Question 1

You are working in a cardiologist's office. A client has been advised by the cardiologist to stop smoking. Which of the following statements by you would be considered therapeutic?
A)I know exactly how you feel. I'm trying to stop smoking as well.
B)I would suggest stopping cold turkey. I'm sure you can do it!
C)Let me get you some information on different techniques available to help you with the quitting process.
D)You really need to quit, you know. The nicotine is not good for your heart

Accepted Answer

The client has been advised by the cardiologist to stop smoking, so the most therapeutic response is to offer information about the many methods available. Nurses need to know that every client has the right to choose and make decisions for him or herself. By providing as much information as possible the nurse will be helping the client make an informed decision.

Question 2

You are charting information about a client when you suddenly realize you are writing in another client's chart. Which of the following is the appropriate way to correct this error?
A)Scratch out the entry with pen.
B)Use white out to cover up the entry you just made.
C)Draw a straight line through the entry and write error, followed by your initial and date.
D)Get rid of the entry by using an eraser designed for removing pen marks.

Accepted Answer

To correct an entry made in error in a client's chart, you should draw a straight line through the entry, write error, then initial and date beside this entry. The client's chart is a legal document, and altering entries in any other fashion could lead to legal issues. Any corrections must be made as soon as possible. Always chart in the immediate next available space; do not leave line space between entries.

Question 3

John is to be discharged from the hospital, and he tells you that he is very happy with the support you have given him in his journey to stop drinking. He states that he is sure that, with your continued support, he will be able to stay away from alcohol permanently. He asks if you would meet him for lunch at a public restaurant. Which of the following statements indicates your understanding of the nurse-client boundaries in the therapeutic relationship?
A)"I am happy I could provide you with the support you have needed thus far. I will provide you with information of therapists and groups who can continue to support you once you leave this hospital."
B)"Yes, I would be happy to have lunch with you, just so long as you realize it will be purely as a nurse-client relationship."
C)"That is a very nice offer. When and where shall we have lunch?"
D)"I don't think so. I don't see patients after hours."

Accepted Answer

A therapeutic nurse-client relationship must have boundaries, but the support of the client does not have to stop once they leave hospital. Providing clients with contact information for further resources for on-going support is a solid professional strategy to ensure the client's continued journey to a healthier lifestyle. It is not a good idea to get involved with your clients outside the care center, as this could be interpreted wrongly by the client.

Question 4

Your client has been admitted to the psychiatric unit because she has expressed a desire to kill herself. The doctor has ordered her to be under constant supervision. She tells you she needs to go to the bathroom, gets up and attempts to close the door behind her . She seems upset, stating, "I don't need you to follow me in to the bathroom!" Which of the following is the appropriate response?
A)"Ok, I'll just wait outside here until you are done."
B)"Sorry, but you are not allowed to go anywhere on your own, not even the bathroom."
C)"While you're in there, I'll just pop out to the bathroom myself."
D)"I'm sorry, I realize this may feel uncomfortable for you, but for your own safety I must stay with you at all times."

Accepted Answer

When a client expresses suicidal tendencies, the doctor will order that the client be watched consistently, so the nurse assigned to that client must follow them, even in to the bathroom. Letting the client know you understand their discomfort with the situation shows your understanding and empathy, and staying with the client shows your understanding of professional obligation to that client's well-being.

Question 5

You are working on a surgical unit. During coffee break in the hospital cafeteria you overhear that a coworker has been admitted to the medical floor. When you return to your unit, you access her chart on the computer. You and this coworker have been becoming friends, so you are concerned about her admission and just want to check to see if she will be ok. How will your actions be construed?
A)Since you are friends with this coworker, it will be ok to look in to her chart.
B)Your actions will be seen as a breach of confidentiality, and you could be reprimanded.
C)As a nurse, you are entitled to look at any chart of any client in the hospital.
D)So long as you ask first, you will be permitted to look at the coworker's chart.

Accepted Answer

Even though you are friends with the coworker, accessing a chart for any client to whom you are not directly assigned will be construed as a breach of confidentiality. Even if you were given permission to look by your immediate supervisor, you could both be charged with a breach of confidentiality. Nurses may only have access to client's charts on a need-to-know basis.

Question 6

A nurse working in the ICU is concerned that a client who has overdosed will be violent when she regains consciousness. The nurse has seen this happen with other clients. This client has an endotracheal tube, plus several intravenous lines, running. The nurse believes it would be in the client's best interest to apply wrist restraints. What must she do prior to applying the restraints?
A)Obtain consent from the family.
B)Go ahead and apply the restraints, as it is a nursing decision.
C)Discuss the situation with the physiotherapist.
D)Discuss the decision with her coworkers.

Accepted Answer

Since the client is unconscious, permission from the family must be obtained. Of course, the matter must also be discussed with the attending doctor. The decision is not up to the physiotherapist.

Question 7

Stark is a resident in a long term care facility. He has signed a facility form which states he does not wish to be resuscitated in the event he should have a heart attack or just stop breathing. You arrive in his room to deliver his medications and find him lying on his bed, unresponsive with no apparent pulse or breaths. What should you do?
A)Immediately call a code and have someone bring the crash cart.
B)Give two rescue breaths and then start CPR.
C)Call for a coworker and have them call the resident's doctor to inform him that the client has died.
D)Quietly leave the room and hope someone else finds him.

Accepted Answer

The resident signed a legal form stating he did not wish to be resuscitated. In this case, even though itmay be difficult for you to accept, you must respect the resident's wishes. Have someone call thedoctor immediately and inform him/her of the death. Be sure to note the time you found the resident. If you have other medications to deliver to other residents, you must carry on with this task.

Question 8

As the RN is charting on a client, he realizes that the medication bag that was hung for his client an hour ago had twice the dose it should have. Upon reviewing the doctor's orders, the nurse realizes the order had been transcribed incorrectly on to the medication record. What should the nurse do?
A)Go to the head nurse and complain that someone transcribed the order incorrectly.
B)Nothing, and hope no one notices the error.
C)Erase the incorrect entry and correct it to what was originally written by the doctor.
D)Check on the client right away, including taking vital signs, then immediately report the incident to your supervisor.

Accepted Answer

When a medication error occurs, you should check on the client right away, including taking a set of vital signs. You must also report the incident immediately to your supervisor, who will then report it to the doctor. Though it can be a frightening and unsettling experience, a nurse's first priority is to the care and safety of his/her clients, and the nurse must report such incidences, even if no harm has come to the client.

Question 9

Your client was prescribed a narcotic, every four hours, for post-surgical pain. When you arrive in his room to give him the medication, he refuses it. He is alert, oriented and does not seem in distress. What should you do?
A)Return the medication to the med room, then chart the refusal, and the reason the client gave, on the client's chart.
B)Become stern with the client and tell him he must take the medication the doctor has ordered.
C)Try to calmly and politely talk him into taking the medication.
D)Shrug your shoulders and just leave the client's room. Later, you can chart that he refused his medication.

Accepted Answer

Every client has a right to accept or refuse care on their terms. This client was alert, coherent, and in no apparent distress, so the nurse needs to respect the client's decision. The nurse should chart all the details on the client's chart as soon as possible

Question 10

A forty-year-old woman arrives in the emergency room and is diagnosed with a ruptured appendix. She is febrile and seems only vaguely aware of where she is, and you are having difficulty knowingwhether she understands that the surgeon has ordered she be taken to the O.R. immediately. Thereis no other family or next of kin with her. What should you, as the nurse, do next?
A)Take her to the operating room as ordered.
B)Wait until the fever medication takes effect, hoping she will be more conscious and can sign a surgical consent form.
C)Contact the nursing supervisor for further direction.
D)Search through her belongings to try to find a family contact number.

Accepted Answer

A surgeon has the right to perform life-saving surgery, even in the event a formal consent cannot be obtained. You should take the client to the operating room immediately, as ordered; otherwise this woman would be at risk of dying from internal infection complications. Delaying the surgery in an attempt to find next of kin may cost the client her health, or even her life.

Question 11

A charge nurse becomes frustrated with a client who is constantly calling out. It is disruptive for the other clients, as this has been going on for over one hour. The nurse yells down the hall, "If you don't shut up, I will give you something to yell about!" The charge nurse could be accused of which of the following?
A)Assault
B)Negligence
C)Slander
D)Battery

Accepted Answer

Assault can be defined as causing fear or apprehension of physical harm. The charge nurse could be accused in a court of law with assault. The charge nurse would have been better to remove herself from the circumstance until she calmed down. More appropriately, the nurses should investigate why the client is calling out.

Question 12

A client in the Emergency Room asks the nurse about her opinion of the attending physician. The nurse tells the client she thinks the doctor is cute, but finds his bed side manner inexcusable and sometimes wonders about his diagnoses. The nurse is at risk of being accused of which of the following:
A)Negligence
B)Slander
C)Malpractice
D)Libel

Accepted Answer

Slander is communicating to another person words that could conceivable damage the reputation of another person.

Question 13

Client advocacy on the part of the nurse is characterized by all of the following, except:
A)Providing paternalistic care.
B)Ensuring that the client's rights and privacy are provided for at all times.
C)Working with a "client comes first" attitude.
D)Ensuring the client has access to all necessary information to help make informed decisions.

Accepted Answer

Providing paternalistic care would mean giving care that is not requested or agreed to by the client. This interferes with the client's rights. Nurses must always act with the clients best interests in mind, allowing them freedom of choice and ensuring they have access to all information necessary to make informed decisions.

Question 14

The nursing staff in a large city hospital are expected to float to other units when staffing shortages dictate the need. Jeff, an RN, is sent to maternity one evening. He has not worked in this area of nursing for several years. He approaches the night shift supervisor, stating that he is not comfortable working on the maternity unit. What should the supervisor do?
A)Insist he stay and work, doing the best he can, because they are short of nurses on the unit.
B)Send him back to his original unit and find another qualified RN.
C)Tell him not to worry, he will do fine, and she will check up on him throughout the shift.
D)Write him up for disciplinary action.

Accepted Answer

Every nurse has the obligation to ensure his or her own practice is within his or her professional expertise. Managers and supervisors, like all nurses, must also ensure safe and ethical care of all clients. Jeff has acknowledged his lack of competency, so the supervisor must make other arrangements.

Question 15

Suzanne is a resident in a nursing home who is scheduled for a bath today. She tells the nurse constantly on the way to the tub room that she does not want to have a bath today. The resident does not suffer from any form of dementia. The nurse begins Suzanneï¿½s bath anyway, as the resident hits out and yells at her. The nurse is guilty of which of the following?
A)Verbal abuse
B)Sexual abuse
C)Physical abuse
D)Emotional abuse

Accepted Answer

The nurse was forcing Suzanne, a resident without dementia, to take a bath against her will, despite Suzanne's informed and aware decision against it. Physical abuse involves forcing care upon a client against their wishes. Elderly people in nursing home settings, whether they suffer with dementia problems or not, are still entitled to choice of care and dignified care.

Question 16

A client has been discharged, and while housekeeping is cleaning the room they find a yellow pill on the room floor. They bring it you, as you were the nurse who discharged the client. When you review the client's chart, the pill is identified as Lasix (furosemide), a medication the client normally received in the morning. What should you do?
A)Throw the pill away and forget about the incident.
B)Fill out a medication incident/error report and inform the doctor.
C)Ask the housekeeping staff to throw the pill away.
D)Assume the pill must have been dropped by another nurse who worked the previous morning. I couldn't have been you.

Accepted Answer

If housekeeping staff were to find pills on the floor of a client's room they should notify the nurse. This is a medication error, so an incident form must be filled out and the doctor notified. Filling out an incident form does not mean a nurse is to be reprimanded, rather, these are forms that help track errors and establish guidelines that may help prevent similar errors in the future.

Question 17

Susan works part time as a Registered Nurse and also has a business, providing massage therapy, which she runs out of her home. One day, you hear her telling one of her clients that she could provide massage therapy to help a shoulder injury once the client is discharged from hospital. What should you say to Susan?
A)"How much do you charge for a massage?"
B)"Telling your clients about your massage therapy business is a conflict of interest."
C)"Why don't you offer massage services while you are at work?"
D)"Wow. What a neat job. Why don't you do it full time?"

Accepted Answer

When you work for an employer as a nurse, you must not advertise your own business to your clients. It is a conflict of interest, and you could face disciplinary actions. Most employers will have you sign a special conflict-of-interest form upon being hired.

Question 18

A client's doctor writes an order for a laxative to relieve constipation. The doctor's order states, "enema prn". What should you as the nurse do?
A)Check to see what types of enemas there are on-hand in the medication room and choose one.
B)Ask the client what type of enema and at what time of day they would prefer to receive it.
C)Ignore the order, as it is an incomplete order.
D)Ask the doctor to clarify the order, to include the type and frequency of the enema.

Accepted Answer

Orders from a doctor must be clear and precise. The doctor must clarify the type of enema as well as frequency (e.g. daily or every 2 days prn). If you gave the enema without further clarification, you could be accused of malpractice.

Question 19

You are working in the ER when a highly intoxicated client is brought in by ambulance. The client is aggressive verbally, swears at you, then stumbles off the stretcher, trying to swing at you with his fists. What should you do?
A)Call for assistance, while backing a safe distance away from the client.
B)Subdue the client forcibly and claim self defense.
C)Leave the ER and go to the admission desk and have someone call 911.
D)Yell at the client, telling him to lie back down or you will call the police.

Accepted Answer

When people are highly intoxicated, they may become violent. Your safety is as important as that of this client, and any others in the ER at the time, so back away while calmly calling out for assistance. Getting physical with the client is wrong and could only make him more violent. Talking calmly may help him settle down.

Question 20

A church minister approaches the nurse who is caring for a member of his congregation. He asks the nurse about the client's diagnosis. What is the nurse's most appropriate response to his inquiry?
A)Ask him if he has spoken with the client regarding this matter.
B)Tell him the diagnosis. After all, he is the client's spiritual support.
C)Tell him it is none of his business.
D)Advise him he must ask the doctor for the diagnosis.

Accepted Answer

It is not appropriate for the nurse to discuss a client's diagnosis with any church minister, or even family members, without the client's prior approval. Doing so could be considered a breach of confidentiality. It is best that such individuals talk with the client directly.

Quiz 3: Professionalism

You are working in a cardiologist's office. A client has been advised by the cardiologist to stop smoking. Which of the following statements by you would be considered therapeutic?

You are charting information about a client when you suddenly realize you are writing in another client's chart. Which of the following is the appropriate way to correct this error?

As the RN is charting on a client, he realizes that the medication bag that was hung for his client an hour ago had twice the dose it should have. Upon reviewing the doctor's orders, the nurse realizes the order had been transcribed incorrectly on to the medication record. What should the nurse do?

Your client was prescribed a narcotic, every four hours, for post-surgical pain. When you arrive in his room to give him the medication, he refuses it. He is alert, oriented and does not seem in distress. What should you do?

A client in the Emergency Room asks the nurse about her opinion of the attending physician. The nurse tells the client she thinks the doctor is cute, but finds his bed side manner inexcusable and sometimes wonders about his diagnoses. The nurse is at risk of being accused of which of the following:

Client advocacy on the part of the nurse is characterized by all of the following, except:

A client's doctor writes an order for a laxative to relieve constipation. The doctor's order states, "enema prn". What should you as the nurse do?

You are working in the ER when a highly intoxicated client is brought in by ambulance. The client is aggressive verbally, swears at you, then stumbles off the stretcher, trying to swing at you with his fists. What should you do?

A church minister approaches the nurse who is caring for a member of his congregation. He asks the nurse about the client's diagnosis. What is the nurse's most appropriate response to his inquiry?