Exam Review
- During a site visit, how does The Joint Commission (TJC) evaluate a hospital for accreditation.A)By surveying only patient satisfaction scores.B)By allowing hospitals to self-report their level of compliance.C)By offering financial incentives for compliance.D)By sending a team of reviewers to assess policies, procedures, and actual performance.
- A nurse is delegating care for a group of four clients. Which of the following tasks should the nurse delegate to assistive personnel.A)Irrigate and perform a dressing change for a client who has a pressure injury wound.B)Reinforce teaching the use of an incentive spirometer to a postoperative client.C)Obtain a daily weight on a client who has heart failure.D)Administer oral PRN pain medication to a client who has arthritis.
- A nurse is taking a telephone order from a health-care provider. Which information should the nurse document.A)Clinical admitting diagnosis.B)Patient's room number.C)Name of pharmacist.D)Time order was received.
- Before documenting or attempting any procedure, what safety step helps ensure information is entered in the correct patient's chart.A)Check patient's identification.B)Skip identification.C)Ask the patient's name.D)Perform a thorough assessment.
Exam Review
- What is the primary purpose of The Joint Commission (TJC) when visiting a health-care facility.A)To provide funding for new health-care technologies.B)To improve the safety and quality of care that health-care organizations provide to the public.C)To replace state health department inspections.D)To act as an insurance company by offering reimbursement to hospitals.
- A nurse is documenting data collection findings on a client. Which of the following entries should the nurse identify as subjective data.(SATA)A)Client reports dull, aching pain in lower right calf.B)Client has a raised, red rash on their upper back.C)Client reports the rash on their back is itchy.D)Client's oral temperature is 38.4° C (101.2° F).E)Client reports nausea following administration of pain medication.
- A nurse manager is reviewing documentation of nursing notes on the unit. Which finding warrants immediate intervention.A)Blank area is noted with a single straight line, followed by nurse's name, credentials, and date.B)Notes are entered every fifteen minutes for a critically ill patient.C)Unsigned entry is in a patient's chart.D)Blue ink was used to make the note.
- Which modifier is also considered acceptable in NANDA-I nursing diagnoses.A)Disturbed.B)Elderly.C)Family.D)Patient.
Exam Review
- A nurse discovers a patient lying on the floor. Which should the nurse write when completing an incident report?A)Patient accidentally fell out of bed onto the floor.B)Heard patient fall from the bed to the floor.C)Found patient lying face down on the floor beside the bed.D)Patient fell out of bed onto the floor.
- A nurse is assisting with teaching a class about the steps of critical thinking. The nurse should include that interpreting data is included in which of the following steps?A)Analysis.B)Assessment.C)Intuition.D)Creativity.
- A nurse is providing report to the ongoing shift in a long-term care unit. Which system should the nurse use to provide information?A)Medication administration record (MAR).B)Kardex.C)Narrative chart note.D)Personal notes written during shift assessment.
- A nurse manager is reviewing submitted incident reports. Which of the following does not qualify as an incident report?A)Patient lost hearing aids.B)Patient given the wrong medication.C)Visitor falling in the hallway.D)Patient complaining about dietary services.
Exam Review
- An LPN/LVN has documented that the patient reports nausea. Which notation indicates objective data related to this assessment finding?A)Vomited 300 cc green emesis.B)Blood pressure 116/72.C)Bowel sounds hyperactive.D)Patient self-report.
- A nurse is reviewing the five levels of communication. Which of the following statements should the nurse identify as describing emotional communication?A)It refers to the speaker's state of emotions when sending a message.B)It includes the body's bioelectric energy and its effect on health.C)It includes hearing or cognitive deficits that can affect how a message is received.D)It refers to the receiver's state of emotions when hearing a message.
- A nurse observes the following speech pattern in a patient: frequent repetition of one or two words combined with meaningless sounds. Which speech deficit would the nurse suspect?A)Global aphasia.B)Expressive aphasia.C)Broca aphasia.D)Receptive aphasia.
- A nurse receives a login and password to access an electronic medical record. Where should the nurse store this information?A)Place it in the pocket protector used for care.B)Place it in a wallet that is locked up during the shift.C)Tape it to the underside of the keyboard.D)Tape it to the inside of the locker door.
Exam Review
- A nurse is working with an RN to admit a new client. Which of the following steps of the nursing process is the nurse using when assisting to formulate goals for a positive outcome?A)EvaluationB)Data collectionC)ImplementationD)Planning —
- A nurse is preparing a poster presentation for a group of staff nurses about factors influencing communication. Which of the following factors should the nurse include when discussing cognitive factors?A)Excessive environmental noise.B)Hearing loss.C)Autism spectrum disorder.D)Vision loss.
- A nurse is delegating an outpatient care procedure to unlicensed assistive personnel (UAP) working on the unit. Which example of communication is the nurse employing?A)Do not delegate.B)Non-therapeutic communication.C)Therapeutic communication.D)Non-verbal communication.
- A nurse is admitting a patient to the medical unit who states that they have pain as their primary problem. Which query should the nurse ask next?A)Where is the pain located?B)Are you in pain now?C)Is the pain sharp or dull?D)On a scale of 1 to 10, how would you rate your pain? —
Exam Review
- A patient has a critical pathway to be used for providing care. Which should the nurse keep in mind when following this plan of care?A)Coordinates nursing problems.B)Uses nursing interventions for outcomes statements.C)Care is based on the day of hospitalization.D)Provides areas for allergies to document interventions.
- A nurse receives a phone call from the lab about serum potassium levels for a patient and notes 1.5 mEq/L. What priority nursing action should the nurse take?A)Increase fluids.B)Contact the health-care provider (HCP).C)Document the findings in the chart.D)Continue to monitor.E)—
- Which short-term goal would indicate progress for a patient being discharged to a rehabilitation facility after knee replacement surgery?A)Can walk unassisted with no devices.B)Doesn't require pain medication.C)Voids without difficulty.D)Able to transfer to chair with minimal assistance.
- A nurse is preparing to reinforce discharge instructions with a client who reports a hearing deficit. Which of the following actions should the nurse plan to take?A)Stand next to the client when speaking.B)Provide a copy of the instructions printed in Braille.C)Repeat any phrases that the client misunderstands.D)Guide the client away from background noise.