Question 1

The home health nurse discovers that a homebound cancer patient is using marijuana to control nausea from chemotherapy. What advice should the nurse give this patient?

Accepted Answer

Rationale 1: Some patients report that marijuana does decrease nausea from chemotherapy.
Rationale 2: The nurse cannot legally advise the patient that it is permissible to break a law.
Rationale 3: Any possession of marijuana remains illegal under federal law.
Rationale 4: Some states do have such guidelines and if these are in place and followed, it is unlikely that federal charges would be pursued.
Rationale 5: The mere presence of an illness that can be treated with marijuana is not sufficient to avoid prosecution for the patient and those providing the substance.

Question 2

The nurse has a strong religious conviction against elective sterilization procedures. When seeking employment, how should the nurse handle this belief?

Accepted Answer

Rationale 1: While many units would be unlikely to receive such patients, it cannot be guaranteed that the nurse would never come into contact with them.
Rationale 2: The best strategy is to be up front about these beliefs and to discuss them at the time of the employment interview.
Rationale 3: While it is true that these are personal beliefs, they may impact the way the nurse is assigned or able to practice in given environments.
Rationale 4: There is no need to document the information in the contract.

Question 3

In which situations would the state board of nursing have probable grounds for disciplining a nurse?

Accepted Answer

Rationale 1: Inability to lift 30 pounds may change where a nurse can safely work, but is not grounds for action against the license.
Rationale 2: Failure to report another person for fraudulent, incompetent, unprofessional, or unethical conduct is grounds for action against the non-reporter's license.
Rationale 3: Questioning an order is not grounds for action against the nurse unless the questioning is done in an unethical or unprofessional manner.
Rationale 4: Making a false statement on the licensure application is grounds for action against the nurse's license.
Rationale 5: If the nurse is seeking treatment for depression and the depression does not interfere with safe, competent nursing care there is no reason for disciplinary action.

Question 4

The patient tells the nurse that the physician mentioned deep tissue massage as treatment for rheumatoid arthritis. As a part of the subsequent conversation, the nurse demonstrates techniques and encourages the patient to begin a regimen immediately. What is true regarding this situation?

Accepted Answer

Rationale 1: The nurse is responsible for all nursing actions.
Rationale 2: The recommendation itself would probably not be a liability issue if the nurse was educated to make such a recommendation.
Rationale 3: The nurse is responsible for all nursing actions.
Rationale 4: Deep tissue massage goes beyond the bedtime "backrub" type of massage taught in nursing school and is used for a specific disease therapy, so the nurse may be guilty of practicing massage without a license. States differ on this licensure.

Question 5

A nurse appointed to the state board of nursing would expect work focused on which basic purpose of that body?

Accepted Answer

Rationale 1: The main purpose of the state board of nursing is to protect the public.
Rationale 2: The state board of nursing may support this effort, but this is not the basic function of the board.
Rationale 3: Overseeing nurse competence is a way to support the board's basic purpose.
Rationale 4: The state board may restrict nursing practice in order to support its basic purpose.

Question 6

The nurse is searching for the legal guide to the practice of registered nurse. Which document should the nurse review?

Accepted Answer

Rationale 1: The ANA Code of Ethics is the document that defines ethical principles for nurses.
Rationale 2: The state nurse practice act is the legal guide to define the scope of practice for nurses.
Rationale 3: The Nurse's Bill of Rights are references to nurses' rights, not specific legal aspects of nursing practice.
Rationale 4: The Nightingale Pledge is the nurses' pledge or commitment to serving their patients derived from the writings of Florence Nightingale.

Question 7

The nurse holds original licensure in a compact state and has practice privileges in two remote states. Should practice concerns arise with this nurse in a remote state, what is the status of the nurse's license?

Accepted Answer

Rationale 1: Action may be taken by the home state and the remote state where poor practice was demonstrated.
Rationale 2: All three states do not have to be in accordance with the action against this nurse's license.
Rationale 3: Only the state that issued the license can suspend or revoke it.
Rationale 4: Only the home state can act against the license by using probation.
Rationale 5: The remote state would act against the practice privilege by limiting or stopping practice with a cease-and-desist order.

Question 8

A medical technician working in a physician's office routinely refers to herself as a nurse. Which type of licensure protects that title as well as the professional actions associated with nursing?

Accepted Answer

Rationale 1: Mandatory licensure requires that all persons who are compensated as a member of a licensed profession obtain licensure prior to practicing actions of the profession. It protects both the title "nurse" and the professional actions associated with the nursing.
Rationale 2: Institutional licensure is the process by which a state government regulates health institutions and is an alternative to individual licensure. It does not protect individual practice or title.
Rationale 3: Transitional is not a term used to describe licensure in this text.
Rationale 4: With permissive licensure, nurses cannot use the title RN unless duly licensed, but can perform many or all of the same actions as long as they do not call themselves RN. So, permissive licensure regulates the use of the title, not the actions.

Question 9

A nursing student reports that her grandmother served as a nurse in World War II. At the end of the war, her grandmother was licensed as a nurse, even though she never graduated from nursing school. Which type of exemption from licensure does this reflect?

Accepted Answer

Rationale 1: The grandfather clause is a form of exemption that allows certain persons working within a given profession prior to a given deadline to apply for licensure without meeting all the requirements for that licensure. It was used to allow World War II nurses with on-the-job training and expertise licensure as a nurse.
Rationale 2: Reciprocity allows a person who has a license in one state to practice in another state if the states have an agreement to do so.
Rationale 3: Endorsement is similar to reciprocity but there is no prior agreement among the states.
Rationale 4: Licensure by waiver is similar to licensure by exam. If the person meets the exam requirements without taking the test, the exam is waived and a license is issued.

Question 10

Changes to nursing licensure are being considered. The nurse identifies which source of the state's power to license nurses?

Accepted Answer

Rationale 1: It is the states' police power that enables them to provide a license for nurses.
Rationale 2: State and federal case laws may define actions that the state may take in certain circumstances, but they do not extend to providing licensure for nurses.
Rationale 3: The Constitution is a federal document that does not address licensing power of the states.
Rationale 4: The state practice act defines the scope of practices and the processes for licensure, not the power to issue the license.

Question 11

A physician reported a case of possible nursing negligence to the state board of nursing. What action will be taken by the board?

Accepted Answer

Rationale 1: A single complaint triggers action on the part of the board. The complaint is screened and an investigation is initiated, if appropriate.
Rationale 2: Any interested person can file a complaint with the board of nursing.
Rationale 3: There is no way to know if probation is necessary until an investigation is done.
Rationale 4: No action against the nurse is indicated until an investigation is completed.

Question 12

The hospital nurse supervisor has concerns that a staff nurse is no longer capable of competent patient care because of alcohol use. Repeated counseling sessions with the nurse have not changed the behaviors that are of concern. What action should be taken by the supervisor?

Accepted Answer

Rationale 1: Of the options provided, the one most protective of public safety is to report concerns to the state board of nursing.
Rationale 2: Simply terminating employment does not address the problem at the nurse's level and does not guarantee that the nurse will not have similar issues at the next place of employment.
Rationale 3: Transfer of the nurse to a non-patient care position is only a temporary solution and does not address the safety issues. Nurses can make errors that impact the public, even in non-patient care roles.
Rationale 4: Ignoring the problem for fear of suit will not make the problem go away.

Question 13

Which information would the nurse provide as rationale for supporting the nurse licensure and mutual recognition movements?

Accepted Answer

Rationale 1: Advancing technologies such as telehealth and telephone triage have expanded practice beyond geographic boundaries.
Rationale 2: Multistate licensure is not a logical means of correcting this situation.
Rationale 3: There is no guarantee that changes in licensure will protect these patients.
Rationale 4: While this situation has some relation to mutual recognition and nurse licensure compacts it is not the most important force to consider.

Question 14

A nurse executive has requested that additional budgetary funds be allocated to support staff seeking a baccalaureate degree in nursing or specialty certification. Which information should this executive provide during discussions of this funding?

Accepted Answer

Rationale 1: Typically nurses do receive salary increases as educational level increases.
Rationale 2: Kendall-Gallagher and colleagues (2011) concluded that hospitals' nurse specialty certification lowers patient mortality.
Rationale 3: There is no evidence that this is the case.
Rationale 4: Higher rates of nurse specialty certification have been correlated with reduction of failure-to-rescue rates in hospital settings.
Rationale 5: Researchers have noted a reduction of adverse patient outcomes when specialty certification exists along with education at the BSN level.

Question 15

The patient decides to discontinue standard medical treatment for diabetes mellitus and to rely on diet and herbal medications for blood sugar control. Which statements, made by the nurse, are appropriate?

Accepted Answer

Rationale 1: This statement closes the conversation before additional assessment can be completed.
Rationale 2: This statement could be helpful in setting the stage for additional patient education.
Rationale 3: Before the nurse makes any other comments, more assessment must be done. Asking the patient to describe why this decision was made will help gather data for this assessment.
Rationale 4: This statement is not therapeutic and could be evaluated as belittling to the patient.
Rationale 5: The nurse should not offer this opinion, but should seek to continue talking with the patient about this choice.

Quiz 11: Nurse Practice Acts, Licensure, and the Scope of Practice