Nursing Judgment #2

A novice nurse on a medical-surgical unit is released from the orientation phase of training. The nurse is able to care for a four- to five-client assignment independently and is assigned a coach on the unit who will help with problem solving if needed. According to Benner's stages of nursing expertise, this nurse would belong in which stage?

A) Stage II
B) Stage V
C) Stage III
D) Stage IV

A) Stage II

A nurse, who has been working in a small rural hospital for 4 years since obtaining a nursing license, participates on an interdisciplinary task force to improve client care. Which skill level is this nurse demonstrating according to Benner's stages of nursing expertise?

A) Advanced beginner
B) Competent
C) Proficient
D) Expert

C) Proficient

The nurse is working in a community health setting. Which situation should the nurse identify as a threat to environmental quality?

A. Children in many neighborhoods are playing in the street with no adult supervision.
B. Many people walking their pets do not clean up their pets' waste.
C. Many residences appear to be vulnerable to intrusion, with open garage doors or ground-floor windows.
D. On many residential streets, cars are parked in a way that blocks traffic and creates potential driving hazards.

B. Many people walking their pets do not clean up their pets' waste.

The nurse is organizing a client advocacy committee focused on improvements in water quality to protect the health of vulnerable populations. Which area of improvement should the nurse identify in the healthcare environment?

A. Oil spills
B. Disposal of disinfectants
C. Flushing of medications in the toilet
D. Use of arsenic

B. Disposal of disinfectants

The nurse is organizing a community effort to reduce the rate of birth defects in the area. A nuclear power plant provides most of the electricity for the community. Which aspect of this power plant's operation should the nurse identify as problematic?

A. Production of nuclear-generated electricity
B. Production of particulate matter such as smoke
C. Production of ionizing radiation
D. Production of hazardous waste

D. Production of hazardous waste

Which action by the nurse working in the emergency department best demonstrates advocacy for better environmental quality?

A. Adapting practices in the ED to cultural needs of clients
B. Ensuring that bandages and dressings are properly disposed of according to protocol
C. Revising policies for telephone triage to ensure better distribution of resources
D. Improving prioritization skills for nurses in the ED

B. Ensuring that bandages and dressings are properly disposed of according to protocol

The nurse involved in promoting client advocacy efforts in the community is assessing the vulnerability of populations in the area served by the healthcare facility where he works. This is a high-ozone area. Which client would have the lowest risk for ground-level ozone?

A. A 33-year-old female client with COPD and without a job living at the poverty line
B. A 73-year-old female client with a high level of financial security
C. A 23-year-old male client with a regular salaried job able to pay his bills
D. A 13-year-old male client whose parents both work at mid-level professional jobs

C. A 23-year-old male client with a regular salaried job able to pay his bills

A nurse, who works in a clinic environment, places great emphasis on cost control, customer satisfaction, health promotion, and preventive services. The primary focus of this nurse is representative of which type of healthcare system?

A) Functional method
B) Client-focused care
C) Case method
D) Managed care

D) Managed care

A nurse is completing discharge teaching for a client who is hospitalized for total hip replacement. The client asks the nurse why there is a case manager involved and expresses confusion about who is in charge. The client states, "I thought my doctor manages my care." Which is the best response by the nurse?

A) "No, I manage your care."
B) "You are correct; the doctor is responsible for managing your care."
C) "A case manager coordinates everyone involved in your care to ensure your needs are met."
D) "The case manager delegates your care to the nurse."

C) "A case manager coordinates everyone involved in your care to ensure your needs are met."

A novice nurse is looking for employment and hopes to find a facility where the nursing staff participates in making, implementing, and evaluating client care policies. Which organizational module implements these practices?

A) Client-focused care
B) Differentiated practice
C) Managed care
D) Shared governance

D) Shared governance

The nurse is appointed to a clinical-administrative task force studying critical staffing issues and care delivery models for the hospital. Which evidence on the effects of different staffing choices and care delivery models should the task force consider? Select all that apply.

A) Higher nurse-to-client ratios have been linked to a decrease in the amount of time clients are hospitalized.
B) Shared governance is linked to a reduction in adverse outcomes.
C) A higher proportion of registered nurses can reduce the risk of mortality in surgical clients.
D) Research indicates that functional assignment of staff improves the likelihood of meeting clients' emotional needs.
E) There is little or no research studying nursing ratios and client outcomes.

A) Higher nurse-to-client ratios have been linked to a decrease in the amount of time clients are hospitalized.

C) A higher proportion of registered nurses can reduce the risk of mortality in surgical clients.

A nurse is applying for a job as a case manager for a managed care insurance organization. Which responsibility is associated with this role?

A) Providing home visits to clients
B) Independent treatment planning
C) Coordinating client care over time
D) Approving treatment decisions

C) Coordinating client care over time

What nursing concept is essential to ensure continuity of client care when a nurse is managing the care of a client?

A) Ethics
B) Communication
C) Advocacy
D) Teaching and Learning

B) Communication

An older adult client tells the nurse, "I am worried about how I will pay for my hospital bill." The client is being discharged, is being referred to home healthcare, and the new plan of care involves extremely expensive drugs. Which response by the nurse is appropriate?

A) "You need to focus on recovering and not worry about finances."
B) "I'll have someone from the business office come and set up your payment plan."
C) "Don't worry. I'm sure everything will work out okay."
D) "Much of your care will be covered by Medicare."

D) "Much of your care will be covered by Medicare."

The nurse is caring for an adult client from Canada who has come to the United States for a serious neurologic surgery. The client tells the nurse, "I came to this country so that I would receive the care I need." Which is the most likely rationale for the client's statement?

A) The U.S. has many choices about healthcare.
B) The U.S. has a universal healthcare system.
C) Healthcare rationing in the U.S. decreases cost.
D) There is very little competition in healthcare in the U.S.

A) The U.S. has many choices about healthcare.

An instructor is teaching the class about cost-conscious nursing practice. The instructor knows that the students understand this concept when the students make which statements? Select all that apply.

A) "Nurses must search for more efficient ways to deliver nursing care."
B) "Careful use of supplies will reduce waste and save money."
C) "I do have to take shortcuts every now and then."
D) "There are insufficient healthcare workers to meet the need right now."
E) "A new emphasis has been placed on health promotion and disease prevention."

A) "Nurses must search for more efficient ways to deliver nursing care."
B) "Careful use of supplies will reduce waste and save money."
E) "A new emphasis has been placed on health promotion and disease prevention."

A client recovering from an emergency appendectomy is a citizen of a foreign country. The client asks the nurse to explain why the United States has chosen such a different healthcare reimbursement system from other Western countries. Which American value could the nurse mention to explain the system in this country?

A) Acceptance of the role of government
B) Individual freedom
C) Skepticism about markets and competition
D) Universality

B) Individual freedom

A nurse working in a large municipal hospital is appointed to a task force whose focus is addressing nursing shortages. Which factor should the task force consider?

A) Nurses are only used for clinical services.
B) Nursing shortages contribute to salary fluctuations.
C) Only licensed nurses are used for all nursing duties.
D) Reductions in nursing staff encourage nurses to remain in the profession.

B) Nursing shortages contribute to salary fluctuations.

What action will allow facilities to better track the cost effectiveness of various nursing actions and allocate nursing resources most efficiently?

A) Bundling nursing care
B) Quantifying nursing care
C) Rationing nursing care
D) Increasing demand for nursing care

B) Quantifying nursing care

The movement from a retrospective payment system to a prospective payment system using a diagnosis-related group may have what unintentional consequence for hospitals trying to contain their costs?

A) Hospitals are now admitting more clients than previously.
B) Patients are sent home from the hospital as soon as possible.
C) Physicians order as many tests as needed to correctly diagnose the client's condition.
D) Nurses are encouraged to follow safety protocols to reduce complications.

B) Patients are sent home from the hospital as soon as possible.

The nurse is responding in the aftermath of a hurricane. Hundreds of clients demand attention. The nurse will implement which plan to assess the priority of these​ clients?

A. A disaster response plan
B. Reverse triage
C. Standard emergency department triage
D. American Nurses Association​ (ANA) ethics rules

B. Reverse triage

For which reason should job seekers in the healthcare sector pay attention to advances in healthcare​ technology?

A. Advances in technology involve policies and strategies at the organizational level.
B. Advances in technology require specialized personnel.
C. Technology plays a role in health literacy.
D. Changing demographics increase the need for new jobs.

B. Advances in technology require specialized personnel.

A group of nurses attend an​ in-service regarding emergency preparedness for the hospital. One of the nurses has three small children and lives in a​ two-story house in the suburbs. After the​ class, the nurse plans to initiate which action to enhance family​ safety?

A. Ensuring she and her family move to a safe area unlikely to be involved in a disaster
B. Training her family in performing nursing interventions to take part in an emergency response
C. Developing a plan for her family to join her in the event of an emergency
D. Obtaining a fire escape ladder for the second floor of the home

D. Obtaining a fire escape ladder for the second floor of the home

The nurse is assessing an older adult client in the free clinic. The nurse notes that the​ client's cholesterol level is higher than the target and has increased since the​ client's last visit. The nurse assesses the client for possible causes for this increase. After determining that the client has not changed dietary and exercise​ habits, which conclusion by the nurse is the most​ appropriate?

A. The client has increased egg consumption.
B. The client may be experiencing high triglyceride levels.
C. The client may not be taking medications as prescribed.
D. The client needs more aerobic activity.

C. The client may not be taking medications as prescribed.

The nurse on the pediatric unit contemplates the changes in healthcare insurance when speaking with other colleagues. Which aspects of the Affordable Care Act​ (ACA) affect children​ favorably? Select all that apply.

A. Insurance companies cannot drop children who have serious illnesses.
B. All children are covered regardless of whether the parents are covered.
C. Benefits are paid through private benefactors.
D. The government must make appropriate arrangements for children based on need.
E. Insurance companies cannot deny coverage based on preexisting conditions.

A. Insurance companies cannot drop children who have serious illnesses.
E. Insurance companies cannot deny coverage based on preexisting conditions.

The nurse educator is presenting information to a group of nursing students regarding uninsured and underinsured clients. Which example of this problem should the educator share with the​ students?

A. "Delays of diagnoses lead to higher mortality and morbidity​ rates."
B. "Immunizations are free for children at public health​ clinics."
C. "Delays in health coverage for children put the health provider at risk for​ litigation."
D. "Older adults are less likely to be treated for​ falls."

A. "Delays of diagnoses lead to higher mortality and morbidity​ rates."

A client in the clinic asks the nurse about a medication seen on television. When the nurse suggests a​ generic, cheaper version of the​ medication, the client is resistant to this recommendation. Of which type of situation is this an​ example?

A. Healthcare treatment choices that drive up costs
B. Client-focused care
C. The need for stricter Food and Drug Administration​ (FDA) safeguards for consumers
D. Factually misleading advertisements by pharmaceutical manufacturers

A. Healthcare treatment choices that drive up costs

The nurse is performing START triage for clients injured in a terrorist attack. Which client would the nurse classify as​ expectant?

A. Client is apneic after positioning of an airway.
B. Client is breathing but has an absent radial pulse.
C. Client has a respiratory rate below 30.
D. Client is breathing adequately with a radial pulse but does not obey commands.

A. Client is apneic after positioning of an airway.

As a working professional concerned with proper resource​ allocation, the nurse knows that one reason to join the American Nurses Association​ (ANA) is for which​ opportunity?

A. Determine how to fight for resources locally
B. Participate in national discussions about resources
C. Advocate for resources through different business sources
D. Draw attention to the​ nurse's credentials

B. Participate in national discussions about resources

The nurse taking care of a client in the clinic notes that the client comes in twice per​ week, but never seems to have anything majorly wrong. For which reason should the client receive education about​ self-care?

A. The​ client's perception of need will​ change, promoting appropriate and timely healthcare.
B. The client will continue to come to the clinic seeking help until someone helps the client.
C. The client will learn to seek healthcare services from legitimate sources.
D. The client will seek affordable insurance by which to gain appropriate healthcare.

A. The​ client's perception of need will​ change, promoting appropriate and timely healthcare.

The nurse is taking care of a client who is being discharged but will need home nursing​ care, physical​ therapy, and speech therapy. Which framework helps the client who has multiple care​ needs?

A. Managed care
B. Case management
C. Client-focused care
D. A health maintenance organization

B. Case management

A nurse educator is teaching a group of students about managed care. The educator knows that the students have understood the concept when they state that managed care has which​ emphasis? Select all that apply.

A. Ensuring​ high-quality care
B. Providing​ cost-effective care
C. Bringing services of multiple providers to the client
D. Using a health maintenance organization model
E. Organizing healthcare services around the stated needs of the client

A. Ensuring​ high-quality care
B. Providing​ cost-effective care
D. Using a health maintenance organization model

Terrorists have detonated a bomb in the downtown area of a major​ city, killing / injuring an unknown number of people. A nurse in an emergency department handling many clients injured in the explosion receives a phone call from the babysitter for her children who says​ she's been watching the event unfold on TV since it happened. The​ nurse's family lives in a suburb more than 20 miles. Which response should the nurse​ make?

A. "If you plan to continue to watch the TV​ coverage, please do it on the TV in my bedroom away from the​ kids."
B. "Please tell my children​ I'm alright but turn off the television and play a game with them to get them thinking about something​ else."

C. "Explain to the children that the people who did this are sick and will be punished for what​ they've done."
D. "Please continue to watch the TV coverage with my kids in the room to ensure that you know​ what's going on at all​ times."

B. "Please tell my children​ I'm alright but turn off the television and play a game with them to get them thinking about something​ else."

If more older adults live in Mississippi than elsewhere in the United States and clients in Massachusetts have much greater access to health services than clients elsewhere in the United​ States, then what does this imply about access of older adults to healthcare in​ Mississippi?

A. The likelihood is that more specialists serving older populations will work in Mississippi than in Massachusetts.

B. There will be much more robust rural services for older adults in Mississippi than in Massachusetts.
C. Their access to healthcare should be roughly equal to that of older adults living in Massachusetts but with a different mix of providers.
D. The need for services will be much greater for older adults in Mississippi than in Massachusetts due to a decreasing number of healthcare providers.

D. The need for services will be much greater for older adults in Mississippi than in Massachusetts due to a decreasing number of healthcare providers.

A hospital in the community has been notified of a​ multi-car crash on the interstate that will result in the transfer of many injured clients to the hospital. As part of the emergency​ response, the charge nurses in the emergency department​ (ED) and intensive care unit​ (ICU) are responsible for which​ tasks? Select all that apply.

A. Exceeding their scope of practice when and if required
B. Assigning care for the clients as they are admitted to the unit
C. Delegating staff nurses to gather needed supplies for the arriving clients
D. Assessing the priority of the current clients for the ED or ICU
E. Providing any care that any patient needs

B. Assigning care for the clients as they are admitted to the unit
C. Delegating staff nurses to gather needed supplies for the arriving clients
D. Assessing the priority of the current clients for the ED or ICU

The nurse knows that Congress enacted the Emergency Medical Treatment and Labor Act​ (EMTALA) of 1986 to prevent which action by emergency​ services?

A. Stopping the poor from using emergency services as primary care
B. Providing free examinations to the poor
C. Refusing to treat uninsured clients
D. Servicing suburban clients only

C. Refusing to treat uninsured clients

The charge nurse assesses clients during a mass casualty incident​ (MCI) and transfers some to other units but discharges others to home. In planning for the admission of critically ill clients from the emergency​ department, to which nurses will the charge nurse assign the new clients when admitted to the​ unit?

A. Nurses with​ risk-reduction knowledge
B. Nurses with impeccable ethics
C. Nurses with advanced assessment skills
D. Nurses with exceptional​ self-care methods

C. Nurses with advanced assessment skills

A nurse recently attended a seminar that discussed the many threats to homeland security. As nurse manager of the emergency​ department, the nurse is responsible for planning for emergencies from bioterrorism. Which agents does the nurse include when planning for​ bioterrorism? Select all that apply.

A. Flu
B. Anthrax
C. Tuberculosis
D. Cancer
E. Smallpox

B. Anthrax

E. Smallpox

The nurse in an urgent care center is assessing an adult client who is diagnosed with the flu. The nurse discusses the need for flu shots with the​ client, who​ states, "I cannot afford the shots. I do not have health​ insurance." Which suggestion by the nurse is most​ appropriate?

A. Seek preventive care at the local health department.
B. Get the shot every year in the emergency department.
C. Obtain the flu shot at a local pharmacy.
D. Find a primary care physician who will give free care.

A. Seek preventive care at the local health department.

A young mother brings her children to the health department for routine immunizations. The mother is crying because she lost her job and fears that her asthmatic daughter may be denied appropriate healthcare because she is unable to pay for it. The nurse realizes that many clients are experiencing these fears. Which action by the nurse would have the greatest impact for all clients who experience this​ fear?

A. Moving to an area that needs healthcare workers
B. Reminding the client that everything will be fine
C. Becoming involved in the American Nurses Association​ (ANA)
D. Giving the client medications and supplies from the clinic at no charge

C. Becoming involved in the American Nurses Association​ (ANA)

The nurse manager is discussing the preparedness phase of a revised emergency management plan for the emergency department. For which reason will the manager use The American Nurses Association​ (ANA) as a resource during an emergency​ response?

A. Explain the ethics of emergency response
B. Examine the role of the incident commander in a disaster response
C. Provide the best means of communicating with agencies such as the Centers for Disease Control and Prevention​ (CDC) during a crisis
D. Identify the procedure for working in a hot zone during a hazardous material incident

A. Explain the ethics of emergency response

The nurse is caring for a client who sustained multiple injuries in an automobile accident. As a part of secondary prevention for this​ client, which intervention does the nurse include in the plan of​ care?

A. Restore the client to previous functioning.
B. Screen for early disease.
C. Promote wellness.
D. Prevent the progression of more symptoms.

D. Prevent the progression of more symptoms.

The nurse is participating on a local council as an advisor regarding community needs during an emergency. Which recommendation regarding community needs during an emergency that the nurse might include when advising the council would be involved in the emergency response​ phase?

A. Programs to restore the community
B. A coordinated emergency preparedness plan
C. Assembling disaster kits
D. The identification of potential hazards to the community

B. A coordinated emergency preparedness plan

The nurse is working with an emergency response team following massive flooding caused by a hurricane. Which activity will the nurse perform when working with the Clinical Outreach Communication Activity​ (COCA) team?

A. Facilitate communication between doctors in the field during a disaster and their healthcare team.
B. Have​ two-way communication with the Centers for Disease Control and Prevention​ (CDC) concerning infection risks.
C. Provide resources to the community during times of disaster.
D. Provide expert advice to other nurses during natural disasters.

B. Have​ two-way communication with the Centers for Disease Control and Prevention​ (CDC) concerning infection risks.

At a local seminar discussing healthcare​ resources, the nurse discusses the phenomenon that healthcare resources are declining while costs for healthcare are increasing. An older adult in attendance asks the speaker why it has become so difficult to obtain needed care and services. Which response should the nurse​ make?

A. "There is a decrease in the number of adults needing​ care."
B. ​"There is increased cost due to the increased incidence of malpractice​ lawsuits."
C. "There are plenty of nurses but not enough​ doctors."
D. "There are not enough medications produced for those who need​ them."

B. ​"There is increased cost due to the increased incidence of malpractice​ lawsuits."

The nurse is planning a community health fair at a local community center. Which goals regarding health promotion does the nurse plan to highlight at the​ event? Select all that apply.

A. Promote​ cost-saving techniques to healthcare providers
B. Clients to be able to assess and evaluate their health needs
C. Clients to promote health in other individuals
D. Prevent disease by imitating nursing techniques
E. Change and modify goals as health needs change

B. Clients to be able to assess and evaluate their health needs
E. Change and modify goals as health needs change

The detonation of several incendiary devices in a suburban area has caused widespread fires. A nursing home nearest one of the largest fires needs to be evacuated. Which concern would be the greatest for the nursing staff providing care in this​ facility?

A. Limited mobility
B. Diminished sensory awareness
C. Inadequate thermoregulation mechanisms
D. Socioeconomic limitations

A. Limited mobility

A client asks the​ nurse, "How am I going to pay for a​ surgery? I'm​ broke, but​ I've been so​ sick." Which statement regarding the Affordable Care Act​ (ACA) may be applicable to this​ client's situation?

A. "Because the rate of inflation is​ slowing, the ACA will also help curb medical​ costs."
B. "The ACA extends coverage to people who do not qualify for public assistance and whose employers do not offer health​ insurance."
C. "Unfortunately, you will probably be denied coverage because of your existing​ condition."
D. "Most insurance premiums will be more and some​ less; you will have to shop​ around."

B. "The ACA extends coverage to people who do not qualify for public assistance and whose employers do not offer health​ insurance."

A railway accident causes the release of a dangerous chemical compound into the atmosphere. The nurse providing rapid triage and emergency treatment for clients in an effort to stabilize them knows that which is the primary purpose of the warm zone in this​ incident?

A. Reverse triage
B. Decontamination
C. Rapid triage
D. Emergency medical treatment

B. Decontamination

The manager of a small clinic has​ cross-trained the nurses to perform electrocardiogram​ (ECG) testing,​ phlebotomy, and some respiratory therapy interventions. This clinic is providing​ client-focused care. Which action demonstrates this delivery model in​ action?

A. Many disciplines collaborate to provide client care.
B. If a client complains of breathing​ difficulty, nurses concentrate on respiratory therapy for that client.
C. Client progress is efficiently tracked.
D. Client care is carefully managed to control costs.

B. If a client complains of breathing​ difficulty, nurses concentrate on respiratory therapy for that client.

The nurse educator is teaching a group of nursing students about the methods that are used by insurance companies to ration healthcare resources. Which method does the educator include in the teaching session regarding this​ topic?

A. Providing health savings accounts for covered individuals
B. Covering clients for preexisting conditions only
C. Covering organ donations
D. Denying coverage for services not supported by research

D. Denying coverage for services not supported by research