Question 1

The nurse is providing care for a client who is newly diagnosed with chronic obstructive pulmonary disease (COPD).Which action by the nurse conveys therapeutic communication with the client?
A) The nurse asks appropriate questions about the client's medical history.
B) The nurse closes the conversation with an anecdote about breathing.
C) The nurse plans to tell the client about a COPD support group.
D) The nurse bonds with the client by describing her life living with COPD.

Accepted Answer

A) Attentive or "mindful" listening involves listening and absorbing the content and feeling of what an individual is conveying, without selectivity. It is more than being quiet as the other individual talks: It involves paying attention to the total message, both verbal and nonverbal, and noting whether these communications are congruent. The listener does not select or listen solely to what the listener wants to hear; the nurse focuses not on the nurse's own needs but rather on the client's needs. Attentive listening conveys an attitude of caring and interest, thereby encouraging the client to talk.
B) Attentive or "mindful" listening involves listening and absorbing the content and feeling of what an individual is conveying, without selectivity. It is more than being quiet as the other individual talks: It involves paying attention to the total message, both verbal and nonverbal, and noting whether these communications are congruent. The listener does not select or listen solely to what the listener wants to hear; the nurse focuses not on the nurse's own needs but rather on the client's needs. Attentive listening conveys an attitude of caring and interest, thereby encouraging the client to talk.
C) Attentive or "mindful" listening involves listening and absorbing the content and feeling of what an individual is conveying, without selectivity. It is more than being quiet as the other individual talks: It involves paying attention to the total message, both verbal and nonverbal, and noting whether these communications are congruent. The listener does not select or listen solely to what the listener wants to hear; the nurse focuses not on the nurse's own needs but rather on the client's needs. Attentive listening conveys an attitude of caring and interest, thereby encouraging the client to talk.
D) Attentive or "mindful" listening involves listening and absorbing the content and feeling of what an individual is conveying, without selectivity. It is more than being quiet as the other individual talks: It involves paying attention to the total message, both verbal and nonverbal, and noting whether these communications are congruent. The listener does not select or listen solely to what the listener wants to hear; the nurse focuses not on the nurse's own needs but rather on the client's needs. Attentive listening conveys an attitude of caring and interest, thereby encouraging the client to talk.

Question 2

The nurse educator is teaching a group of nursing students about the purpose of documentation and medical records.Which purpose is appropriate for the educator to include in the teaching session with the students?
A) Communication
B) Planning
C) Auditing
D) Research

Accepted Answer

A) Client records are kept for a number of purposes. These include communication among healthcare professionals who are treating the same client, planning client care to evaluate care plan effectiveness, tracking services provided for reimbursement purposes, research to help all clients, education for students in health disciplines, healthcare analysis to determine agency needs, and quality assurance purposes.
B) Client records are kept for a number of purposes. These include communication among healthcare professionals who are treating the same client, planning client care to evaluate care plan effectiveness, tracking services provided for reimbursement purposes, research to help all clients, education for students in health disciplines, healthcare analysis to determine agency needs, and quality assurance purposes.
C) Client records are kept for a number of purposes. These include communication among healthcare professionals who are treating the same client, planning client care to evaluate care plan effectiveness, tracking services provided for reimbursement purposes, research to help all clients, education for students in health disciplines, healthcare analysis to determine agency needs, and quality assurance purposes.
D) Client records are kept for a number of purposes. These include communication among healthcare professionals who are treating the same client, planning client care to evaluate care plan effectiveness, tracking services provided for reimbursement purposes, research to help all clients, education for students in health disciplines, healthcare analysis to determine agency needs, and quality assurance purposes.

Question 3

The nurse on third shift is handing off clients to the nurse on first shift.Which key element is most important for the third shift nurse to report during this handoff?
A) The nurse reports, "The client in room 312 continues to complain about a headache unrelieved by pain medication. I am awaiting a call from the physician for orders."
B) The nurse reports on the clients in no apparent order of acuity or room number.
C) The nurse reports, "The client in room 315 received an enema at 2100."
D) The nurse reports, "The client in room 311 was transferred from 212."

Accepted Answer

A) Change-of-shift reports may be written or given orally, either in a face-to-face exchange or by audiotape recording. The face-to-face report permits the listener to ask questions during the report; written and tape-recorded reports are often briefer and less time consuming. Reports are sometimes given at the bedside, and clients as well as nurses may participate in the exchange of information. Key elements of the change-of-shift report include: follow a particular order; provide basic identifying information for each client; provide a reason of admission for new and transferred clients, as well as a summary; include significant changes in a client's condition; provide exact information; report need for special emotional support; include current nurse or primary care provider-prescribed orders; and state clear and concise priorities of care and background information.
B) Change-of-shift reports may be written or given orally, either in a face-to-face exchange or by audiotape recording. The face-to-face report permits the listener to ask questions during the report; written and tape-recorded reports are often briefer and less time consuming. Reports are sometimes given at the bedside, and clients as well as nurses may participate in the exchange of information. Key elements of the change-of-shift report include: follow a particular order; provide basic identifying information for each client; provide a reason of admission for new and transferred clients, as well as a summary; include significant changes in a client's condition; provide exact information; report need for special emotional support; include current nurse or primary care provider-prescribed orders; and state clear and concise priorities of care and background information.
C) Change-of-shift reports may be written or given orally, either in a face-to-face exchange or by audiotape recording. The face-to-face report permits the listener to ask questions during the report; written and tape-recorded reports are often briefer and less time consuming. Reports are sometimes given at the bedside, and clients as well as nurses may participate in the exchange of information. Key elements of the change-of-shift report include: follow a particular order; provide basic identifying information for each client; provide a reason of admission for new and transferred clients, as well as a summary; include significant changes in a client's condition; provide exact information; report need for special emotional support; include current nurse or primary care provider-prescribed orders; and state clear and concise priorities of care and background information.
D) Change-of-shift reports may be written or given orally, either in a face-to-face exchange or by audiotape recording. The face-to-face report permits the listener to ask questions during the report; written and tape-recorded reports are often briefer and less time consuming. Reports are sometimes given at the bedside, and clients as well as nurses may participate in the exchange of information. Key elements of the change-of-shift report include: follow a particular order; provide basic identifying information for each client; provide a reason of admission for new and transferred clients, as well as a summary; include significant changes in a client's condition; provide exact information; report need for special emotional support; include current nurse or primary care provider-prescribed orders; and state clear and concise priorities of care and background information.

Question 4

A new nurse on a unit asks to speak to the nurse manager as several clients have complained because family members were able to hear the verbal report outside the room during nursing rounds.The nurse manager asks the nurse for suggestions that could enhance client privacy.Which suggestion by the new nurse is appropriate?
A) Nursing rounds should take place in each client's room.
B) The unit should be closed to family and visitors during rounds.
C) Nurses should tape-record their reports outside the room.
D) Clients should be allowed to choose whether a written or oral report is used.

Accepted Answer

A) In order for the client's privacy to be protected, closing the unit during nursing rounds permits nurses to talk freely and relate important information regarding the client and care. Rounds could take place in the room, but if the family is present, confidentiality is compromised. The staff and manager should determine the form of report used, keeping in mind the confidentiality of the client. Taped reports are acceptable if conducted in private but not out on the unit.
B) In order for the client's privacy to be protected, closing the unit during nursing rounds permits nurses to talk freely and relate important information regarding the client and care. Rounds could take place in the room, but if the family is present, confidentiality is compromised. The staff and manager should determine the form of report used, keeping in mind the confidentiality of the client. Taped reports are acceptable if conducted in private but not out on the unit.
C) In order for the client's privacy to be protected, closing the unit during nursing rounds permits nurses to talk freely and relate important information regarding the client and care. Rounds could take place in the room, but if the family is present, confidentiality is compromised. The staff and manager should determine the form of report used, keeping in mind the confidentiality of the client. Taped reports are acceptable if conducted in private but not out on the unit.
D) In order for the client's privacy to be protected, closing the unit during nursing rounds permits nurses to talk freely and relate important information regarding the client and care. Rounds could take place in the room, but if the family is present, confidentiality is compromised. The staff and manager should determine the form of report used, keeping in mind the confidentiality of the client. Taped reports are acceptable if conducted in private but not out on the unit.

Question 5

The nurse is caring for a school-age client who is scheduled to have major heart surgery the next morning.The nurse enters the room to administer a medication and finds the client crying.Which response by the nurse is most therapeutic?
A) "Would you like some toys from the playroom?"
B) "I'm going to go get the doctor."
C) "You shouldn't cry. You are not in pain."
D) "It is okay to cry. I know this is scary."

Accepted Answer

A) Assertive communication is appropriate in the group setting, but for this client, the nurse should be accepting of the client's feelings of fear. Telling the client not to cry invalidates the client's feelings. Leaving to get the doctor could be seen by the child as abandonment and would signal that the nurse is uncomfortable with the child. Distraction is not appropriate when the client is clearly upset; instead, the nurse should attempt to seek more information about what the child is feeling.
B) Assertive communication is appropriate in the group setting, but for this client, the nurse should be accepting of the client's feelings of fear. Telling the client not to cry invalidates the client's feelings. Leaving to get the doctor could be seen by the child as abandonment and would signal that the nurse is uncomfortable with the child. Distraction is not appropriate when the client is clearly upset; instead, the nurse should attempt to seek more information about what the child is feeling.
C) Assertive communication is appropriate in the group setting, but for this client, the nurse should be accepting of the client's feelings of fear. Telling the client not to cry invalidates the client's feelings. Leaving to get the doctor could be seen by the child as abandonment and would signal that the nurse is uncomfortable with the child. Distraction is not appropriate when the client is clearly upset; instead, the nurse should attempt to seek more information about what the child is feeling.
D) Assertive communication is appropriate in the group setting, but for this client, the nurse should be accepting of the client's feelings of fear. Telling the client not to cry invalidates the client's feelings. Leaving to get the doctor could be seen by the child as abandonment and would signal that the nurse is uncomfortable with the child. Distraction is not appropriate when the client is clearly upset; instead, the nurse should attempt to seek more information about what the child is feeling.

Question 6

The nurse is preparing to document care provided to the client during the day shift.The nurse documents that the client experienced an increased pain level while ambulating which required an extra dose of pain medication; took a shower; visited with family; and ate a small lunch.Which information is important to include during the oral end-of-shift reporting? Select all that apply.
A) The extra dose of pain medication
B) The client's visit with family
C) The client's response to ambulation
D) The last antibiotics given
E) The client's taking a shower

Accepted Answer

A) In order to provide for the client's safety, the nurse would pass on the client's response to ambulation so that the oncoming staff can take fall precautions. The nurse would also report any as-needed medications given and when they were last given. Visiting with the family need not be mentioned at change of shift but should be documented. Taking a shower does not need to be reported, only documented. Antibiotics are reflected on the medication administration record (MAR).
B) In order to provide for the client's safety, the nurse would pass on the client's response to ambulation so that the oncoming staff can take fall precautions. The nurse would also report any as-needed medications given and when they were last given. Visiting with the family need not be mentioned at change of shift but should be documented. Taking a shower does not need to be reported, only documented. Antibiotics are reflected on the medication administration record (MAR).
C) In order to provide for the client's safety, the nurse would pass on the client's response to ambulation so that the oncoming staff can take fall precautions. The nurse would also report any as-needed medications given and when they were last given. Visiting with the family need not be mentioned at change of shift but should be documented. Taking a shower does not need to be reported, only documented. Antibiotics are reflected on the medication administration record (MAR).
D) In order to provide for the client's safety, the nurse would pass on the client's response to ambulation so that the oncoming staff can take fall precautions. The nurse would also report any as-needed medications given and when they were last given. Visiting with the family need not be mentioned at change of shift but should be documented. Taking a shower does not need to be reported, only documented. Antibiotics are reflected on the medication administration record (MAR).
E) In order to provide for the client's safety, the nurse would pass on the client's response to ambulation so that the oncoming staff can take fall precautions. The nurse would also report any as-needed medications given and when they were last given. Visiting with the family need not be mentioned at change of shift but should be documented. Taking a shower does not need to be reported, only documented. Antibiotics are reflected on the medication administration record (MAR).

Question 7

A nurse manager is working with staff nurses regarding the types and frequency of documentation required for clients being cared for in long-term care facilities.Which laws contribute to the specific documentation required for client's in long-term care facilities? Select all that apply.
A) Kardex
B) Omnibus Budget Reconciliation Act (OBRA)
C) Health Care Financing Administration Act
D) Minimum Data Set (MDS)
E) Charting by exception (CBE)

Accepted Answer

A) Laws influencing the kind and frequency of documentation required are the Health Care Financing Administration and the Omnibus Budget Reconciliation Act (OBRA) of 1987. It is under the OBRA law that the Minimum Data Set (MDS) is identified. With charting by exception (CBE) only abnormal or significant findings or exceptions to norms are recorded. The Kardex is a system of organizing client information so it can be accessed quickly and is usually used in the acute care area.
B) Laws influencing the kind and frequency of documentation required are the Health Care Financing Administration and the Omnibus Budget Reconciliation Act (OBRA) of 1987. It is under the OBRA law that the Minimum Data Set (MDS) is identified. With charting by exception (CBE) only abnormal or significant findings or exceptions to norms are recorded. The Kardex is a system of organizing client information so it can be accessed quickly and is usually used in the acute care area.
C) Laws influencing the kind and frequency of documentation required are the Health Care Financing Administration and the Omnibus Budget Reconciliation Act (OBRA) of 1987. It is under the OBRA law that the Minimum Data Set (MDS) is identified. With charting by exception (CBE) only abnormal or significant findings or exceptions to norms are recorded. The Kardex is a system of organizing client information so it can be accessed quickly and is usually used in the acute care area.
D) Laws influencing the kind and frequency of documentation required are the Health Care Financing Administration and the Omnibus Budget Reconciliation Act (OBRA) of 1987. It is under the OBRA law that the Minimum Data Set (MDS) is identified. With charting by exception (CBE) only abnormal or significant findings or exceptions to norms are recorded. The Kardex is a system of organizing client information so it can be accessed quickly and is usually used in the acute care area.
E) Laws influencing the kind and frequency of documentation required are the Health Care Financing Administration and the Omnibus Budget Reconciliation Act (OBRA) of 1987. It is under the OBRA law that the Minimum Data Set (MDS) is identified. With charting by exception (CBE) only abnormal or significant findings or exceptions to norms are recorded. The Kardex is a system of organizing client information so it can be accessed quickly and is usually used in the acute care area.

Question 8

The nurse is providing care to a client who is diagnosed with hypertension.Which response by the nurse is an appropriate example of informational confrontation with the client?
A) "I noticed you rubbing your head and your eyes, are you hurting? Let's take your blood pressure."
B) "I heard raised voices when I was coming down the hall to your room. Are you upset?"
C) "It is 3 p.m. and time to take your blood pressure before I give you your medication."
D) "Is the blood pressure medication making your head hurt?"

Accepted Answer

A) To be effective a group must accomplish its goals, maintain cohesion, and develop/modify its structure to improve effectiveness. The features of an effective group include an informal, comfortable, and relaxed atmosphere; goals, tasks, and objectives that are clear and understood; leadership and member participation; goal oriented; open and two-way communication; appropriate decision-making procedures; cohesion; conflict tolerance; and shared power.
B) To be effective a group must accomplish its goals, maintain cohesion, and develop/modify its structure to improve effectiveness. The features of an effective group include an informal, comfortable, and relaxed atmosphere; goals, tasks, and objectives that are clear and understood; leadership and member participation; goal oriented; open and two-way communication; appropriate decision-making procedures; cohesion; conflict tolerance; and shared power.
C) To be effective a group must accomplish its goals, maintain cohesion, and develop/modify its structure to improve effectiveness. The features of an effective group include an informal, comfortable, and relaxed atmosphere; goals, tasks, and objectives that are clear and understood; leadership and member participation; goal oriented; open and two-way communication; appropriate decision-making procedures; cohesion; conflict tolerance; and shared power.
D) To be effective a group must accomplish its goals, maintain cohesion, and develop/modify its structure to improve effectiveness. The features of an effective group include an informal, comfortable, and relaxed atmosphere; goals, tasks, and objectives that are clear and understood; leadership and member participation; goal oriented; open and two-way communication; appropriate decision-making procedures; cohesion; conflict tolerance; and shared power.

Question 9

The nurse is providing care to a client who is newly diagnosed with human immunodeficiency virus (HIV).Which statements by the nurse could inhibit the development of a therapeutic communication with this client? Select all that apply.
A) "I am so happy today! I found out that I got accepted into nurse practitioner school, isn't that great?"
B) "Well, I guess your homosexual lifestyle finally caught up to you, huh?"
C) "One of my cousins has AIDS. It is hard to watch him die."
D) "Tell me your feelings about the diagnosis."
E) "Perhaps you would like to talk about the new medications that you have been prescribed?"

Accepted Answer

A) Blocks of attentive listening can inhibit the development of therapeutic communication. Being concerned with oneself, assuming, and identifying are all blocks to attentive listening. The use of open-ended questions and providing general leads in are actions that enhance therapeutic communication.
B) Blocks of attentive listening can inhibit the development of therapeutic communication. Being concerned with oneself, assuming, and identifying are all blocks to attentive listening. The use of open-ended questions and providing general leads in are actions that enhance therapeutic communication.
C) Blocks of attentive listening can inhibit the development of therapeutic communication. Being concerned with oneself, assuming, and identifying are all blocks to attentive listening. The use of open-ended questions and providing general leads in are actions that enhance therapeutic communication.
D) Blocks of attentive listening can inhibit the development of therapeutic communication. Being concerned with oneself, assuming, and identifying are all blocks to attentive listening. The use of open-ended questions and providing general leads in are actions that enhance therapeutic communication.
E) Blocks of attentive listening can inhibit the development of therapeutic communication. Being concerned with oneself, assuming, and identifying are all blocks to attentive listening. The use of open-ended questions and providing general leads in are actions that enhance therapeutic communication.

Question 10

The nurse is assigned to provide care to a client who is diagnosed with chronic obstructive pulmonary disease (COPD).Overnight,the client's oxygen saturation levels decreased and the client was placed on oxygen by the respiratory therapist.To review specific information about the care received from the respiratory therapist,which portion of the medical record will the nurse review?
A) The consultation report
B) The nurses' notes
C) The medication record
D) The diagnostic report

Accepted Answer

A) The traditional client record is a source-oriented record. Each individual or department makes notations in a separate section or sections of the client's chart. The consultation report has the various reports about the client from physical therapy, respiratory therapy, and occupational therapy. The nurses' notes are specific to nursing care and include pertinent client information; the medication record has the client's name, dosage, route, time, and date of regularly administered medications, the diagnostic report has various laboratory, x-ray, and scan reports on the client.
B) The traditional client record is a source-oriented record. Each individual or department makes notations in a separate section or sections of the client's chart. The consultation report has the various reports about the client from physical therapy, respiratory therapy, and occupational therapy. The nurses' notes are specific to nursing care and include pertinent client information; the medication record has the client's name, dosage, route, time, and date of regularly administered medications, the diagnostic report has various laboratory, x-ray, and scan reports on the client.
C) The traditional client record is a source-oriented record. Each individual or department makes notations in a separate section or sections of the client's chart. The consultation report has the various reports about the client from physical therapy, respiratory therapy, and occupational therapy. The nurses' notes are specific to nursing care and include pertinent client information; the medication record has the client's name, dosage, route, time, and date of regularly administered medications, the diagnostic report has various laboratory, x-ray, and scan reports on the client.
D) The traditional client record is a source-oriented record. Each individual or department makes notations in a separate section or sections of the client's chart. The consultation report has the various reports about the client from physical therapy, respiratory therapy, and occupational therapy. The nurses' notes are specific to nursing care and include pertinent client information; the medication record has the client's name, dosage, route, time, and date of regularly administered medications, the diagnostic report has various laboratory, x-ray, and scan reports on the client.

Question 11

The clinic nurse is faxing a client's medical record to the local hospital.Which actions by the nurse are appropriate to ensure the client's confidentiality is maintained? Select all that apply.
A) Using a fax cover sheet
B) Having signed client consent from the client
C) Conducting a check of the fax number prior to transmitting
D) Including identifiable client information on the cover sheet
E) Signing an employee consent form

Accepted Answer

A) The nurse knows to take safety measures before faxing confidential information. A fax cover sheet should contain instruction that the faxed material is to be given only to the named recipient. Consent is needed from the client to fax information about the client. Make sure that personally identifiable information has been removed or is not immediately visible on the top sheet. Finally, check that the fax number is correct, check the number on the display of the machine after dialing, and check a third time before pressing the "send" button. Some facilities require the recipient agency to return a signed receipt.
B) The nurse knows to take safety measures before faxing confidential information. A fax cover sheet should contain instruction that the faxed material is to be given only to the named recipient. Consent is needed from the client to fax information about the client. Make sure that personally identifiable information has been removed or is not immediately visible on the top sheet. Finally, check that the fax number is correct, check the number on the display of the machine after dialing, and check a third time before pressing the "send" button. Some facilities require the recipient agency to return a signed receipt.
C) The nurse knows to take safety measures before faxing confidential information. A fax cover sheet should contain instruction that the faxed material is to be given only to the named recipient. Consent is needed from the client to fax information about the client. Make sure that personally identifiable information has been removed or is not immediately visible on the top sheet. Finally, check that the fax number is correct, check the number on the display of the machine after dialing, and check a third time before pressing the "send" button. Some facilities require the recipient agency to return a signed receipt.
D) The nurse knows to take safety measures before faxing confidential information. A fax cover sheet should contain instruction that the faxed material is to be given only to the named recipient. Consent is needed from the client to fax information about the client. Make sure that personally identifiable information has been removed or is not immediately visible on the top sheet. Finally, check that the fax number is correct, check the number on the display of the machine after dialing, and check a third time before pressing the "send" button. Some facilities require the recipient agency to return a signed receipt.
E) The nurse knows to take safety measures before faxing confidential information. A fax cover sheet should contain instruction that the faxed material is to be given only to the named recipient. Consent is needed from the client to fax information about the client. Make sure that personally identifiable information has been removed or is not immediately visible on the top sheet. Finally, check that the fax number is correct, check the number on the display of the machine after dialing, and check a third time before pressing the "send" button. Some facilities require the recipient agency to return a signed receipt.

Question 12

Handoff communication,the transfer of information during transitions in care such as during change-of-shift reports,includes an opportunity to ask questions,clarify,and confirm the information between sender and receiver.Which is the main objective for ensuring effective communication during a client handoff?
A) To avoid lawsuits
B) To make sure all documentation is done
C) To facilitate quality improvement
D) To ensure client safety

Accepted Answer

A) Ineffective communication is the primary cause of sentinel events, making patient safety the primary objective of the handoff communication process. Handoff communication may be scrutinized during a lawsuit, but avoiding litigation is not a primary objective. Handoff communication may be verbal or written. Analysis of handoff communication may be a quality improvement criterion, not a primary objective. Effective communication is not intended for ease of use.
B) Ineffective communication is the primary cause of sentinel events, making patient safety the primary objective of the handoff communication process. Handoff communication may be scrutinized during a lawsuit, but avoiding litigation is not a primary objective. Handoff communication may be verbal or written. Analysis of handoff communication may be a quality improvement criterion, not a primary objective. Effective communication is not intended for ease of use.
C) Ineffective communication is the primary cause of sentinel events, making patient safety the primary objective of the handoff communication process. Handoff communication may be scrutinized during a lawsuit, but avoiding litigation is not a primary objective. Handoff communication may be verbal or written. Analysis of handoff communication may be a quality improvement criterion, not a primary objective. Effective communication is not intended for ease of use.
D) Ineffective communication is the primary cause of sentinel events, making patient safety the primary objective of the handoff communication process. Handoff communication may be scrutinized during a lawsuit, but avoiding litigation is not a primary objective. Handoff communication may be verbal or written. Analysis of handoff communication may be a quality improvement criterion, not a primary objective. Effective communication is not intended for ease of use.

Question 13

A novice nurse asks the preceptor why the staff spends time talking about the clients between shifts when the oncoming nurses can read the charts instead.Which is the best response by the preceptor?
A) "Maybe we should suggest primary nursing."
B) "Change-of-shift report ensures that the oncoming staff knows the most critical information about the client requiring care."
C) "It has always been done this way."
D) "You are right. It is a waste of time."

Accepted Answer

A) Nurses often do not have time to read the clients' charts prior to assuming care, which could result in errors and assumptions; by participating in change-of-shift reports, nurses make sure the oncoming staff knows critical information. The preceptor would not tell the new nurse that a change-of-shift report is a waste of time because valuable information regarding changes in the client is communicated during a change-of-shift report. Stating that it has always been done a certain way does not help the graduate understand why a change-of-shift report is necessary. Primary nursing promotes continuity of care, but even the primary nurse needs to be apprised of changes in the client during the nurse's absence.
B) Nurses often do not have time to read the clients' charts prior to assuming care, which could result in errors and assumptions; by participating in change-of-shift reports, nurses make sure the oncoming staff knows critical information. The preceptor would not tell the new nurse that a change-of-shift report is a waste of time because valuable information regarding changes in the client is communicated during a change-of-shift report. Stating that it has always been done a certain way does not help the graduate understand why a change-of-shift report is necessary. Primary nursing promotes continuity of care, but even the primary nurse needs to be apprised of changes in the client during the nurse's absence.
C) Nurses often do not have time to read the clients' charts prior to assuming care, which could result in errors and assumptions; by participating in change-of-shift reports, nurses make sure the oncoming staff knows critical information. The preceptor would not tell the new nurse that a change-of-shift report is a waste of time because valuable information regarding changes in the client is communicated during a change-of-shift report. Stating that it has always been done a certain way does not help the graduate understand why a change-of-shift report is necessary. Primary nursing promotes continuity of care, but even the primary nurse needs to be apprised of changes in the client during the nurse's absence.
D) Nurses often do not have time to read the clients' charts prior to assuming care, which could result in errors and assumptions; by participating in change-of-shift reports, nurses make sure the oncoming staff knows critical information. The preceptor would not tell the new nurse that a change-of-shift report is a waste of time because valuable information regarding changes in the client is communicated during a change-of-shift report. Stating that it has always been done a certain way does not help the graduate understand why a change-of-shift report is necessary. Primary nursing promotes continuity of care, but even the primary nurse needs to be apprised of changes in the client during the nurse's absence.

Question 14

The nurse is documenting care in the medical record.The nurse provides narrative documentation only for abnormal assessment findings.Which type of charting is the nurse using based on this example?
A) Computerized documentation
B) Charting by exception (CBE)
C) SOAP charting
D) Focus charting

Accepted Answer

A) Charting by exception (CBE) is a documentation system in which only abnormal or significant findings or exceptions to norms are recorded. Flow sheets, standards of nursing care, and bedside access to chart forms are all incorporated into CBE. Computerized documentation is a way to manage the volume of information required in a client's chart, and different systems may include a variety of setups and programs. Focus charting is organized into data, action, and response sections, referred to as DAR. SOAP charting is a way to organize data and information in the client's record: S-subjective data; O-objective data; A-assessment; P-plan.
B) Charting by exception (CBE) is a documentation system in which only abnormal or significant findings or exceptions to norms are recorded. Flow sheets, standards of nursing care, and bedside access to chart forms are all incorporated into CBE. Computerized documentation is a way to manage the volume of information required in a client's chart, and different systems may include a variety of setups and programs. Focus charting is organized into data, action, and response sections, referred to as DAR. SOAP charting is a way to organize data and information in the client's record: S-subjective data; O-objective data; A-assessment; P-plan.
C) Charting by exception (CBE) is a documentation system in which only abnormal or significant findings or exceptions to norms are recorded. Flow sheets, standards of nursing care, and bedside access to chart forms are all incorporated into CBE. Computerized documentation is a way to manage the volume of information required in a client's chart, and different systems may include a variety of setups and programs. Focus charting is organized into data, action, and response sections, referred to as DAR. SOAP charting is a way to organize data and information in the client's record: S-subjective data; O-objective data; A-assessment; P-plan.
D) Charting by exception (CBE) is a documentation system in which only abnormal or significant findings or exceptions to norms are recorded. Flow sheets, standards of nursing care, and bedside access to chart forms are all incorporated into CBE. Computerized documentation is a way to manage the volume of information required in a client's chart, and different systems may include a variety of setups and programs. Focus charting is organized into data, action, and response sections, referred to as DAR. SOAP charting is a way to organize data and information in the client's record: S-subjective data; O-objective data; A-assessment; P-plan.

Question 15

The healthcare provider prescribes digoxin for a client who is to be discharged in the morning.When documenting the order in the medical record,which action by the nurse is the most appropriate?
A) Write digoxin, .0125 mg QD
B) Write digoxin, 0.0125 mg QD PO
C) Write digoxin, 0.0125 mg, once daily.
D) Write digoxin, 1 pill each day.

Accepted Answer

A) The nurse would enter the order as 0.0125 mg daily and would include the words "daily," or "once a day" on printed material given to the client. The nurse would change the doctor's order when giving instruction to the client to the correct format, placing a zero before a decimal and changing "qd," which can be interpreted incorrectly and should not be used. Saying that the nurse will be contacting the doctor because the order is inappropriate is not necessary; the nurse can interpret the order and write it for the client in an appropriate manner. Oral instructions are appropriate, but written instructions help the client to review instructions if forgotten.
B) The nurse would enter the order as 0.0125 mg daily and would include the words "daily," or "once a day" on printed material given to the client. The nurse would change the doctor's order when giving instruction to the client to the correct format, placing a zero before a decimal and changing "qd," which can be interpreted incorrectly and should not be used. Saying that the nurse will be contacting the doctor because the order is inappropriate is not necessary; the nurse can interpret the order and write it for the client in an appropriate manner. Oral instructions are appropriate, but written instructions help the client to review instructions if forgotten.
C) The nurse would enter the order as 0.0125 mg daily and would include the words "daily," or "once a day" on printed material given to the client. The nurse would change the doctor's order when giving instruction to the client to the correct format, placing a zero before a decimal and changing "qd," which can be interpreted incorrectly and should not be used. Saying that the nurse will be contacting the doctor because the order is inappropriate is not necessary; the nurse can interpret the order and write it for the client in an appropriate manner. Oral instructions are appropriate, but written instructions help the client to review instructions if forgotten.
D) The nurse would enter the order as 0.0125 mg daily and would include the words "daily," or "once a day" on printed material given to the client. The nurse would change the doctor's order when giving instruction to the client to the correct format, placing a zero before a decimal and changing "qd," which can be interpreted incorrectly and should not be used. Saying that the nurse will be contacting the doctor because the order is inappropriate is not necessary; the nurse can interpret the order and write it for the client in an appropriate manner. Oral instructions are appropriate, but written instructions help the client to review instructions if forgotten.

Question 16

A nurse has just been hired as a medical information system (MIS)trainer at a hospital where an electronic medical record is being installed.The nurse has been asked to assess the security of the client's medical records.According to the Security Rule of HIPAA,which recommendations by the nurse will enhance security? Select all that apply.
A) Assign each staff member a unique username and password.
B) Install a firewall.
C) Store computer-generated materials in a locked vault.
D) Turn monitors away from view when unattended.
E) Assign each unit unique passwords.

Accepted Answer

A) The Security Rule of HIPAA includes the assignment of individual passwords to each staff member for logging on and off computer files. Firewall installations will also enhance the security of client records. Client information should not be displayed if the terminal is unattended, regardless of which direction the monitor faces; never leave a monitor unattended after logging on. Computer-generated materials should be shredded when no longer needed.
B) The Security Rule of HIPAA includes the assignment of individual passwords to each staff member for logging on and off computer files. Firewall installations will also enhance the security of client records. Client information should not be displayed if the terminal is unattended, regardless of which direction the monitor faces; never leave a monitor unattended after logging on. Computer-generated materials should be shredded when no longer needed.
C) The Security Rule of HIPAA includes the assignment of individual passwords to each staff member for logging on and off computer files. Firewall installations will also enhance the security of client records. Client information should not be displayed if the terminal is unattended, regardless of which direction the monitor faces; never leave a monitor unattended after logging on. Computer-generated materials should be shredded when no longer needed.
D) The Security Rule of HIPAA includes the assignment of individual passwords to each staff member for logging on and off computer files. Firewall installations will also enhance the security of client records. Client information should not be displayed if the terminal is unattended, regardless of which direction the monitor faces; never leave a monitor unattended after logging on. Computer-generated materials should be shredded when no longer needed.
E) The Security Rule of HIPAA includes the assignment of individual passwords to each staff member for logging on and off computer files. Firewall installations will also enhance the security of client records. Client information should not be displayed if the terminal is unattended, regardless of which direction the monitor faces; never leave a monitor unattended after logging on. Computer-generated materials should be shredded when no longer needed.

Question 17

The nurse is caring for a client who received analgesic medication via central line to treat pain associated with cancer.After reassessing the client's response,which section of PIE will the nurse use when documenting the client's care?
A) Evaluation
B) Progress notes
C) Problem
D) Intervention

Accepted Answer

A) Reassessing the client's pain level after medication administration is considered evaluation and would be documented as "E" for evaluation and is numbered according to the problem. Interventions such as medication administration are labeled "I" and numbered according to the problem. The problem statement is labeled "P" and referred to by number. Progress notes are not part of the identified labels of PIE charting.
B) Reassessing the client's pain level after medication administration is considered evaluation and would be documented as "E" for evaluation and is numbered according to the problem. Interventions such as medication administration are labeled "I" and numbered according to the problem. The problem statement is labeled "P" and referred to by number. Progress notes are not part of the identified labels of PIE charting.
C) Reassessing the client's pain level after medication administration is considered evaluation and would be documented as "E" for evaluation and is numbered according to the problem. Interventions such as medication administration are labeled "I" and numbered according to the problem. The problem statement is labeled "P" and referred to by number. Progress notes are not part of the identified labels of PIE charting.
D) Reassessing the client's pain level after medication administration is considered evaluation and would be documented as "E" for evaluation and is numbered according to the problem. Interventions such as medication administration are labeled "I" and numbered according to the problem. The problem statement is labeled "P" and referred to by number. Progress notes are not part of the identified labels of PIE charting.

Question 18

The nurse is conducting a health history on a client who is being admitted to a medical-surgical unit for the treatment of chronic pain.The client is concerned about privacy and asks why it is necessary for the nurse to ask for private information and then document it in the medical record.Which response by the nurse is most appropriate?
A) "You will be able to read the record and review your care."
B) "Documentation decreases the likelihood that you will have to repeat this information to others who will care for you."
C) "Your family can review the record and ensure that care is appropriate."
D) "A record ensures there are no breaches of confidentiality."

Accepted Answer

A) The client's record serves as a vehicle by which different health professionals who interact with a client communicate with one another. This prevents fragmentation, repetition, and delays in client care, and relieves the client from having to repeat information to each provider offering care. The client can read the record, but that is not a reason to keep one. The client's family does not have access to the record. Record keeping does not prevent breaches of confidentiality.
B) The client's record serves as a vehicle by which different health professionals who interact with a client communicate with one another. This prevents fragmentation, repetition, and delays in client care, and relieves the client from having to repeat information to each provider offering care. The client can read the record, but that is not a reason to keep one. The client's family does not have access to the record. Record keeping does not prevent breaches of confidentiality.
C) The client's record serves as a vehicle by which different health professionals who interact with a client communicate with one another. This prevents fragmentation, repetition, and delays in client care, and relieves the client from having to repeat information to each provider offering care. The client can read the record, but that is not a reason to keep one. The client's family does not have access to the record. Record keeping does not prevent breaches of confidentiality.
D) The client's record serves as a vehicle by which different health professionals who interact with a client communicate with one another. This prevents fragmentation, repetition, and delays in client care, and relieves the client from having to repeat information to each provider offering care. The client can read the record, but that is not a reason to keep one. The client's family does not have access to the record. Record keeping does not prevent breaches of confidentiality.

Question 19

The nurse is preparing to provide care for a client who is newly admitted to the unit.Prior to assessing the client,which should the nurse review to determine care that may be needed?
A) The written care plan
B) The client's medical record
C) The Kardex
D) The medication administration record (MAR)

Accepted Answer

A) The Kardex is a concise method of organizing and recording data about a client, making information quickly accessible to all health professionals. The medical record contains the same information as the Kardex, but the complete medical record is lengthy and would take the student more time to review. The MAR includes only those medications that are prescribed or scheduled to be administered during the client's stay and does not include other information like diagnostic tests, daily care, and so on. The written care plan may be included in the Kardex, or at least a portion of the care plan, but it would not be as inclusive as the Kardex.
B) The Kardex is a concise method of organizing and recording data about a client, making information quickly accessible to all health professionals. The medical record contains the same information as the Kardex, but the complete medical record is lengthy and would take the student more time to review. The MAR includes only those medications that are prescribed or scheduled to be administered during the client's stay and does not include other information like diagnostic tests, daily care, and so on. The written care plan may be included in the Kardex, or at least a portion of the care plan, but it would not be as inclusive as the Kardex.
C) The Kardex is a concise method of organizing and recording data about a client, making information quickly accessible to all health professionals. The medical record contains the same information as the Kardex, but the complete medical record is lengthy and would take the student more time to review. The MAR includes only those medications that are prescribed or scheduled to be administered during the client's stay and does not include other information like diagnostic tests, daily care, and so on. The written care plan may be included in the Kardex, or at least a portion of the care plan, but it would not be as inclusive as the Kardex.
D) The Kardex is a concise method of organizing and recording data about a client, making information quickly accessible to all health professionals. The medical record contains the same information as the Kardex, but the complete medical record is lengthy and would take the student more time to review. The MAR includes only those medications that are prescribed or scheduled to be administered during the client's stay and does not include other information like diagnostic tests, daily care, and so on. The written care plan may be included in the Kardex, or at least a portion of the care plan, but it would not be as inclusive as the Kardex.

Question 20

The nurse is caring for a client who is reporting pain of 8/10 on a 1 to 10 numeric pain scale.The nurse administers the prescribed pain medication.When the nurse re-evaluates the client one hour later,the client is still reporting pain of 8/10.Which action by the nurse is appropriate at this time?
A) Wait for the healthcare provider to make rounds to report the problem.
B) Report to the healthcare provider by telephone.
C) Increase the dosage of the medication.
D) Include in the nursing report that the medication is ineffective.

Accepted Answer

A) In this case reporting to the physician by telephone is appropriate. The nurse would address the client's distress immediately and later include the event in the end-of-shift report to the oncoming nurse. The nurse cannot alter the dose of medication. Waiting for the physician to arrive could cause the client to experience a great deal of pain in the interim.
B) In this case reporting to the physician by telephone is appropriate. The nurse would address the client's distress immediately and later include the event in the end-of-shift report to the oncoming nurse. The nurse cannot alter the dose of medication. Waiting for the physician to arrive could cause the client to experience a great deal of pain in the interim.
C) In this case reporting to the physician by telephone is appropriate. The nurse would address the client's distress immediately and later include the event in the end-of-shift report to the oncoming nurse. The nurse cannot alter the dose of medication. Waiting for the physician to arrive could cause the client to experience a great deal of pain in the interim.
D) In this case reporting to the physician by telephone is appropriate. The nurse would address the client's distress immediately and later include the event in the end-of-shift report to the oncoming nurse. The nurse cannot alter the dose of medication. Waiting for the physician to arrive could cause the client to experience a great deal of pain in the interim.

Quiz 38: Communication

The nurse is providing care for a client who is newly diagnosed with chronic obstructive pulmonary disease (COPD) .Which action by the nurse conveys therapeutic communication with the client?

The nurse educator is teaching a group of nursing students about the purpose of documentation and medical records.Which purpose is appropriate for the educator to include in the teaching session with the students?

The nurse on third shift is handing off clients to the nurse on first shift.Which key element is most important for the third shift nurse to report during this handoff?

The nurse is caring for a school-age client who is scheduled to have major heart surgery the next morning.The nurse enters the room to administer a medication and finds the client crying.Which response by the nurse is most therapeutic?

A nurse manager is working with staff nurses regarding the types and frequency of documentation required for clients being cared for in long-term care facilities.Which laws contribute to the specific documentation required for client's in long-term care facilities? Select all that apply.

The nurse is providing care to a client who is diagnosed with hypertension.Which response by the nurse is an appropriate example of informational confrontation with the client?

The nurse is providing care to a client who is newly diagnosed with human immunodeficiency virus (HIV) .Which statements by the nurse could inhibit the development of a therapeutic communication with this client? Select all that apply.

The clinic nurse is faxing a client's medical record to the local hospital.Which actions by the nurse are appropriate to ensure the client's confidentiality is maintained? Select all that apply.

A novice nurse asks the preceptor why the staff spends time talking about the clients between shifts when the oncoming nurses can read the charts instead.Which is the best response by the preceptor?

The nurse is documenting care in the medical record.The nurse provides narrative documentation only for abnormal assessment findings.Which type of charting is the nurse using based on this example?

The healthcare provider prescribes digoxin for a client who is to be discharged in the morning.When documenting the order in the medical record,which action by the nurse is the most appropriate?

The nurse is caring for a client who received analgesic medication via central line to treat pain associated with cancer.After reassessing the client's response,which section of PIE will the nurse use when documenting the client's care?

The nurse is preparing to provide care for a client who is newly admitted to the unit.Prior to assessing the client,which should the nurse review to determine care that may be needed?

The nurse is caring for a client who is reporting pain of 8/10 on a 1 to 10 numeric pain scale.The nurse administers the prescribed pain medication.When the nurse re-evaluates the client one hour later,the client is still reporting pain of 8/10.Which action by the nurse is appropriate at this time?