Deck 9: Implementation and Evaluation

Question 1

The nurse is preparing to administer medications to a patient. The patient is complaining of shortness of breath. The nurse should:

A) provide the patient with oxygen since it does not require a provider order.
B) complete at least two checks to ensure that the proper medication is given.
C) check the provider orders for all forms of prescription medications.
D) remember that medication administration is an independent nursing action.

Answer 1

check the provider orders for all forms of prescription medications.

Question 2

The nurse recognizes which of the following as appropriate teaching for the patient who is returning from surgery?

A) Signs and symptoms of infection
B) Use of patient-controlled analgesia
C) Activity limitations upon discharge
D) Physical therapy

Answer 2

Use of patient-controlled analgesia

Question 3

Change of shift report, collaboration with other health care members, and ensuring availability of needed equipment are examples of:

A) indirect care.
B) direct care.
C) referrals.
D) delegation

Answer 3

indirect care.

Question 4

The five rights of delegation include:

A) right task, right circumstance, right person, right direction, and right supervision
B) right medication, right route, right time, right patient, and right dose
C) right task, right route, right patient, right direction, and right medication
D) right role, right job, right task, right need, and right dose

Question 5

The nurse correctly identifies which one of the following referrals as an inappropriate nursing referral?

A) Music therapist
B) Community agencies
C) Adaptive care services
D) Dermatologist

Question 6

The male nurse is caring for a female patient who needs a complete bed bath. The patient requests that a female nurse bathe her. The male nurse recognizes this request as an example of:

A) gender diversity involving generational norms or cultural considerations.
B) life span diversity.
C) disability diversity.
D) morphology diversity.

Question 7

The nurse is considering asking the patient for permission to involve the patient's family members in the teaching plan for the patient. Which of the following is the best rationale to support this involvement?

A) Involving the family in effective teaching empowers the patient and their support system.
B) Teaching family members decreases the number of questions they may ask.
C) Educated family members choose not to become part of the health care process.
D) The education is interesting although family do not usually care for patients after discharge.

Question 8

Which of the following cannot be delegated?

A) Obtaining vital signs
B) Assessment of lung sounds
C) Bathing a patient
D) Ambulating a patient

Question 9

The nurse is learning to identify readiness to learn in patients. Which one of the following patients would the nurse identify correctly as ready to learn?

A) The patient requesting pain medication for treatment of severe discomfort
B) The patient with nausea and vomiting
C) The patient who learned 30 minutes ago that she has cancer of the pancreas
D) The patient who was recently diagnosed with diabetes mellitus and is scheduled to be discharged in 2 days

Question 10

After the nurse completes a patient's initial assessment and develops a plan of care:

A) continual reassessment of the patient is required.
B) no changes to the care interventions should be allowed.
C) reassessment should be done randomly.
D) the nursing process becomes static to maintain the course of the cure.

Question 11

Documentation is a vital nursing role since the patient's health record:

A) should be completed accurately and in a timely manner.
B) should not be computerized (EHR) because of disclosure risks.
C) is not a legal document although they can be helpful in lawsuits.
D) cannot be used in determining billing and reimbursement issues.

Question 12

The nurse manager is creating the patient assignment for today. She has five registered nurses (RNs), two licensed practical nurses (LPNs), and five nurse technicians (NAs) scheduled. When making the assignment, the nurse manager needs to remember that:

A) RNs are responsible for all care delegated to unlicensed nursing personnel.
B) delegation is considered direct intervention for patient care.
C) LPNs operate independently and may delegate patient care.
D) nursing practice is clearly delineated and is standard across the country.

Question 13

In implementing research-based interventions, the nurse realizes that:

A) implementation of evidence-based care is unique to the nursing profession.
B) evidence-based practice is based entirely in nursing research.
C) evidence-based care is focused on practices and not outcomes.
D) nurses must read recent literature and remain current in practice

Question 14

The nurse has many roles. One is to support and work on behalf of patients for whom he/she has concern. This role is known as:

A) advocate.
B) primary care provider.
C) collaborator.
D) delegator.

Question 15

Which of the following is a direct care intervention?

A) Administration of an injection
B) Making the change-of-shift report
C) Collaborating with members of the health care team
D) Ensuring availability of needed equipment

Question 16

The nurse is caring for a patient with blindness. When reviewing the care plan, the nurse notes which of the following goals need to be modified?

A) The patient will report any drainage from the wound with a foul odor to the primary care provider after discharge.
B) The patient will agree to report pain promptly while hospitalized.
C) The patient will obtain no injuries while in the hospital.
D) The patient will report any wound drainage with a purulent appearance to the primary care provider after discharge.

Question 17

Repositioning a patient, providing hygiene, and active listening are examples of:

A) dependent interventions.
B) independent nursing interventions.
C) standing orders.
D) counseling.

Question 18

The nurse is providing care for a patient of the Jehovah's Witness faith. Based on the nurse's knowledge of the patient's religious beliefs, the nurse would question which of the following orders?

A) Obtain vital signs every shift
B) Regular diet as tolerated
C) Activity as tolerated
D) Infuse 1 unit packed red blood cells

Question 19

The patient has an order for morphine sulfate 2 mg intravenously prn (as needed) every 2 hours. When the nurse administers this medication, she is providing:

A) an independent nursing intervention.
B) a dependent nursing intervention.
C) a referral
D) an indirect care procedure.

Question 20

The registered nurse is providing an independent nursing intervention when:

A) administering oral medications.
B) administering oxygen.
C) providing emotional support.
D) administering intravenous medication.

Question 21

The final phase of the nursing process is evaluation, which focuses on:

A) recording the care that was implemented.
B) medical and nursing goals for the welfare of the patient.
C) long-term goals only.
D) the patient responses to interventions and outcomes.

Question 22

Of the following interventions, which are prevention oriented? (Select all that apply.)

A) Immunization programs
B) Cleansing an incision
C) Cardiac education related to risk factor modification
D) Placing infants prone when they sleep
E) Teaching patients to ask their physicians to wash their hands
F) None of the above

Question 23

Of the following skills, which is considered an invasive procedure? (Select all that apply.)

A) Administering oral medications
B) Starting an intravenous (IV) line
C) Repositioning the patient.
D) Inserting a urinary catheter.

Question 24

During the evaluation phase of the nursing process, the nurse realizes that the patient's short-term goals have not been met. The nurse should:

A) revise or adapt the plan of care.
B) assume that the patient did not want to achieve his goals.
C) understand that a plan of care is almost never changed.
D) reassess plans of care only after major patient-nurse interactions.

Question 25

The nursing process is an attempt to meet patient needs. As such, it:

A) is linear in nature.
B) is dynamic and cyclic.
C) requires care plans to be re-evaluated occasionally.
D) does not allow care plans to be modified.