Deck 17: Reflecting on Your Transition

Question 1

A patient weighed 200 lb 6 months ago. He now weighs 160 lb. He has not been trying to lose weight. Based on the defining characteristics of nutrition, less than body requirements, the nurse's best response would be

A) "You need to modify your diet so you don't lose more weight."
B) "That is a significant weight loss. How would you account for it?"
C) "Congratulations. That is a major achievement."
D) "How tall are you? I am wondering if that is a good weight for your height."

Answer 1

B
Acknowledging the weight loss and asking how the patient could account for it are respectful and allow the patient to express himself freely without judgment. The other responses are insensitive and/or limiting in patient responses. Del Bueno remarks that the beginning RN must meet a minimum set of competencies to be safe in the new role. These competencies include the ability to recognize problems from presenting signs and symptoms, awareness of the urgency of a situation and acting appropriately, capacity to design a care plan that safely meets the needs of the patient, and understanding the nature of the care plan in relation to the patient's medical and nursing problems.

Question 2

The nurse asks a hospitalized patient to sign the operative consent. The patient tells the nurse, "I do not really understand what is involved in the surgery." The nurse should

A) postpone the consent form signing and notify the operating room that the anesthesiologist needs to discuss the surgery with the patient.
B) explain what the planned surgical procedure entails before having the patient the sign the consent form.
C) have the patient sign the form and ask the health care provider to visit the patient before surgery to explain the procedure further.
D) delay the patient's signature on the consent form and notify the surgeon that the informed consent process is not complete.

Answer 2

D
The surgeon is responsible for explaining the surgery to the patient, and the nurse should wait until the surgeon has clarified the surgery before having the patient sign the consent form. The nurse should communicate with the surgeon directly about the consent form. It is not within the nurse's legal scope of practice to explain the surgical procedure. Del Bueno remarks that the beginning RN must meet a minimum set of competencies to be safe in the new role. These competencies include the ability to recognize problems from presenting signs and symptoms, awareness of the urgency of a situation and acting appropriately, capacity to design a care plan that safely meets the needs of the patient, and understanding the nature of the care plan in relation to the patient's medical and nursing problems.

Question 3

If a patient refuses a medication or is undergoing a diagnostic test that results in a missed dose of medication, the nurse will document the omission on the medication administration record and

A) discontinue the physician's order.
B) document why the dose was not given.
C) write an incident report.
D) double the dose at the next scheduled administration time.

Answer 3

B
Document what was done. Do not document before performing an intervention. The nurse is not authorized to discontinue any physician's order or to double the dose of medication unless directed by the physician. Missing a medication dose does not warrant an incident report. Del Bueno remarks that the beginning RN must meet a minimum set of competencies to be safe in the new role. These competencies include the ability to recognize problems from presenting signs and symptoms, awareness of the urgency of a situation and acting appropriately, capacity to design a care plan that safely meets the needs of the patient, and understanding the nature of the care plan in relation to the patient's medical and nursing problems.

Question 4

A 43-year-old patient is scheduled for a laparoscopic cholecystectomy. A nurse has a plan to teach the preoperative patient how to splint his abdomen with a pillow and cough and deep breathe, so the patient can avoid fluid accumulation in the lungs postoperatively. When the nurse enters the room, it becomes evident that the patient is blind. What critical thinking skill would you recommend a scenario like this requires?

A) Intellectual curiosity
B) Flexibility
C) Reflection
D) Open-mindedness

Question 5

A patient who had recent abdominal surgery is becoming increasingly agitated and confused. He has pulled out his IV and his nasogastric tube. His skin is pale and clammy, heart rate 120 bpm, BP 130/60. The physician has been called. What nursing action is most important at this time?

A) Gather needed supplies and assign the aide to remain with the patient.
B) Stay with the patient and have another nurse obtain needed supplies.
C) Administer pain medication and then recheck vital signs.
D) Assign the aide to retake vital signs every 15 minutes.

Question 6

The nurse enters the room of a sleeping patient to administer the 0200 dose of antibiotic that has been ordered every 6 hours. Which action would most effectively maintain a therapeutic blood level of this medication?

A) Administer the medication whenever the client awakens.
B) Omit this dose and chart the reason for doing so.
C) Awaken the patient and administer the medication.
D) Let the patient sleep and double the next dose.

Question 7

Which patient is at greatest risk for injury and requires the nurse's immediate attention? The patient who had a(n)

A) paracentesis 20 minutes ago and is sitting in bed with the arms resting on the overbed tray.
B) surgical repair of an incarcerated hernia yesterday and now has slight bruising at the incision site.
C) echocardiogram that showed an ejection fraction of 40% and has a resting heart rate of 110 occasional PVCs.
D) needle liver biopsy 1 hour ago and is now thrashing about in bed and complaining of severe abdominal pain.

Question 8

The nurse is to take a meal tray to a patient the nurse knows nothing about. Before leaving the tray with the patient, which is the most critical safety factor the nurse should determine?

A) The room is neat and orderly without offending odors.
B) The tray has condiments placed within easy reach.
C) The patient is seated securely and in a comfortable position.
D) The patient's ability to swallow is intact.

Question 9

As a graduate nurse, which statement strongly suggests future success in the current nursing practice environment?

A) "I am really good at performing nursing skills."
B) "I always get my work done on time."
C) "When possible I attend all staff meetings."
D) "I am actively involved in decision-making on the unit."

Question 10

Which of the following is an example of an anxiety-causing situation below that is potentially caused by a role transition from licensed practical nurse/license vocational nurse (LPN/LVN) to RN?

A) A shift assignment of four patients
B) Managing care based on your knowledge and skills
C) Changing work shifts from days to nights
D) Delegating tasks to LPNs/LVNs and medical assistants

Question 11

A nurse notices that the respiratory therapist assigned to his unit frequently forgets to raise the bed rails after completing treatments. The nurse's best action is to

A) ask other nurses whether they have noticed the same problem.
B) discuss the problem with the therapist.
C) report the problem to the nurse in charge.
D) report the problem to the director of respiratory therapy.

Question 12

A graduate RN on the telemetry unit is on the way to the nurse's station to chart and suddenly hears from a patient's room, "Help! Nurse!" This is not the nurse's assigned patient. Others also hear this cry for help and quickly run in with the crash cart while the graduate RN looks on. In planning care for this patient, the beginning RN must realize the importance of identifying and (Select all that apply)

A) arranging experiences.
B) correcting weaknesses.
C) investigating insights.
D) leveraging strengths.
E) applying poise.
F) accepting doubts.

Question 13

Which comments by the graduate RN are examples of interventions that will lead to a successful transition into professional nursing? (Select all that apply.)

A) "May I care for patients with COPD? I feel I need more experience with that pulmonary condition."
B) "How should I prioritize my five patients in order of importance?"
C) "Thanks for your insights about knowing when to appropriately call the physician."
D) "Now that my new role is as an RN, I would like to be treated as any new graduate RN although I've worked here as a LVN for 3 years."
E) "I'm so nervous every day I come to work, hoping nothing happens to my patients."

Question 14

A toddler is brought to the well-child community clinic by her grandmother. The health history reveals recurrent nausea, vomiting, and diarrhea. Her physical exam reveals a negligible gain in height and weight, lethargy, and a delay in achieving milestones. As a result of the child's delays, multiple disciplines would likely be involved in caring for the child. Which of the following represents the most effective role the nurse would play in caring for the child?

A) Coordinator
B) Teacher
C) Counselor
D) Advocate

Question 15

It is 0800 and the nurse just received report. Which patient situation demands the nurse's immediate attention? The patient

A) with a blood glucose of 200.
B) who needs a 0800 vancomycin level drawn.
C) receiving a blood transfusion who reports slight itching and chills.
D) with a serum potassium level of 4.3 mEq/dL who is receiving digoxin.

Question 16

The patient reports intense pain and rates it 10/10. He is talking and laughing on the telephone but interrupts his conversion to request pain medication. The nurse would make a decision about the administration of medication based on which indicator of pain?

A) The patient's body language and emotional state
B) The patient's level of activity and interaction with others
C) The patient's subjective statements about the pain
D) The nurse's objective data regarding the physical characteristics of the pain

Question 17

What could a nurse say who believed that a nursing student has a duty to understand pertinent clinical information to make sound clinical judgments?

A) "Sometimes work does get in the way of studying."
B) "Nursing school is difficult, and striving for average is understandable."
C) "You should be honest when critically reflecting on your strengths and weaknesses."
D) "Experience after nursing school will provide real nursing knowledge."

Question 18

A nurse is assigned to care for an elderly, confused patient. The patient's son is sitting at the bedside and is watching a loud television program. The nurse needs to complete the respiratory and cardiac assessment and vital signs. What would be the best approach to this situation?

A) Do not say anything. Just do the best you can with the TV on loud.
B) Say: "That TV is too loud for me to do my work. You have to shut it off."
C) Say: "I'll come back after you've finished watching this TV show. Can you use the call bell to let me know when it's over?"
D) Say: "I need a quiet environment while I listen to your mother's chest. I will need to turn the TV down until I'm finished."