportunities to develop your clinical skills.

Promote Self-Care

Nursing students often prioritize the health and well-being of others but forget about self-care. Remember that you can provide better care when you are physically and emotionally healthy. Make self-care a priority.

Network and Collaborate Nursing Homework Questions

Networking in the nursing field can open up numerous career opportunities. Attend nursing conferences, seminars, and workshops to build professional relationships and collaborate with experts in the field.

Additional Nursing Homework Help Resources Nursing Homework Questions

By incorporating these strategies and resources into your nursing journey, you’ll not only excel in your nursing homework but also grow as a confident and competent future nurse.

In conclusion, the path to becoming a nurse involves a commitment to learning and a dedication to providing the best care for patients. While nursing homework can be challenging, it’s a vital part of your education, preparing you for the demands of the profession. Remember, you’re not alone on this journey. Reach out for help when you need it, collaborate with your peers, and stay curious about the ever-evolving field of nursing. You’re on your way to becoming a knowledgeable and compassionate nurse.

Incorporate Technology Nursing Homework Questions

The nursing field has witnessed significant technological advancements. As a nursing student, embrace these innovations in your study routine. Utilize apps, software, and online platforms designed to aid in nursing education and practice. Technology can enhance your understanding of complex concepts and improve your efficiency in homework completion.

Master Time Management Nursing Homework Questions

Time management is a critical skill for nursing students. The demands of coursework, clinical rotations, and personal life can be overwhelming. Learn to prioritize tasks, create study schedules, and allocate specific time for nursing homework. Effective time management will reduce stress and ensure you meet deadlines.

Stay Informed about Nursing Policies

Nursing policies and guidelines can change over time. To excel in your nursing homework and clinical practice, it’s essential to stay updated with the latest nursing policies and procedures. This ensures that your work aligns with industry standards and best practices.

Aim for Excellence

In nursing, excellence is not just a goal but a standard. Strive for excellence in your academic pursuits, whether it’s nursing homework, research papers, or exams. Nursing is a profession where precision and quality care are paramount, and your academic journey should reflect these principles.

Don’t Hesitate to Seek Nursing Homework Questions

While nursing is a rewarding profession, it can be academically challenging. If you ever find yourself struggling with nursing homework, don’t hesitate to seek help. Online nursing homework assistance services and expert nursing tutors are available to guide you through complex assignments and topics.

Join Nursing Communities

Being part of a nursing community provides valuable support and resources. Consider joining online nursing forums, social media groups, and associations where you can engage with fellow nursing students, share experiences, and access helpful materials.

Be Resilient

Nursing students face various challenges throughout their education. From demanding coursework to intense clinical experiences, resilience is key. Develop a resilient mindset to overcome obstacles and setbacks, and remember that each challenge is an opportunity for growth.

Stay Committed to Your Goal Nursing Homework Questions

Becoming a nurse is a journey that requires unwavering commitment. Keep your ultimate goal of making a positive impact on patients’ lives at the forefront of your mind. Your dedication will drive you to excel in your nursing homework and prepare you for the rewarding path ahead.

Nursing homework is an integral part of your journey toward becoming a qualified and compassionate nurse. By following these strategies, seeking support when needed, and staying dedicated to your goals, you can excel in your nursing homework and, ultimately, in your nursing career. Your commitment to learning and patient care will make you a valuable asset to the field of nursing.

Nursing Homework Services: Your Academic Companion

Are you a nursing student facing a mountain of assignments and struggling to keep up with your academic workload? Our Nursing Homework Services are tailored to ease your academic burden and ensure that you excel in your nursing studies.

What Sets Our Nursing Homework Services Apart in ?

  • Nursing Experts : We have a team of experienced nursing professionals and academic writers who specialize in nursing and understand the intricacies of your coursework.
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Comprehensive Coverage of Nursing Subjects Nursing Homework Questions

Our Nursing Homework Services cover a wide array of subjects, including:

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Nursing Homework Questions

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Our Nursing Homework Services have played a crucial role in helping countless nursing students achieve their academic aspirations. We are dedicated to providing you with the support you need to succeed in your nursing education.

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76 NURSING PICOT Question Ideas with PICO Examples on Evidence-based Practice

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76 NURSING PICOT Question Ideas with PICO Examples on evidence-based practice

In all nursing levels (BSN, MSN, or DNP), you are required to begin your research queries using an evidence-based practice framework developed from a well-constructed PICOT question. Here we’ll show you how to formulate a PICO Question and provide some elaborative PICOT Question Examples for DNP, NP and BSN Students.

Here's What You'll Learn

What is a Nursing PICO (T) QUESTION?

“The well-formed question makes it relatively straightforward to elicit and combine the appropriate terms needed to represent your need for information in the query language of whichever searching service is available to you,” the University of Oxford author said. “Once you have formed the question using the PICO structure, you can think about what type of question it is you are asking, and therefore what type of research would provide the best answer.” cebm.ox.ac.uk(opens in a new tab)
“The question needs to identify the patient or population we intend to study, the intervention or treatment we plan to use, the comparison of one intervention to another (if applicable) and the outcome we anticipate,” wrote Kathy A. Jensen, MHA, RN in EBSCO Health’s whitepaper, ‘7 Steps To The Perfect Pico Search.’ This clear and concise formulation of the question allows researchers to focus on the specific elements that are relevant to their study. https://www.ebsco.com/blogs/health-notes/seven-steps-perfect-pico-search

How can the components of PICOT questions be used in clinical decision-making?

Creating a clinical question: nursing picot question, how can a well-structured picot question facilitate a seamless research process, how can picot questions meet the specific requirements of nursing schools, what are the fundamental elements for defining outstanding clinical questions that are researchable, how should picot questions be formulated to focus on the most relevant evidence for nursing practice, how can a picot question be formulated to be specific and precise.

  • P (Patient, population or problem): This element focuses on identifying the specific patient, population, or problem under investigation. By clearly defining the target group, including relevant demographics and features, the researcher can narrow down the scope of the inquiry.
  • I (Intervention): The intervention refers to the action or treatment being considered. It is vital to outline the specific intervention, such as diagnostic tests, therapies, or nursing interventions, to accurately address the research question.
  • C (Comparison or control): Considering alternative strategies or controls against which the intervention will be compared is a critical aspect of a PICOT question. By including this element, researchers can assess the effectiveness of different approaches and determine the best course of action.
  • O (Outcome or objective): The desired or expected outcome or objective of the intervention should be clearly defined. By identifying the intended result, researchers can focus on measuring the impact of the intervention accurately.
  • T (Time frame): The timeframe allocated for implementing the intervention is another essential element of a PICOT question. Researchers need to specify the duration within which the desired outcome is expected to be achieved, allowing for a more precise assessment of the intervention’s effectiveness.

Example: PICO(T) Question and Search Strategy

  • Does the bariatric adolescent patient undergoing gastric bypass have better continuity of care perioperatively and postoperatively when the nurse is a primary member of the multidisciplinary team versus when the nurse is a secondary member whose only role is in providing perioperative care and has no specialized training?

This blog post shows how to formulate a PICO Question with some elaborative PICOT Questions Examples for DNP, NP and BSN

7 Steps to the Perfect PICO Search Evidence-Based Nursing Practice –  Steps to the PICOT Question Formulation Process

  • Formulate the PICOT question in general terms: Based on the EBSCO Health example , the research question would be, “In patients recovering from abdominal surgery, is there evidence that suggests gum-chewing postoperatively, compared to not chewing gum, impacts postoperative ileus?”
  • Identify the keywords for the PICOT mnemonic: P – Patients recovering from abdominal surgery I – Gum chewing C – Not chewing gum O – Impacts post-operative ileus
  • Plan the search strategy: With the question in mind, researchers consider which databases and other search sites they might use to find information and answers. Researchers use strategies to maximize their search terms such as looking up synonyms and phrases that mean the same thing.
  • Execute a search: At first, researchers search each PICOT element individually. For example, when researching patients recovering from abdominal surgery, use the search terms “abdominal surgery,” but also consider the search terms “recovery and postoperative.”
  • Refine the results: Narrow the search results by limiting the works to pertinent content, such as articles from peer-reviewed journals or research documents.
  • Review the content: Review the research results to establish if they have the necessary information to answer the PICOT question.
  • Determine if research results meet standards: After reviewing the research results, determine whether they provide the best available evidence.

8 DNP PICOT Question Examples and Ideas for evidence-based nursing project

  • In adult patients diagnosed with bacterial infections, how does improving patient education regarding antibiotic therapy, disease process, and preventative measures for infection control affect the need for additional care or treatment/medication (patient outcome) within two weeks of initiating treatment?
  • Among primary care providers how does education on autism spectrum disorders in adults compared to no education affect knowledge, attitudes and beliefs in providing care to this population?
  • If or to what degree the implementation of the American Association of Diabetes Educators seventh edition (AADE7) healthy eating program would impact the pre-prandial blood glucose levels when compared to current practice among type II diabetic patients in a skilled nursing rehabilitation center in an urban area in New York
  • In patients at a Veterans Administration outpatient facility, how does a nurse navigator program, compared to before the implementation of the nurse navigator program, increase patient engagement as measured by the PHE-s over a period of six weeks?
  • In regards to COPD patients, 60-80 years of age who are nonadherent with their medication regimen. Does the use of teach-back technique decrease the number of exacerbation events during a 30-day period post educational intervention as compared to the 30-day period prior to using the teach-back technique?
  • Do new nurse graduates (less than one year experience) in a hospital setting who experience an evidence-based empowerment program and orientation policy change, compared to no empowerment model, have increased feelings of workplace empowerment within 8 weeks?
  • In Neonatal healthcare providers working in a NICU (Population) does an electronic hand off communication tool (Intervention) positively improve the discharge process and patient safety outcomes (Outcome) as compared with a paper hand off tool? (Compare).
  • In patients suffering from low to mild chronic pain, do adjuvant therapies, when compared to current pain management practices, decrease overprescribing of opioids?

28 Evidence Based Practice PICOT Questions Examples and MSN PICOT Question Examples and Ideas

  • In adult patients with total hip replacements (Patient population), how effective is PCA pain medication (Intervention of interest) compared to prn IM pain medication (Comparison intervention) in controlling post-operative pain (Outcome) during the perioperative and recovery time?  Note: The IM pain medication would be called the control group. It would be unethical to have a control group that received NO pain medication. Many times the control group means they get “business as usual!” or the current standard of care.
  • Therapy PICOT Question Example, a non-intervention example: What is the duration of recovery (O) for patients with total hip replacement (P) who developed a post-operative infection (I) as opposed to those who did not (C) within the first six weeks of recovery (T)?
  •  Aetiology PICOT Question Examples: Are kids (P) who have obese adoptive parents (I) at Increased risk for obesity (O) compared with kids (P) without obese adoptive parents (C) during the ages of five and 18 (T)?
  • Diagnostic PICOT Question Example: Is a PKU test (I) done on two-week-old infants (P) more accurate in diagnosing inborn errors in metabolism (O) compared with PKU tests done at 24 hours of age (C)? Time is implied in two weeks and 24 hours old.
  • Prevention PICOT Question Example: In OR nurses doing a five-minute scrub (P) what are the differences in the presence and types of microbes (O) found on natural polished nails and nail beds (I) and artificial nails (C) at the time of surgery (T)?
  • Prognosis/Prediction PICOT Question Examples: Does telemonitoring blood pressure (I) in urban African Americans with hypertension (P) improve blood pressure control (O) within the six months of initiation of the medication (T)?
  • Meaning PICOT Question Example: (picot question examples nursing) How do pregnant women (P) newly diagnosed with diabetes (I) perceive reporting their blood sugar levels (O) to their healthcare providers during their pregnancy and six weeks postpartum (T)?
  • P: In adult patients with type 2 diabetes (P), how does regular exercise (I) compare to medication therapy (C) in controlling blood glucose levels (O) over a 6-month period (T)?
  • P: Among pregnant women (P), does prenatal yoga (I) have a greater impact on reducing stress and anxiety (O) compared to standard prenatal exercises (C)?
  • P: In adolescent smokers (P), how does a smoking cessation program (I) compare to nicotine replacement therapy (C) in achieving long-term smoking cessation (O) within a 1-year follow-up (T)?
  • P: Among elderly patients with chronic pain (P), does acupuncture (I) provide better pain relief (O) compared to traditional pain medications (C) within a 3-month treatment period (T)?
  • P: In post-operative patients (P), does the use of multimodal analgesia (I) lead to reduced opioid consumption (O) compared to traditional opioid-based pain management (C) during the first 48 hours post-surgery (T)?
  • P: In children diagnosed with ADHD (P), does behavioral therapy (I) result in better academic performance (O) compared to pharmacological treatment (C) over a 12-month period (T)?
  • P: Among elderly patients with insomnia (P), does melatonin supplementation (I) improve sleep quality (O) compared to sleep hygiene education (C) within a 4-week intervention (T)?
  • P: In hospitalized patients with pressure ulcers (P), does the use of specialized wound dressings (I) promote faster wound healing (O) compared to standard dressings (C) within a 2-week treatment period (T)?
  • P: Among pregnant women with gestational diabetes (P), does a low-carbohydrate diet (I) lead to better glycemic control (O) compared to a standard diabetic diet (C) during pregnancy (T)?
  • P: In patients with major depressive disorder (P), does cognitive-behavioral therapy (I) result in a greater reduction in depressive symptoms (O) compared to antidepressant medication (C) within a 6-month treatment period (T)?
  • What is the impact of a mindfulness intervention program (I) compared to a relaxation technique (C) on reducing stress levels (O) among college students (P) within a 10-week timeframe (T)?
  • Does the implementation of a nurse-led education program (I) in comparison to standard care (C) result in improved self-management behaviors (O) among patients with type 2 diabetes (P) over a six-month period (T)?
  • How does the use of virtual reality therapy (I) compared to traditional physical therapy (C) affect pain management (O) in post-operative orthopedic patients (P) during the first two weeks after surgery (T)?
  • What is the effectiveness of a nurse-led smoking cessation program (I) compared to pharmacological interventions alone (C) in achieving long-term smoking cessation (O) among adult smokers (P) over a one-year follow-up period (T)?
  • Does the implementation of bedside rounding (I) when compared to traditional rounding methods (C) improve patient satisfaction (O) among hospitalized elderly patients (P) within a four-week timeframe (T)?
  • What is the impact of a structured exercise program (I) in comparison to usual care (C) on functional independence (O) among stroke survivors (P) three months after discharge (T)?
  • Does the use of telehealth services (I) compared to in-person appointments (C) lead to a decrease in hospital readmission rates (O) among heart failure patients (P) within a 30-day post-discharge period (T)?
  • What is the effect of implementing a comprehensive falls prevention program (I) compared to standard fall prevention measures (C) on reducing fall rates (O) among older adults residing in long-term care facilities (P) over a six-month timeframe (T)?
  • Does the administration of prophylactic antibiotics (I) in comparison to no antibiotics (C) reduce the incidence of surgical site infections (O) among patients undergoing elective orthopedic surgery (P) within a perioperative period of 48 hours (T)?
  • What is the impact of implementing a nurse-led pain management protocol (I) compared to physician-directed pain management (C) on opioid consumption (O) among postoperative patients (P) within the first 24 hours after surgery (T)?

40 BSN PICOT Question Examples for EBP Capstone Projects

  • In adult patients with type 2 diabetes (P), does regular exercise (I) compared to standard care (C) result in better glycemic control (O) over a period of 6 months (T)?
  • In elderly patients with chronic pain (P), does acupuncture (I) compared to pharmacological interventions (C) lead to reduced pain intensity (O) within 4 weeks (T)?
  • In pregnant women with gestational hypertension (P), does magnesium sulfate administration (I) compared to standard treatment (C) reduce the risk of eclampsia (O) during labor and delivery (T)?
  • In children with asthma (P), does regular use of inhaled corticosteroids (I) compared to as-needed use (C) result in fewer acute exacerbations (O) within 1 year (T)?
  • In patients undergoing cardiac surgery (P), does early ambulation (I) compared to bedrest (C) decrease the incidence of postoperative complications (O) within the first week (T)?
  • In cancer patients receiving chemotherapy (P), does the use of antiemetic drugs (I) compared to placebo (C) prevent nausea and vomiting (O) during treatment (T)?
  • In older adults with Alzheimer’s disease (P), does cognitive stimulation therapy (I) compared to usual care (C) improve cognitive function (O) over a period of 3 months (T)?
  • In postpartum women with breastfeeding difficulties (P), does the use of nipple shields (I) compared to latch techniques alone (C) increase exclusive breastfeeding rates (O) within 2 weeks (T)?
  • In critically ill patients on mechanical ventilation (P), does daily oral care with chlorhexidine (I) compared to saline solution (C) reduce the incidence of ventilator-associated pneumonia (O) within 30 days (T)?
  • In patients with chronic kidney disease (P), does dietary restriction of phosphorus (I) compared to unrestricted intake (C) slow the progression of renal dysfunction (O) over a period of 6 months (T)?
  • In adolescents with depression (P), does cognitive-behavioral therapy (I) compared to pharmacotherapy alone (C) lead to improved depressive symptoms (O) within 12 weeks (T)?
  • In patients with congestive heart failure (P), does daily weight monitoring (I) compared to usual care (C) reduce the number of hospital readmissions (O) within 6 months (T)?
  • In individuals with chronic low back pain (P), does yoga (I) compared to physical therapy (C) result in greater pain relief (O) after 8 weeks (T)?
  • In patients with rheumatoid arthritis (P), does the use of biologic agents (I) compared to traditional disease-modifying antirheumatic drugs (C) improve joint function (O) within 3 months (T)?
  • In postmenopausal women with osteoporosis (P), does regular weight-bearing exercise (I) compared to no exercise (C) increase bone mineral density (O) over a period of 1 year (T)?
  • In infants with neonatal jaundice (P), does phototherapy (I) compared to breastfeeding alone (C) lower serum bilirubin levels (O) within 48 hours (T)?
  • In patients with chronic obstructive pulmonary disease (P), does pulmonary rehabilitation (I) compared to standard care (C) improve exercise tolerance (O) within 3 months (T)?
  • In individuals with obesity (P), does a low-carbohydrate diet (I) compared to a low-fat diet (C) result in greater weight loss (O) over a period of 6 months (T)?
  • In elderly patients with hip fractures (P), does early surgical intervention (I) compared to delayed surgery (C) decrease mortality rates (O) within 30 days (T)?
  • In patients with hypertension (P), does mindfulness-based stress reduction (I) compared to relaxation techniques (C) lower blood pressure (O) after 8 weeks (T)?
  • In adult patients with diabetes (P), does regular exercise (I) compared to no exercise (C) result in improved glycemic control (O) within a 12-week period (T)?
  • Among pregnant women (P), does prenatal yoga (I) compared to standard prenatal care (C) reduce the incidence of gestational hypertension (O) during the third trimester (T)?
  • In elderly patients with chronic pain (P), does acupuncture (I) compared to pharmacological interventions (C) lead to a decrease in pain severity (O) over a six-month period (T)?
  • Among pediatric patients with asthma (P), does inhaler education and counseling (I) compared to standard asthma management (C) lead to a decrease in emergency room visits (O) over a one-year period (T)?
  • In post-operative patients (P), does early ambulation (I) compared to bed rest (C) reduce the risk of deep vein thrombosis (O) within the first 48 hours post-surgery (T)?
  • Among ICU patients with ventilator-associated pneumonia (P), does oral care with chlorhexidine (I) compared to standard oral care (C) decrease the incidence of ventilator-associated pneumonia (O) during their ICU stay (T)?
  • In adults with hypertension (P), does a low-sodium diet (I) compared to a normal-sodium diet (C) lower blood pressure levels (O) over a four-week period (T)?
  • Among cancer patients undergoing chemotherapy (P), does the use of ginger supplements (I) compared to placebo (C) reduce the severity and frequency of chemotherapy-induced nausea and vomiting (O) during the treatment period (T)?
  • In elderly patients with dementia (P), does music therapy (I) compared to standard care (C) improve cognitive function (O) over a six-month period (T)?
  • Among postpartum women (P), does breastfeeding (I) compared to formula feeding (C) reduce the risk of postpartum depression (O) within the first eight weeks post-delivery (T)?
  • In patients with heart failure (P), does telemonitoring (I) compared to standard care (C) decrease hospital readmissions (O) within a three-month period (T)?
  • Among obese adolescents (P), does a structured exercise program (I) compared to no structured exercise (C) result in weight loss (O) over a six-month period (T)?
  • In adults with chronic migraines (P), does acupuncture (I) compared to medication therapy (C) reduce the frequency and severity of migraines (O) over a three-month period (T)?
  • Among patients with chronic obstructive pulmonary disease (P), does pulmonary rehabilitation (I) compared to usual care (C) improve exercise tolerance (O) within a six-week period (T)?
  • In patients undergoing total knee replacement (P), does preoperative education and counseling (I) compared to no preoperative education (C) enhance postoperative recovery (O) within a four-week period (T)?
  • Among adolescents with mental health disorders (P), does mindfulness meditation (I) compared to cognitive-behavioral therapy (C) improve overall well-being (O) over a three-month period (T)?
  • In diabetic patients with foot ulcers (P), does honey dressings (I) compared to conventional dressings (C) promote faster wound healing (O) within a two-month period (T)?
  • Among stroke patients (P), does early rehabilitation intervention (I) compared to delayed rehabilitation intervention (C) improve functional outcomes (O) within a six-month period (T)?

PICO(T) Model & Question Types

Here's how to format a PICOT Question with PICOT Question Examples and Ideas for BSN, MSN and DNP Nursing Students

Frequently Asked Questions about NURSING PICOT Question Ideas

1. what is a picot question in nursing research, 2. how can i develop a research question using the picot framework, 3. why is formulating a picot question important in evidence-based practice, 4. can a picot question help in diagnosing patients, 5. what are some examples of picot questions in nursing research, 6. how can nursing students effectively use the picot framework in their studies, 7. where can i find resources to help me formulate a picot question, does this look like your assignment we can do an original paper for you, have no time to write let a subject expert write your paper for you​.

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Nursing and Healthcare Assignments

The nursing and healthcare assignments below were written by students to help you with your own studies. If you are looking for help with your nursing assignment then we offer a comprehensive writing service provided by fully qualified academics in your field of study.

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Nursing Delegation and Prioritization Questions and Scenarios

nursing interview questions for delegation

Nurses get questioned on delegation and prioritization for a lot of good reasons. It allows for hospitals and clinical facilities to test their critical thinking and analytical skills, ability to make difficult, real-time decisions, and understanding of the big picture when it comes to getting things done in an orderly and safe fashion.

Although all practical and registered nurses will have already taken their NCLEX exam, it’s prudent to provide some delegation and prioritization questions and scenarios to assess whether they’re ready to join your team of nurses and medical professionals. 

What is Nursing Delegation and Prioritization?

Delegation and prioritization are critical aspects of becoming a nurse and, although they sound simple, are some of the most challenging topics a nurse can be tested on.

Delegation is when a licensed nurse (RN), or someone with equivalent qualifications, assigns responsibility to a subordinate who is able to complete that task. 

While this may sound easy, delegation is a difficult and critical part of being a good leader. It’s as much about getting things done in a timely manner as it is being able to cultivate and nourish lower-level nurses while balancing their workload. 

Maslow’s Hierarchy of Needs is a helpful framework when thinking about prioritization because nurses need to think of their plan of action in a similar fashion. Having an understanding of the big picture will allow nurses to take the most vital and most important actions first. It’s the basis from which they can delegate action and respond to the needs of their patients. 

Questions on both delegation and prioritization aren’t some of the most difficult because health leaders want to challenge nurses; they’re some of the most difficult questions because they are that crucial to the everyday tasks and scenarios that nurses will face on the job. 

Nursing Delegation and Prioritization Questions

Below are some simple delegation and prioritization questions to incorporate into your interviews. 

  • How do you manage tending to multiple projects and patients in a single workday?
  • How do you know a nurse is ready to be given a task? What do you look for in a nurse when assessing their ability to manage these tasks?
  • What’s your typical work day from start to finish?
  • Describe a time when you successfully delegated a task and a time when you unsuccessfully delegated a task. What happened? And what was the difference between the successful delegation and the unsuccessful delegation. 
  • Describe a time you’ve felt overwhelmed at work. How did you handle it?
  • Describe a time where you missed a deadline. What happened? If you haven’t, what do you think is helping you in staying ahead?
  • How do you decide which tasks are delegated to specific team members?
  • Imagine you’ve been on vacation for a week and return to work with a pile of emails. How do you decide which ones to read and handle first?
  • Describe a time when you had to juggle care between several different patients. How did you do this without being overwhelmed?
  • What were some of the tools or techniques you used, either with programs/applications or simply on your own, to deal with a busy and fast-paced environment? 

Nursing Delegation and Prioritization Scenarios 

The following scenarios are NCLEX practice questions created by Nurselabs , an education and nursing resource dedicated to serving millions of nurses across the country. 

  • After exposure to hot weather and sun, clients with signs and symptoms of heat-related ailment rush to the Emergency Department (ED). Sort clients into those who need critical attention and those with less serious conditions.
  • 1. An abandoned person who is a teacher, has altered mental state, weak muscle movement, hot, dry, pale skin; and whose duration of heat exposure is unknown.
  • 2. An elderly traffic enforcer who complains of dizziness and syncope after standing under the heat of the sun for several hours to perform his job.
  • 3. A comparatively healthy housewife who states that the air conditioner has been down for 5 days and who exhibits hypotension, tachypnea, profuse diaphoresis, and fatigue.
  • 4. A sportsman who complains of severe leg cramps and nausea, and displays paleness, tachycardia, weakness, and diaphoresis.

Correct Answer: 1,2,4,3

  • Several clients arrive in the ED with the same complaint of abdominal pain. Designate them for care in order of the severity of their condition.
  • 1. A 12-year-old girl with a low-grade fever, anorexia, nausea, and right lower quadrant tenderness for the past 2 days
  • 2. A 25-year-old woman complaining of dizziness and severe left lower quadrant pain who states she is probably pregnant
  • 3. A 38-year-old man complaining of severe occasional cramps with three episodes of watery diarrhea hours after meal
  • 4. A 42-year-old woman with moderate right upper quadrant pain who has vomited little amounts of yellow bile and whose symptoms have worsened over the past week
  • 5. A 53-year-old man who experiences discomforting mid-epigastric pain that is worse between meals and during the night
  • 6. A 68-year-old man with a pulsating abdominal mass and sudden onset of “tearing” pain in the abdomen and flank within the past hour

Correct Answers: 6, 2, 1, 4, 3, 5

  • The newly hired nurse is in his first week on the job in the ED. He used to be a traveling nurse for 5 years. Which area in his present job is the most appropriate assignment for him?
  • Fast-track clinic
  • Pediatric medicine team
  • Trauma team

Correct Answer: Fast-track clinic

  • A client with multiple injuries is rushed to the ED after a head-on car collision. Which assessment finding takes priority?
  • Irregular apical pulse
  • Ecchymosis in the flank area
  • A deviated trachea
  • Unequal pupils

Correct Answer: A deviated trachea

Delegation, prioritization, critical thinking, leadership; these are all essential to what it means to be a successful nurse in today’s health industry. By properly assessing the analytical skills of your nurses through delegation and prioritization questions and scenarios, you can be one step closer to finding and hiring the most qualified nurses you come across. 

Final Thoughts: Nursing Delegation and Prioritization Questions and Scenarios

Medely is making it easier for health clinics and hospitals to find, vet, and book highly qualified professionals for their staffing needs. With access to the largest pool of qualified nurses in the US, you can start getting ahead of your staffing shortage and find the best care with Medely today .

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FULL-TEXT: Nursing Prioritization, Delegation and Assignment NCLEX Practice (100 Questions)

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Nursing Prioritization, Delegation and Assignment NCLEX Practice Quiz #1 (25 Items)

A 16-year old patient with cystic fibrosis is admitted with increased shortness of breath and possible pneumonia . Which nursing activity is most important to include in the patient’s care?

  • A. Perform postural drainage and chest physiotherapy every 4 hours.
  • B. Allow the patient to decide whether she needs aerosolized medications.
  • C. Place the patient in a private room to decrease the risk of further infection.
  • D. Plan activities to allow at least 8 hours of uninterrupted sleep .

Correct Answer: A. Perform postural drainage and chest physiotherapy every 4 hours.

Airway clearance techniques are critical for patients with cystic fibrosis and should take priority over other activities. The Cystic Fibrosis Transmembrane Conductance Regulator defect causes mucus to become dehydrated. Secretions in cystic fibrosis are generally thick, sticky, and more difficult to clear. Frequent airway clearance is a mainstay in the treatment of acute exacerbations, as well as an integral part of health maintenance in cystic fibrosis.

  • Option B: Although allowing more independent decision-making is important for adolescents, the physiologic need for an improved respiratory function takes precedence at this time. Collaborate with the client and staff to ensure that the schedule for therapy is amenable to all and does not interfere with meals, rest times, or medications.
  • Option C: A private room may be desirable for the patient but is not necessary. Ensure that clients with CF are not cohorted. The cohorting of clients with CF is not recommended based on published CF Infection Control Consensus Guidelines.
  • Option D: With increased shortness of breath, it will be more important that the patient has frequent respiratory treatments than 8 hours of sleep . Infection, inflammation, and mucous plugging will cause an increase in the respiratory effort to compensate for airway obstruction. As moving air into and out of the lungs becomes more difficult, the breathing pattern alters to include the use of accessory muscles and retractions.

A patient with a pulmonary embolism is receiving anticoagulation with IV heparin. What instructions would you give the nursing assistant who will help the patient with activities of daily living? Select all that apply.

  • A. Use a lift sheet when moving and positioning the patient in bed.
  • B. Use an electric razor when shaving the patient each day.
  • C. Use a soft-bristled toothbrush or tooth sponge for oral care.
  • D. Use a rectal thermometer to obtain a more accurate body temperature.
  • E. Be sure the patient’s footwear has a firm sole when the patient ambulates.

Correct Answers: A, B, C, and E.

All of the other instructions are appropriate to the care of a patient receiving anticoagulants. Risk for bleeding may arise in any condition that disturbs the “close circuit” integrity of the circulatory system . Bleeding is the primary complication of anticoagulant therapy and is a risk of all anticoagulants even when maintained within the usual therapeutic ranges.

  • Option A: Educate the at-risk patient about precautionary measures to prevent tissue trauma or disruption of the normal clotting mechanisms. Information about precautionary measures lessens the risk for bleeding.
  • Option B: Be careful when using sharp objects like scissors and knives. Use an electric razor for shaving (not razor blades). The patient needs to avoid situations that may cause tissue trauma and increase the risk for bleeding. 
  • Option C: Use a soft-bristled toothbrush and nonabrasive toothpaste. Avoid the use of toothpicks and dental floss. This method providing oral hygiene reduces trauma to oral mucous membranes and the risk for bleeding from the gums.
  • Option D: While a patient is receiving anticoagulation therapy, it is important to avoid trauma to the rectal tissue, which could cause bleeding (e.g., avoid rectal thermometers and enemas). These invasive devices or medications may cause trauma to the mucous membranes that line the rectum or vagina.
  • Option E: Educate the patient and family members about signs of bleeding that need to be reported to a health care provider. Early evaluation and treatment of bleeding by a health care provider reduces the risk for complications from blood loss.

A patient with acute respiratory distress syndrome (ARDS) is receiving oxygen by a non-rebreather mask, but arterial blood gas measurements still show poor oxygenation. As the nurse responsible for this patient’s care, you would anticipate a physician order for what action?

  • A. Perform endotracheal intubation and initiate mechanical ventilation.
  • B. Immediately begin continuous positive airway pressure (CPAP) via the patient’s nose and mouth.
  • C. Administer furosemide ( Lasix ) 100 mg IV push stat.
  • D. Call a code for respiratory arrest.

Correct Answer: A. Perform endotracheal intubation and initiate mechanical ventilation

A non-rebreather mask can deliver nearly 100% oxygen. When the patient’s oxygenation status does not improve adequately in response to the delivery of oxygen at this high concentration, refractory hypoxemia is present. Usually, at this stage, the patient is working very hard to breathe and may go into respiratory arrest unless healthcare care providers intervene by providing intubation and mechanical ventilation to decrease the patient’s work of breathing.

  • Option B: To maintain oxygenation, ARDSnet recognizes the benefit of PEEP. The protocol allows for a low or a high PEEP strategy relative to FiO2. Either strategy tolerates a PEEP of up to 24 cm HO in patients requiring 100% FiO2. Interestingly, the mode in which a patient is ventilated affects lung recovery. Evidence suggests that some ventilatory strategies can exacerbate alveolar damage and perpetuate lung injury in the context of ARDS.
  • Option C: The chief treatment strategy is supportive care and focuses on 1) reducing shunt fraction, 2) increasing oxygen delivery, 3) decreasing oxygen consumption, and 4) avoiding further injury. Patients are mechanically ventilated, guarded against fluid overload with diuretics, and given nutritional support until evidence of improvement is observed.
  • Option D: The major cause of death in patients with ARDS was sepsis or multiorgan failure. While mortality rates are now around 9% to 20%, it is much higher in older patients. ARDS has significant morbidity as these patients remain in the hospital for extended periods and have significant weight loss, poor muscle function, and functional impairment.

The nurse is caring for a patient with chronic obstructive pulmonary disease (COPD). Which intervention for airway management should you delegate to a nursing assistant?

  • A. Assisting the patient to sit up on the side of the bed.
  • B. Instructing the patient to cough effectively.
  • C. Teaching the patient to use incentive spirometry .
  • D. Auscultation of breath sounds every 4 hours.

Correct Answer: A. Assisting the patient to sit up on the side of the bed.

Assisting patients with positioning and activities of daily living is within the educational preparation and scope of practice of a nursing assistant. Some examples of tasks and aspects of care that can be delegated legally to nonprofessional, unlicensed assistive nursing personnel, provided they are competent in these areas, under the direct supervision of the nurse include assistance with transfers, range of motion, feeding , ambulation, and other tasks such as making beds and assisting with bowel and bladder functions.

  • Option B: The staff members’ levels of education, knowledge, past experiences, skills, abilities, and competencies are also evaluated and matched with the needs of all of the patients in the group of patients that will be cared for. 
  • Option C: Teaching, instructing, and assessing patients all require additional education and skills and are more appropriate for a licensed nurse. Based on the basic entry educational preparation differences among these members of the nursing team, care should be assigned according to the level of education of the particular team member.
  • Option D: Among the tasks that cannot be legally and appropriately delegated to nonprofessional, unlicensed assistive nursing personnel, such as nursing assistants, patient care technicians, and personal care aides, include assessments, nursing diagnosis, establishing expected outcomes, evaluating care and any and all other tasks and aspects of care including but not limited to those that entail sterile technique, critical thinking, professional judgment, and professional knowledge.  

A patient with sleep apnea has a nursing diagnosis of Sleep Deprivation related to disrupted sleep cycle. Which action should you delegate to the nursing assistant?

  • A. Discuss weight-loss strategies such as diet and exercise with the patient.
  • B. Teach the patient how to set up the BiPAP machine before sleeping.
  • C. Remind the patient to sleep on his side instead of his back.
  • D. Administer modafinil (Provigil) to promote daytime wakefulness.

Correct Answer: C. Remind the patient to sleep on his side instead of his back.

The nursing assistant can remind patients about actions that have already been taught by the nurse and are part of the patient’s plan of care. The right person must be assigned to the right tasks and jobs under the right circumstances. The nurse who assigns the tasks and jobs must then communicate with and direct the person doing the task or job. The nurse supervises the person and determines whether or not the job was done in the correct, appropriate, safe, and competent manner.

  • Option A: Among the tasks that cannot be legally and appropriately delegated to nonprofessional, unlicensed assistive nursing personnel, such as nursing assistants, patient care technicians, and personal care aides, include assessments, nursing diagnosis, establishing expected outcomes, evaluating care, and any and all other tasks and aspects of care including but not limited to those that entail sterile technique, critical thinking, professional judgment, and professional knowledge.
  • Option B: The registered nurse must also ensure that the delegated tasks are permissible according to the nursing team members’ position description which is also referred to as the job description, and the particular facility’s specific policies and procedures relating to client care and who can and who cannot perform certain tasks.
  • Option D: Discussing and teaching require additional education and training. These actions are within the scope of practice of the RN. The RN can delegate the administration of medication to an LPN/LVN.

After a change of shift, you are assigned to care for the following patients. Which patient should you assess first ?

  • A. A 60-year old patient on a ventilator for whom a sterile sputum specimen must be sent to the lab.
  • B. A 55-year old with COPD and a pulse oximetry reading from the previous shift of 90% saturation.
  • C. A 70-year old with pneumonia who needs to be started on intravenous (IV) antibiotics.
  • D. A 50-year old with asthma who complains of shortness of breath after using a bronchodilator.

Correct Answer: D. A 50-year old with asthma who complains of shortness of breath after using a bronchodilator.

The patient with asthma did not achieve relief from shortness of breath after using the bronchodilator and is at risk for respiratory complications. This patient’s needs are urgent. In particular, a patient who is chronically on short-acting beta-2 agonists risks not achieving the same relief from their medicine as they once did. This phenomenon is called receptor downregulation. It happens because a portion of the receptors targeted end up being inactivated by the body due to overuse.

  • Option A: The sterile sputum specimen of the patient should be sent to the laboratory for not more than 60 minutes, or it will not be acceptable. This is not an urgent case and can be done after the nurse sees the other patients.
  • Option B: In COPD patients pulse oximetry oxygen saturations of more than 90% are acceptable. In the treatment of exacerbations of chronic obstructive pulmonary disease (COPD), oxygen should be titrated to achieve a target oxygen saturation range of 88–92%. This results in a greater than twofold reduction in mortality, compared with the routine administration of high-concentration oxygen therapy
  • Option C: The other patients need to be assessed as soon as possible, but none of their situations are urgent. Patients older than 60 years or younger than 4 years of age have a relatively poorer prognosis than young adults. If pneumonia is left untreated, the overall mortality may become 30%. The Pneumonia Severity Index (PSI) may be utilized as a tool to establish a patient’s risk of mortality.

After the respiratory therapist performs suctioning on a patient who is intubated, the nursing assistant measures vital signs for the patient. Which vital sign value should the nursing assistant report to the registered nurse immediately ?

  • A. Heart rate of 98 beats/min
  • B. Respiratory rate of 24 breaths/min
  • C. Blood pressure of 168/90 mm Hg
  • D. Tympanic temperature of 101.4ºF (38.6ºC)

Correct Answer: D. Tympanic temperature of 101.4ºF (38.6ºC)

Infections are always a threat to the patient receiving mechanical ventilation. The endotracheal tube bypasses the body’s normal air-filtering mechanisms and provides a direct access route for bacteria or viruses to the lower part of the respiratory system .

  • Option A: The normal range used in an adult is between 60 to 100 beats/minute with rates above 100 beats/minute and rates below 60 beats per minute, referred to as tachycardia and bradycardia, respectively. The rate of the pulse is significant to measure for assessing the physiological and pathological processes affecting the body.
  • Option B: The normal breathing rate is about 12 to 20 breaths per minute in an average adult. Tachypnea is described as a respiratory rate of more than 20 breaths per minute that could occur in physiological conditions like exercise, emotional changes, or pregnancy. Pathological conditions like pain, pneumonia, pulmonary embolism, asthma, foreign body aspiration , anxiety conditions, sepsis, carbon monoxide poisoning, and diabetic ketoacidosis can also present with tachypnea .
  • Option C: Blood pressure is an essential vital sign to comprehend the hemodynamic condition of the patient. Unfortunately, though, there are a lot of inter-person variabilities when measuring it. All healthcare providers should be aware of making sure all the essential prerequisites are met before checking the blood pressure of the patient.

An experienced LPN, under the supervision of the team leader RN, is providing nursing care for a patient with a respiratory problem. Which actions are appropriate to the scope of practice of an experienced LPN? Select all that apply.

  • A. Auscultate breath sounds
  • B. Administer medications via metered-dose inhaler (MDI)
  • C. Complete in-depth admission assessment
  • D. Initiate the nursing care plan
  • E. Evaluate the patient’s technique for using MDI’s

Correct Answers: A and B.

Appropriate decisions relating to the successful assignment of care are accurately based on the needs of the patient, the skills of the staff, the staffs’ position description or job descriptions, the employing facility’s policies and procedures, and legal aspects of care such as the states’ legal scopes of practice for nurses, nursing assistants and other members of the nursing team.

  • Option A: The experienced LPN is capable of gathering data and making observations, including noting breath sounds and performing pulse oximetry. The scope of practice for the licensed practical or vocational nurse will most likely include the legal ability of this nurse to perform data collection , plan, implement, and evaluate care under the direct supervision and guidance of the registered nurse.
  • Option B: Administering medications, such as those delivered via MDIs, is within the scope of practice of the LPN. Based on the basic entry educational preparation differences among these members of the nursing team, care should be assigned according to the level of education of the particular team member.
  • Option C: Scopes of practice should be considered prior to the assignment of care. All states have scopes of practice for advanced nurse practitioners, registered nurses, licensed practical nurses and unlicensed assistive personnel like nursing assistants and patient care technicians.
  • Option D: The staff members’ levels of education, knowledge, past experiences, skills, abilities, and competencies are also evaluated and matched with the needs of all of the patients in the group of patients that will be cared for. Some staff members may possess greater expertise than others.
  • Option E: Independently completing the admission assessment, initiating the nursing care plan , and evaluating a patient’s abilities require additional education and skills. These actions are within the scope of practice of the professional RN.

The charge nurse is making assignments for the next shift. Which patient should be assigned to the fairly new nurse (6 months experience) pulled from the surgical unit to the medical unit?

  • A. A 58-year old on airborne precautions for tuberculosis (TB).
  • B. A 68-year old just returned from a bronchoscopy and biopsy.
  • C. A 72-year old who needs teaching about the use of incentive spirometry.
  • D. A 69-year old with COPD who is ventilator dependent.

Correct Answer: C. A 72-year old who needs teaching about the use of incentive spirometry

Many surgical patients are taught about coughing , deep breathing, and the use of incentive spirometry preoperatively. The needs of the client must be competently met with the knowledge, skills and abilities of the staff to meet these needs. In other words, the nurse who delegates aspects of care to other members of the nursing team must balance the needs of the client with the abilities of those to which the nurse is delegating tasks and aspects of care.

  • Option A: To care for the patient with TB in isolation, the nurse must be fitted for a high-efficiency particulate air (HEPA) respirator mask. All healthcare facilities and agencies must assess and validate competency before total care or any aspect of care is performed by an individual without the direct supervision of another, regardless of their years of experience.
  • Option B: The bronchoscopy patient needs a specialized procedure. The staff members’ levels of education, knowledge, past experiences, skills, abilities, and competencies are also evaluated and matched with the needs of all of the patients in the group of patients that will be cared for.
  • Option D: The ventilator-dependent patient needs a nurse who is familiar with ventilator care. Some patients require high levels of professional judgment and skill; and other patient needs are somewhat routine and without the need for high levels of professional judgment and skill.

The high-pressure alarm on a patient’s ventilator goes off. When you enter the room to assess the patient, who has ARDS, the oxygen saturation monitor reads 87% and the patient is struggling to sit up. Which action should you take next ?

  • A. Reassure the patient that the ventilator will do the work of breathing for him.
  • B. Manually ventilate the patient while assessing possible reasons for the high-pressure alarm.
  • C. Increase the fraction of inspired oxygen on the ventilator to 100% in preparation for endotracheal suctioning.
  • D. Insert an oral airway to prevent the patient from biting on the endotracheal tube.

Correct Answer: B. Manually ventilate the patient while assessing possible reasons for the high-pressure alarm

Manual ventilation of the patient will allow you to deliver a FiO 2 of 100% to the patient while you attempt to determine the cause of the high-pressure alarm. Proper ventilation techniques with the BVM should consider safe ventilation parameters for each individual patient and their conditions.

  • Option A: The patient may need reassurance, but this is not the priority nursing intervention. Indicators of appropriate ventilation include but are not limited to patient chest rise, skin color, electronic vital sign monitoring, resistance on bag squeeze according to patient lung pathology, CO2 monitoring, and a flashing light on the BVM for rate of breath delivery.
  • Option C: Excessive volume, pressure or flow may result in morbidity from lung damage, stomach insufflation, or hemodynamic and pulmonary compromise. Lower tidal volumes are needed in ARDS to prevent regional overdistension.
  • Option D: The patient may need insertion of an oral airway, but the first step should be an assessment of the reason for the high-pressure alarm and resolution of the hypoxemia. PEEP (5–20 cmH2O) is a key element of protective ventilation and is routinely applied in all patients with ARDS to facilitate adequate oxygenation and maintain alveolar recruitment.

The nursing assistant tells you that a patient who is receiving oxygen at a flow rate of 6 L/min by nasal cannula is complaining of nasal passage discomfort. What intervention should you suggest to improve the patient’s comfort for this problem?

  • A. Suggest that the patient’s oxygen be humidified.
  • B. Suggest that a simple face mask be used instead of a nasal cannula.
  • C. Suggest that the patient be provided with an extra pillow.
  • D. Suggest that the patient sit up in a chair at the bedside.

Correct Answer: A. Suggest that the patient’s oxygen be humidified.

When the oxygen flow rate is higher than 4 L/min, the mucous membranes can be dried out. The best treatment is to add humidification to the oxygen delivery system. It is reasonable to use humidified oxygen for patients who require high-flow oxygen systems for more than 24 hours or who report upper airway discomfort due to dryness. Application of a water-soluble jelly to the nares can also help decrease mucosal irritation. None of the other options will treat the problem.

  • Option B: For patients wearing a nasal cannula for standard oxygen supplementation, switching to high-flow nasal cannula oxygen therapy (HNFC) may be a good alternative to combat the side effect of dry nose.
  • Option C: Providing an extra pillow would not alleviate the dryness of the patient’s nose. Water-based lubricants, such as K-Y jelly, help prevent dryness, irritation, and cracking of the nose commonly associated with supplemental oxygen therapy, BiPAP, and CPAP by adding moisture to the affected area.
  • Option D: Changing the patient’s position would not treat the dry nose. Medical oxygen contains no moisture, so regular or even occasional use can dry out the nasal passages. Nasal saline spray adds moisture to dry nasal passages and assists the nose’s natural cleaning system. It’s important to keep the nasal passages moist because bacterial infections can develop under the nasal crusts that develop inside dry nostrils.

When a patient with TB is being prepared for discharge, which statement by the patient indicates the need for further teaching?

  • A. “Everyone in my family needs to go and see the doctor for TB testing.”
  • B. “I will continue to take my isoniazid until I am feeling completely well.”
  • C. “I will cover my mouth and nose when I sneeze or cough and put my used tissues in a plastic bag.”
  • D. “I will change my diet to include more foods rich in iron, protein, and vitamin C.”

Correct Answer: B. “I will continue to take my isoniazid until I am feeling completely well.”

Patients taking isoniazid must continue the drug for 6 months. The other 3 statements are accurate and indicate an understanding of TB. Drug of choice is isoniazid. It is usually given with vitamin B6, pyridoxine (to prevent nerve damage). Isoniazid is recommended for Mantoux or quantiferon positive individuals and should be continued for 6 or 9 months.

  • Option A: Family members should be tested because of their repeated exposure to the patient. Most people who develop tuberculosis do so after a long period of latency (usually several years after initial primary infection). This is known as secondary tuberculosis. 
  • Option C: Covering the nose and mouth when sneezing or coughing, and placing the tissues in plastic bags help prevent transmission of the causative organism. Although usually a lung infection, tuberculosis is a multi-system disease with protean manifestation. The principal mode of spread is through inhalation of infected aerosolized droplets.
  • Option D: The dietary changes are recommended for patients with TB. Nutritional supplementation may help to improve outcomes in tuberculosis patients. A study found that nutritional counseling to increase energy intake combined with provision of supplements, when started during the initial phase of tuberculosis treatment, produced a significant increase in body weight, total lean mass, and physical function after six weeks.

To improve respiratory status, which medication should you be prepared to administer to the newborn infant with respiratory distress syndrome (RDS)?

  • A. Theophylline (Theolair, Theochron)
  • B. Surfactant (Exosurf)
  • C. Dexamethasone (Decadron)
  • D. Albuterol (Proventil)

Answer: B. Surfactant (Exosurf)

Exosurf neonatal is a form of synthetic surfactant. An infant with RDS may be given two to four doses during the first 24 to 48 hours after birth. It improves respiratory status, and research has shown a significant decrease in the incidence of pneumothorax when it is administered.

  • Option A: Theophylline is indicated for the treatment of asthma and COPD (bronchitis, emphysema). Theophylline relaxes the smooth muscles located in the bronchial airways and pulmonary blood vessels. It also reduces the airway responsiveness to histamine, adenosine, methacholine, and allergens.
  • Option C: Dexamethasone has a wide variety of uses in the medical field. As a treatment, dexamethasone has been useful in the treatment of acute exacerbation of multiple sclerosis, allergies, cerebral edema , inflammation, and shock. It works by suppressing the migration of neutrophils and decreasing lymphocyte colony proliferation.
  • Option D:  Albuterol is often used for the treatment of pediatric acute asthma. Albuterol acts on beta-2 adrenergic receptors to relax the bronchial smooth muscle. It also inhibits the release of immediate hypersensitivity mediators from cells, especially mast cells.

The clinical instructor directed the student nurse to care for a client whose potassium is 6.7 mEq/L. Which intervention is delegated correctly to the student nurse?

  • A. Give potassium 10 mEq orally
  • B. Give sodium polystyrene sulfonate (Kayexalate) 15 g orally
  • C. Give spironolactone ( Aldactone ) 25 mg orally
  • D. Assess electrocardiogram (ECG) strip for tall T waves

Correct Answer: B. Give sodium polystyrene sulfonate (Kayexalate) 15 g orally

Delegation, supervision. The normal range for potassium is 3.5 to 5 mEq/L. The client’s potassium level is high. Kayexalate eliminates potassium from the body through the gastrointestinal system.  The right person must be assigned to the right tasks and jobs under the right circumstances. The nurse who assigns the tasks and jobs must then communicate with and direct the person doing the task or job.

  • Option A: Giving additional potassium may further increase the serum potassium level. The registered nurse determines and analyzes all of the health care needs for a group of clients; the registered nurse delegates care that matches the skills of the person that the nurse is delegating to.
  • Option C: Spironolactone is a potassium-sparing diuretic that may cause the client’s potassium level to go even higher. The delegating registered nurse remains accountable for all client care despite the fact that some of these aspects of care can, and are, delegated to others.
  • Option D: The beginning nursing student does not have the skill to assess ECG strips. Some client needs are relatively predictable; and other patient needs are unpredictable based on the changing status of the client. Some needs require high levels of professional judgment and skill; and other patient needs are somewhat routine and without the need for high levels of professional judgment and skill.

The patient with COPD has a nursing diagnosis of Ineffective Breathing Pattern. Which is an appropriate action to delegate to the experienced LPN under your supervision?

  • A. Observe how well the patient performs pursed-lip breathing.
  • B. Plan a nursing care regimen that gradually increases activity intolerance .
  • C. Assist the patient with basic activities of daily living.
  • D. Consult with the physical therapy department about reconditioning exercises.

Correct Answer: A. Observe how well the patient performs pursed-lip breathing

Experienced LPNs/LVNs can use observation of patients to gather data regarding how well patients perform interventions that have already been taught. The scope of practice for the licensed practical or vocational nurse will most likely include the legal ability of this nurse to perform data collection , plan, implement and evaluate care under the direct supervision and guidance of the registered nurse.

  • Option B: Planning requires additional education and skills, appropriate to an RN. The scope of practice for the registered nurse will most likely include the legal ability of the registered professional nurse to perform all phases of the nursing process including assessment, nursing diagnosis, planning, implementation and evaluation.
  • Option C: Assisting patients with ADLs is more appropriately delegated to a nursing assistant. Some examples of tasks and aspects of care that can be delegated legally to nonprofessional, unlicensed assistive nursing personnel, provided they are competent in these areas, under the direct supervision of the nurse include assisting the client with their activities of daily living such as ambulation, dressing, grooming , bathing and hygiene .
  • Option D: Scopes of practice are also considered prior to the assignment of care. All states have scopes of practice for advanced nurse practitioners, registered nurses, licensed practical nurses and unlicensed assistive personnel like nursing assistants and patient care technicians.

When assessing a 22-year old patient who required emergency surgery and multiple transfusions 3 days ago, you find that the patient looks anxious and has labored respirations at the rate of 38 breaths/min. The oxygen saturation is 90% with the oxygen delivery at 6 L/min via nasal cannula. Which action is most appropriate ?

  • A. Increase the flow rate on the oxygen to 10 L/min and reassess the patient after about 10 minutes.
  • B. Assist the patient in using the incentive spirometer and splint his chest with a pillow while he coughs.
  • C. Administer the ordered morphine sulfate to the patient to decrease his anxiety and reduce the hyperventilation.
  • D. Switch the patient to a nonrebreather mask at 95% to 100% oxygen and call the physician to discuss the patient’s status.

Correct Answer: D. Switch the patient to a nonrebreather mask at 95% to 100% oxygen and call the physician to discuss the patient’s status.

The patient’s history and symptoms suggest the development of ARDS, which will require intubation and mechanical ventilation. Patients are mechanically ventilated, guarded against fluid overload with diuretics, and given nutritional support until evidence of improvement is observed.

  • Option A: The maximum oxygen delivery with a nasal cannula is a Fio2 of 44%. This is achieved with the oxygen flow at 6 L/min, so increasing the flow to 10 L/min will not be helpful. Interestingly, the mode in which a patient is ventilated affects lung recovery. Evidence suggests that some ventilatory strategies can exacerbate alveolar damage and perpetuate lung injury in the context of ARDS.
  • Option B: Helping the patient to cough and deep breathe will not improve the lung stiffness that is causing his respiratory distress. The chief treatment strategy is supportive care and focuses on 1) reducing shunt fraction, 2) increasing oxygen delivery, 3) decreasing oxygen consumption, and 4) avoiding further injury.
  • Option C: Morphine sulfate will only decrease the respiratory drive and further contribute to his hypoxemia. A lung-protective ventilatory strategy is advocated to reduce lung injury. Novel invasive ventilation strategies have been developed to improve oxygenation. These include airway pressure release ventilation (APRV) and high-frequency oscillation ventilation (children).

Which of these medication orders for a patient with a pulmonary embolism is more important to clarify with the prescribing physician before administration?

  • A. Warfarin (Coumadin) 1.0 mg by mouth (PO)
  • B. Morphine sulfate 2 to 4 mg IV
  • C. Cephalexin (Keflex) 250 mg PO
  • D. Heparin infusion at 900 units/hr

Correct Answer: A. Warfarin (Coumadin) 1.0 mg by mouth (PO)

Medication safety guidelines indicate that the use of a trailing zero is not appropriate when writing medication orders because the order can easily be mistaken for a larger dose, such as 10 mg. The order should be clarified before administration. The other orders are appropriate, based on the patient’s diagnosis.

  • Option B: FDA-approved usage of morphine sulfate includes moderate to severe pain that may be acute or chronic. Most commonly used in pain management , morphine provides major relief to patients afflicted with pain.
  • Option C: Cephalexin is an FDA-approved antibiotic. Cephalexin is a first-generation cephalosporin utilized in the treatment of urinary tract infections, respiratory infections, and other bacterial infections. Cephalexin is also commonly used in treating streptococcal and staphylococcal skin infections.
  • Option D: Unfractionated heparin is an anticoagulant indicated for both the prevention and treatment of thrombotic events such as deep vein thrombosis (DVT) and pulmonary embolism (PE) as well as atrial fibrillation (AF). Heparin is also used to prevent excess coagulation during procedures such as cardiac surgery, extracorporeal circulation, or dialysis, including continuous renal replacement therapy.

You are a team leader RN working with a student nurse. The student nurse is to teach a patient how to use an MDI without a spacer. Put in the correct order the steps that the student nurse should teach the patient.

  • 1. Remove the inhaler cap and shake the inhaler
  • 2. Tilt your head back and breathe out fully
  • 3. Open your mouth and place the mouthpiece 1 to 2 inches away
  • 4. Press down firmly on the canister and breathe deeply through your mouth
  • 5. Hold your breath for at least 10 seconds
  • 6. Wait at least 1 minute between puffs

The correct order is shown above.

  • Before each use, the cap is removed and the inhaler is shaken according to the instructions in the package insert. 
  • Next, the patient should tilt the head back and breathe out completely. 
  • Each inhaler consists of a small canister of medicine connected to a mouthpiece. The canister is pressurized. As the patient presses down on the inhaler, it releases a mist of medicine.
  • As the patient begins to breathe deeply through the mouth, the canister should be pressed down to release one puff (dose) of the medication. 
  • The patient should continue to breathe in slowly over 3 to 5 seconds and then hold the breath for at least 10 seconds to allow the medication to reach deep into the lungs. 
  • The patient should wait for at least 1 minute between puffs from the inhaler.

You are acting as a preceptor for a newly graduated RN during her second week of orientation. You would assign the new RN under your supervision to provide care to which patients? Select all that apply. 

  • A. A 38-year old with moderate persistent asthma awaiting discharge.
  • B. A 63-year old with a tracheostomy needing tracheostomy care every shift.
  • C. A 56-year old with lung cancer who has just undergone left lower lobectomy.
  • D. A 49-year old just admitted with a new diagnosis of esophageal cancer .

Correct Answer: A and B.

  • Option A: A patient who is waiting for discharge may be stable enough for the care of the student nurse. The client is the center of care. The needs of the client must be competently met with the knowledge, skills and abilities of the staff to meet these needs. 
  • Option B: The new RN is at an early point in her orientation. The most appropriate patients to assign to her are those in stable condition who require routine care. In other words, the nurse who delegates aspects of care to other members of the nursing team must balance the needs of the client with the abilities of those to which the nurse is delegating tasks and aspects of care, among other things such as the scopes of practice and the policies and procedures within the particular healthcare facility.
  • Option C: The patient with the lobectomy will require the care of a more experienced nurse, who will perform frequent assessments and monitoring for postoperative complications. Some needs require high levels of professional judgment and skill; and other patient needs are somewhat routine and without the need for high levels of professional judgment and skill.
  • Option D: The patient admitted with newly diagnosed esophageal cancer will also benefit from care by an experienced nurse. This patient may have questions and needs a comprehensive admission assessment. As the new nurse advances through her orientation, you will want to work with her in providing care for these patients with more complex needs.

Jenna is a nurse from the medical-surgical unit of a tertiary hospital. She was asked to float on the orthopedic ward in which she has no prior experience working on. Which client should be assigned to her?

  • A. A client with a cast for a fractured femur and who has numbness and discoloration of the toes.
  • B. A client with balanced skeletal traction and needs assistance with morning care.
  • C. A client who had an above-the-knee amputation yesterday and currently has a temperature of 101.4ºF.
  • D. A client who had a total hip replacement two days ago and needs blood glucose monitoring.

Correct Answer: D. A client who had a total hip replacement two days ago and needs blood glucose monitoring.

A nurse from the medical-surgical floor floated to the orthopedic unit should be given clients with a stable condition as those who have care similar to her training and experience. A client who is in a postoperative state is more likely to be in a stable condition.

  • Option A: The client may be experiencing compartment syndrome and would need the expertise of an orthopedic nurse. Acute compartment syndrome is a condition in which there is increased pressure within a closed osteofascial compartment, resulting in impaired local circulation. Without prompt treatment, acute compartment syndrome can lead to ischemia and eventually, necrosis.
  • Option B: The care of a patient with skeletal traction would need a nurse who had experience with handling the apparatus. It requires frequent reassessment of neurovascular function of the extremity after application of the traction.
  • Option C: A newly recovered postoperative patient should be monitored by an experienced ortho nurse. An above-knee amputation is associated with enormous morbidity; unlike a below-knee amputation, fitting a prosthesis for an above-knee stump is difficult.

Which intervention for a patient with a pulmonary embolus could be delegated to the LPN on your patient care team?

  • A. Evaluating the patient’s complaint of chest pain .
  • B. Monitoring laboratory values for changes in oxygenation.
  • C. Assessing for symptoms of respiratory failure.
  • D. Auscultating the lungs for crackles.

Correct Answer: D. Auscultating the lungs for crackles.

An LPN who has been trained to auscultate lung sounds can gather data by routine assessment and observation, under the supervision of an RN. The scope of practice for the licensed practical or vocational nurse will most likely include the legal ability of this nurse to perform data collection , plan, implement and evaluate care under the direct supervision and guidance of the registered nurse.

  • Option A: The scope of practice for the registered nurse will most likely include the legal ability of the registered professional nurse to perform all phases of the nursing process including assessment, nursing diagnosis, planning, implementation and evaluation.
  • Option B: Part of supervision entails the ongoing evaluation of staff’s ability by the registered nurse to perform assigned tasks using direct observations and with indirect observations of patient safety, the quality of the care provided, the appropriateness of care provided, and the timeliness of care provided.
  • Option C: Independently evaluating patients, assessing for symptoms of respiratory failure, and monitoring and interpreting laboratory values require additional education and skill, appropriate to the scope of practice of the RN.

The nurse plans to care for a client in the post- anesthesia care unit. Which of the following should the nurse assess first ? 

  • A. Respiratory status
  • B. Level of consciousness
  • C. Level of pain
  • D. Reflexes and movement of extremities

Correct Answer: A. Respiratory status

Assessing respiratory status is the first priority. Remember ABC. General anesthesia and mechanical ventilation impair pulmonary function, even in normal individuals, and result in decreased oxygenation in the postanesthesia period. They also cause a reduction in functional residual capacity of up to 50% of the preanesthesia value.

  • Option B: A level of consciousness assessment is also helpful, such as the AVPU scale or the Glasgow Coma Scale. The AVPU scale assesses if the patient is alert and oriented, responds to voice, responds to pain, or is unresponsive. The Glasgow Coma Scale is an objective way to record the conscious state of a patient, examining eye , verbal, and motor responses. 
  • Option C: Pain is a common occurrence after most all types of surgical procedures and is probably the most significant postoperative problem in the eyes of the patient. Prompt and adequate pain relief is a critical nursing intervention.
  • Option D: Neurologic functions can be assessed by the patient’s response to verbal stimuli, pupils’ responsiveness to light and accommodation, ability to move all extremities, and strength and equality of a hand grip.

Nurse Jackie is reviewing the diet of a 28-year-old female who reports several months of intermittent abdominal pain, abdominal bloating, and flatulence. The nurse should tell the client to avoid :

  • B. Broccoli
  • D. Simple carbohydrates

Correct Answer: B. Broccoli

Broccoli is known to be gas-forming which can lead to bloating and therefore, should be avoided. In general, gassy foods are those that contain certain sugars (fructose, lactose, raffinose, and sorbitol) and/or soluble fiber. These substances are not digested at the level of the stomach and thus make their way down to the intestines where bacteria break them down. The end result of this breakdown is the release of gas.​

  • Option A: One way to prevent uncomfortable intestinal gas is to slowly increase the fiber in the diet. Giving the body a chance to get used to processing the increase in fiber will make the transition easier and reduce the amount of intestinal gas to deal with.
  • Option C: Plain yogurt can actually help the stomach because it contains probiotics, which are known to regulate digestion. However, if the patient is eating flavored yogurt that’s high in sugar, she’ll have more fermentation going on in her body, which means more gas and bloating.
  • Option D: Complex Carbohydrate Intolerance (CCI) occurs because there is a lack of the enzyme necessary to digest complex carbohydrates. There is little gas production in the small intestine because the bacterial concentration is low. When the undigested carbohydrates reach the colon, the bacteria that normally live in the colon ferment them. This fermentation often results in the production of gas.

Nurse Jenny of Nurseslabs Medical Center is planning care for a client who had undergone colposcopy. Which of the following actions should the RN take first ?

  • A. Discuss the client’s fear regarding potential cervical cancer.
  • B. Assist with silver nitrate application to the cervix to control bleeding.
  • C. Give instructions regarding douching and sexual relations.
  • D. Administer pain medications.

Correct Answer: B. Assist with silver nitrate application to the cervix to control bleeding.

Colposcopy is a procedure to examine the cervix, vagina, and vulva for signs of disease. The priority nursing action when caring for a client who underwent colposcopy is to assist in controlling potential bleeding by applying silver nitrate to the cervix.

  • Option A: Colposcopy is a procedure in which a lighted, magnifying instrument called a colposcope is used to examine the cervix, vagina, and vulva. The indications for a colposcopy to be performed are risk-based. Women referred for colposcopy have a variety of underlying risks for cervical pre-cancer based on their cytological results, the HPV testing if it was performed, and personal history of cervical dysplasia.
  • Option C: There is no required preparation for the patient having the colposcopy; however, it can be difficult to perform if she is on her menstrual cycle due to obscuring blood. Having the room with the proper equipment readily available will expedite the patient’s visit.
  • Option D: The procedure is typically not painful. It does not require local or regional anesthesia. Slight discomfort may be felt when a speculum is inserted into the vagina, which can be minimized by deep breathing during the procedure. 

Sally is a nurse working in an emergency department and receives a client after a radiological accident. Which task is the utmost priority for the nurse to do first?

  • A. Decontaminate the client’s clothing.
  • B. Decontaminate the open wound on the client’s thigh.
  • C. Decontaminate the examination room the client is placed in.
  • D. Save the client’s vomitus for analysis by the radiation safety staff.

Correct Answer: B. Decontaminate the open wound on the client’s thigh.

Decontaminating an open wound is the first priority for the client. This minimizes the absorption of radiation in the client’s body. A radiological accident is an event that involves the release of potentially dangerous radioactive materials into the environment. This release is usually in the form of a cloud or “plume” and could affect the health and safety of anyone in its path.

  • Option A: Getting radioactive material off the body as soon as possible can lower a worker’s radiation dose from external contamination. Removing outer clothing and showering or, at a minimum, washing the face, hands, and any other exposed skin are essential decontamination steps.
  • Option C: Decontamination of emergency response workers, their clothing, and any equipment, including PPE they may be using, is essential to limit radiation dose and prevent the spread of radioactive contamination outside of the response area.
  • Option D: A prodromal period during which victims may experience loss of appetite, nausea, vomiting, fatigue , and diarrhea ; after extremely high doses, additional symptoms such as fever, prostration (laying down), respiratory distress, and hyper-excitability can occur. In cases where the dose is not sufficient to cause rapid death, these symptoms usually disappear within 1-2 days.

Nursing Prioritization, Delegation and Assignment NCLEX Practice Quiz #2 (25 Items)

Nurse Channing is caring for four clients and is preparing to do his initial rounds. Which client should the nurse assess first ?

  • A. A client with diabetes was discharged today.
  • B. A 35-year-old male with tracheostomy and copious secretions.
  • C. A teenager scheduled for physical therapy this morning.
  • D. A 78-year-old female client with a pressure ulcer that needs a dressing change.

Correct Answer: B. A 35-year-old male with tracheostomy and copious secretions.

The patient with an airway problem should be given the highest priority. The ABCs identifies the airway, breathing and cardiovascular status of the patient as the highest of all priorities in that sequential order.

  • Option A: The client who was discharged today is not a priority because he is stable enough to be sent home. Maslow’s Hierarchy of Needs identifies the physiological or biological needs, including the ABCs, the safety/psychological/emotional needs, the need for love and belonging, the needs for self-esteem and the esteem by others and the self-actualization needs in that order of priority.
  • Option C: The teenager who will undergo physical therapy is under Maslow’s safety and physiological needs. The psychological or emotional, safety, and security needs include needs like low level stress and anxiety, emotional support, comfort, environmental and medical safety and emotional and physical security.
  • Option D: The client needing a dressing change for her pressure ulcer belongs to Maslow’s physical and biological needs. Some physical needs include the need for the ABCs of airway, breathing and cardiovascular function, nutrition, sleep, fluids, hygiene and elimination.

Nurse Janus enters a room and finds a client lying on the floor. Which of the following actions should the nurse perform first ?

  • A. Call for help to get the client back in bed
  • B. Establish whether the client is responsive
  • C. Assist the client back to bed
  • D. Ask the client what happened

Correct Answer: B. Establish whether the client is responsive

Assess the client’s current level of consciousness first to determine whether the patient has had a loss of consciousness then do the remaining choices if possible. The initial step is to evaluate for reactivity using objective measures. Address the patient verbally, progress to light shaking, then progress to more intense mechanical stimulation.

  • Option A: After establishing the client’s ABCs, the nurse may call for help. The initial step in the evaluation of an unconscious patient is to evaluate for the basic signs of life. The American Heart Association recommends examining for a pulse, followed by assessing airway patency and breathing pattern . 
  • Option C: If the client is stable and has been seen by a physician, the nurse may assist him back to his bed. The best practice for reporting level of responsiveness is to document specifically how the patient reacted to the external stimulus provided for testing.
  • Option D: History regarding an unconscious patient is based on supplementary data. Questioning a person who has good knowledge of the recent history of the patient is preferable. The physical exam should be repeated at least daily, in a sequential fashion, and documented systematically.

Paige is a nurse preceptor who is working with a new nurse, Joyce. She notes that Joyce is reluctant to delegate tasks to members of the care team. Paige recognizes that this reluctance is most likely due to:

  • A. Role modeling behaviors of the preceptor
  • B. The philosophy of the new nurse’s school of nursing
  • C. The orientation provided to the new nurse
  • D. Lack of trust in the members of the healthcare team

Correct Answer: D. Lack of trust in the members of the healthcare team.

Lack of trust is the common reason for reluctance in a delegation of tasks. Some managers don’t delegate because they feel they can work better than others. Since ultimate responsibility is of the delegator, they prefer doing the work themselves rather than getting it done through others.

  • Option A: Proper and appropriate assignments facilitate quality care. Improper and inappropriate assignments can lead to poor quality of care, disappointing outcomes of care, the jeopardization of client safety, and even legal consequences.
  • Option B: Staff members differ in terms of their knowledge, skills, abilities and competencies. A staff member who has just graduated as a certified nursing assistant and a newly graduated registered nurse cannot be expected to perform patient care tasks at the same level of proficiency, skill and competency as an experienced nursing assistant or registered nurse.
  • Option C: Validated and documented competencies must also be considered prior to assignment of patient care. No aspect of care can be assigned or delegated to another nursing staff member unless this staff member has documented evidence that they are deemed competent by a registered nurse to do so.

Nurse Paul is developing a care plan for a client after bariatric surgery for morbid obesity. The nurse should include which of the following on the care plan as the priority complication to prevent:

  • B. Wound infection
  • C. Depression
  • D. Thrombophlebitis

Correct Answer: B. Wound infection

Wound infection is the most common complication among obese clients who had undergone surgery. This is due to their poor blood supply in their adipose tissues. From a surgical standpoint, obesity is associated with a multitude of complications including impairments of cutaneous wound healing, total wound failure, and fascial dehiscence.

  • Option A: A 2006 study of post bariatric patients found that over the ensuing six months after surgery, complication rates actually approached 40 percent. These complications included abdominal pain, nutritional deficiencies, endocrine or metabolic disorders, gastrointestinal disorders, and wound compromise.
  • Option C: After bariatric surgery, improvements are significant in disease processes involving endocrine (diabetes), cardiovascular ( hypertension , hyperlipidemia , and coronary artery disease), rheumatic, and hypercoagulation disorders (deep vein thrombosis and pulmonary embolism). Reductions in the severity of symptoms relating to sleep apnea and depression have also been observed.
  • Option D: Compared with nonobese surgical patients, obese patients have an increased incidence of surgical complications, including atelectasis , thrombophlebitis , mortality, wound infection, and wound separation.

A client presents to the emergency room with dyspnea, chest pain, and syncope. The nurse assesses the client and notes the following assessment cues: pale, diaphoretic, blood pressure of 90/60, respirations of 33. The client is also anxious and fearing death. Which action should the nurse take first ?

  • A. Administer pain medications
  • B. Administer IV fluids
  • C. Administer dopamine
  • D. Administer oxygen via nasal cannula

Correct Answer: D. Administer oxygen via nasal cannula.

The promotion of adequate oxygenation is the most vital to life and therefore should be given the highest priority by the nurse. When the nurse needs to prioritize patients, Maslow’s hierarchy of needs theory is used to decide which patient is to be seen first. A part of Maslow’s hierarchy of needs is airway, breathing, and circulation (ABC), which are physiological elements that are needed for the body to survive and help determine one’s level of health.

  • Option A: The 2nd priority needs include MAAUAR which is mental status, acute pain , acute impaired urinary elimination , unresolved and unaddressed needs, abnormal diagnostic test results, and risks. The 3rd level priorities include all concerns and problems addressed with the 2nd level priority needs.
  • Option B: Maslow’s Hierarchy of Needs identifies the physiological or biological needs, including the ABCs, the safety/psychological/emotional needs, the need for love and belonging, the needs for self-esteem and the esteem by others and the self-actualization needs in that order of priority. Administering IV fluids belong in Maslow’s physical and biological needs, but still after airway.
  • Option C: Dopamine (DA) is a peripheral vaso stimulant used to treat low blood pressure, low heart rate, and cardiac arrest, especially in acute neonatal cases via a continuous intravenous drip. For stimulation of the sympathetic nervous system, the indication is for a continuous intravenous drip administration. 

Nurse Pietro receives an 11-month old child with a fracture of the left femur on the pediatric unit. Which action is important for the nurse to take first ?

  • A. Call for a social worker to meet with the family.
  • B. Check the child’s blood pressure, pulse, respiration, and temperature.
  • C. Administer pain medications
  • D. Speak with the parents about how the fracture occurred.

Correct Answer: D. Speak with the parents about how the fracture occurred.

In case of injury, especially among children, it is very important that the nurse should first assess possible abuse. Abuse is one of the reporting responsibilities of the nurse. The first step in any child protection response system is the identification of possible incidents of child maltreatment. Medical personnel, educators, childcare providers, mental health professionals, law enforcement personnel, the clergy, and other professionals are often in a position to observe and/or screen families and children to identify abuse or neglect when it occurs.

  • Option A: An initial assessment or investigation is conducted on reports that are screened in during the intake process to identify whether the maltreatment can be substantiated. In addition to child protective services and law enforcement, other professionals such as medical and mental health personnel, teachers and childcare providers, and foster care or residential staff may play a role in the initial assessment.
  • Option B: After initial screening for child abuse , the nurse may take the patient’s vital signs. State laws provide guidance to child protective services (CPS) agencies regarding identifying and reporting suspected child maltreatment, investigating to determine whether abuse occurred, and providing necessary services for children and youth and their families.
  • Option C: Administering pain medications can be done after assessing the patient’s vital signs. Ibuprofen worked at least as well as acetaminophen with codeine for fracture pain control, and had fewer adverse effects. Children given ibuprofen were better able to eat and play than those given acetaminophen with codeine—an important patient-oriented functional outcome.

Nurse Skye is assigned to the cardiac unit caring for four clients. He is preparing to do initial rounds. Which client should the nurse assess first ?

  • A. A client scheduled for cardiac ultrasound this morning.
  • B. A client with syncope being discharged today.
  • C. A client with chronic bronchitis on nasal oxygen.
  • D. A client with diabetic foot ulcer that needs a dressing change.

Correct Answer: C. A client with chronic bronchitis on nasal oxygen.

A client with airway problems should be attended first. When the nurse needs to prioritize patients, Maslow’s hierarchy of needs theory is used to decide which patient is to be seen first. A part of Maslow’s hierarchy of needs is airway, breathing, and circulation (ABC),which are physiological elements that are needed for the body to survive and help determine one’s level of health. Observing ABCs is a rapid assessment of life-threatening conditions in order of priority.

  • Option A: Clinical judgment and prioritization of patient care is built on the nursing process. Nurses learn the steps of the nursing process in their foundational nursing course and utilize it throughout their academic and clinical career to direct patient care and determine priorities. Analysis (interpreting what is going on with the patient through reviewing lab work, diagnostic testing, patient history, complaints and observations) comes after assessment.
  • Option B: The client who was discharged today is not a priority because he is stable enough to be sent home. Maslow’s Hierarchy of Needs identifies the physiological or biological needs, including the ABCs, the safety/psychological/emotional needs, the need for love and belonging, the needs for self-esteem and the esteem by others and the self-actualization needs in that order of priority.

A nurse enters a room and finds a patient lying face down on the floor and bleeding from a gash in the head. Which action should the nurse perform first ?

  • A. Determine the level of consciousness
  • B. Push the call button for help
  • C. Turn the client face up to assess
  • D. Go out in the hall to get the nursing assistant to stay with the client while the nurse calls the physician

Correct Answer: A. Determine the level of consciousness.

Assessing the level of consciousness should be the first action when dealing with clients that might have fallen over. The initial step is to evaluate for reactivity using objective measures. Address the patient verbally, progress to light shaking, then progress to more intense mechanical stimulation.

  • Option B: After establishing the client’s ABCs, the nurse may call for help. The initial step in the evaluation of an unconscious patient is to evaluate for the basic signs of life. The American Heart Association recommends examining for a pulse, followed by assessing airway patency and breathing pattern .
  • Option C: Refrain from moving the patient until a physician comes into the scene and assesses the overall condition. For patients with a pulse, who are breathing adequately, the evaluation shifts to a detailed neurological examination. The neurologic examination would serve to determine the location and nature of the neurological lesion and to determine prognosis.
  • Option D: Do not leave the patient. A systematic evaluation of the unconscious patient is recommended. Because many cases of unconsciousness are reversible, the management of unconscious patients necessitates thorough history-taking, patient evaluation, stabilizing treatment, and diagnostic testing occurring simultaneously.

Nurse Adonai is working on the night shift with a nursing assistant. The nursing assistant comes to the nurse stating that the other nurse working on the unit is not assessing a client with abdominal pain despite multiple requests. Which of the following actions by the nurse is best ?

  • A. Ask the other nurse if she needs help
  • B. Assess the client and let the other nurse know what should be done
  • C. Ask the client if he is satisfied with his care
  • D. Contact the nursing supervisor to address the situation

Answer: D. Contact the nursing supervisor to address the situation

The nurse should use a proper channel of communication. The nursing supervisor is responsible for the actions of the different members of the nursing team. Assessment and treatment of pain is often complex. The standard definition of pain is “whatever the experiencing person says it is, existing whenever the experiencing person says it does” (McCaffery, 1968, p. 65).

  • Option A: Current health care requires effective collaboration among providers. Poor communication may lead to poor patient outcomes . Although emphasis has been placed on interprofessional communication (particularly between physicians and nurses) in the health system, little has been written about problems in communication within the medical profession.
  • Option B: The problem of variability in clinical judgment occurs in virtually all medical fields. The type of workplace and the opportunity to discuss and receive advice about interpersonal issues appear to be important in dealing with some difficulties (e.g., overcoming misunderstandings).
  • Option C: Patient feedback is an important source of information that should help staff implement changes that will improve care quality and patient safety. According to the NHS Confederation (2010), in some trusts, there have been “unspoken but widely held beliefs” that providing good patient experiences is “nice but not necessary” or “nice but too expensive”. 

Nurse Vivian is reviewing immunizations with the caregiver of a 72-year-old client with a history of cerebrovascular disease. The caregiver learns which immunization is a priority for the client?

  • A. Hepatitis A vaccine
  • B. Lyme’s disease vaccine
  • C. Hepatitis B vaccine
  • D. Pneumococcal vaccine

Correct Answer: D. Pneumococcal vaccine

Pneumococcal vaccine is a priority immunization amongst the elderly, especially those with chronic illnesses. It is administered every five (5) years. A pneumococcal vaccine, PPSV23, is indicated in the United States for all adults 65 years of age and older, as well as younger patients with conditions that increase the risk for developing pneumococcal pneumonia or invasive pneumococcal disease.

  • Option A: Hepatitis A vaccine is given to at-risk individuals to prevent infection from the hepatitis A virus (HAV). The Advisory Committee on Immunization Practices (ACIP)’s recommendations are to provide routine immunization for children aged 12 to 13 months for persons at high risk of having hepatitis A infection and or persons who wish to have immunity.
  • Option B: Lyme disease, which is caused by the spirochetal agent Borrelia burgdorferi, is the most common vector-borne illness in the United States. In 1998, the US Food and Drug Administration approved a recombinant Lyme disease vaccine that was later voluntarily withdrawn from the market by the manufacturer.
  • Option C: Hepatitis B vaccination is indicated to prevent active infection with the hepatitis B virus, which can lead to chronic liver failure and hepatocellular carcinoma. In addition to all infants and any yet unvaccinated children, the Advisory Committee on Immunization Practices recommends primarily vaccinating any adults who may have a higher risk for contracting or complication from hepatitis B.

You are admitting a patient for whom a diagnosis of pulmonary embolism must be ruled out. The patient’s history and assessment reveal all of these findings. Which finding supports the diagnosis of pulmonary embolism?

  • A. The patient was recently in a motor vehicle accident
  • B. The patient participated in an aerobic exercise program for 6 months
  • C. The patient gave birth to her youngest child 1 year ago
  • D. The patient was on bed rest for 6 hours after a diagnostic procedure

Correct Answer: A. The patient was recently in a motor vehicle accident

Patients who have recently experienced trauma are at risk for deep vein thrombosis and pulmonary embolism. PE remains relatively common after trauma and occurs in the absence of lower extremity or spinal fractures. Although PE is usually thought to occur between days 5 and 7 after injury, data suggest that as many as 37% of pulmonary emboli occur early. 

  • Option B: The better the circulation is, the lower the chance of blood pooling up and clotting. Clotting is often caused by long periods of inactivity, so practicing a regular exercise routine can help reduce the risk of clots and other conditions related to blood clots, such as diabetes and obesity.
  • Option C: Pulmonary embolisms (PE) typically occur during or shortly after the labor and delivery, and may be fatal for the mother if not treated immediately. The client gave birth a year ago, therefore eliminating the risk for pulmonary embolism.
  • Option D: None of the other findings are risk factors for pulmonary embolism. Prolonged immobilization is also a risk factor for DVT and pulmonary embolism, but this period of bed rest was very short.

You are assigned to provide nursing care for a patient receiving mechanical ventilation. Which action should you delegate to an experienced nursing assistant?

  • A. Assessing the patient’s respiratory status every 4 hours
  • B. Taking vital signs and pulse oximetry readings every 4 hours
  • C. Checking the ventilator settings to make sure they are as prescribed
  • D. Observing whether the patient’s tube needs suctioning every 2 hours

Correct Answer: B. Taking vital signs and pulse oximetry readings every 4 hours

The nursing assistant’s educational preparation includes measurement of vital signs, and an experienced nursing assistant would know how to check oxygen saturation by pulse oximetry. The staff members’ levels of education, knowledge, past experiences, skills, abilities, and competencies are also evaluated and matched with the needs of all of the patients in the group of patients that will be cared for. 

  • Option A: Delegation should be done according to the differentiated practice for each of the staff members. Some needs require high levels of professional judgment and skill; and other patient needs are somewhat routine and without the need for high levels of professional judgment and skill. 
  • Option C: Assessing and observing the patient, as well as checking ventilator settings, require the additional education and skills of the RN. The scope of practice for the registered nurse will most likely include the legal ability of the registered professional nurse to perform all phases of the nursing process including assessment, nursing diagnosis, planning, implementation and evaluation.
  • Option D: Among the tasks that cannot be legally and appropriately delegated to nonprofessional, unlicensed assistive nursing personnel, such as nursing assistants, patient care technicians, and personal care aides, include assessments, nursing diagnosis, establishing expected outcomes, evaluating care and any and all other tasks and aspects of care including but not limited to those that entail sterile technique, critical thinking, professional judgment and professional knowledge.

You are caring for a patient with emphysema and respiratory failure who is receiving mechanical ventilation through an endotracheal tube. To prevent ventilator-associated pneumonia (VAP), which action is most important to include in the plan of care?

  • A. Administer ordered antibiotics as scheduled
  • B. Hyperoxygenate the patient before suctioning
  • C. Maintain the head of the bed at a 30 to a 45-degree angle
  • D. Suction the airway when coarse crackles are audible

Correct Answer: C. Maintain the head of the bed at a 30 to a 45-degree angle

Research indicates that nursing actions such as maintaining the head of the bed at 30 to 45 degrees decrease the incidence of VAP. These actions are part of the standard of care for patients who require mechanical ventilation. Proper positioning (keeping the head of the bed between 30–45 degrees) and encouraging early mobility of mechanically ventilated patients aid in the prevention of VAP.

  • Option A: To reduce risk for VAP, the following nurse-led evidence-based practices are recommended: reduce exposure to mechanical ventilation, provide excellent oral care and subglottic suctioning, promote early mobility, and advocate for adequate nurse staffing and a healthy work environment.
  • Option B: Aspiration of secretions that accumulate around the endotracheal tube of mechanically ventilated patients can lead to VAP. Subglottic secretion suctioning can be performed by both the nurse and respiratory therapist and can aid in prevention. 
  • Option D: A recent meta-analysis of 20 RCTs found that subglottic suctioning reduced the risk for VAP by 45% compared to patients who didn’t receive suctioning. Coordinating subglottic suctioning when conducting oral care may be a good mechanism to cluster care and ensure both of these practices are routinely delivered.

You are evaluating and assessing a patient with a diagnosis of chronic emphysema. The patient is receiving oxygen at a flow rate of 5 L/min by nasal cannula. Which finding concerns you immediately ?

  • A. The patient has fine bibasilar crackles.
  • B. The patient’s respiratory rate is 8 breaths/min.
  • C. The patient sits up and leans over the night table.
  • D. The patient has a large barrel chest.

Correct Answer: B. The patient’s respiratory rate is 8 breaths/min.

For patients with chronic emphysema, the stimulus to breathe is a low serum oxygen level (the normal stimulus is a high carbon dioxide level). This patient’s oxygen flow is too high and is causing a high serum oxygen level, which results in a decreased respiratory arrest. 

  • Option A: The rest of the examination may range from prolonged expiration or wheezes on forced exhalation to increased resonance, indicating hyperinflation as the airway obstruction increases. Distant breath sounds, wheezes, crackles at the lung bases, and/or distant heart sounds are heard on auscultation.
  • Option C: Patients with emphysema are typically referred to as “pink puffers,” meaning cachectic and non- cyanotic . Expiration through pursed lips increases airway pressure and prevents airway collapse during respiration, and the use of accessory muscles of respiration indicates advanced disease.
  • Option D: A chest x-ray is only helpful in diagnosis if emphysema is severe, but it is usually the first step when suspecting COPD to rule out other causes. Destruction of alveoli and air trapping causes hyperinflation of the lungs with flattening of the diaphragm, and the heart appears elongated and tubular in shape.

You are initiating a nursing care plan for a patient with pneumonia. Which intervention for cough enhancement should you delegate to a nursing assistant?

  • A. Teaching the patient about the importance of adequate fluid intake and hydration.
  • B. Assisting the patient to a sitting position with neck flexed, shoulders relaxed, and knees flexed.
  • C. Reminding the patient to use an incentive spirometer every 1 to 2 hours while awake.
  • D. Encouraging the patient to take a deep breath, hold it for 2 seconds, then cough two or three times in succession.

Correct Answer: C. Reminding the patient to use an incentive spirometer every 1 to 2 hours while awake

A nursing assistant can remind the patient to perform actions that are already part of the plan of care. The right person must be assigned to the right tasks and jobs under the right circumstances. The nurse who assigns the tasks and jobs must then communicate with and direct the person doing the task or job. The nurse supervises the person and determines whether or not the job was done in the correct, appropriate, safe and competent manner.

  • Option A: Teaching patients about adequate fluid intake requires additional education and skill and is within the scope of practice of the RN. Among the tasks that cannot be legally and appropriately delegated to nonprofessional, unlicensed assistive nursing personnel, such as nursing assistants, patient care technicians, and personal care aides, include assessments, nursing diagnosis, establishing expected outcomes, evaluating care and any and all other tasks and aspects of care including but not limited to those that entail sterile technique, critical thinking, professional judgment and professional knowledge.
  • Option B: Assisting the patient in the best position to facilitate coughing requires specialized knowledge and understanding that is beyond the scope of practice of the basic nursing assistant. However, an experienced nursing assistant could assist the patient with positioning after the nursing assistant and the patient had been taught the proper technique. The nursing assistant would still be under the supervision of the RN. 
  • Option D: Discussing and teaching require additional education and training. These actions are within the scope of practice of the RN. The client is the center of care. The needs of the client must be competently met with the knowledge, skills and abilities of the staff to meet these needs. 

You are making a home visit to a 50-year old patient who was recently hospitalized with a right leg deep vein thrombosis and a pulmonary embolism. The patient’s only medication is enoxaparin (Lovenox) subcutaneously. Which assessment information will you need to communicate to the physician?

  • A. The patient says that her right leg aches all night
  • B. The right calf is warm to the touch and is larger than the left calf
  • C. The patient is unable to remember her husband’s first name
  • D. There are multiple ecchymotic areas on the patient’s arms

Correct Answer: C. The patient is unable to remember her husband’s first name

Confusion in a patient this age is unusual and may be an indication of intracerebral bleeding associated with enoxaparin use. Because of the reduced effectiveness of the antidote (e.g., protamine), bleeding complications can be severe and life-threatening.

  • Option A: The right leg symptoms are consistent with a resolving deep vein thrombosis.  Around half of people who have had a DVT will experience some degree of chronic discomfort and around 15% of people will experience moderate to severe chronic pain and swelling. This is called post-thrombotic syndrome (PTS) and is caused partly by damage or leftover scar tissue inside the vein. 
  • Option B: The patient may need teaching about keeping the right leg elevated above the heart to reduce swelling and pain. The client may also wear graduated compression stockings. These specially fitted stockings are tight at the feet and become gradually loosened up on the leg, creating gentle pressure that keeps blood from pooling and clotting.
  • Option D: The presence of ecchymoses may point to a need to do more patient teaching about avoiding injury while taking anticoagulants but does not indicate that the physician needs to be called.

You are providing care for a patient with recently diagnosed asthma. Which key points would you be sure to include in your teaching plan for this patient? Select all that apply.

  • A. Avoid potential environmental asthma triggers such as smoke.
  • B. Use the inhaler 30 minutes before exercising to prevent bronchospasm.
  • C. Wash all bedding in cold water to reduce and destroy dust mites.
  • D. Be sure to get at least 8 hours of rest and sleep every night.
  • E. Avoid foods prepared with monosodium glutamate (MSG).

Correct Answer: A, B, D, and E.

Asthma comprises a range of diseases and has a variety of heterogeneous phenotypes. The recognized factors that are associated with asthma are a genetic predisposition, specifically a personal or family history of atopy (propensity to allergy , usually seen as eczema, hay fever, and asthma).

  • Option A: Environmental control is vital if one wants to avoid recurrent attacks. Allergen avoidance can significantly improve the quality of life. This means avoiding tobacco, dust mites, animals, and pollen.
  • Option B: Medical management includes bronchodilators like beta-2 agonists and muscarinic antagonists (salbutamol and ipratropium bromide respectively) and anti-inflammatories such as inhaled steroids (usually beclomethasone but steroids via any route will be helpful).
  • Option C: Bedding should be washed in hot water to destroy dust mites. Put bed sheets, pillows cases, clothes, curtains, drapes, and other washable fabrics through a wash setting between 130° and 140°F (54° to 60°C) in order to kill them and remove their fecal matter and skin particles.
  • Option D: Whether it’s due to the symptoms of asthma or just staying up too late, missing sleep can make asthma worse. Sleep loss promotes inflammation in the body and affects lung function, increasing the chances of an asthma attack.
  • Option E: Foods that contain high concentrations of MSG include stock cubes, gravy, soy sauce and packet soups. Hydrolyzed vegetable protein is sometimes added to foods in place of MSG, and may trigger asthma in people who are sensitive to MSG.

You are providing nursing care for a newborn infant with respiratory distress syndrome (RDS) who is receiving nasal CPAP ventilation. What complications should you monitor for this infant?

  • A. Pulmonary embolism
  • B. Bronchitis
  • C. Pneumothorax
  • D. Pneumonia

Correct Answer: C. Pneumothorax

The most common complications after birth for infants with RDS is pneumothorax. Alveoli rupture and air leaks into the chest and compresses the lungs, which makes breathing difficult. Pulmonary air leak syndromes such as pneumothorax and pneumomediastinum may also present as respiratory distress, but the onset of symptoms may be more acute.

  • Option A: Complications of neonatal respiratory distress syndrome are related mainly to the clinical course of RDS in neonates and the long term outcomes of the neonates. While surfactant therapy has decreased the morbidity associated with RDS, many patients continue to have complications during and after the acute course of RDS.
  • Option B: Acute complications due to positive pressure ventilation or invasive mechanical ventilation include air-leak syndromes such as pneumothorax, pneumomediastinum, and pulmonary interstitial emphysema. There is also an increase in the incidence of intracranial hemorrhage and patent ductus arteriosus in very low birth weight infants with RDS, although independently linked to prematurity itself. 
  • Option D: BPD is a chronic complication of RDS. The pathophysiology of BPD involves both arrested lung development as well as lung injury and inflammation. Besides a surfactant deficiency, the immature lung of the premature infant has decreased compliance, decreased fluid clearance, and immature vascular development, which predisposes the lung to injury and inflammation, further disrupting the normal development of alveoli and pulmonary vasculature.

You are responsible for the care of a postoperative patient with a thoracotomy. The patient has been given a nursing diagnosis of Activity Intolerance. Which action should you delegate to the nursing assistant?

  • A. Instructing the patient to alternate rest and activity periods
  • B. Encouraging, monitoring, and recording nutritional intake
  • C. Monitoring cardiorespiratory response to activity
  • D. Planning activities for periods when the patient has the most energy

Correct Answer: B. Encouraging, monitoring, and recording nutritional intake

The nursing assistant’s training includes how to monitor and record intake and output. After the nurse has taught the patient about the importance of adequate nutritional intake for energy, the nursing assistant can remind and encourage the patient to take-in adequate nutrition. 

  • Option A: Instructing patients requires more education and skill, and are appropriate to the RN’s scope of practice. Discussing and teaching require additional education and training. These actions are within the scope of practice of the RN.
  • Option C: Monitoring the patient’s cardiovascular response to activity is a complex process requiring additional education, training, and skill, and falls within the RN’s scope of practice.
  • Option D: The scope of practice for the registered nurse will most likely include the legal ability of the registered professional nurse to perform all phases of the nursing process including assessment, nursing diagnosis, planning, implementation and evaluation.

You are supervising a nursing student who is providing care for a patient with thoracotomy with a chest tube. What findings would you clearly instruct the nursing student to notify you about immediately?

  • A. Chest tube drainage of 10 to 15 mL/hr.
  • B. Continuous bubbling in the water seal chamber.
  • C. Complaints of pain at the chest tube site.
  • D. Chest tube dressing dated yesterday.

Correct Answer: B. Continuous bubbling in the water seal chamber

Continuous bubbling indicates an air leak that must be identified. With the physician’s order you can apply a padded clamp to the drainage tubing close to the occlusive dressing. If the bubbling stops, the air leak may be at the chest tube insertion, which will require you to notify the physician. If the air bubbling does not stop when you apply the padded clamp, the air leak is between the clamp and the drainage system, and you must assess the system carefully to locate the leak. 

  • Option A: Chest tube drainage of 10 to 15 mL/hr is acceptable. Alert physician if drainage greater than 100 mL per hour in an adult and 3 mL/Kg/hour in a 3 hour period or 5 to 10 mL/Kg in any 1 hour period in pediatric patients.
  • Option C: The patient’s complaints of pain need to be assessed and treated. This is important but is not as urgent as investigating a chest tube leak. Severe pain during chest drain therapy significantly influences the well being of the patient and leads to severe pathophysiological disorders. Early mobilization, sufficient coughing to mobilize secretions, and effective deep breathing are only possible with adequate pain management .
  • Option D: Chest tube dressings are not changed daily but may be reinforced. In adults, chest tube dressing should be changed every other day and prn. In pediatric patients, if it is an uncomplicated chest tube insertion site, the dressing should be left as is until it is soiled or lifting. Changed ONLY when necessary and with a physician present.

You are supervising a student nurse who is performing tracheostomy care for a patient. For which action by the student should you intervene?

  • A. Suctioning the tracheostomy tube before performing tracheostomy care
  • B. Removing old dressings and cleaning off excess secretions
  • C. Removing the inner cannula and cleaning using universal precautions
  • D. Replacing the inner cannula and cleaning the stoma site.
  • E. Changing the soiled tracheostomy ties and securing the tube in place.

Correct Answer: C. Removing the inner cannula and cleaning using universal precautions

When tracheostomy care is performed, a sterile field is set up and sterile technique is used. Standard precautions such as washing hands must also be maintained but are not enough when performing tracheostomy care. The presence of a tracheostomy tube provides direct access to the lungs for organisms, so sterile technique is used to prevent infection. All of the other steps are correct and appropriate.

  • Option A: Suctioning of the tracheostomy tube is necessary to remove mucus, maintain a patent airway, and avoid tracheostomy tube blockages. The frequency of suctioning varies and is based on individual patient assessment. It is recommended that the episode of suctioning (including passing the catheter and suctioning the tracheostomy tube) is completed within 5-10 seconds.
  • Option B: The tracheal stoma in the immediate post-operative period requires regular assessment and wound management including once daily dressing change following cleaning of the stoma area or more frequently if required.
  • Option D: Care of the stoma is commenced in the immediate postoperative period, and is ongoing. Clean stoma with cotton wool applicator sticks moistened with 0.9% sodium chloride. Use each cotton wool applicator stick once only taking it from one side of the stoma opening to the other and then discard in waste.
  • Option E: The frequency of a tracheostomy tube changes is determined by the Respiratory and ENT teams except in an emergency situation. This can vary depending on the patient’s individual needs and tracheostomy tube type. It is imperative that the first tracheostomy tube change is performed with both nursing and medical staff who are competent in tracheostomy management and the tracheostomy kit is available at the bedside.

You are supervising an RN who was pulled from the medical-surgical floor to the emergency department. The nurse is providing care for a patient admitted with anterior epistaxis (nosebleed). Which of these directions would you clearly prove to the RN? Select all that apply.

  • A. Position the patient supine and turn on his side.
  • B. Apply direct lateral pressure to the nose for 5 minutes.
  • C. Maintain universal body substances precautions.
  • D. Apply ice or cool compresses to the nose.
  • E. Instruct the patient not to blow the nose for several hours.

Correct Answers: B, C, D, and E.

Epistaxis (nasal bleeding) is relatively common but rarely fatal. Anterior bleeding is usually managed by digital pressure, gentle chemical cauterization, or nasal packing. Posterior bleeding, which is less common, is characterized by massive bleeding that’s initially bilateral; this bleeding may be more difficult to control.

  • Option A: Have the patient sit upright with her head tilted forward, and instruct her to apply direct external digital pressure to the nares with her index finger and thumb. The correct position for a patient with an anterior nosebleed is upright and leaning forward to prevent blood from entering the stomach and avoid aspiration . All of the other instructions are appropriate according to best practice for emergency care of a patient with an anterior nosebleed.
  • Option B: Tell her to breathe through her mouth while she holds firm pressure on the soft flesh of her nose for at least 10 minutes. If bleeding persists, cotton pledgets soaked in a vasoconstrictor and anesthetic will be placed in the anterior nasal cavity , and direct pressure should be applied at both sides of the nose.
  • Option C: Put on protective gear, including gown, gloves, and face shields. Provide an emesis basin and tissues. Tell her to spit blood into the basin if necessary. This helps prevent nausea and vomiting and lets you estimate the amount of bleeding.
  • Option D: Cooling the nape of the neck is said to induce reflex constriction of the mucosal vessels of the nose, but there is no general agreement in the literature on the benefit of an ice pack as an adjuvant treatment of epistaxis.
  • Option E: The nasal packing will be left in place for 3 to 5 days. Instruct the patient to avoid exerting herself, forcefully blowing her nose, or bending over. She should also avoid NSAIDs, alcoholic beverages, and smoking for 5 to 7 days. Tell her to apply water-soluble ointment to her lips and nostrils while packing is in place and to use a cool-mist room humidifier. Advise her to take steps to prevent constipation and straining, which increases the risk of bleeding.

You are the preceptor for an RN who is undergoing orientation to the intensive care unit. The RN is providing care for a patient with ARDS who has just been intubated in preparation for mechanical ventilation. You observe the nurse perform all of these actions. For which action must you intervene immediately?

  • A. Assessing for bilateral breath sounds and symmetrical chest movements.
  • B. Auscultating over the stomach to rule out esophageal intubation.
  • C. Marking the tube 1 cm from where it touches the incisor tooth or nares.
  • D. Ordering a chest radiograph to verify that tube placement is correct.

Correct Answer: C. Marking the tube 1 cm from where it touches the incisor tooth or nares

The endotracheal tube should be marked at the level where it touches the incisor tooth or nares. This mark is used to verify that the tube has not shifted. If the patient has an endotracheal tube, check for tube slippage into the right mainstem bronchus, as well as inadvertent extubation.

  • Option A: Auscultate over the epigastrium to assess for the absence of sounds in the stomach. The presence of an enlarging abdomen or audible air inflation into the stomach with each positive-pressure ventilation may be the initial sign of an ET tube in the esophagus or an esophageal intubation.
  • Option B: Since the advent of ET intubation, the use of physical examination methods has been the mainstay for the initial evaluation of proper ET tube placement. Direct visualization of the insertion of the ET tube through the vocal cords and into the trachea is the first method to confirm proper ET tube placement.
  • Option D:   A chest X-ray is often acquired following placement of an endotracheal tube (ET tube) to determine the position of its tip. The priority at this time is to verify that the tube has been correctly placed. The trachea, carina and main bronchi are almost always identifiable on a chest X-ray image, as long as the image is viewed on a high quality screen in a darkened room.

You have just finished assisting the physician with a thoracentesis for a patient with recurrent left pleural effusion caused by lung cancer. The thoracentesis removed 1800 mL of fluid. Which patient assessment information is important to report to the physician?

  • A. The patient starts crying and says she can’t go on with treatment much longer.
  • B. The patient complains of sharp, stabbing chest pain with every deep breath.
  • C. The patient’s blood pressure is 100/48 mm Hg and her heart rate is 102 beats/ min.
  • D. The patient’s dressing at the thoracentesis site has 1 cm of bloody drainage.

Correct Answer: C. The patient’s blood pressure is 100/48 mm Hg and her heart rate is 102 beats/ min

Removal of large quantities of fluid from the pleural space can cause fluid to shift from the circulation into the pleural space, causing hypotension and tachycardia. The patient may need to receive IV fluids to correct this. 

  • Option A: A large build up of fluid can make it hard to breathe. Removing some fluid may make the person more comfortable. To remove this fluid for evaluation (testing) or improve a patient’s breathing, a procedure called a thoracentesis is done.
  • Option B: Discomfort can result from the needle at the time it is inserted. Doctors try to lessen any pain or discomfort by giving a local numbing medicine (local anesthetic). The discomfort is usually mild and goes away once the needle or tube is removed.
  • Option D: During insertion of the needle, a blood vessel in the skin or chest wall may be accidentally nicked. Bleeding is usually minor and stops on its own. Sometimes, bleeding can cause a bruise on the chest wall.

You have obtained the following assessment information about a 3-year old who has just returned to the pediatric unit after having a tonsillectomy. Which finding requires the most immediate follow-up?

  • A. Frequent swallowing
  • B. Hypotonic bowel sounds
  • C. Complaints of a sore throat
  • D. Heart rate of 112 beats/min

Correct Answer: A. Frequent swallowing

Frequent swallowing after a tonsillectomy may indicate bleeding. You should inspect the back of the throat for evidence of bleeding. The other assessment results are not unusual in a 3-year old after surgery.

  • Option B: Hypoactive bowel sounds are normal during sleep. They also occur normally for a short time after the use of certain medicines and after abdominal surgery. Decreased or absent bowel sounds often indicate constipation.
  • Option C: It is common for the child to have a temporary sore throat for about 2-3 weeks after getting tonsils and adenoids removed. The pain will be most severe for the first week after surgery and will usually be gone in 2-3 weeks
  • Option D:  No strenuous exercise or activity – running, jumping, swimming or playing sports – until the child’s throat is fully healed. Anything that increases the child’s heart rate or blood pressure can increase the risk of bleeding. If this occurs, it may require another surgery to stop the bleeding.

Nursing Prioritization, Delegation and Assignment NCLEX Practice Quiz #3 (25 Items)

After exposure to hot weather and sun, clients with signs and symptoms of heat-related ailment rush to the Emergency Department (ED). Sort clients into those who need critical attention and those with less serious conditions.

  • 1. An abandoned person who is a teacher; has altered mental state, weak muscle movement, hot, dry, pale skin; and whose duration of heat exposure is unknown.
  • 2. An elderly traffic enforcer who complains of dizziness and syncope after standing under the heat of the sun for several hours to perform his job.
  • 3. A sportsman who complains of severe leg cramps and nausea, and displays paleness, tachycardia, weakness, and diaphoresis.
  • 4. A comparatively healthy housewife who states that the air conditioner has been down for 5 days and who exhibits hypotension, tachypnea , profuse diaphoresis, and fatigue.

The correct order is shown above

  • The abandoned person has symptoms of heat stroke, a medical emergency, which heightens the risk of brain damage. The sequelae of the insult may persist beyond the initial CNS dysfunction, involving injury to the gut, kidney, skeletal muscle , or other organ systems.
  • The elderly traffic enforcer is at risk for heat syncope and should be instructed to relax in a cool environment and withdraw from approaching related circumstances. It represents a temporary, self-limited dizziness, weakness, or loss of consciousness during prolonged standing or positional changes in a hot environment, including physical activity .
  • The sportsman is experiencing heat cramps, which can be treated with rest and fluids.  This condition is due to a relative deficiency of sodium, potassium, chloride, or magnesium . Other symptoms may include nausea, vomiting, fatigue, weakness, sweating, and tachycardia.
  • The homemaker is having heat exhaustion and management includes IV or oral fluids and settling in a cool area. External temperatures may be more moderate if associated with intense physical exertion. Survey-based data has shown that some of the most common symptoms are headache, exhaustion, or a combination of symptoms.

The ambulance has transported a man with severe chest pain. As the man is being transferred to the emergency stretcher, the nurse assessed the following: unresponsiveness, cessation of breathing, and absence of palpable pulse. Which of the following tasks is proper to assign to the nursing assistant?

  • A. Aiding with oral intubation
  • B. Performing chest compressions
  • C. Placing the defibrillator pads
  • D. Starting bag valve mask ventilation

Correct Answer: B. Performing chest compressions

Basic cardiac life support is learned by nursing assistants so they can perform chest compressions. Certified nursing assistants deal directly with the patients so they must be cardiopulmonary resuscitation certified. It is the nursing assistant who witnesses the victims of cardiac arrests and becomes an immediate responder. A trained certified assistant can easily cater the instantaneous needs of the patient.

  • Option A: The nurse or the respiratory therapist should provide assistance as needed during intubation. Assisting with tracheal intubation is an aspect of clinical practice that requires knowledge and skill if the procedure is to be carried out in a timely and safe manner.
  • Option C: The defibrillator pads are accurately labeled; nevertheless, the responsibility of placing them should be done by the RN or physician because of the potential for skin damage and electrical arcing.
  • Option D: The use of the bag valve mask demands practice, and normally, a respiratory therapist will implement this measure. If bag-valve-mask ventilation is used for a prolonged period of time or if improperly performed, air may be introduced into the stomach. If this occurs and gastric distention is noted, a nasogastric tube should be inserted to evacuate the accumulated air in the stomach.

A high school student comes in the triage area alert and ambulatory, and his uniform is soaked with blood. He and his classmates are saying, “We were running around outside the school and he got hit in the abdomen with a stick!” Which statement should be a priority ?

  • A. “The stick was absolutely filthy and muddy.”
  • B. “He has a family history of diabetes, so he requires attention right now.”
  • C. “He pulled the stick out because it was too painful for him.”
  • D. “There was plenty of blood so we used three gauzes.”

Correct Answer: C. “He pulled the stick out because it was too painful for him.”

An impaled object may be giving a tamponade effect, and removal can result in abrupt hemodynamic decompensation. Surgery is often required; impaled objects are secured in place so that they do not move and they should only be removed in an operating room.

  • Option A: Penetrating trauma often causes damage to internal organs resulting in shock and infection. The severity depends on the body organs involved, the characteristics of the object, and the amount of energy transmitted.
  • Option B: Information such as the dirt on the stick or history of diabetes, is significant in the overall treatment plan but can be addressed next. The indications for surgical intervention include a patient with hemodynamic instability, development of peritoneal findings such as involuntary guarding, point tenderness or rebound tenderness, and diffuse abdominal pain that does not resolve.
  • Option D: Additional history including a more precise extent of blood loss, depth of penetration, and medical history should be collected. If the pancreas is injured, further injury occurs from autodigestion. Injuries of the liver often present in shock because the liver tissue has a large blood supply.

A mother is so worried that her son took an unknown amount of children’s chewable vitamins at an unknown time. While in the ED, the child is alert and asymptomatic. What information should be directly stated to the physician?

  • A. The child was nauseated and vomited before arriving in the ED.
  • B. The child has been managed multiple times for unexpected injuries.
  • C. The child has been treated many times for the ingestion of toxic substances.
  • D. The ingested children’s chewable vitamins contain iron.

Correct Answer: D. The ingested children’s chewable vitamins contain iron.

Iron is a toxic substance that can lead to severe bleeding, shock, hepatic failure, and coma. The antidote that can be used for severe cases of iron poisoning is deferoxamine. Iron poisoning is one of the most common toxic ingestion and one of the most deadly among children. Failure to diagnose and treat iron poisoning can have serious consequences including multi-organ failure and death.

  • Option A: During the first stage (0.5 to 6 hours), the patient mainly exhibits gastrointestinal (GI) symptoms including abdominal pain, vomiting, diarrhea , hematemesis, and hematochezia. The second stage (6 to 24 hours) represents an apparent recovery phase, as the patient’s GI symptoms may resolve despite toxic amounts of iron absorption.
  • Option B: This information needs further investigation but will not change the immediate diagnostic testing or treatment plan. Patients who have GI symptoms that resolve after a short period of time and have normal vital signs require supportive care and an observation period, as it may represent the second stage of iron toxicity.
  • Option C: Patients who are symptomatic or demonstrate signs of hemodynamic instability require aggressive management and admission to an intensive care unit. Deferoxamine, a chelating agent that can remove iron from tissues and free iron from plasma , is indicated in patients with systemic toxicity, metabolic acidosis, worsening symptoms, or a serum iron level predictive of moderate or severe toxicity.

Several clients arrive in the ED with the same complaint of abdominal pain. Designate them for care in order of the severity of their condition.

  • 1. A 68-year-old man with a pulsating abdominal mass and sudden onset of “tearing” pain in the abdomen and flank within the past hour.
  • 2. A 25-year-old woman complaining of dizziness and severe left lower quadrant pain who states she is probably pregnant.
  • 3. A 12-year-old girl with a low-grade fever, anorexia, nausea, and right lower quadrant tenderness for the past 2 days.
  • 4. A 42-year-old woman with moderate right upper quadrant pain who has vomited little amounts of yellow bile and whose symptoms have worsened over the past week.
  • 5. A 38-year-old man complaining of severe occasional cramps with three episodes of watery diarrhea hours after meal.
  • 6. A 53-year-old man who experiences discomforting mid-epigastric pain that is worse between meals and during the night.
  • The 68-year-old man with pulsating mass is experiencing abdominal aneurysm that may rupture, and he may abruptly deteriorate. Rupture of an abdominal aortic aneurysm is life-threatening. These patients may present in shock often with diffuse abdominal pain and distension. Most patients with a ruptured abdominal aortic aneurysm die before hospital arrival.
  • The 25-year-old woman with lower left quadrant pain is at risk for ectopic pregnancy, which is a life-threatening condition.
  • The 12-year-old girl needs evaluation to rule out appendicitis . Appendicitis is an acute inflammatory process involving the appendix. It is the number one surgical emergency and one of the most common causes of abdominal pain, particularly in children.
  • The 42-year-old woman with vomiting needs evaluation for gallbladder problem, which seems to be worsening. Occlusion of the cystic duct or malfunction of the mechanics of gallbladder emptying is the pathophysiology of this disease. Cases of acute untreated cholecystitis could lead to perforation of the gallbladder, sepsis, and death.
  • The 38-year-old man has food poisoning, which is usually self-limiting. Most food-borne illnesses are mild and improve without any specific treatment. Some patients have severe disease and require hospitalization, aggressive hydration, and antibiotic treatment. 
  • The 53-year-old man with mid-epigastric pain may have ulcer, but followup diagnostic testing and educating lifestyle modification can be scheduled with the primary health care provider.  It is important to understand this disease process is both preventable and treatable. Patients may be treated differently depending on the etiology of their gastric ulcer.

The newly hired nurse is in his first week on the job in the ED. He used to be a traveling nurse for 5 years. Which area in his present job is the most appropriate assignment for him?

  • A. Fast-track clinic
  • B. Pediatric medicine team
  • C. Trauma team

Correct Answer: A. Fast-track clinic

The ambulatory or fast-track clinic deals with relatively stable clients. The decision of whether or not to delegate or assign is based upon the RN’s judgment concerning the condition of the patient, the competence of all members of the nursing team and the degree of supervision that will be required of the RN if a task is delegated.

  • Option B: Few places are more hectic than a pediatric ward. Clearly, delegating important nursing tasks is the only plausible way for short-staffed emergency rooms to meet the challenges of providing quality patient care. All decisions related to delegation and assignment are based on the fundamental principles of protection of the health, safety, and welfare of the public.
  • Option C: This area should be filled with nurses who are experienced with hospital routines and policies and have the ability to locate equipment immediately. There is both individual accountability and organizational accountability for delegation. Organizational accountability for delegation relates to providing sufficient resources, including sufficient staffing with an appropriate staff mix.
  • Option D: The RN delegates only those tasks for which he or she believes the other health care worker has the knowledge and skill to perform, taking into consideration training, cultural competence, experience and facility/agency policies and procedures. 

A client with multiple injuries is rushed to the ED after a head-on car collision. Which assessment finding takes priority ?

  • A. Irregular apical pulse
  • B. Ecchymosis in the flank area
  • C. A deviated trachea
  • D. Unequal pupils

Correct Answer: C. A deviated trachea

A deviated trachea is a symptom of tension pneumothorax, which will result in respiratory arrest if not managed. The first question in the ESI triage algorithm for triage nurses asks whether “the patient requires immediate life-saving interventions” or simply “is the patient dying?” The nurse determines this by looking to see if the patient has a patent airway, if the patient is breathing, and if the patient has a pulse.

  • Option A: Assessment of circulation comes after the airway. The nurse evaluates the patient, checking pulse, rhythm, rate, and airway patency. Is there concern for inadequate oxygenation? Is this person hemodynamically stable? Does the patient need any immediate medication or interventions to replace volume or blood loss? Does this patient have pulselessness, apnea, severe respiratory distress, oxygen saturation below 90, acute mental status changes, or unresponsiveness?
  • Option B: Ecchymosis can be a sign of internal bleeding, which belongs to assessment of circulation. If the patient is not categorized as a level 1, the nurse then decides if the patient should wait or not. This is determined by three questions; is the patient in a high-risk situation, confused, lethargic, or disoriented? Or is the patient in severe pain or distress? The high-risk patient is one who could easily deteriorate, one who could have a threat to life, limb, or organ.
  • Option D: Anisocoria due to trauma may remain permanent but also may improve over time. Surgical management is rarely warranted. A referral to a neuro-ophthalmologist, ophthalmologist, or neurologist may be warranted in cases that do not resolve.

Several people were killed and injured in a recent industrial explosion. The victims are being interviewed and assessed by the nurses for possible psychiatric crises. Which client has the greatest risk for posttraumatic stress disorder?

  • A. An individual who was injured and trapped for 8 hours before rescue.
  • B. A person who saw the death of a co-worker during the blast.
  • C. An individual who recently discovered that her daughter was killed in the incident.
  • D. A person who repeatedly watched television coverage of the event.

Correct Answer: A. An individual who was injured and trapped for 8 hours before rescue

Any of these victims may need or require psychiatric counseling. There will be changes in previous coping skills and support groups; nevertheless, the individual who encounters a threat to his or her own life is at the greatest chance of having psychiatric difficulties following a disaster incident.

  • Option B: It is important to remember that not everyone who lives through a dangerous event develops PTSD. In fact, most people will not develop the disorder. Not everyone with PTSD has been through a dangerous event. Some people develop PTSD after a friend or family member experiences danger or harm.
  • Option C: Many factors play a part in whether a person will develop PTSD. Some examples are listed below. Risk factors make a person more likely to develop PTSD. Other factors, called resilience factors, can help reduce the risk of the disorder.
  • Option D: Anyone can develop PTSD at any age. This includes war veterans, children, and people who have been through a physical or sexual assault , abuse, accident, disaster, or other serious events.

When several areas of a daycare center collapsed due to an earthquake, children, especially injured ones, were brought to the ED. As a competent nurse, you know that children will be more predisposed to which of the following? Select all that apply.

  • A. Bradycardia
  • B. Fracture of the long bones
  • C. Head trauma
  • D. Hypothermia
  • E. Hypoxemia
  • F. Junctional arrhythmias
  • G. Liver and spleen contusions
  • H. Lumbar spine injuries

Correct Answer: C, D, E, and G

Children will be more prone to head trauma, hypothermia, hypoxemia, and liver and spleen injuries. 

  • Option A: Children have strong hearts; hence pulse rate will increase to compensate. A fast heart rate in children in most situations is a normal response to increased levels of activity or, occasionally, anxiety.
  • Option B: They have almost flexible bones compared with those adults. A child’s bones are more flexible because their chemical composition is different from that of adult bones. This means a kid’s bone might bend or “bow” instead of breaking.
  • Option C: They have proportionately larger heads that predispose them to head injuries or trauma. When one looks at an average growth chart for a child who has reached the age of 18, it can be seen that the steepest curve is from 0 to 2 years of age. From the ages of two to 18, a child experiences more growth in the size of their head, reaching its full size at anywhere from 54 to 60 cm.
  • Option D: Hypothermia is more likely due to their thinner skin and proportionately larger body surface area. Newborns, infants, and young children are more likely to develop hypothermia because they have a larger surface area compared to body weight so they can lose body heat faster than older children and adults.
  • Option E: Hypoxemia is more likely because of their higher oxygen demand. Neonates, infants, and children are at increased risk of hypoxemia because of smaller functional residual capacities, increased heart rates, and increased metabolic requirements compared with adults.
  • Option F: Other arrhythmias are less likely to occur. In most cases an irregular heartbeat is abnormal. The most common cause of an irregular heartbeat in children is isolated premature beats. Both premature atrial contractions and premature ventricular contractions are relatively common in children. Fortunately, in many instances these can be completely benign.
  • Option G: Liver and spleen injuries are more likely due to the thoracic cage of children giving less protection. The liver, spleen, and pancreas lie in the upper abdomen. They are partly protected by the ribs. This protection is less effective in children than in adults because the ribs are very pliable and because the liver and spleen may extend caudally beyond the ribs, especially in infants and toddlers. In addition, children have relatively larger viscera, less overlying fat, and weaker abdominal musculature.
  • Option H: Injury to the cervical area is the most likely spinal injury in children. Majority of the pediatric cervical spine injuries (CSIs) occur between the skull and C4 vertebra; and around 10.8% to 38.7% of these injuries involve C1 and C2 vertebrae. Children suffer from atlanto-axial injuries 2.5 times more often than adults.

What is regarded as one of the priority actions that must be accomplished when a primary assessment of a trauma client is conveyed?

  • A. Taking a full set of vital sign measurements.
  • B. Completing a brief neurologic assessment.
  • C. Monitoring pulse oximetry reading.
  • D. Palpating and auscultating the abdomen.

Correct Answer: B. Completing a brief neurological assessment

A brief neurologic assessment to ascertain level of consciousness and pupil reaction is part of the primary survey. Once the patient is stabilized, a neurologic examination should be conducted. CT scan is the diagnostic modality of choice in the initial evaluation of patients with head trauma.

  • Option A: Vital signs are considered part of the secondary survey. Avoid hypotension. Normal blood pressure may not be adequate to maintain adequate flow and CPP if ICP is elevated. Isolated head trauma usually does not cause hypotension. Look for another cause if the patient is in shock.
  • Option C: Identify any condition which might compromise the airway, such as pneumothorax. The cervical spine should be maintained in-line during intubation. Nasotracheal intubation should be avoided in patients with facial trauma or basilar skull fracture.
  • Option D: Assessment of abdomen is basically part of the secondary survey. The secondary survey is a rapid but thorough head to toe examination assessment to identify potential injuries. It should be performed after the primary survey and the initial stabilization is complete.

Prior to oral defense, a 21-year-old nursing student goes straight to the clinic due to tingling sensations, palpitations, and chest tightness. Deep, rapid breathing and carpal spasms are also observed. What is the nursing priority action for this situation?

  • A. Give supplemental oxygen
  • B. Allow the student to breathe into a paper bag
  • C. Report to the physician immediately
  • D. Get an order for an anxiolytic medication

Correct Answer: B. Allow the student to breathe into a paper bag

The student is hyperventilating secondary to anxiety, and breathing into a paper bag will provide rebreathing of carbon dioxide. Encouraging slow breathing will also help. The idea behind breathing into a paper bag or mask is that rebreathing exhaled air helps the body put CO2 back into the blood.

  • Option A: Acute anxiety may require treatment with a benzodiazepine. Chronic anxiety treatment consists of psychotherapy, pharmacotherapy, or a combination of both. Anxiety disorders appear to be caused by an interaction of biopsychosocial factors. Genetic vulnerability interacts with situations that are stressful or traumatic to produce clinically significant syndromes.
  • Option C: Report it to the physician once there is a recurrence or the breathing did not improve. Anxiety is one of the most common psychiatric disorders but the true prevalence is not known as many people do not seek help or clinicians fail to make the diagnosis. Anxiety is one of the most common psychiatric disorders in the general population. Specific phobia is the most common with a 12-month prevalence rate of 12.1%. Social anxiety disorder is the next most common, with a 12-month prevalence rate of 7.4%.
  • Option D: Selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), benzodiazepines, tricyclic antidepressants, mild tranquilizers, and beta-blockers treat anxiety disorders.

The nurse is assigned to a small rural community hospital. Six clients have arrived at the ED because the local church is caught on deadly fire. More affected residents are expected to arrive soon and it is the only hospital in the nearby area. Arrange the following six clients in the order in which they should obtain medical attention utilizing disaster triage principles.

  • 1. An 11-year-old boy wheezing and heavily labored breathing unrelieved by an asthma inhaler
  • 2. A firefighter who is exhibiting combative behavior and has respiratory stridor
  • 3. A 19-year-old anxious girl with a crushed leg that is very swollen and has tachycardia
  • 4. A 62-year-old grandmother with full-thickness burns to the hands and forearms
  • 5. A 5-year-old child with respiratory distress and burns over more than 70% of the anterior body.
  • 6. A 50-year-old man in full cardiac arrest who has been receiving CPR continuously for the past 30 minutes
  • The 11-year-old may die if the nurse consumes too much time attempting to control the firefighter. First, initiate an albuterol treatment for the 11-year-old with asthma. This action is quick to perform, and the child or significant other can be instructed to hold the apparatus while the nurse attends to other clients.
  • The firefighter is in greater respiratory distress than the 11-year-old; nevertheless, maintaining a strong combative client is demanding and time-consuming. If a patient is uncooperative or combative and it interferes with conducting a proper primary trauma survey then the patient should be sedated and intubated so that the exam may proceed.
  • Next, attend to the 19-year-old with a crush injury. Anxiety and tachycardia may be due to the pain or stress; yet, the swelling hints of hemorrhage. Adequate circulation is required for oxygenation to the brain and other vital organs. Blood loss is the most common cause of shock in trauma patients.
  • Take care of the grandmother with burns on the forearms next by providing dressings and pain management . By the end of the primary survey, the trauma patient should have received a well-organized resuscitation, and any immediately life-threatening condition should have been identified and addressed. 
  • T hen, give comfort measures to the child with burns over more than 70% of the anterior body; however, the prognosis is very poor. In certain patients who are too unstable to move on from their primary survey and are unable to be resuscitated and stabilized, a secondary survey should not be performed.
  • The prognosis of the client in cardiac arrest is also very poor, and the CPR attempts have been held. The only contraindication to the secondary survey would be if the patient succumbs to their injuries. Otherwise, the secondary survey must be completed on all trauma patients.  If the patient is severely injured, they might not be capable of providing a history.

Identify the five most important elements in conducting disaster triage for multiple victims. Select all that apply.

  • A. Assess level of consciousness
  • B. Check airway, breathing, and circulation
  • C. Monitor vital signs, including pulse and respirations
  • D. Inquire about last tetanus shot
  • E. Determine history of allergies to food or medicine
  • F. Know the list of current medications
  • G. Identify past medical and surgical history
  • H. Note color, presence of moisture, and temperature of the skin
  • I. Visually examine for gross deformities, bleeding, and obvious injuries

Correct Answers: A, B, C, H, and I

The following would be appropriate for disaster triage. The other options would be discussed when the staff has time and means to collect additional data. It would be appropriate to include all items during nondisaster circumstances.

  • Option A: A rapid assessment of the patient’s neurologic status is necessary on arrival in the emergency department. This should include the patient’s conscious state and neurological signs. This is assessed by the patient’s Glasgow coma scale (GCS), pupil size and reaction, and lateralizing signs.
  • Option B: The common acronym for performing the primary trauma survey is ABCDE, each letter representing an area of focus. If any abnormality is identified in one of the areas of focus, it should be resolved before a practitioner progresses further through the algorithm.
  • Option C: Assess vital signs; A narrow pulse pressure and tachycardia indicate hypovolemic shock in a trauma setting until proven otherwise. Vital signs should be closely monitored and response to interventions should be assessed. In elderly population, normal vital signs should not be reassuring as hemodynamic changes such as tachycardia or hypotension may be delayed.
  • Option D: Rendering care to a trauma patient can be a challenging endeavor due to the potential for numerous injuries.  This part of evaluation should not be performed until the primary survey is completed.
  • Option E: It should be performed after the primary survey and the initial stabilization is complete. The purpose of the secondary survey is to obtain pertinent historical data about the patient and his or her injury, as well as to evaluate and treat injuries not found during the primary survey.
  • Option F: Patients who are hemodynamically unstable should be stabilized first before they are transferred to a trauma center. An attempt should be made to obtain the patient’s history regarding the mechanism of injury since certain mechanisms can raise suspicion for certain injuries. 
  • Option G: The purpose of the secondary survey is to obtain a detailed history, perform a head-to-toe physical exam, reassess all vital signs, and obtain pertinent lab and imaging studies to identify injuries and metabolic abnormalities. 
  • Option H: In this, visualize all possible areas of skin.  This includes the locations of lacerations, abrasions, ecchymosis, hematoma, marks, or bruises. Pay attention to the hidden areas. Back should be evaluated by log-rolling the patient, and the spine should be palpated for step-offs or focal tenderness.
  • Option I: The extremities should be assessed for fractures by carefully palpating each extremity over its entire length for tenderness and decreased the range of motion. Assess the integrity of uninjured joints by both active and passive movements. Injured joints should also be immobilized, and radiographs should be obtained if necessary.

A group of passengers enters the ED with complaints of cough, tightness in the throat, and extreme periorbital swelling. There is a strong odor exuding from their clothes. They report exposure to a “gas bomb” that was placed in the bus terminal. What is the priority action?

  • A. Readily transfer clients and visitors from the area
  • B. Check vital signs and auscultate lung sounds
  • C. Assist clients in the decontamination area
  • D. Direct clients to the cold or clean zone for immediate treatment

Correct Answer: C. Assist clients in the decontamination area

Decontamination in a specified area is the priority. The decontamination and support areas are established within the Warm Zone, also referred to as the Contamination Reduction Zone. Decontamination involves thorough washing to remove contaminants.

  • Option A: Decontamination triage is especially important in mass casualty incidents and should not be confused with medical triage. Decontamination triage is the process of determining which victims require decontamination and which do not. Rapidly identifying victims who may not require decontamination can significantly reduce the time and resources needed for mass decontamination.
  • Option B: Doing assessments and transferring others delay decontamination and do not protect the total environment. Set up or assign an area or building as a safe refuge/observation area for victims who do not require medical attention. Here they can be monitored for a delayed outbreak of symptoms or indications of residual contamination. Donning personal protective equipment and measures is vital before assisting with decontamination or assessing the clients.
  • Option D: The clients must undergo decontamination before entering cold or clean zones. In mass casualty incidents, decontamination corridors can be set up that consist of high volume, low-pressure water deluges. Assign personnel to decontamination stations to control and instruct victims when they enter the decontamination area.

A drunk driver has been in the police station for 48 hours. During the first hours, he had tremors and was feeling anxious and sweaty. Currently, he is experiencing disorientation, hallucination, and hyperactivity. It was noted that the client has a history of alcohol abuse. What is the priority nursing diagnosis?

  • A. Risk for Nutritional Deficit related to chronic alcohol abuse
  • B. Risk for Injury related to seizures
  • C. Risk for Situational Low Self-Esteem related to police custody
  • D. Risk for Other-Directed Violence related to hallucinations

Correct Answer: B. Risk for Injury related to seizures

Client safety is the priority because the driver exhibits neurologic hyperactivity and is on the verge of a seizure. Medications such as chlordiazepoxide (Librium) are needed to decrease neurologic irritability and phenytoin (Dilantin) for seizures. Thiamine and haloperidol (Haldol) may also be ordered to treat other problems.

  • Option A: If withdrawal symptoms remain untreated, this can typically lead to DT. Additional evaluation of a patient with DT involves identifying electrolyte, nutrition, and fluid abnormalities. Most of these patients present with severe dehydration (up to 10 L fluid deficit) and severe electrolyte abnormalities, including hypoglycemia and severe hypomagnesemia and hypophosphatemia.
  • Option C: Delirium tremens occur in chronic alcohol abusers who abruptly discontinue alcohol use, often as early as 48 hours. The initial minor withdrawal symptoms are characterized by anxiety, insomnia, palpitations, headache, and gastrointestinal symptoms. These symptoms usually occur as early as 6 hours after cessation of alcohol use. More than 50% of those with a history of alcohol abuse can exhibit alcohol withdrawal symptoms at discontinuing or decreasing their alcohol use.
  • Option D: After 12 hours, minor withdrawal symptoms can progress to alcohol hallucinosis, a condition characterized by visual hallucinations. It can typically resolve in 24 to 48 hours, and may also be associated with auditory and tactile hallucinations. 

During a class discussion, the 50-year-old professor suddenly feels left-sided chest pain, dizziness, and diaphoresis. What is the priority action when he arrives in the ED triage area?

  • A. Supply oxygen via nasal cannula
  • B. Place intravenous (IV) access
  • C. Notify the ED physician
  • D. Set the client on continuous electrocardiographic monitoring

Correct Answer: A. Supply oxygen via nasal cannula

Increasing myocardial oxygenation is the priority goal. Place the patient on a cardiac monitor, establish intravascular access (IV) access, give 162 mg to 325 mg chewable aspirin , clopidogrel, or ticagrelor (unless bypass surgery is imminent), control pain and consider oxygen (O2) therapy.

  • Option B: Intravenous opioids (e.g., morphine) are the analgesics most commonly used for pain relief (Class IIa). The results from CRUSADE quality improvement initiative have shown that the use of morphine may be associated with a higher risk of death and adverse clinical outcomes.
  • Option C: After providing initial treatment, the physician should be notified. Patients with non-ST elevation myocardial infarction (NSTEMI) and unstable angina should be admitted for cardiology consultation and workup. Patients with stable angina may be appropriate for outpatient workup.
  • Option D: The other actions are also appropriate and should be done immediately. Electrocardiogram (ECG) preferably in the first 10 min of arrival, (consider serial ECGs). Patients with ST-elevation on ECG patients should receive immediate reperfusion therapy either pharmacologic (thrombolytics) or transfer to the catheterization laboratory for percutaneous coronary intervention (PCI).

A child with fever has been admitted to the ED for several hours. Cooling measures are ordered by the physician in order for the client’s temperature to come down. Which task would be appropriate to delegate to the nursing assistant?

  • A. Prepare and administer a tepid bath
  • B. Assist the child in removing outer garments
  • C. Educate the need for giving cool fluids
  • D. Tell the parent to use acetaminophen (Tylenol) instead of aspirin

Correct Answer: B. Assist the child in removing outer garments

The nursing assistant can assist with the elimination of outer garments, which enables the heat to dissipate from the child’s skin. The nurse who delegates aspects of care to other members of the nursing team must balance the needs of the client with the abilities of those to which the nurse is delegating tasks and aspects of care, among other things such as the scopes of practice and the policies and procedures within the particular healthcare facility.

  • Option A: Tepid baths are not usually given because of the potential for rebound and shivering. Registered nurses who assign, delegate and/or provide nursing care to clients and groups of clients must report all significant changes that occur in terms of the client and their condition. For example, a significant change in a client’s laboratory values requires that the registered nurse report this to the nurse’s supervisor and doctor.
  • Option C: Explaining is a teaching function only appropriate for a registered nurse. The staff members’ levels of education, knowledge, past experiences, skills, abilities, and competencies are also evaluated and matched with the needs of all of the patients in the group of patients that will be cared for.
  • Option D: Advising is a teaching function that is the responsibility of the registered nurse. Delegation should be done according to the differentiated practice for each of the staff members.

A traveler’s feet suddenly become pale, turn red, and feel very cold. In just 30 minutes, the affected part became prickly and numb. Place the following interventions in the correct order for a client with frostbite.

  • 1. Remove the client from the cold environment
  • 2. Administer pain medication
  • 3. Immerse the feet in warm water of 105°F to 115°F (40.6°C to 46.1°C)
  • 4. Apply loose, sterile, bulky dressing
  • 5. Monitor for compartment syndrome

Initially, the client should be removed from the cold environment. Pain medication should be given before immersing the feet in warm water to lessen the discomfort. The client should be monitored for compartment syndrome every hour after initial treatment.

  • Patients should have protection from further injury by covering exposed areas. Remove patients from the wind. Remove wet clothing and replace it with dry clothing. Avoid vigorous rubbing as this can cause further damage.
  • NSAIDS (ibuprofen) are indicated for controlling pain and preventing further inflammation, but stronger analgesics including narcotics may be necessary to achieve pain control. Frequent re-examination for sensation should accompany rewarming.
  • The care of patients with frostbite begins with rewarming in the field if there is no anticipation of refreezing, as thaw-refreezing may worsen injuries. In-hospital management includes warm water baths, approximately 40-42 degrees C. Patients with systemic hypothermia should be managed by raising core temperature above 35 degrees C using warm IV fluids, and this should precede warming of the affected extremity.
  • Apply a loose, bulky dressing to prevent infection. As with burn patients, particular care to prevent infections and dehydration should be a priority. Overly aggressive surgical debridement may remove skin that is otherwise viable, so complete rewarming should be achieved before surgical debridement.
  • Signs of compartment syndrome ( edema , pulselessness, extreme pain) should prompt urgent surgery. Delayed amputation (up to 6 weeks following injury) until the determination of tissue viability may prevent surgical morbidity from unnecessary procedures.

An elderly maintenance staff is lying on the floor and the ED nurse responds to a call for help. List the order in which the nurse must carry out the following actions.

  • 1. Establish unresponsiveness
  • 2. Call for help and activate the code team
  • 3. Perform the chin lift or jaw thrust maneuver
  • 4. Initiate cardiopulmonary resuscitation (CPR)
  • 5. Instruct the nurse assistant to get the crash cart
  • First, establish unresponsiveness. (The patient may have fallen and sustained a minor injury.) The Code Blue will follow the AHA/HSFC ACLS/PALS guidelines. It is recommended all members have current ACLS/PALS training and certification.
  • Get help and activate the code team if the client is unresponsive. Any individual may call a code blue and certified staff will initiate BLS and AED if available, until relieved by the Code Blue team.
  • To open the airway, perform chin lift or jaw thrust maneuver. Place 1 hand on the casualty’s forehead and gently tilt their head back, lifting the tip of the chin using 2 fingers. This moves the tongue away from the back of the throat. Don’t push on the floor of the mouth, as this will push the tongue upwards and obstruct the airway.
  • Then start CPR. CPR should not be interrupted until the client recovers or it is determined that all heroic efforts have been exhausted . The Emergency Medical System (EMS) will be activated for all areas in the hospital not covered by the Code Blue team, as well as all arrests occurring outside the building. If the team is not able to transport the Code Blue Cart to the scene, the team will provide Basic Life Support (BLS) until EMS arrives.
  • A crash cart should be present at the site when the code team arrives; however, basic CPR can be definitely performed until the team is present. The units where the Code Blue carts are located are only responsible for transporting the cart to the unit where a Code Blue has been called.

Which task is most appropriate to assign to the nursing assistant when an instantaneous death transpires in the ED? Select all that apply

  • A. Assisting with postmortem care
  • B. Escorting the family to a place of privacy
  • C. Going with the organ donor specialist to talk to the family
  • D. Helping the family to collect belongings

Correct Answer: A. Assisting with postmortem care

Postmortem care demands some turning, cleaning, lifting, and so on, and the nursing assistant is equipped and authorized to assist with these responsibilities. The use of NAPs increasingly demands registered nurses to delegate patient care tasks according to the principles of the ANA. These principles define nursing delegation as the “transfer of responsibility for the performance of an activity from one individual to another while retaining accountability for the outcome.”

  • Option B: The RN should be responsible for the other duties mentioned to help the family begin the grieving process. The RN delegates only those tasks for which he or she believes the other health care worker has the knowledge and skill to perform, taking into consideration training, cultural competence, experience, and facility/agency policies and procedures.
  • Option C: Federal law mandates that only clinicians who completed certified training approach the family about organ donation. Physicians approaching families independently are associated with the lowest rate of consent. Hence, it is best practice for OPO staff to approach families together with the health care team.
  • Option D: In case of uncertain death, belongings may be preserved for evidence, so the chain of custody would have to be maintained. One nurse shall enter items to be handed over in the valuables book in the presence of a second staff member, and wherever possible in the presence of the patient. This is to protect staff in the event of a dispute. 

During the shift of a triage nurse in the Emergency Department (ED), the following clients arrive. Which client needs the most rapid response to protect other clients in the ED from infection?

  • A. A 72-year-old who must undergo tuberculosis (TB) testing after being exposed to TB during a recent international airplane flight.
  • B. A 58-year-old who has a history of a methicillin-resistant Staphylococcus aureus (MRSA) abdominal wound infection.
  • C. A 7-year-old who has a new pruritic rash and a possible chickenpox infection.
  • D. A 4-year-old who has paroxysmal coughing and whose sibling has pertussis .

Correct Answer: C. A 7-year-old who has a new pruritic rash and a possible chickenpox infection

Varicella or chickenpox is spread by airborne means and could be quickly transmitted to other clients in the ED. The child with a rash should be immediately isolated from the other clients through placement in a negative-pressure room.

  • Option A: The client who has been exposed to TB does not set other clients at risk for infection because there are no symptoms of active TB. In the past few decades, there has been a concerted global effort to eradicate TB. These efforts had yielded some positive dividends especially since 2000 when the World  Health Organization (WHO,  2017) estimated that the global incidence rate for tuberculosis has fallen by 1.5% every year.
  • Option B: Prevention and control of MRSA infections include necessary infection-control steps like strict hand hygiene and adequate contact precautions. Contact precautions include the use of gowns, gloves, and possibly masks during clinical encounters with patients with MRSA infection. Infection control also may include keeping patients in isolated rooms or the same rooms of other patients who have an MRSA infection.
  • Option D: Droplet precautions should be instituted for the clients with possible pertussis, but this can be achieved after isolating the child with possible chickenpox. Strict isolation is important while the patient remains infectious. Pertussis is contagious throughout the catarrhal phase and for 3 weeks after the onset of the paroxysmal phase.

The nurse is assigned to a client who has a draining sacral wound infected by MRSA. Which personal protective equipment ( PPE ) will the nurse plan to use in preparing to change the linens of the client? Select all that apply.

  • D. N95 respirator
  • E. Surgical mask
  • F. Shoe covers

Correct Answer: A and C

Gloves and a gown should be applied when coming in contact with linens that may be contaminated by the client’s wound secretions. Contact precautions include the use of gowns, gloves, and possibly masks during clinical encounters with patients with MRSA infection. Infection control also may include keeping patients in isolated rooms or the same rooms of other patients who have an MRSA infection.

  • Option B: Goggles are the primary protectors intended to shield the eyes against liquid or chemical splash, irritating mists, vapors, and fumes. They form a protective seal around the eyes, and prevent objects or liquids from entering under or around the goggles. This is especially important when working with or around liquids that may splash, spray, or mist.
  • Option D: An N95 respirator protects against dust, fumes, mists, and other microorganisms. This can be used when working with live animals or infectious materials in BSL-2 level labs with known airborne transmissible disease (e.g. tuberculosis, also required for influenza (flu).
  • Option E: Surgical masks protect against large droplets and splashes. It does not require fit-testing. This can be used when working with live animals; working with infectious material in BSL-2+ level labs but only protects your sample from you, not the other way around. 
  • Option F: A shoe cover is not necessary, because transmission by splashes, droplets, or airborne means will not occur when the bed is changed. The inclusion of protective shoe covers or footwear as a component of PPE for prevention of acquisition and dissemination of pathogenic microbial agents by healthcare staff derives from documentation of extensive floor contamination with bacterial pathogens.

Which action will the nurse take to most effectively reduce the incidence of hospital-related urinary tract infections (UTI)?

  • A. Make sure that clients have an adequate fluid intake
  • B. Educate assistive personnel on how to provide good perineal hygiene
  • C. Restrict the use of indwelling catheters
  • D. Perform dipstick urinalysis for clients with risk factors for UTI

Correct Answer: C. Restrict the use of indwelling catheters

The most effective way to lessen UTIs in the hospital setting is to avoid using retention catheters. Nurses are associated with promoting policies that lessen the unnecessary use of catheters because the use of catheters is the most common cause of hospital-acquired UTIs in the United States.

  • Option A: Increase the patient’s fluid intake. This has been shown to decrease UTI incidence, possibly by diluting the urine and flushing out bacteria. In the past, catheter-associated UTIs were seen as an inevitable consequence of hospitalization. Now they’re considered unacceptable results of poor care.
  • Option B: Perform meatal care twice daily using soap and water and working from the front to the back of the perineal area. Evidence shows no advantage to antiseptic use. Though some research suggests cleaning the catheter with povidone-iodine and applying antibiotic ointment at the insertion site may decrease bacteria, most studies show this practice has no benefit and may even lead to infection.
  • Option D: The other options also reduce the risk for and/or detect UTIs, but avoidance of indwelling catheter use will be more effective. Urine may be assessed both at the bedside (dipstick) and in the laboratory (microscopy, culture, sensitivity and urinary electrolytes). Urine for laboratory analysis must be transferred quickly and at the correct temperature otherwise breeding ground for contaminants.

A 90-year-old client is confined to the unit for two weeks. He has been receiving antibiotics for more than a week and says that he is having frequent watery stools. Which action will you take first ?

  • A. Place the client on contact precautions
  • B. Educate the client about correct hand washing
  • C. Notify the physician about the loose stools
  • D. Get stool specimens for culture

Correct Answer: A. Place the client on contact precautions

The client may have Clostridium difficile infection based on his age, history of antibiotic therapy, and watery stools. The initial action should be to place him on contact precautions to prevent the spread of C. difficile to other clients.

  • Option B: General strategies such as early detection of the disease, placing the patient under isolation with a dedicated toilet and contact precautions, promoting hygiene measures such as improved hand hygiene, and environmental cleaning are effective measures in preventing infections from C. difficile infections.
  • Option C: Watery diarrhea with mucus or occult blood, anorexia, nausea, vomiting, low-grade fever, and lower abdominal pain are the symptoms commonly associated with diarrhea and colitis caused by C. difficile.
  • Option D: Patients with new-onset 3 or more loose or unformed stools in 24 hours with no obvious other etiology should be checked for testing for C. difficile infection. Stool examination for C. difficile toxins or toxigenic C. difficile bacillus is the commonly used diagnostic test used to diagnose C. difficile infection.

The nurse is assigned to a client with meningococcal meningitis. Which information about the client is the best indicator that the nurse can discontinue droplet precautions?

  • A. Appropriate antibiotics have been given 24 hours
  • B. Cough is productive of clear, nonpurulent mucus
  • C. Pupils are equal and reactive to light
  • D. Temperature is lower than 100°F (37.8°C)

Correct Answer: A. Appropriate antibiotics have been given 24 hours

Contemporary CDC evidence-based guidelines indicate that droplet precautions for clients with meningococcal meningitis can be discontinued when the client has received antibiotic therapy (with drugs that are effective against Neisseria meningitidis ) for 24 hours.

  • Option B: The patient with suspected or confirmed N. meningitidis should follow droplet precaution. This should be continued until after 24 hours of effective antibiotics administration. Meningococcal meningitis is a medical emergency presenting with severe sepsis syndrome, fever, petechiae, and ecchymosis requiring prompt resuscitation and antibiotic administration.
  • Option C: A thorough neurologic exam should be performed looking for alteration in mental status, as well as any focal deficits. The classic triad of neck stiffness, fever, and altered mental status is a more specific sign for meningitis. Infants can present with a variety of non-specific symptoms, which include lethargy, irritability, and in some cases bulging fontanelles.
  • Option D: The other information may mean that the client’s condition is improving but does not mean that droplet precautions should be stopped. Patients can present with abnormal vital signs, including fever, tachypnea, tachycardia, and hypotension. Hypotension with elevated pulse rate is suggestive of early vascular instability.

Nursing Prioritization, Delegation and Assignment NCLEX Practice Quiz #4 (25 Items)

There are four clients with infections in the ED and only one private room is available. Which among the clients is the most appropriate to occupy the private room?

  • A. A client with a cough who may have tuberculosis
  • B. A client with toxic shock syndrome and a temperature of 102.4°F (39.1°C)
  • C. A client with diarrhea caused by C. difficile
  • D. A client with a wound infected with Vancomycin-resistant enterococci (VRE)

Correct Answer: A. A client with a cough who may have tuberculosis

Private rooms should be occupied mainly for clients with infections that require airborne precautions such as TB. Despite the gains in tuberculosis control and the decline in both new cases and mortality, it still accounts for a huge burden of morbidity and mortality worldwide.

  • Option B: Standard precautions are required for the client with toxic shock syndrome. Any source of bacteria such as tampons or nasal packing should immediately be removed. Emergent surgical consultation should be obtained for any wound debridement or surgical cause. This is critical in the early management of toxic shock syndrome.
  • Option C: The primary mode of the disease transmission is the fecal-oral route. Effective prevention of C. difficile infection includes several generalized strategies and certain targeted strategies. General strategies such as early detection of the disease, placing the patient under isolation with a dedicated toilet and contact precautions, promoting hygiene measures such as improved hand hygiene, and environmental cleaning are effective measures in preventing infections from C. difficile infections.
  • Option D: Clients with VRE infections that require contact precautions should ideally be placed in private rooms; however, they can be placed in rooms with other clients with the same diagnosis. The primary transmission of vancomycin-resistant Enterococcus in the hospital setting is through the hands of healthcare providers. Basic infection control prevention practices such as hand hygiene can help. Contact precautions such as wearing gowns and gloves also decrease transmission.

The nurse is assigned to a client who has been diagnosed with disseminated herpes zoster. Which PPE will the nurse plan to use when preparing to assess the client? Select all that apply.

  • E. Surgical face mask

Correct Answer: A, C, and D

The nurse should don an N95 respirator or high-efficiency particulate air filter respirator, a gown, and gloves because herpes zoster (shingles) is spread through airborne means and by direct contact with lesions.

  • Option B: Safety goggles protect the eyes, eye sockets, and the facial area immediately surrounding the eyes. Indirectly-vented or non-vented goggles prevent splashes, sprays, and respiratory droplets. Anti-fog safety goggles offer the most practical and reliable use.
  • Option E: Surgical face masks filter particularly large particles and will not render protection from herpes zoster. A surgical mask is a loose-fitting disposable mask that protects the wearer’s nose and mouth from contact with droplets, splashes and sprays that may contain germs. A surgical mask also filters out large particles in the air.
  • Option F: Shoe covers are not required for airborne or contact precautions. General occupational health guidance recommends shoe covers when there is a risk of splashing from infected body fluids. Further research is needed on whether shoe covers should be added to PPE.

A newly admitted client is suspected to have avian influenza (“bird flu”) due to increasing dyspnea and dehydration . Which of these prescribed actions will the nurse implement first ?

  • A. Give first dose of oseltamivir ( Tamiflu )
  • B. Instill 5% dextrose in water at 100 mL/hr
  • C. Collect blood and sputum specimens for testing
  • D. Start oxygen using a non-rebreather mask

Correct Answer: D. Start oxygen using a non-rebreather mask

The nurse’s first action should be to start oxygen therapy because the respiratory manifestations linked to avian influenza are most likely life-threatening. Patients with respiratory compromise should be placed on supplemental oxygen and monitored closely for signs of deterioration as these patients are at high risk of requiring intubation and mechanical ventilation.

  • Option A: The World Health Organization released Rapid Advice Guidelines in 2007, outlining consensus treatment recommendations for H5N1 influenza outbreaks. Similar recommendations can likely be used in avian influenza outbreaks due to other strains of the virus. These recommendations include neuraminidase inhibitors (especially oseltamivir) for strongly suspected or confirmed cases of H5N1.
  • Option B: Treatment of avian influenza usually consists of supportive care and antiviral medications. The majority of care should aim at managing the sequelae of infection. For instance, patients with volume loss or possible electrolyte imbalances should receive volume resuscitation and treatment to correct imbalances. 
  • Option C: The preferred source of a sample for testing is a nasopharyngeal swab or aspirate, but other body fluids are usable if the nasopharyngeal swab or aspirate is not available. Because the infection carries high mortality risk, a negative rapid antigen test should not rule out AIV infection when high suspicion exists.

The charge nurse is delegating tasks to her subordinates in the medical unit. Which infection control activity should she assign to an experienced nursing assistant?

  • A. Asking clients about the use of immunosuppressant medications.
  • B. Demonstrating correct hand washing to client visitors.
  • C. Disinfecting blood pressure cuffs after clients are discharged.
  • D. Screening clients for upper respiratory tract symptoms.

Correct Answer: C. Disinfecting blood pressure cuffs after clients are discharged

Nursing assistants can support agency policy to disinfect items that come in contact with intact skin such as blood pressure cuffs by cleaning with chemicals like alcohol. Depending on a nurse’s role, some tasks can be delegated to a CNA depending on their scope of practice. Essentially, a nurse can delegate tasks to a CNA anytime help is necessary.

  • Option A: This task should be performed by licensed nurses. The practice of pervasive functions of critical decisions, nursing judgment, and clinical reasoning cannot be delegated. There should be no confusion between assignments and delegation.
  • Option B: Also known as a certified nursing assistant, a CNA’s main role is to provide patients with basic care and assist them in their everyday activities, particularly when patients have a hard time doing a few activities on their own, such as bathing.
  • Option D: Assessment for upper respiratory tract symptoms require further education and a broader scope of practice. A licensed nurse cannot delegate any activity involving critical decision-making or nursing judgment.

The nurse is caring for a client with a leg ulcer that is infected with vancomycin-resistant S. aureus (VRSA). Which of the following nursing actions can a nurse assign to an LPN/LVN?

  • A. Assess risk for further skin breakdown.
  • B. Collect wound cultures during dressing changes.
  • C. Create methods to improve the client’s oral protein intake.
  • D. Educate the client about home care of the leg ulcer.

Correct Answer: B. Collect wound cultures during dressing changes

Performing dressing changes and obtaining specimens for wound culture are part of the LPN/LVN education and scope of practice. LPN/LVN can perform routine procedures (ostomy care, catheter insertion, wound care, check blood glucose, obtaining EKG etc.).

  • Option A: The scope of practice for LPN/LVN nurses includes observing patient data according to a list of set rules that they must follow unconditionally. Any abnormal findings that they observe must be reported to an RN. An LPN/LVN cannot perform a complete and exhaustive physical assessment . LPNs/LVN can suggest interventions but cannot implement them unless instructed and supervised.
  • Option C: LPN/LVN assists with care plans by implementing the interventions (as within scope of practice) but does NOT develop the nursing diagnosis or interventions or evaluate the care plan.
  • Option D: Education is a complex action that should be carried out by an RN. LPNs/LVNs may not become involved in teaching patients, although in some cases they can engage in basic teaching procedures under very specific guidelines. An LPN can for example teach a patient to do motion exercises. RNs have the sole responsibility when it comes to teaching patients.

The charge nurse from the unit receives a call from the pediatrician wanting to admit an 8-year-old child with rubeola (measles). Which of the following is of most concern in deciding whether to admit the child to the unit?

  • A. The unit is not staffed with the usual number of RNs
  • B. There are several children receiving chemotherapy on the unit.
  • C. No negative-airflow rooms are available on the unit.
  • D. The infection control nurse liaison is not on the unit today.

Correct Answer: C. No negative-airflow rooms are available on the unit.

The child cannot be admitted to the pediatric unit without the implementation of airborne precautions which is required for clients with rubeola. One of the components of airborne infection isolation (AII) is respiratory protection for health-care workers and visitors when entering AII rooms. Recommendations of the type of respiratory protection are dependent on the patient’s airborne infection (indicating the need for AII) and the risk of infection to persons entering the AII room.

  • Option A: Staff reassignment can be done but this would not prevent the client’s admission. Nursing is a critical factor in determining the quality of care in hospitals and the nature of patient outcomes . Twenty-four hour nursing care is one of the distinctive hallmarks of inpatient care in hospitals.
  • Option B: Children undergoing cancer treatment are particularly vulnerable to illnesses such as measles, as chemotherapy greatly reduces their immunity and can make their previous vaccinations ineffective. However, the client with rubeola can be placed in an isolation room distant from the clients undergoing chemotherapy.
  • Option D: The absence of the infection control nurse liaison would not prevent the admission of a client with rubeola. The infection control liaison nurse (ICLN) is a nurse in the ward, appointed to participate in education for infection control, and to liaise between the ward and the infection control nurse (ICN).

A 7-year-old girl who has just endured allogeneic stem cell transplantation will need protective environmental stimulation. Which nursing task should the nurse delegate to the nursing assistant? Select all that apply.

  • A. Educating the client to perform careful handwashing after using the bathroom.
  • B. Communicating with the family members about the grounds for isolation.
  • C. Stock the client’s room with the required PPE items.
  • D. Reminding the visitors to wear a face mask, gloves, and gown.
  • E. Posting the precautions for protective isolation on the door of the client’s room.

Correct Answer: C, D, and E

The nursing assistant is capable of stocking the room and posting the precautions on the client’s door because all staff who care for clients should be familiar with the various types of isolation. Reminding visitors about previously taught information is a task of the nursing assistant although the RN is responsible for the initial teaching.

  • Option A: Education is a complex action that should be carried out by an RN. If a CNA does something that is not in their scope of work, the hospital is within their rights to dismiss them or at least issue them with a warning.
  • Option B: Client discussion of the reason for the protective isolation falls within the RN-level-scope of practice. The scope of practice for a CNA includes tasks such as basic daily patient care including doing all of the things for the patient that they cannot do themselves. These tasks are classified as ADLs or activities of daily living and are called this because they need to be done daily.
  • Option C: A CNA is allowed to stock the patient’s room with necessary equipment. In hospitals, certified nursing assistants are more likely to help a diverse patient population with a wide range of needs. Their patients could be young or old, and likely recovering from illness or surgery.
  • Option D: Depending on daily needs, this can involve changing soiled sheets, cleaning up spills, changing bedpans, setting up equipment, and reducing the spread of germs and infection in the patient’s living area.
  • Option E: CNAs are primarily responsible for helping patients with ADLs, such as bathing, grooming , toileting, eating, and moving. CNAs often measure a patient’s blood pressure, pulse, and temperature, and then record their findings and report them to a supervisor to determine whether action is necessary.

In which order will the nurse perform the following actions as she prepares to leave the room of a client with airborne precautions after performing oral suctioning?

  • 1. Remove gloves
  • 2. Take off gown
  • 3. Take off goggles
  • 4. Remove N95 respirator
  • 5. Perform hand hygiene

This order will prevent contact of the contaminated gloves and gown with areas like the hair that cannot be readily cleaned after client contact and stop transmission of microorganisms to the nurse and the client. The correct order for donning and removal of PPE has been standardized by agencies such as the Centers for Disease Control and Prevention (CDC) and the Occupational Safety and Health Administration.

  • Remove gown and gloves together. If gloves are removed first, hands must only touch uncontaminated surfaces of the gown, typically behind the neck (ties) and at the back of the shoulders. 
  • The gown is then peeled down off the body and arms, balling or rolling in the contaminated surfaces (front and sleeves). The preferred method for doffing a disposable gown and gloves is, therefore, to break the ties at the neck by pulling on the upper front portion of the gown with the hands still gloved, balling or rolling in the contaminated surfaces, and pulling the gloves off inside-out as the hands are withdrawn from the gown’s sleeves. The gown and gloves can then be placed in a disposal receptacle together.
  • Remove eye protection. Remove from the back of the head by lifting headband or ear pieces. If reusable, place it in the designated reprocessing receptacle. If not, discard in the waste container.
  • Remove mask/respirator. Grasp the bottom ties/elastics, then the top ones, and remove without touching the front of the mask. Discard in the waste container.
  • Perform hand hygiene. Remember that all PPE is contaminated after use. Perform hand hygiene immediately after each step of doffing (Queensland DoH 2020).

The nurse assessed the client and noted shortness of breath and a recent trip to China . The client is strongly suspected of having Severe Acute Respiratory Syndrome (SARS). Which of these prescribed actions will the nurse take first ?

  • A. Place the client on airborne and contact precautions
  • B. Introduce normal saline at 75 mL/hr
  • C. Give methylprednisolone (SOLU-Medrol) 1 g intravenously (IV)
  • D. Take blood, urine, sputum cultures

Correct Answer: A. Place the client on airborne and contact precautions

SARS is considered deadly so the initial action is to protect other clients and healthcare workers by securing the client in isolation. If an airborne-agent isolation (negative-pressure) room is not yet available, droplet precautions should be initiated until the client can be moved to a negative-pressure room.

  • Option B: Early in the pandemic, a combination of ribavirin and corticosteroids was adopted as the standard treatment in Hong Kong, Canada and elsewhere because of the apparent good results of the first few patients. Subsequent reports showed that ribavirin was associated with a high rate of toxicity and lacked in vitro antiviral effect on SARS- coronavirus (SAR-CoV).
  • Option C: The timing and dosage regimens of steroids in the treatment of SARS are controversial. Pulse methylprednisolone 250 to 500 mg/day for 3 to 6 days has been reported to have some efficacy in a subset of patients with “critical SARS”, i.e., critically ill SARS patients with deteriorating radiographic consolidation, increasing oxygen requirement with PaO2 <10 kPa or SpO2 <90% on air, and respiratory distress (rate of 30/min). 
  • Option D: Handle these specimens using Universal Precautions, which includes use of gloves, gown, mask, and eye protection. Any procedure with the potential to generate fine-particulate aerosols (e.g., vortexing or sonication of specimens in an open tube) should be performed in a biological safety cabinet (BSC).

The nurse is caring for four clients receiving IV infusions of normal saline. Which client is at the highest risk for bloodstream infection?

  • A. A client who has a non-tunneled central line in the left internal jugular vein .
  • B. A client with an implanted port in the right subclavian vein .
  • C. A client with a peripherally inserted central catheter (PICC) line in the right upper arm.
  • D. A client who has a midline IV catheter in the left antecubital fossa.

Correct Answer: A. A client who has a non-tunneled central line in the left internal jugular vein

Central lines are associated with a higher infection risk, the skin of the neck and chest have high numbers of microorganisms, and the line is non-tunneled: such factors increase the risk for infection. About half of nosocomial bloodstream infections occur in intensive care units, and the majority of them are associated with intravascular devices. Central-venous-catheter-related bloodstream infections (CRBSIs) are an important cause of healthcare-associated infections.

  • Option B: Implanted ports are placed under the skin and so are less likely to be associated with catheter infection than a nontunneled central IV line. Inflow obstruction (7.6%) and infection (6.9%) were the main complications, followed by reflux (3.1%), subcutaneous masses (1.5%) and fistulae (1.5%). The median interval between port implantation and port complication was 5.4 months (range: 0.3–40.9 months).
  • Option C: A peripherally inserted central catheter (PICC) infection occurs when bacteria enters the bloodstream through or around a central line catheter . A PICC is a long, thin tube that is inserted through a vein in the arm.
  • Option D: Midline catheters are associated with a lower incidence of infection. Midline catheters (MCs) are peripheral IV access devices that may reduce the need for central lines and hence decrease central line-associated bloodstream infections.

The school nurse is asked which action will have the most impact on the incidence of infectious diseases in school. The correct response is:

  • A. Granting written information about infection control to all parents.
  • B. Ensure that students are immunized according to national guidelines.
  • C. Make soap and water easily accessible in the classrooms.
  • D. Educate students on how to cover their mouths when coughing.

Correct Answer: B. Ensure that students are immunized according to national guidelines.

The incidence of once-common infectious diseases like measles, chickenpox, and mumps has been most effectively reduced by immunization of all school-aged children. Infectious diseases that used to be common in children in the United States – including polio, diphtheria, pertussis (whooping cough), rubella (German measles), and chickenpox – are preventable with vaccines approved by the U.S. Food and Drug Administration (FDA).

  • Option A: People are to be given information on the infectious disease hazards in their environment, the modes of transmission and appropriate control methods. This is best provided during induction and in ongoing training.
  • Option C: Infectious disease can be spread via contaminated hands. Hand hygiene is one of the most important measures in preventing transmission of infection. Hands can become contaminated from touching contaminated surfaces or by being contaminated through coughing, sneezing, rubbing eyes etc. The infectious agent can then be passed on to others e.g. shaking hands and/or contaminating clean surfaces. Hand should be regularly washed with soap, running water and then dried. 
  • Option D: Respiratory hygiene is a set of routine practices to prevent potentially infectious secretions from the nose and mouth from contaminating others directly or indirectly via surfaces. Cough into a single use tissue or into the sleeve, never into the hands. Always turn to direct the cough away from others and away from surfaces or food sources.

The nurse is caring for a client with a vancomycin-resistant enterococcus (VRE) infection. Which action can be delegated to the nursing assistant?

  • A. Implement contact precautions when caring for the client.
  • B. Monitor the results of ordered laboratory culture and sensitivity tests.
  • C. Teach the client and family members about means to prevent transmission of VRE.
  • D. Interact with other departments when the client is transported for ordered tests.

Correct Answer: A. Implement contact precautions when caring for the client

Correct implementation of contact precautions should be well-known by the hospital staff. Depending on daily needs, this can involve changing soiled sheets, cleaning up spills, changing bedpans, setting up equipment, and reducing the spread of germs and infection in the patient’s living area.

  • Option B: The key item identified by the American Nurses Association as being unable to be delegated is the nursing process itself. This notably includes any task that requires nursing judgment (or critical judgments) or decision making.
  • Option C: Education is a complex action that should be carried out by an RN. If a CNA does something that is not in their scope of work, the hospital is within their rights to dismiss them or at least issue them with a warning.
  • Option D: Appropriate delegation allows for responsibility transition in a consistent, safe manner. The RN transfers the performance of a procedure, skill, or activity to a CNA. However, the practice of pervasive functions of critical decisions, nursing judgment, and clinical reasoning cannot be delegated. 

A client who has frequent watery stool is admitted to the unit due to dehydration possibly caused by C. difficile. Which nursing action should the charge nurse delegate to an LPN?

  • A. Giving the ordered metronidazole ( Flagyl ) 500 mg PO to the client.
  • B. Reconsidering the client’s medical history for any risk factors for diarrhea.
  • C. Doing ongoing assessments to determine the client’s hydration status.
  • D. Explaining the purpose of ordered stool cultures to the client family.

Correct Answer: A. Giving the ordered metronidazole (Flagyl) 500 mg PO to the client.

LPN scope of practice and education include the administration of medications. Each state board of nursing regulates what the LPN can and cannot do.  In general, LPN’s provide patient care in a variety of settings within a variety of clinical specializations.  LPN’s can usually administer oral and intravenous medication.

  • Option B: LPN’s are often the first point of contact that a hospital, doctor’s office, or other healthcare clinic has with patients. After patients are called back to be seen by a doctor, LPN’s record their medical history, known allergies, height, weight, internal body temperature, blood pressure, pulse, and breathing rate. These signs give doctors and registered nurses a good indication of patients’ overall health before any additional tests are administered.
  • Option C: Assessment is not within the LPNs’ scope of practice. However, LPN’s can be asked to monitor their patients’ health throughout the course of their shift. Close monitoring is especially important after major surgeries, accidents, and when patients have received new medications. LPN’s are trained to quickly identify adverse reactions or complications and notify doctors and registered nurses immediately.
  • Option D: Client and family education should be done by the RN. However, LPN’s are often tasked with providing a human touch to routine healthcare. They often teach patients and their family members how to administer medication, which symptoms to be aware of after the patient goes home, which activities to avoid, and how to adopt and maintain a healthy lifestyle.

A 25-year-old client comes to the outpatient unit with complaints of diarrhea, abdominal pain, shortness of breath, and epistaxis. Which action should the nurse take first ?

  • A. Learn whether the client has had recommended immunizations.
  • B. Ask the client about any recent travel to Asia or the Middle East.
  • C. Have the client pinch the anterior nares firmly for 5 minutes.
  • D. Request an ambulance to take the client quickly to the hospital.

Correct Answer: B. Ask the client about any recent travel to Asia or the Middle East.

Based on the client’s manifestations, avian influenza (“bird flu”) is suspected. Outbreaks of bird flu have occurred in Asia or the Middle East. Airborne and contact precautions should be instituted immediately. Although adapted to birds, and often causing only mild illness, avian influenza viruses can be extremely dangerous with successful transmission to humans with a high percentage of confirmed cases requiring hospitalization and frequently intensive care unit (ICU) care.

  • Option A: Any patient hospitalized with a suspected or confirmed diagnosis of avian influenza should have an infectious disease consultation to better direct care and minimize complications. While the recommendations presented here are necessary for any patient with suspected avian influenza, an infectious disease consultant may be able to better direct treatment for specific avian influenza strains and manage treatment and patient expectations more appropriately.
  • Option C: After isolating the client accordingly, management of epistaxis may be done. Treatment for anterior bleeding can be started with direct pressure for at least 10 minutes. Have the patient apply constant direct pressure by pinching the nose over the cartilaginous tip (instead of over the bony areas) for a few minutes to try to control the bleed.
  • Option D: When an outbreak is identified, it is crucial for public health officials to identify at-risk populations and to inform the public of risk factors and ways to detect infection. Because the presence of deadly diseases in a community can incite fear and panic, announcements should include which populations are at low risk for contracting avian influenza. 

A mother of a 14-year-old client receiving chemotherapy for leukemia calls out to the unit concerning her other child having chickenpox. Which of these actions will the nurse anticipate taking next?

  • A. Plan to admit the client to a private room in the hospital.
  • B. Teach the mother about contact and airborne precautions.
  • C. Educate the mother about the correct use of acyclovir (Zovirax).
  • D. Administer varicella-zoster immune globulin to the client.

Correct Answer: D. Administer varicella-zoster immune globulin to the client

The development of varicella in high-risk clients can be prevented via administration of varicella-zoster immune globulin prescribed by the physician. Varicella zoster immunoglobulin (VZIG) is a scarce blood product that is offered to individuals at high risk of severe chickenpox following an exposure.

  • Option A: Hospitalization may be required if the child develops a varicella-zoster virus infection. The incidence of varicella was higher in children with leukemia or lymphoma than in children with other types of cancer. Virus reactivation was uncommon and had a benign course. Varicella mortality in these children could be favorably modified through an active immunization of immunocompetent children.
  • Option B: Contact and airborne precautions will be implemented to prevent the spread of infection to other children if the child develops varicella. Contact Precautions only if Herpes simplex, localized zoster in an immunocompetent host or vaccinia viruses most likely.
  • Option C: Acyclovir is a medication used in the management and treatment of infections caused by the herpes simplex virus (HSV). It is FDA approved to treat genital herpes and HSV encephalitis. Some off-label uses include cold sores, shingles, and chickenpox. It is in the antiviral class of medications.

Two student nurses are assigned to a client with lung cancer who has received oxycodone (Roxicodone) 10 mg orally for pain. During the assessment, which finding should the student nurses report immediately ?

  • A. Decrease in pain level from 6 to 2 (on a scale of 10)
  • B. Heart rate of 90 to 100 beats/min
  • C. Request by the client that the room door be closed
  • D. Respiratory rate of 8 to 10 breaths/min

Correct Answer: D. Respiratory rate of 8 to 10 breaths/min

A drop in respiratory rate indicates respiratory depression, which also puts the client at risk for respiratory acidosis. Signs and symptoms of an oxycodone overdose include bradycardia, hypotension, miosis, respiratory depression, somnolence, muscle flaccidity, cold and clammy skin, and death. 

  • Option A: Oxycodone is an opioid agonist prescription medication. The oxycodone immediate-release formulation is FDA-approved for the management of acute or chronic moderate to severe pain, for which other treatments do not suffice and for which the use of opioid medication is appropriate.
  • Option B: A heart rate of 100/min is slightly higher than normal, therefore this should still be reported to the RN. Patients taking oxycodone require monitoring for the presence of constipation, pain relief, other side effects, and appropriate usage. Their blood pressure, heart rate, and respiratory rate should also be monitored, especially for the first 24 to 72 hours after initiating therapy or increasing dosage.
  • Option C: The student nurses should still inform the RN of the client’s wishes. Due to the high misuse potential and possibly fatal results of an oxycodone overdose, prescriptions should be written for the lowest therapeutic dose and only for the period the patient is expected to be in pain. Close follow-up should be arranged.

The nurse just received the client’s morning laboratory results. Which of these results is of most concern?

  • A. Serum sodium level of 134 mEq/L
  • B. Serum potassium level of 5.2 mEq/L
  • C. Serum magnesium level of 0.8 mEq/L
  • D. Serum calcium level of 10.6 mg/dL

Correct Answer: C. Serum magnesium level of 0.8 mEq/L

With a magnesium level this low, the client is at risk for ECG changes and life-threatening ventricular dysrhythmias. Normal serum magnesium levels are between 1.46 and 2.68 mg/dL. Hypomagnesemia can be attributed to chronic disease, alcohol use disorder, gastrointestinal losses, renal losses, and other conditions. Signs and symptoms of hypomagnesemia include anything from mild tremors and generalized weakness to cardiac ischemia and death.

  • Option A: Hyponatremia is defined as a serum sodium concentration of less than 135 mEq/L but can vary to some extent depending upon the set values of varied laboratories. Patients with mild-to-moderate hyponatremia (greater than 120 mEq/L) or gradual decrease in sodium (greater than 48 hours) have minimal symptoms.
  • Option B: Hyperkalemia is defined as a serum or plasma potassium level above the upper limits of normal, usually greater than 5.0 mEq/L to 5.5 mEq/L. While mild hyperkalemia is usually asymptomatic, high levels of potassium may cause life-threatening cardiac arrhythmias, muscle weakness or paralysis.
  • Option D: Hypercalcemia is defined as serum calcium concentration two standard deviations above the mean values. The normal serum calcium ranges from 8.8 mg/dL-10.8 mg/dL. Primary hyperparathyroidism and malignancy accounts for 90% of the cases of hypercalcemia. 

The assigned LPN of the unit reports to you that a client’s blood pressure and heart rate have decreased, and when her face is assessed, one side twitches. What is the most appropriate thing to do as a nurse?

  • A. Assess the client’s pupillary reaction to light.
  • B. Obtain a neurologic exam request for the client.
  • C. Review the client’s morning calcium level.
  • D. Retake the client’s blood pressure and heart rate.

Correct Answer: C. Review the client’s morning calcium level.

Facial twitching of one side of the mouth, nose, and cheek in response to tapping the face just below and in front of the ear is a positive Chvostek sign. It is a neurologic manifestation of hypocalcemia .

  • Option A: Pupillary light reflex is used to assess the brain stem function. Abnormal pupillary light reflex can be found in optic nerve injury, oculomotor nerve damage, brain stem lesions, such as tumors, and medications like barbiturates.
  • Option B: The neurological examination is an assessment tool to determine a patient’s neurologic function. It is beneficial in a variety of ways as it allows the localization of neurologic diseases and helps in ruling in or ruling out differential diagnoses.
  • Option D: The LPN is experienced and holds the skills to carefully and accurately measure vital signs. The clinical manifestations of hypocalcemia can range from no symptoms if it is mild to life-threatening symptoms like seizures, heart failure , or laryngospasm if it is severe. Also, the clinical manifestation depends on the rate of development of hypocalcemia and its chronicity.

A client going through intense chemotherapy treatment is admitted to the unit. Which of these would the nurse instruct the nursing assistant to report to prevent an acid-base imbalance?

  • A. Hair loss during the morning bath.
  • B. Complaints of pain associated with exertion.
  • C. Failure to eat all the food on the breakfast tray.
  • D. Prolonged episodes of nausea and vomiting.

Correct Answer: D. Prolonged episodes of nausea and vomiting.

Repeated nausea and vomiting can lead to an acid base deficit and metabolic alkalosis. Other causes of metabolic alkalosis include the loss of hydrochloric acid from the stomach through vomiting, potassium depletion due to the use of diuretics for hypertension , and the excessive use of laxatives.

  • Option A: Chemotherapy drugs are powerful medications that attack rapidly growing cancer cells. Unfortunately, these drugs also attack other rapidly growing cells in the body — including those in the hair roots. Fortunately, most of the time hair loss from chemotherapy is temporary.
  • Option B: Chemotherapy or radiation induced pain is most often a form of nerve pain. It can cause peripheral neuropathy (painful numbness of the extremities), or paresthesia (numbness and tingling of hands, feet or any extremity of the body).
  • Option C: Cancer treatments may lower appetite or change the way food tastes or smells. Side effects such as mouth and throat problems, or nausea and vomiting can also make eating difficult. Cancer-related fatigue can also lower the appetite.

The newly hired nurse is assigned by the charge nurse to care for a client with acute renal failure and hypernatremia . Which action can the nurse assign to the nursing assistant? Select all that apply.

  • A. Administer 0.45% saline by IV line
  • B. Assess daily weights for trends
  • C. Check for indications of dehydration
  • D. Render oral care every 3 to 4 hours

Correct Answer: D. Render oral care every 3 to 4 hours

The nursing assistant can provide oral care to the client. This is within the scope of practice of nursing assistants. The scope of practice for a CNA includes tasks such as basic daily patient care. This includes activities such as bathing, eating and dressing, but also smaller things such as grooming .

  • Option A: Appropriate delegation allows for responsibility transition in a consistent, safe manner. The RN transfers the performance of a procedure, skill, or activity to a CNA. However, the practice of pervasive functions of critical decisions, nursing judgment, and clinical reasoning cannot be delegated. 
  • Option B: RNs cannot delegate any activity including the nursing judgment that involves critical decision making. When specific aspects of nurse care need to be delegated beyond the traditional assignments and roles of care providers, the delegation process and state NPA or nurse practice act must be understood clearly so that it is effectively and safely carried out.
  • Option C: Monitoring clients demand the additional education and skills of the RN. A CNA’s main role is to provide patients with basic care and assist them in their everyday activities, particularly when patients have a hard time doing a few activities on their own, such as bathing.

The nurse is caring for a client diagnosed with diabetic ketoacidosis . Which action should you delegate to the nursing assistant? Select all that apply.

  • A. Assess for indicators of fluid imbalance .
  • B. Review fingerstick glucose results every hour.
  • C. Measure vital signs every 15 minutes.
  • D. Document intake and output every hour.

Correct Answer: C and D

A well-trained and educated nursing assistant is knowledgeable in measuring vital signs and recording intake and output. In addition to helping patients with daily tasks, CNAs spend time taking vital signs and recording information about a patient’s condition. As a result, a CNA serves as an invaluable link between a patient and the rest of their healthcare team.  

  • Option A: RNs cannot delegate any activity including the nursing judgment that involves critical decision making. Validation competency needs to be specific to the skill and knowledge necessary to safely perform responsibilities delegated as well as to the level of the CNA to whom the procedure, skill, or activity has been delegated.
  • Option B: Performing fingerstick glucose checks demands further education and skill, as possessed by licensed nurses. The practice of pervasive functions of critical decisions, nursing judgment, and clinical reasoning cannot be delegated.

A client is admitted to the unit with the diagnosis of Deficient Fluid Volume related to excessive fluid loss . Which action related to fluid management should be charged to a nursing assistant?

  • A. Administer intravenous (IV) fluids as prescribed by the physician.
  • B. Develop a plan for added fluid intake over 24 hours.
  • C. Provide straws and offer fluids between meals.
  • D. Educate family members to assist the client with fluid intake.

Correct Answer: C. Provide straws and offer fluids between meals.

Additional fluid intake can be reinforced by the nursing assistance once it is part of the care plan. A CNA’s main role is to provide patients with basic care and assist them in their everyday activities, particularly when patients have a hard time doing a few activities on their own, such as bathing.

  • Option A: In some hospitals, a CNA will administer a patient’s medication. Usually, however, this depends on the CNA’s level of experience and training, as well as the regulations of the state.
  • Option B: Among the tasks that CANNOT be legally and appropriately delegated to nursing assistants include assessments, nursing diagnosis, establishing expected outcomes, evaluating care and any and all other tasks and aspects of care.
  • Option D: Educating families demand further education and skills that are within the field of practice of an RN. Based on the basic entry educational preparation differences among these members of the nursing team, care should be assigned according to the level of education of the particular team member.

A group of nursing students is assigned to care for a client with a nasogastric tube connected to a wall suction. One student asks why the client’s respiratory rate has decreased. Choose the best response.

  • A. “Whenever a client develops a respiratory acid-base problem, decreasing the respiratory rate helps fix the problem.”
  • B. “The client is hypoventilating because of anxiety, and we will have to stay observant for the development of respiratory acidosis.”
  • C. “It’s common for clients with uncomfortable equipment such as nasogastric tubes to have a lower rate of breathing.”
  • D. “The client may have a metabolic alkalosis due to the nasogastric suctioning, and the decreased respiratory rate is a compensatory mechanism.”

Correct Answer: D. “The client may have a metabolic alkalosis due to the nasogastric suctioning, and the decreased respiratory rate is a compensatory mechanism.”

Nasogastric suctioning can result in a decrease in acid components and a metabolic alkalosis. The client’s decrease in rate and depth of ventilation is an attempt to compensate by retaining carbon dioxide. Vomiting or nasogastric (NG) suction generates metabolic alkalosis by the loss of gastric secretions, which are rich in hydrochloric acid (HCl). Whenever a hydrogen ion is excreted, a bicarbonate ion is gained in the extracellular space.

  • Option A: Metabolic alkalosis causes hypoventilation, which may cause hypoxemia, especially in patients with poor respiratory reserve, and it may impair weaning from mechanical ventilation.
  • Option B: Hypoventilation develops because of inhibition of the respiratory center in the medulla. Symptoms of hypocalcemia (eg, jitteriness, perioral tingling, muscle spasms) may be present.
  • Option C: This response may be right, but it does not discuss all the components of the question. As a compensatory mechanism, metabolic alkalosis leads to alveolar hypoventilation with a rise in arterial carbon dioxide tension (PaCO 2 ), which diminishes the change in pH that would otherwise occur.

A 56-year-old male is newly admitted to the medical unit. Which factor alerts the nurse that this client has a risk for acid-base imbalances?

  • A. The client takes antacids for occasional indigestion.
  • B. The client gets short of breath with extreme exertion.
  • C. The client has a history of myocardial infarction 1 year ago.
  • D. The client has chronic renal insufficiency.

Correct Answer: D. The client has chronic renal insufficiency.

Chronic renal disease and pulmonary disease are risk factors for acid-base imbalances in the older adult. Renal failure patients have an altered acid-base balance ; most commonly, a mixed type of metabolic acidosis (hyperchloremic, and of a high anion gap) is observed.

  • Option A: Although antacid abuse is a risk factor for metabolic alkalosis, occasional antacid use will not cause imbalances. Antacid use won’t normally lead to metabolic alkalosis. But if the patient has a weak or failing kidneys and uses a nonabsorbable antacid, it can bring on alkalosis. Nonabsorbable antacids contain aluminum hydroxide or magnesium hydroxide.
  • Option B: A typical respiratory response to all types of metabolic alkalosis is hypoventilation leading to a pH correction towards normal. Increases in arterial blood pH depress respiratory centers. The resulting alveolar hypoventilation tends to elevate PaCO2 and restore arterial pH toward normal.
  • Option C: MI is not related to metabolic alkalosis. Metabolic alkalosis is caused by too much bicarbonate in the blood. It can also occur due to certain kidney diseases. Hypochloremic alkalosis is caused by an extreme lack or loss of chloride, such as from prolonged vomiting.

The monitor watcher from the telemetry units informs the assigned nurse that the client developed prominent U waves. Which laboratory value should the nurse monitor?

  • A. Sodium level
  • B. Potassium level
  • C. Calcium level
  • D. Magnesium level

Correct Answer: B. Potassium level

The nurse should immediately check the client’s potassium level for hypokalemia . Common ECG changes with hypokalemia include ST depression, inverted T waves, and prominent U waves. Heart block may also transpire to clients with hypokalemia.

  • Option A: Increased and decreased serum sodium levels do not have any effect on the ECG, nor cardiac rhythm, or impulse conduction.
  • Option C: Common ECG changes due to hypercalcemia include shortened QT interval, lengthened QRS duration, and bradycardia may also occur. Hypocalcemia may cause lengthened QT interval and shortened QRS duration.
  • Option D: Hypermagnesemia is rare but severe hypermagnesemia may cause atrioventricular and intraventricular conduction disturbances, which may culminate in third-degree AV block or asystole.

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Best Nursing Research Topics for Students

What is a nursing research paper.

  • What They Include
  • Choosing a Topic
  • Best Nursing Research Topics
  • Research Paper Writing Tips

Best Nursing Research Topics for Students

Writing a research paper is a massive task that involves careful organization, critical analysis, and a lot of time. Some nursing students are natural writers, while others struggle to select a nursing research topic, let alone write about it.

If you're a nursing student who dreads writing research papers, this article may help ease your anxiety. We'll cover everything you need to know about writing nursing school research papers and the top topics for nursing research.  

Continue reading to make your paper-writing jitters a thing of the past.

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A nursing research paper is a work of academic writing composed by a nurse or nursing student. The paper may present information on a specific topic or answer a question.

During LPN/LVN and RN programs, most papers you write focus on learning to use research databases, evaluate appropriate resources, and format your writing with APA style. You'll then synthesize your research information to answer a question or analyze a topic.

BSN , MSN , Ph.D., and DNP programs also write nursing research papers. Students in these programs may also participate in conducting original research studies.

Writing papers during your academic program improves and develops many skills, including the ability to:

  • Select nursing topics for research
  • Conduct effective research
  • Analyze published academic literature
  • Format and cite sources
  • Synthesize data
  • Organize and articulate findings

About Nursing Research Papers

When do nursing students write research papers.

You may need to write a research paper for any of the nursing courses you take. Research papers help develop critical thinking and communication skills. They allow you to learn how to conduct research and critically review publications.

That said, not every class will require in-depth, 10-20-page papers. The more advanced your degree path, the more you can expect to write and conduct research. If you're in an associate or bachelor's program, you'll probably write a few papers each semester or term.

Do Nursing Students Conduct Original Research?

Most of the time, you won't be designing, conducting, and evaluating new research. Instead, your projects will focus on learning the research process and the scientific method. You'll achieve these objectives by evaluating existing nursing literature and sources and defending a thesis.

However, many nursing faculty members do conduct original research. So, you may get opportunities to participate in, and publish, research articles.

Example Research Project Scenario:

In your maternal child nursing class, the professor assigns the class a research paper regarding developmentally appropriate nursing interventions for the pediatric population. While that may sound specific, you have almost endless opportunities to narrow down the focus of your writing. 

You could choose pain intervention measures in toddlers. Conversely, you can research the effects of prolonged hospitalization on adolescents' social-emotional development.

What Does a Nursing Research Paper Include?

Your professor should provide a thorough guideline of the scope of the paper. In general, an undergraduate nursing research paper will consist of:

Introduction : A brief overview of the research question/thesis statement your paper will discuss. You can include why the topic is relevant.

Body : This section presents your research findings and allows you to synthesize the information and data you collected. You'll have a chance to articulate your evaluation and answer your research question. The length of this section depends on your assignment.

Conclusion : A brief review of the information and analysis you presented throughout the body of the paper. This section is a recap of your paper and another chance to reassert your thesis.

The best advice is to follow your instructor's rubric and guidelines. Remember to ask for help whenever needed, and avoid overcomplicating the assignment!

How to Choose a Nursing Research Topic

The sheer volume of prospective nursing research topics can become overwhelming for students. Additionally, you may get the misconception that all the 'good' research ideas are exhausted. However, a personal approach may help you narrow down a research topic and find a unique angle.

Writing your research paper about a topic you value or connect with makes the task easier. Additionally, you should consider the material's breadth. Topics with plenty of existing literature will make developing a research question and thesis smoother.

Finally, feel free to shift gears if necessary, especially if you're still early in the research process. If you start down one path and have trouble finding published information, ask your professor if you can choose another topic.

The Best Research Topics for Nursing Students

You have endless subject choices for nursing research papers. This non-exhaustive list just scratches the surface of some of the best nursing research topics.

1. Clinical Nursing Research Topics

  • Analyze the use of telehealth/virtual nursing to reduce inpatient nurse duties.
  • Discuss the impact of evidence-based respiratory interventions on patient outcomes in critical care settings.
  • Explore the effectiveness of pain management protocols in pediatric patients.

2. Community Health Nursing Research Topics

  • Assess the impact of nurse-led diabetes education in Type II Diabetics.
  • Analyze the relationship between socioeconomic status and access to healthcare services.

3. Nurse Education Research Topics

  • Review the effectiveness of simulation-based learning to improve nursing students' clinical skills.
  • Identify methods that best prepare pre-licensure students for clinical practice.
  • Investigate factors that influence nurses to pursue advanced degrees.
  • Evaluate education methods that enhance cultural competence among nurses.
  • Describe the role of mindfulness interventions in reducing stress and burnout among nurses.

4. Mental Health Nursing Research Topics

  • Explore patient outcomes related to nurse staffing levels in acute behavioral health settings.
  • Assess the effectiveness of mental health education among emergency room nurses .
  • Explore de-escalation techniques that result in improved patient outcomes.
  • Review the effectiveness of therapeutic communication in improving patient outcomes.

5. Pediatric Nursing Research Topics

  • Assess the impact of parental involvement in pediatric asthma treatment adherence.
  • Explore challenges related to chronic illness management in pediatric patients.
  • Review the role of play therapy and other therapeutic interventions that alleviate anxiety among hospitalized children.

6. The Nursing Profession Research Topics

  • Analyze the effects of short staffing on nurse burnout .
  • Evaluate factors that facilitate resiliency among nursing professionals.
  • Examine predictors of nurse dissatisfaction and burnout.
  • Posit how nursing theories influence modern nursing practice.

Tips for Writing a Nursing Research Paper

The best nursing research advice we can provide is to follow your professor's rubric and instructions. However, here are a few study tips for nursing students to make paper writing less painful:

Avoid procrastination: Everyone says it, but few follow this advice. You can significantly lower your stress levels if you avoid procrastinating and start working on your project immediately.

Plan Ahead: Break down the writing process into smaller sections, especially if it seems overwhelming. Give yourself time for each step in the process.

Research: Use your resources and ask for help from the librarian or instructor. The rest should come together quickly once you find high-quality studies to analyze.

Outline: Create an outline to help you organize your thoughts. Then, you can plug in information throughout the research process. 

Clear Language: Use plain language as much as possible to get your point across. Jargon is inevitable when writing academic nursing papers, but keep it to a minimum.

Cite Properly: Accurately cite all sources using the appropriate citation style. Nursing research papers will almost always implement APA style. Check out the resources below for some excellent reference management options.

Revise and Edit: Once you finish your first draft, put it away for one to two hours or, preferably, a whole day. Once you've placed some space between you and your paper, read through and edit for clarity, coherence, and grammatical errors. Reading your essay out loud is an excellent way to check for the 'flow' of the paper.

Helpful Nursing Research Writing Resources:

Purdue OWL (Online writing lab) has a robust APA guide covering everything you need about APA style and rules.

Grammarly helps you edit grammar, spelling, and punctuation. Upgrading to a paid plan will get you plagiarism detection, formatting, and engagement suggestions. This tool is excellent to help you simplify complicated sentences.

Mendeley is a free reference management software. It stores, organizes, and cites references. It has a Microsoft plug-in that inserts and correctly formats APA citations.

Don't let nursing research papers scare you away from starting nursing school or furthering your education. Their purpose is to develop skills you'll need to be an effective nurse: critical thinking, communication, and the ability to review published information critically.

Choose a great topic and follow your teacher's instructions; you'll finish that paper in no time.

Joleen Sams

Joleen Sams is a certified Family Nurse Practitioner based in the Kansas City metro area. During her 10-year RN career, Joleen worked in NICU, inpatient pediatrics, and regulatory compliance. Since graduating with her MSN-FNP in 2019, she has worked in urgent care and nursing administration. Connect with Joleen on LinkedIn or see more of her writing on her website.

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Questions to Ask in Making the Decision to Accept a Staffing Assignment for Nurses

Registered nurses need to know their rights and responsibilities when considering a patient assignment. If you feel that you lack expertise on a unit and patient population, you don’t just have the right to refuse an assignment there, you have an obligation to do so. Your case managers should never ask you to work with patients you aren’t qualified to have in your care. There are many factors to consider before accepting a new patient assignment.

This set of questions can help guide you through decisions about nurse staffing assignments .

  • What is the assignment? Clarify what is expected. Do not assume. Be certain in the details.
  • What are the characteristics of the patients being assigned? Don’t just respond to the number of patients; make a critical assessment of the needs of each patient, complexity, stability, and acuity and the resources available to meet those needs.
  • Do you have the expertise to care for the patients? Are you familiar with caring for the types of patients assigned? If this is a “float assignment,” are you crossed-trained to care for these patients? Is there a “buddy system” in place with staff who are familiar with the unit? If there is no cross-training or “buddy system,” has the patient load been modified accordingly?
  • Do you have the experience and knowledge to manage the patients for whom you are being assigned care? If the answer to the question is “no,” you have an obligation to articulate your limitations. Limitations in experience and knowledge may not require refusal of the assignment, but rather an agreement regarding supervision or a modification of the assignment to ensure patient safety. If no accommodation for limitations is considered, the nurse has an obligation to refuse an assignment for which she or he lacks education or experience.
  • What is the geography of the assignment? Are you being asked to care for patients who are in close proximity for efficient management, or are the patients at opposite ends of the hall or in different units? If there are geographic difficulties, what resources are available to manage the situation? If the patients are in more than one unit and you must go to another unit to provide care, who will monitor patients out of your immediate attention?
  • Is this a temporary assignment? When other staff are located to assist, will you be relieved? If the assignment is temporary, it may be possible to accept a difficult assignment, knowing that there will soon be reinforcements. Is there a pattern of short staffing, or is this truly an emergency?
  • Is this a crisis or an ongoing staffing pattern? If the assignment is being made because of an immediate need or crisis on the unit, the decision to accept the assignment may be based on that immediate need. However, if the staffing pattern is an ongoing problem, you have the obligation to identify unmet standards of care that are occurring as a result of ongoing staffing inadequacies. This may result in a request for “safe harbor” and/or peer review.
  • Can you take the assignment in good faith? If not, you will need to get the assignment modified — or refuse the assignment. Consult your state’s nursing practice act regarding clarification of accepting an assignment in good faith. In understanding “good faith,” it’s sometimes easier to identify what would constitute bad faith. For example, if you have not taken care of pediatric patients since nursing school and you are asked to take charge of a pediatric unit, unless this is an extreme emergency, such as a disaster (in which case you would need to let people know your limitations, but you might still be the best person, given all factors for the assignment), it would be bad faith to take the assignment. It’s always your responsibility to articulate your limitations and to get an adjustment to the assignment that acknowledges the limitations you have articulated. Good-faith acceptance of an assignment means that you are concerned about the situation and believe that a different pattern of care or policy should be considered. However, you acknowledge the difference of opinion on the subject between you and your supervisor and are willing to take the assignment, and await the judgment of other peers and supervisors.

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