Question 1

At 2:00 a.m. the night nurse gives a patient 600 mg of ibuprofen according to the standard dosage she has given other patients. When charting the medication the nurse discovers that this patient's PRN order for ibuprofen calls for administering 400 mg of the drug. What nursing action is indicated?

A) Just monitor the patient as the dose given is within normal limits.
B) Notify the physician immediately.
C) Report the error and complete an incident report.
D) Chart that 400 mg of ibuprofen was given for pain.

Accepted Answer

Rationale 1: The nurse should monitor the patient, but this is not sufficient intervention.
Rationale 2: There is likely no need to notify the physician immediately. The physician should be notified at the next convenient time.
Rationale 3: This is a medication error. The ethical action is to report the error and complete an incident report.
Rationale 4: This is not a truthful statement.

Question 2

Which option reflects the nurse's duty to prevent patient falls?&#10;A) The nurse has a duty to assess the patient for risk for falls.&#10;B) The nurse has a duty to provide minimal assistance.&#10;C) The nurse has a duty to provide continual observation of patients.&#10;D) The nurse has a duty to see that siderails on all beds are raised at all times.&#10;

Accepted Answer

Rationale 1: Identification of patient risk is the primary duty to prevent falls.
Rationale 2: Minimal assistance often provides insufficient care.
Rationale 3: Continual observation is not always feasible.
Rationale 4: Siderails often produce a risk for patient falls, in some instances are regarded as restraints, and are not always recommended.

Question 3

Which person would be the best choice as an interpreter for a non-English-speaking patient?&#10;A) A hospital-provided interpreter&#10;B) The patient's daughter who is bilingual&#10;C) The patient's neighbor who is bilingual&#10;D) A hospital housekeeper who is bilingual&#10;

Accepted Answer

Rationale 1: The best choice of interpreter is one who is hospital-supplied for that purpose. Many of the common problems associated with using interpreters can be avoided by using a hospital-supplied person.
Rationale 2: The patient may not be comfortable divulging sensitive medical information to the daughter.
Rationale 3: Using a neighbor as an interpreter has confidentiality implications that should be avoided if possible.
Rationale 4: A hospital housekeeper may not be aware of medical terminology.

Question 4

A confused patient frequently calls out for "help" throughout the shift. When nursing staff respond to the call, the patient is unable to explain what is needed. What action should be taken by the nurse?

A) Continue to respond and attempt to reorient the patient.
B) Restrain the patient in soft wrist restraints.
C) Move the call bell out of the patient's reach.
D) Chemically restrain the patient with a mild sedative.

Accepted Answer

Rationale 1: Since there is no indication that this patient is in danger of getting out of bed or otherwise getting injured, the correct answer is to keep attempting reorientation.
Rationale 2: The nurse should try other methods of caring for the patient, prior to using physical restraints.
Rationale 3: Moving the call bell out of the patient's reach is dangerous.
Rationale 4: Restraints should never be used for the convenience of the staff.

Question 5

What is the nurse's legal duty with regard to implementing a physician's order?&#10;A) The nurse should follow the order unless the nurse believes some other course of action would be better.&#10;B) The nurse should follow the order unless the nurse has reason to believe that the patient could come to harm if the order is followed.&#10;C) The nurse should discuss each order with the physician, since physicians are only human.&#10;D) The nurse should follow all orders as written.&#10;

Accepted Answer

Rationale 1: Prescribing treatment is not within the scope of nursing practice.
Rationale 2: Unless the nurse has a valid reason to question an order, the order should be followed.
Rationale 3: It is not feasible or necessary to discuss each order with the physician.
Rationale 4: The nurse should question unclear or unsafe orders.

Question 6

The physician, in telling the nurse to follow an order, states, "If anything happens, I'll take full responsibility." What effect would the physician's statement have in a subsequent lawsuit for malpractice?

A) It alters the rule of professional accountability, because the physician is also a professional.
B) It alters the rule of personal accountability, because accountability is now substituted to the physician.
C) It does not alter the nurse's personal accountability at all.
D) It provides a valid defense for the nurse in the lawsuit.

Accepted Answer

Rationale 1: The physician's statement does not remove the nurse's accountability.
Rationale 2: The nurse has personal accountability for all actions.
Rationale 3: Despite what the physician may say, this nurse has accountability for any action taken. The responsibility and accountability is not to do anything that would bring harm to the patient.
Rationale 4: The physician's statement will not absolve the nurse of accountability for actions taken.

Question 7

The nurse has many responsibilities in the care of patients. What are the most important components of this care?&#10;A) Following physician orders exactly as written.&#10;B) Communicating with others regarding patient care.&#10;C) Adequately and efficiently assessing the patient.&#10;D) Monitoring the patient throughout the care encounter.&#10;E) Selecting correct staff to provide patient care.&#10;

Accepted Answer

Rationale 1: Just following orders is not sufficient to provide quality care.
Rationale 2: Communication, both verbally and through written documentation, to patients, physician, other staff members, and members of the interdisciplinary team is an essential component of nursing care.
Rationale 3: Assessment is the first step of the nursing process and becomes the basis for all nursing action. Inadequate assessment can result in dangerous omissions or mistakes.
Rationale 4: Failure to monitor has been found to be the cause of action for liability in multiple legal cases.
Rationale 5: Correctly selecting staff is important, but is all based on other more important components of care.

Question 8

The nurse suspects that a patient's death was related to faulty monitoring equipment. What is the nurse's duty to report?&#10;A) The nurse must notify the patient's survivors.&#10;B) The nurse must notify hospital risk management.&#10;C) The nurse must notify local law enforcement.&#10;D) The nurse must notify the Food and Drug Administration.&#10;

Accepted Answer

Rationale 1: Notification of survivors is not the responsibility of the nurse.
Rationale 2: If there is a possibility that faulty equipment was involved in a patient incident or death, the nurse should notify risk management and take the equipment out of service if possible.
Rationale 3: Notifying law enforcement is not the responsibility of the nurse.
Rationale 4: The nurse is not responsible for notifying the FDA.

Question 9

The triage nurse in a busy emergency department calls the charge nurse and says, "We have a patient who attempted suicide in the waiting room. I think we should just let him wait awhile so he has time to think about what he has done." Which response by the charge nurse is indicated?

A) "Is he in any danger of dying right now?"
B) "Please bring him back immediately while I get a treatment room prepared."
C) "Okay if that is what you think we should do."
D) "Is anyone with the patient?"

Accepted Answer

Rationale 1: The manager has done nothing to address the triage nurse's attitude or to provide quality care by asking this question.
Rationale 2: This patient should be seen immediately as any attempt to kill one's self is serious.
Rationale 3: The manager has done nothing to address the triage nurse's attitude by making this statement.
Rationale 4: Whether or not someone is with the patient is not relevant at this time. The patient needs care.

Question 10

Hostile or angry patients present unique nursing challenges from a legal perspective. Which basic interventions can a nurse take when caring for a hostile or angry patient?&#10;A) Allow the patient to be alone and have long periods of quiet time.&#10;B) Spend additional time with the patient, showing that he or she is important.&#10;C) Ensure that family members are always present to calm the patient.&#10;D) Sedate the patient to diffuse further encounters with the patient.&#10;E) Include the patient in discussions of treatment plans.&#10;

Accepted Answer

Rationale 1: Isolating the patient with time alone can exacerbate the problem of aggression.
Rationale 2: Spending additional time with the patient and showing that he or she is important provides the opportunity to express concern for the patient's issues and allows the nurse the opportunity to identify strategies for resolution of the patient's problems.
Rationale 3: The nurse cannot divert professional responsibility for patient observation onto the family.
Rationale 4: Sedation of the patient does not solve the problem and may be seen as improper use of chemical restraints.
Rationale 5: The nurse should respect the patient's autonomy by addressing concerns and ensuring that the patient is educated about their condition and treatment plan.

Question 11

Which options reflect what the nurse should consider prior to administering medication to a hospitalized patient?&#10;A) Correct, common dosage for this patient&#10;B) Action of the medication&#10;C) Cost of the medication&#10;D) Signs of untoward reaction to the medication&#10;E) Whether the patient's insurance covers the medication&#10;

Accepted Answer

The answer of Which options reflect what the nurse should...

Question 12

The physician made a calculation error that lead to the patient receiving a serious medication error. This error was overlooked by the pharmacist and the nurse who administered the dose as ordered. The patient ed the medication saying, "This doesn't look like I was taking at home," but took the medication anyway when the nurse said it was a generic form of the drug. Who holds liability in this situation?

A) The physician
B) The pharmacist
C) The nurse
D) The patient
E) The drug manufacturer

Accepted Answer

The answer of The physician made a calculation error that...

Question 13

Which option reflects the nurse's duty regarding use of equipment?&#10;A) Nurses are responsible for cleaning and repairing equipment so that it can be used readily.&#10;B) Nurses should modify equipment so that it meets the particular patient's requirements.&#10;C) Nurses have no responsibility for use or maintenance of equipment.&#10;D) The nurse is required to select the proper equipment and to use it correctly.&#10;

Accepted Answer

The answer of Which option reflects the nurse's duty regarding...

Question 14

Which options reflect a general criterion for restraining a patient?&#10;A) The patient's inability to care for himself or herself&#10;B) The patient's verbally abusive but nonthreatening behavior toward others&#10;C) The patient's immediate ability to harm self&#10;D) The patient's refusal to take psychotropic medications as prescribed&#10;E) The patient's threat to harm another patient&#10;

Accepted Answer

The answer of Which options reflect a general criterion for...

Question 15

What is the principal reason that a higher standard of care may be required for safeguarding mentally ill persons?&#10;A) Mentally ill persons bring more lawsuits than those with no mental illness.&#10;B) The standards of care for mentally ill patients are higher than those for physically ill patients.&#10;C) Mentally ill persons cannot fully appreciate their exposure to potential harm.&#10;D) These patients require more care than do those who are physically ill.&#10;

Accepted Answer

The answer of What is the principal reason that a...

Deck 17: Nursing in Acute Care Settings