Question 1

A nurse discontinues patient-controlled analgesia per the health care provider's prescription, and notes that there is 10 mL of morphine sulfate left in the cartridge. All other nurses on the unit appear busy. What is the most appropriate action by the nurse?

Accepted Answer

Opioids (eg, morphine, hydromorphone, fentanyl) are controlled medications, regulated in the United States by the Controlled Substances Act and in Canada by the Controlled Drugs and Substances Act. These laws contain regulations (eg, methods of disposal) for various controlled substances. To properly dispose of leftover opioid medication in a patient-controlled analgesia pump, the nurse must have a second licensed nurse witness the waste of the medication (Option C). Hospital policy should be followed to properly waste the medication and discard the empty cartridge. When a controlled substance is discontinued, the nurse documents the date, time, amount used, reason for the waste, and amount wasted. (Option A) Unlicensed assistive personnel (UAP) cannot witness the waste of medication as it is outside their scope of practice. Two licensed nurses must document this process. (Option B) Simply documenting that another nurse is not available does not follow government regulations for wasting controlled substances. Disposal should occur only when a second licensed nurse is available as a witness. (Option D) It is never appropriate to waste a controlled substance without the witness of another nurse. In addition, nurses should never document or sign off on anything that was not personally witnessed or completed as this constitutes falsified documentation. Educational objective: Waste of controlled substances (eg, opioids) must be witnessed by two licensed nurses to comply with facility policy and government regulations.

Question 2

While reviewing prenatal records with a client and her partner, the nurse notes documentation in the medical record indicating that the client is a G2P0.  However, the client denies a previous pregnancy.  Which action by the nurse is appropriate?

Accepted Answer

When reviewing obstetric history, the GTPAL notation system gives the health care provider information about a client's past pregnancies. This notation may be shortened to gravida (ie, number of previous pregnancies) and para (ie, number of births after 20 weeks). For example, a G2P0 indicates 1 prior pregnancy ending before 20 weeks and 1 current pregnancy. The nurse should be cautious of discussing obstetric history with a client in front of the partner or family and not assume that others have knowledge of the client's past pregnancies. If there is a discrepancy between what the client discloses in the interview and the medical record, the information should be clarified when the client is alone to maintain confidentiality (Option C). (Option A) The nurse should not change information in the medical record until the information is clarified appropriately with the client. (Option B) Although the client's medical record indicates a previous pregnancy, it is not appropriate to ask if the pregnancy was an abortion or a miscarriage in front of the client's partner. (Option D) Explaining the need for accurate information is not appropriate at this time and does not assist with clarifying the client's obstetric history in a private manner. Educational objective: The nurse should be cautious of discussing a client's obstetric history in front of the client's partner or family to avoid breaching confidentiality. Clarification or further questioning about the client's history should take place when the client is alone.

Question 3

A major earthquake has occurred. Local gas lines and water pipes are breaking with resulting fires and flooding in collapsed buildings. Multiple victims arrive at the triage area. Which client should the nurse care for first?

Accepted Answer

11ecbb05_cba8_a399_b433_7fc00c8b04d4_MD0009_00 Disaster triage is based on the principle of providing the greatest good for the greatest number of people. Clients are triaged rapidly using a color-coded system to categorize them from highest medical priority (emergent) to lowest (expectant). The client with stridor (eg, high-pitched, crowing inspiratory respirations), which typically occurs from constricted or blocked upper airways, is at risk for impending respiratory failure due to a compromised airway. This client should be classified as emergent, requiring immediate treatment and possibly prophylactic intubation (Option D). (Option A) Using the rule of nines, clients with full-thickness burns to the chest, back, and legs are suspected to have at least 72% total body surface area burns and should be classified as expectant (black tag). (Option B) Clients with wet clothing or cold water immersion are at risk for hypothermia but can be easily self-managed by provision of warm, dry blankets; this client should be classified as nonurgent (green tag). Untreated hypothermia may lead to decreased cerebral metabolism, dysrhythmias, and coagulopathies. (Option C) Clients with diabetes mellitus who are unable to receive insulin may develop hyperglycemia, which is unlikely to cause rapid deterioration. This client can perform self-care and should be classified as nonurgent (green tag). Educational objective: During mass casualty events, the goal is the greatest good for the greatest number of people. Clients are triaged rapidly using a color-coded system that categorizes them from highest medical priority to lowest: red (emergent), yellow (urgent), green (nonurgent), and black (expectant).

Question 4

The nurse witnessed a signed informed consent for an inguinal hernia repair surgery.  During the procedure, the surgeon discovers a secondary ventral hernia that also requires repair.  Which action should the nurse perform?

Accepted Answer

Informed consent is required before any nonemergency procedure. The 3 principles of informed consent include: The surgeon explains the diagnosis, planned procedure with risks and benefits, expected outcome, alternate treatments, and prognosis without surgery. The client indicates understanding of the information. The client is competent and gives voluntary consent. The nurse is responsible for witnessing the client's signature and ensuring that the client is competent and understands information provided by the surgeon. Clients unconscious or under the influence of mind-altering drugs (eg, opioids) cannot provide consent. If the sedated client requires procedures not listed on the consent form, the client's medical power of attorney, legal guardian, or next of kin should be contacted so that the surgeon can explain the situation and obtain consent (Option B). (Option A) Modifying a consent form after it has been signed is an illegal falsification of documentation. (Option C) Unless family members deny consent or cannot be reached, it is in the client's best interest to have the hernia repaired now rather than go through the physical and financial strain of a second surgery. (Option D) Procedures can be performed without prior consent only when lifesaving measures are necessary. Obtaining consent after a procedure is illegal and considered assault and battery. Educational objective: Informed consent is required before any nonemergency procedure. If the need for an additional procedure is discovered during surgery, the client's medical power of attorney, legal guardian, or next of kin should be contacted to provide consent.

Question 5

The nurse is caring for a client newly diagnosed with mild Alzheimer disease. Which action should the nurse prioritize at this time when teaching the client and family?

Accepted Answer

11ecbb05_cba7_4407_b433_9de56f46657e_MD0009_00 Alzheimer disease (AD) is a progressive neurocognitive disorder resulting in memory loss, personality changes, and inability to perform self-care. Due to the progressive course of AD, it is important to discuss advance directives (eg, living will, medical power of attorney) while the client can make informed decisions (Option B). (Option A) Disruptive behaviors (eg, agitation, aggression) are common as the disease progresses to moderate or late stages and can be very unsettling. However, caregivers can learn behavioral management techniques at any stage of AD. (Option C) Remaining mentally active (eg, doing crossword puzzles) may assist in slowing disease progression. However, it is more important to put an advance directive in place in the early stages of the disease. (Option D) Assistive services (eg, assisted living, adult day care, respite care, meal assistance) are very helpful, especially for clients with moderate to severe dementia. However, caregivers can make decisions regarding assistive services at any disease stage. Educational objective: Clients with Alzheimer disease should be encouraged to make advance directives in the early stages of the disease, while they can make informed decisions.

Question 6

A nurse cares for a client on life support who has been declared brain dead.  Which intervention is appropriate at this time?

Accepted Answer

Local organ procurement services (OPS) are notified for every client death, per hospital protocol (Option B). If the client is deemed appropriate as a donor, then OPS collaborate with hospital staff in approaching the client's family about organ donation. Cardiac support (eg, dopamine, epinephrine) and respiratory support (eg, ventilator) continue as organ donation is discussed and/or performed. Life support is withdrawn only if the client is not a candidate for donation due to physiological reasons or the client/family does not consent. (Option A) Organ donation is discussed before final arrangements and funeral plans are made. In most cases, the family is referred to the hospital chaplain or someone outside the hospital for assistance with final arrangements. (Option C) Medical and nursing care would continue as organ donation is discussed due to organ and tissue perfusion being necessary for viable donation. (Option D) Local OPS are contacted before life support is removed so that physiological support is continued in the event that the client is a viable donor. Educational objective: All client deaths are reported to local organ procurement services, per hospital protocol. Life support is continued until a decision for organ donation is reached so that organs and tissues continue to receive perfusion and oxygenation.

Question 7

The nurse caring for a client who had a femoral angioplasty finds the client's leg pale, cool, and pulseless. The nurse calls the health care provider (HCP) at 2 AM, and the HCP begins to yell at the nurse, stating, "I'm sick and tired of you calling me in the middle of the night!" What is the best response by the nurse?

Accepted Answer

The stress of bullying and workplace violence impairs clinical judgment and creates an unsafe environment for clients. In response to unprofessional conduct, the nurse should shift the focus of the conversation back to the client's needs, especially in situations that may result in client injury (Option A). (Option B) Discussing facility policies does not direct the conversation to the client's needs and fails to address the urgency of the situation. The priority is for the nurse to advocate for the client's needs because the client is experiencing a serious, limb-threatening, postsurgical complication. (Option C) Confrontational statements are more likely to provoke a fight than result in appropriate intervention for the client. (Option D) Incidents of bullying and workplace violence should be reported to a nursing supervisor, but the priority is to ensure that the client's needs are addressed. Educational objective: In response to unprofessional conduct, the priority is to shift the focus of the conversation back to the client's needs. After the client's needs are met, the nurse can take measures to address the unprofessional behavior (eg, filing a report).

Question 8

The acute care clinic nurse administers a prescribed narcotic for a client with renal colic and then discharges the client without ensuring that the client has a designated driver.  The client is subsequently involved in a motor vehicle accident causing injury to self and others.  Which ethical principle did the nurse violate?

Accepted Answer

The nurse violated the ethical principle "nonmaleficence" (ie, do no harm). It is rare to see a nurse inflict intentional harm. However, problems do occur due to unintentional harm, which is usually a result of poor clinical judgment. Beneficence is a nurse's duty to promote good and do what is best for the client. (Option A) Autonomy is allowing the clients to choose the direction of their care. This is accomplished with advanced directives along with informed consent and choices regarding proposed treatments. (Option C) Paternalism is a type of beneficence whereby clients are treated as children. The nurse claims to know what is best for the client and coerces the client to act as the nurse wishes without considering the client's autonomy. (Option D) Veracity refers to the duty to tell the truth. This principle should always be applied to client care and documentation. Educational objective: Nonmaleficence is the ethical principle of doing no harm. All nurses must exercise sound clinical judgment to prevent harm, even if it is unintentional, to their clients.

Question 9

The health care provider gives the preoperative nurse a signed consent form and walks away rapidly. The client turns to the nurse and states, "I don't know what is going on. Why do I need surgery?" What is the most appropriate action?

Accepted Answer

Informed consent requires that the health care provider performing the procedure explain everything to the client's satisfaction (within reason). Signed consent may be witnessed by the nurse. If the client does not fully understand informed consent, the nurse must notify the health care provider or refer up the chain of nursing command. The nurse is not responsible for verifying that the client understands the procedure and its respective risks. (Option A) This would be appropriate if the health care provider refuses to talk to the client. (Option B) This is not the nurse's responsibility; this request would have to be relayed up the chain of nursing command. (Option D) This is premature; the incident is isolated and not all facts are known. Educational objective: Clients may not consent to an invasive procedure without being informed of the clinical reasoning, consequences, and possible complications.

Question 10

Which client condition is concerning and requires further nursing assessment and intervention? Select all that apply.

Accepted Answer

The liver is very vascular, which places it at risk for internal bleeding after a tissue sample is removed for biopsy. Liver dysfunction typically results in coagulopathy as many coagulation factors are synthesized in the liver, thereby increasing the risk for bleeding. Early signs of blood loss/shock are tachypnea, tachycardia, and agitation. A later sign is hypotension. Black stools (melena) indicates slow upper gastrointestinal bleeding; tachycardia may indicate significant blood loss. Therefore, this client needs immediate assessment. (Option B) This change in vital signs from preprocedure to postprocedure most likely reflects decreased anxiety. This client's vital signs are within normal range. Lumbar puncture does not produce bleeding serious enough to make a client hypotensive. If this client was bleeding, it would compress the spinal cord, causing paralysis in the lower extremities. (Option C) This client has a pulse of 62/min (normal 60-100/min), which indicates a therapeutic effect of metoprolol. The nurse should monitor for bradycardia, which is a common and expected finding following administration of a beta-adrenergic blocker. Bradycardia would require nursing intervention only if the client became symptomatic (eg, hypotension, dizziness, nausea). (Option E) A neonate's resting pulse is 110-160/min. Crying or vigorous kicking can cause a temporary rise. Vital signs are concerning if they rise when a client is at rest. Educational objective: Vital sign changes that are early signs of concern for hypovolemic shock are tachypnea, tachycardia, and agitation; hypotension is a late finding.

Question 11

Interdisciplinary client care rounds and hand-off communication are examples of strategies used to improve communication in health care settings. What is the most important outcome of effective communication among care givers?

Accepted Answer

Miscommunication between health care providers may cause serious medical errors when clients are handed off or transferred. Medical errors can be effectively reduced by employing strategies (eg, Situation, Background, Assessment, and Recommendation [SBAR] reporting technique, nurse-to-nurse change of shift reports, multi-professional bedside rounds) to improve communication and collaboration. Nurses should be as proficient in their communication skills as they are in their clinical skills. (Options A, B, and C) Improved communication may aid in assessing a client's educational needs and meeting less obvious needs; it can also contribute to a shorter length of stay. However, these are not the most important outcomes. Educational objective: Effective communication among caregivers is necessary to deliver safe client care and reduce the number of medical errors.

Question 12

A major disaster involving hundreds of victims has occurred, and an emergency nurse is sent to assist with field triage. Which client should the nurse prioritize for transport to the hospital?

Accepted Answer

11ecbb05_cba8_2e68_b433_af661d810cf5_MD0009_00 Disaster triage is based on the principle of providing the greatest good for the greatest number of people. Clients are triaged rapidly using a color-coded system to categorize them from highest medical priority (emergent) to lowest (expectant). The client with flail chest (ie, paradoxical chest movement during respiration) from multiple fractured ribs is at risk for respiratory failure from impaired ventilation. In addition, mobile fractured ribs may puncture the pleura or vessels, causing hemothorax and/or pneumothorax at any time. Therefore, this client would be classified as emergent due to airway compromise, which requires immediate treatment (Option D). (Option A) Spotting at 8 weeks gestation may indicate complications of pregnancy (eg, miscarriage, ectopic pregnancy, hydatidiform mole). With stable vital signs, this client would be classified as nonurgent as the fetus is not at the age of viability and there is no evidence of risk to the mother's life. (Option B) The client with a compound fracture and oozing laceration would be classified as urgent and require care within 2 hours to prevent life-threatening complications (eg, hemorrhagic shock). (Option C) Absent respirations and fixed pupils indicate severe neurologic damage or death. Therefore, this client would be classified as expectant. Educational objective: During mass casualty events, the goal is the greatest good for the greatest number of people. Clients are triaged rapidly using a color-coded system that categorizes them from highest medical priority to lowest: red (emergent), yellow (urgent), green (nonurgent), and black (expectant).

Question 13

An 84-year-old client with oxygen-dependent chronic obstructive pulmonary disease is admitted with an exacerbation and steady weight loss. The client has been in the hospital 4 times over the last several months and is "tired of being poked and prodded." Which topic would be most important for the nurse to discuss with this client's health care team?

Accepted Answer

This client with advanced chronic obstructive pulmonary disease is approaching the end of life. The client has expressed the desire to avoid further tests, treatments, and hospitalizations. The goals of care should be consistent with the client's wishes and emphasize comfort and quality of life. Palliative care is appropriate for clients who wish to focus on quality of life and symptom management rather than life-prolonging treatments (Option C). Palliative care may eventually include hospice care, after it is determined that the client has a life expectancy of less than 6 months. The nurse should advocate for the client and collaborate with members of the health care team to explore care options based on the client's wishes. (Option A) This client has not clearly demonstrated a need for skilled nursing; additional assessment is needed to determine the most appropriate discharge setting. (Option B) A high-calorie diet is appropriate for a client with weight loss, but many clients may have difficulty maintaining weight due to factors such as advanced disease and poor appetite. It is not the highest priority in this client, who is nearing the end of life and has expressed an interest in avoiding further testing and hospitalization. (Option D) Physical therapy may be appropriate to help this client maintain current abilities. However, a client with disease this advanced is not likely to tolerate more activity or gain much additional functional capacity. Therefore, physical therapy is not the highest priority at this point. Educational objective: The client with an advanced, terminal disease (eg, chronic obstructive pulmonary disease) is often an appropriate candidate for palliative care. Palliative care emphasizes quality of life and symptom control and may eventually include hospice care based on the client's life expectancy.

Question 14

The nurse caring for a client in the intensive care unit reports a critical laboratory value of 120,000/mm³ (120 x 10⁹/L) platelets, decreased from 300,000/mm³ (300 x 10⁹/L) on admission. The health care provider says this is normal. The client is receiving heparin injections. Which nursing action would be the most appropriate?

Accepted Answer

There are 2 forms of heparin-induced thrombocytopenia. The first form (platelets >100,000/mm³ [100 x 10⁹/L]) normalizes within a few days. The second form (platelets <40,000/mm³ [40 x 10⁹/L]) is a life-threatening autoimmune process that requires immediate heparin discontinuation. When in doubt of a clinician's judgment, the nurse should document these objections and report to the nursing supervisor. (Options A, C, and D) It is important to first refer up the nursing hierarchy. Educational objective: The nurse should document and then report objections about a clinician's judgment to the nursing supervisor.

Question 15

A large-scale community disaster occurs and clients must share hospital rooms due to the rapid influx of new victims. Which room assignments are appropriate in this situation? Select all that apply.

Accepted Answer

When clients must be housed together in less than ideal circumstances, those infected with the same causative pathogens can be placed together. However, a client who is infectious should not be placed with an immunosuppressed client (eg, on steroids/chemotherapy, HIV positive, new post-operative, multiple chronic co-morbidities, splenectomy, diabetes, very young/elderly). Every client in the hospital is on universal precautions; therefore, there should be no concern about placing a vulnerable post-operative client in the same room where standard precautions are being taken for another client. In a disaster setting, clients of different age groups can be placed in the same room together so long as both are stable and noninfectious (even if this is not socially acceptable). (Option A) Though both clients are on contact isolation, they are infected with different organisms and this places them at risk for cross-infection. (Option C) By around age 4, clients with sickle cell disease have some level of immunosuppression as their spleens are dysfunctional due to infarctions from the sickling episodes. The spleen then fails to carry out protective phagocytosis, especially to encapsulated bacteria (eg, streptococcus pneumoniae). Educational objective: Clients infected with different organisms cannot be placed together in the same room (due to risk of cross-infection). An infectious client should not be housed with an immunocompromised one.

Question 16

The nurse caring for a terminally ill client asks if the client has an advance directive. The client states, "I already have a power of attorney." What is the best response by the nurse?

Accepted Answer

A power of attorney (POA) designates a representative to act on a person's behalf in the event that the individual becomes incapacitated. There are different types of POAs, including medical and financial. An advance directive or living will describes the client's health care decisions (eg, do not resuscitate). As part of an advance directive, the client may designate a representative to make health care decisions for the client - a durable POA for health care or POA for health care (Canada). This client's statement requires further clarification regarding what type of POA is in place (Option D). (Option A) The nurse should not assume that the client's affairs are in order based on this statement. Further clarification is needed to determine whether the client has made the appropriate arrangements regarding health care decisions. (Option B) Although it is correct that the POA makes decisions for a client only when the client is no longer able to make them, the nurse first needs to determine what type of POA is in place. (Option C) Lawyers can help with end-of-life paperwork, but the priority is to clarify whether the client has the appropriate POA in place. Educational objective: An advance directive makes clear a client's health care wishes (eg, do not resuscitate). A power of attorney (POA) designates a representative to act on a person's behalf. It is important to clarify that the client has the type of POA who can make health care decisions (durable POA for health care, POA for health care [Canada]).

Question 17

The nurse notifies the health care provider of a change in client condition. Which of the following reports given by the nurse includes the most appropriate and complete information?

Accepted Answer

The SBAR (Situation-Background-Assessment-Recommendation) provides a framework for communicating information about a change in client status to the health care provider (HCP). It includes the following information: S = Situation - what prompted the communication B = Background - pertinent information, relevant history, vital signs A = Assessment - the nurse's assessment of the situation R = Recommendation - request for prescription or action from the HCP The report given by the nurse in Option C contains the most appropriate and complete information. The nurse includes pertinent data related to history, admission, and present treatment (background); indicates when and what changes occurred (situation, assessment); and requests a prescription from the HCP (recommendation). (Option A) This report does not include any information indicating a time frame for admission or when the change in condition occurred. (Option B) This report does not include any information related to the admission time frame, current diagnosis, or pertinent data assessed by the nurse giving the report. (Option D) This report does not include any information related to the admission time frame or pertinent data assessed by the nurse giving the report. Educational objective: Nurses commonly use the SBAR framework to report changes in client status to the health care provider, communicating the current situation, client background, nurse's assessment, and a recommendation for prescription or action.

Question 18

There has been a major community disaster. Stable clients need to be discharged to make more beds available for the victims. Which clients could be discharged safely? Select all that apply.

Accepted Answer

Ataxia and diplopia are expected signs/symptoms of multiple sclerosis. Two times the control value demonstrates that warfarin has reached a therapeutic level. The long-term antibiotic course (and follow-up lab work) can continue at home through the PICC line (Options A, B, and E). (Option C) Large intestine peristalsis does not return for up to 3-5 days. The client cannot be discharged until able to tolerate oral intake with normal elimination. The client has to at least be passing flatus. (Option D) Coffee ground emesis indicates upper gastrointestinal bleeding. The etiology and treatment need to be determined before the client is discharged. Educational objective: Those who are stable for discharge include the client with multiple sclerosis with ataxia and diplopia, the client on warfarin (Coumadin) that has reached the therapeutic effect, and the client with a PICC line for a long-term antibiotic course.

Question 19

The charge nurse is reviewing events that staff nurses experienced during the shift. Which events require an incident/occurrence report to be completed? Select all that apply.

Accepted Answer

Incident/occurrence reports are used in a health facility to document events that pose unanticipated actual or potential risk to the health or safety of a client, visitor, or employee. Incident/occurrence reporting is a method of quality improvement and should not be considered punitive in nature or be documented in the health record. Examples of events requiring reporting include: Assault and injury Physical, verbal, or sexual assault occurring in a health facility (Option B) Client falls, with or without injury Staff and visitor falls, regardless of acceptance or refusal of treatment (Option E) Treatment and intervention Failure to obtain or intervene upon the results of diagnostic procedures (Option C) Inadequate or delayed diagnosis and monitoring Delay, omission, or incorrect performance or administration of prescribed therapies and medications Hospital equipment failure (Option A) Withdrawal of life support in clients deemed brain dead is an expected and clinically justified course of care, and should be documented in the health record. (Option D) Incident/occurrence reports are used to document clinical health and safety issues; managerial issues (eg, tardy or absent staff) should be documented in the employee's record. Educational objective: Incident/occurrence reports are used to document events that pose actual or potential risk to the health or safety of clients, visitors, or employees. Examples of reportable events include assault and injury; delay, omission, or incorrect provision of treatment; and equipment failure.

Question 20

A client with AIDS treated for intractable seizures is transferred from the intensive care unit to the medical unit. There are 4 semiprivate room beds available. Which room assignment does the charge nurse choose as the best option for this client?

Accepted Answer

The best option is room 4 as the client with the upper gastrointestinal bleed does not put the immunocompromised client with AIDS at increased risk for infection. (Options A, B, and C) These room options put the client with AIDS at increased risk for infection because: Room 1 - C difficileis a highly contagious bacterial infection transmitted through stool and requires contact precautions Room 2 - fever of unknown origin is often a symptom of an undiagnosed viral or bacterial infection Room 3 - pneumonia is an infectious respiratory disease Educational objective: An immunocompromised client should not be assigned to a room with a client who is contagious or potentially infected as there is an increased risk for infection.

Exam 5: Leadership & Management

A nurse discontinues patient-controlled analgesia per the health care provider's prescription, and notes that there is 10 mL of morphine sulfate left in the cartridge. All other nurses on the unit appear busy. What is the most appropriate action by the nurse?

While reviewing prenatal records with a client and her partner, the nurse notes documentation in the medical record indicating that the client is a G2P0. However, the client denies a previous pregnancy. Which action by the nurse is appropriate?

A major earthquake has occurred. Local gas lines and water pipes are breaking with resulting fires and flooding in collapsed buildings. Multiple victims arrive at the triage area. Which client should the nurse care for first?

The nurse witnessed a signed informed consent for an inguinal hernia repair surgery. During the procedure, the surgeon discovers a secondary ventral hernia that also requires repair. Which action should the nurse perform?

The nurse is caring for a client newly diagnosed with mild Alzheimer disease. Which action should the nurse prioritize at this time when teaching the client and family?

A nurse cares for a client on life support who has been declared brain dead. Which intervention is appropriate at this time?

The health care provider gives the preoperative nurse a signed consent form and walks away rapidly. The client turns to the nurse and states, "I don't know what is going on. Why do I need surgery?" What is the most appropriate action?

Which client condition is concerning and requires further nursing assessment and intervention? Select all that apply.

Interdisciplinary client care rounds and hand-off communication are examples of strategies used to improve communication in health care settings. What is the most important outcome of effective communication among care givers?

A major disaster involving hundreds of victims has occurred, and an emergency nurse is sent to assist with field triage. Which client should the nurse prioritize for transport to the hospital?

A large-scale community disaster occurs and clients must share hospital rooms due to the rapid influx of new victims. Which room assignments are appropriate in this situation? Select all that apply.

The nurse caring for a terminally ill client asks if the client has an advance directive. The client states, "I already have a power of attorney." What is the best response by the nurse?

The nurse notifies the health care provider of a change in client condition. Which of the following reports given by the nurse includes the most appropriate and complete information?

There has been a major community disaster. Stable clients need to be discharged to make more beds available for the victims. Which clients could be discharged safely? Select all that apply.

The charge nurse is reviewing events that staff nurses experienced during the shift. Which events require an incident/occurrence report to be completed? Select all that apply.

A client with AIDS treated for intractable seizures is transferred from the intensive care unit to the medical unit. There are 4 semiprivate room beds available. Which room assignment does the charge nurse choose as the best option for this client?